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Tandan M, Dunlea S, Cullen W, Bury G. Teamwork and its impact on chronic disease clinical outcomes in primary care: a systematic review and meta-analysis. Public Health 2024; 229:88-115. [PMID: 38412699 DOI: 10.1016/j.puhe.2024.01.019] [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: 07/14/2023] [Revised: 12/31/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Teamwork positively affects staff performance and patient outcomes in chronic disease management. However, there is limited research on the impact of specific team components on clinical outcomes. This review aims to explore the impact of teamwork components on key clinical outcomes of chronic diseases in primary care. STUDY DESIGN Systematic review and meta-analysis. METHODS This systematic review and meta-analysis conducted searching EMBASE, PubMed, Cochrane Central Register of Controlled Trials. Studies included must have at least one teamwork component, conducted in primary care for selected chronic diseases, and report an impact of teamwork on clinical outcomes. Mean differences and 95% confidence intervals were used to determine pooled effects of intervention. RESULTS A total of 54 studies from 1988 to 2021 were reviewed. Shared decision-making, roles sharing, and leadership were missing in most studies. Team-based intervention showed a reduction in mean systolic blood pressure (MD = 5.88, 95% CI 3.29-8.46, P= <0.001, I2 = 95%), diastolic blood pressure (MD = 3.23, 95% CI 1.53 to 4.92, P = <0.001, I2 = 94%), and HbA1C (MD = 0.38, 95% CI 0.21 to 0.54, P = <0.001, I2 = 58%). More team components led to better SBP and DBP outcomes, while individual team components have no impact on HbA1C. Fewer studies limit analysis of cholesterol levels, hospitalizations, emergency visits and chronic obstructive pulmonary disease-related outcomes. CONCLUSION Team-based interventions improve outcomes for chronic diseases, but more research is needed on managing cholesterol, hospitalizations, and chronic obstructive pulmonary disease. Studies with 4-5 team components were more effective in reducing systolic blood pressure and diastolic blood pressure. Heterogeneity should be considered, and additional research is needed to optimize interventions for specific patient populations.
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Affiliation(s)
- Meera Tandan
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Shane Dunlea
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Walter Cullen
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Gerard Bury
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
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Lin G, Chau CI, Hu H, Ung COL. Pharmacist intervention for pediatric asthma: A systematic literature review and logic model. Res Social Adm Pharm 2023; 19:1487-1510. [PMID: 37679253 DOI: 10.1016/j.sapharm.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Asthma is highly prevalent in children. Evidence about pharmacist-led interventions in the management of pediatric asthma is emerging. OBJECTIVE To summarize empirical evidence of pharmacist-led interventions for pediatric asthma patients, and to identify the components of a logic model, which can inform evidence-based pharmacy practice. METHODS PubMed, Web of Science, Embase Scopus, ScienceDirect, Medline and CNKI were searched. Studies concerning pharmacist-led interventions for pediatric asthma patients with an interventional design published between January 2013 and February 2023 were selected for analysis. Literature was searched and retrieved according to PRISMA guidelines. Components of pharmacist-led interventions were compiled into a logic model comprising input, activity, output, outcome and contextual factors. RESULTS The initial search retrieved 2291 records and 35 were included in the analysis. The main interventional activities included optimising medicines use and prevention and control of asthma. Commonly reported outputs were medication adherence, knowledge and inhaler technique. The main economic outcomes included cost of medication and hospitalization; clinical outcomes included Childhood Asthma Control Test/Asthma Control Test scores and lung function in FEV1% and PEF%; humanistic outcomes included patients' quality of life and satisfaction. Social, economic, political, and technological factors were identified as contextual factors. CONCLUSION The logic model summarized components of interventions evaluated in literature. It provides a blueprint for pharmacist-led management of pediatric asthma. Further research can focus on the pharmacists' role in a multidisciplinary healthcare professional team and transition of care in patient-centered management of pediatric asthma.
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Affiliation(s)
- Guohua Lin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao
| | - Chi Ian Chau
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao.
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Cai S, Huang X, Van C, Li W, Yan M, Lu Y, Li H, Deng Z, Lu P, Xu Z. General practitioners' attitudes towards and frequency of collaboration with pharmacists in China: a cross-sectional study. BMC Health Serv Res 2023; 23:1174. [PMID: 37891601 PMCID: PMC10612245 DOI: 10.1186/s12913-023-10151-0] [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: 07/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Building interprofessional working relationships between general practitioners (GPs) and pharmacists is essential to ensure high-quality patient care. However, there is limited Chinese literature on GP-pharmacist collaboration, and few studies have explored GPs' experiences with pharmacist integration into general practices. This study aimed to investigate GPs' attitudes towards and frequency of collaboration with pharmacists in China. METHODS This cross-sectional study used an online self-administered questionnaire integrating two scales, ATCI-GP and FICI-GP, which had been translated and validated to investigate 3,248 GPs from February 15 to March 15, 2023 across Zhejiang Province, China. Descriptive analyses were used, and the factors associated with GPs' frequency of collaboration with pharmacists were explored using logistic regression analysis. RESULTS A total of 2,487 GPs (76.6%) responded and consented to participate in the survey; 52.3% were male and the mean age was 35.4 years. Most GPs agreed that they shared common goals and objectives with pharmacists when caring for patients (90.0%), and pharmacists were open to working with them on patients' medication management (80.8%). However, half of the GPs did not change or seldom changed the patient's medication on the pharmacist's advice (51.4%). Logistic regression analysis showed that GPs who were older and had more years of practice were more likely to agree that pharmacists were willing to collaborate, had common goals for treatment and that they would change the patient's medication on the advice of the pharmacist. GPs who had regular communication protocols (adjusted odds ratio1 [aOR1] = 1.88, 95% CI 1.45-2.45; aOR2 = 3.33, 95% CI 2.76-4.02), participated in joint continuing education (aOR1 = 1.87, 95% CI 1.44-2.43; aOR2 = 2.27, 95% CI 1.91-2.70), provided recommendations for medication review (aOR1 = 3.01, 95% CI 2.07-4.38; aOR2 = 3.50, 95% CI 2.51-4.86), and communicated with pharmacists during resident training (aOR1 = 2.15, 95% CI 1.78-2.60; aOR2 = 1.38, 95% CI 1.18-1.62) were associated with a more positive attitude towards and higher frequency of cooperation. CONCLUSIONS GPs in China displayed a positive attitude towards cooperating with pharmacists, but they did not demonstrate a similar level of practice. As environmental determinants impact interdisciplinary collaboration, healthcare managers and policy-makers need to implement measures that foster a supportive environment conducive to interdisciplinary collaboration.
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Affiliation(s)
- Songtao Cai
- Department of General Practice, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, 518172, China
| | - Xianghui Huang
- Xinsheng Community Health Service Center, Shenzhen Longgang Central Hospital, Shenzhen, 518116, China
| | - Connie Van
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Wanchao Li
- Lincheng Healthcare Center of Changxing County, Huzhou, 310016, China
| | - Ming Yan
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yiting Lu
- Department of General Practice, Tongji University School of Medicine, Shanghai, 200092, China
| | - Haixin Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhiling Deng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Panpan Lu
- Department of General Practice, Taizhou Municipal Hospital, Taizhou, 318000, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88, Jiefang Rd, Hangzhou, Shangcheng District, 310009, China.
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Al Meslamani AZ. What hinders individualized therapy plans for asthma patients? Expert Opin Pharmacother 2023; 24:1933-1936. [PMID: 38038661 DOI: 10.1080/14656566.2023.2291078] [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: 10/13/2023] [Accepted: 11/30/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
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Md Khairi LNH, Gnanasan S. Emerging Roles of Malaysian Pharmacists in Asthma Management Amidst the COVID-19 Pandemic: A Narrative Review. Malays J Med Sci 2023; 30:33-47. [PMID: 37655143 PMCID: PMC10467601 DOI: 10.21315/mjms2023.30.4.4] [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: 11/29/2021] [Accepted: 03/01/2022] [Indexed: 09/02/2023] Open
Abstract
The arrival of COVID-19 pandemic in March 2020 adversely affected every aspect of human life, including the management of asthma. The pandemic has forced clinicians to revisit the application of high-risk aerosol-generating procedures in asthma management, including spirometry and nebuliser therapy. The use of commercial spacers with pressurised metered-dose inhalers to replace nebulisation is limited by the high cost and pandemic-induced stock unavailability of these inhalers. The need for social distancing, healthcare reserves reallocation, and scarce personal protective equipment has promote increased telemedicine uptake for patients' asthma control and monitoring. Malaysian pharmacists have been providing long-term care of asthma through the introduction of the respiratory Medication Therapy Adherence Clinic (MTAC) to empower patients' general health literacy, train and regularly evaluate their inhalation technique, and reinforce the importance of medication compliance. To minimise the use of unplanned healthcare resources and avoidable COVID-19 infection exposure, Malaysian pharmacists need to better support asthma self-management via increased uptake of written Asthma Action Plans (AAPs). Pharmacist-led asthma treatment step-down to attain the lowest effective dose of inhaled corticosteroids (ICS) has become increasingly relevant during the pandemic, as its prolonged use carries risk of numerous side effects and possible hospitalisation. Telepharmacy offers a promising model for exploration and an alternative to the traditional service delivery of asthma education. Despite not being authorised as vaccinators, Malaysian pharmacists hold strong positions in COVID-19 immunisation programmes for pharmacovigilance and advocacy. The pandemic demands an increased role for pharmacists within medication management to prevent patients from the stockpiling that can cause adverse effects on pharmaceutical supply chain. This review intends to summarise the impact of COVID-19 on asthma management, with a focus on the transitional roles of Malaysian pharmacists before and after the pandemic era.
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Affiliation(s)
- Lukman Nul Hakim Md Khairi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
- Department of Pharmacy, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Terengganu, Malaysia
| | - Shubashini Gnanasan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
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Miller TA, Halza K, Hovis Z. Implementation of
pharmacist‐led HIV pre‐exposure
prophylaxis management to increase access to care at an academic internal medicine practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1667] [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)
- Trisha A. Miller
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
| | - Katherine Halza
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Department of Pharmacy Kingman Regional Medical Center Kingman Arizona USA
| | - Zachary Hovis
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Clinical Sciences Department Medical College of Wisconsin Pharmacy School Milwaukee Wisconsin USA
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Hurley E, Gleeson LL, Byrne S, Walsh E, Foley T, Dalton K. General practitioners' views of pharmacist services in general practice: a qualitative evidence synthesis. Fam Pract 2022; 39:735-746. [PMID: 34564715 PMCID: PMC9295606 DOI: 10.1093/fampra/cmab114] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pharmacist services in general practice are expanding worldwide, with evidence to show pharmacists' presence in general practice has financial, workload, and clinical benefits. Yet, little is known globally about general practitioners' (GPs') views on their presence in general practice. OBJECTIVE To synthesize the qualitative research evidence on GPs' views of pharmacist services in general practice. METHODS Qualitative evidence synthesis; 8 electronic databases were searched from inception to April 2021 for qualitative studies that reported the views of GPs regarding pharmacist services in general practice. Data from included studies were analyzed using thematic synthesis. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach was used to assess the confidence in individual review findings. RESULTS Nineteen studies were included, which captured the views of 159 GPs from 8 different countries. Four analytical themes describing the factors that should be considered in the development or optimization of pharmacist services in general practice, based on the views of GPs, were developed from the coded data and descriptive themes: (i) optimal environment for a pharmacist, (ii) the ideal pharmacist characteristics, (iii) complex stakeholder relationships, and (iv) benefits of an effective pharmacist. CONCLUSION Based on the synthesis of GPs' views, we have created a conceptual model of factors that should be considered by policymakers, GPs, pharmacists, and other relevant stakeholders when developing or optimizing pharmacist services in general practice going forward.
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Affiliation(s)
- Eoin Hurley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Laura L Gleeson
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Elaine Walsh
- Department of General Practice, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Perspectives of primary care providers on multidisciplinary collaboration to prevent medication-related falls. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 6:100149. [PMID: 35755717 PMCID: PMC9218163 DOI: 10.1016/j.rcsop.2022.100149] [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] [Received: 10/08/2021] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background The causes of falls are often multifactorial. The prevention of falls benefits from a multidisciplinary approach. As people who fall are generally older and users of polypharmacy who frequently visit pharmacies, pharmacists may contribute to fall prevention. Objective(s) This study aims to explore the perceptions of primary care providers on multidisciplinary collaboration in fall prevention especially with pharmacists. Methods Two focus groups were held with each of the following health disciplines: physiotherapists, home care nurses, and practice nurses. A topic list was developed based on the capability opportunity motivation – behaviour (COM-B) model and the theoretical domains framework (TDF). Focus groups were audiotaped and transcribed verbatim. Data were collected in the Netherlands between March and June 2021. Results Six online focus groups were held with 17 physiotherapists, 14 home care nurses, and 15 practice nurses. Participants reported to collaborate multidisciplinary to prevent falls, but they had very limited collaboration with community pharmacists regarding fall prevention. Participants had limited knowledge on drugs that increase the risk of falls. This contributed to their low awareness of the potential role of pharmacists in fall prevention. Other reasons for poor collaboration in fall prevention were lack of agreements with pharmacists, limited coordination and communication. Participants were open to more collaboration with pharmacists and believed this could potentially improve patient outcomes. Conclusions Multidisciplinary agreements among health care providers, including community pharmacists, about referral criteria, roles and responsibilities, communication and coordination, could stimulate further collaboration in fall prevention. Fall prevention needs to receive more attention from primary care providers. Primary care providers have low awareness of the potential role of pharmacists in fall prevention. Primary care providers are positive about collaborating with community pharmacists to prevent falls. Primary care providers need enhanced communication and coordination, clarification of roles, and agreements. Primary care providers expect community pharmacists to focus on deprescribing of fall risk-increasing drugs (FRIDs).
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Linn BS, Smith BEY, Cassel T. Impact of Collaborative Inpatient Pairing Between Pharmacy Students and Family Medicine Residents on Perceptions of Interprofessional Care. PRIMER (LEAWOOD, KAN.) 2022; 6:14. [PMID: 35801194 PMCID: PMC9256298 DOI: 10.22454/primer.2022.661338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Interprofessional education (IPE) and collaborative practice increasingly inform accreditation standards for pharmacy and medical education, grounded in evidence of benefits to patients and learners. Optimizing models that meaningfully provide this type of practice remains a challenge. This study examines the impact of inpatient collaboration between pharmacy students and family medicine residents on perceptions of interprofessional care. METHODS Pharmacy students and family medicine residents were invited to participate in an IPE experience during their medicine rotation, in which student-resident pairs worked collaboratively on patient care for a block rotation. We used a Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education Instrument (SPICE-2) survey instrument and included an opportunity for open comments by participants. We performed statistical analysis using paired t tests. RESULTS We observed statistically significant changes (P<.05) in four of the 10 survey items for pharmacy students and two out of 10 in family medicine residents. Narrative comments provided by both students and residents were positive regarding the IPE experience. CONCLUSION This pilot provides preliminary evidence to support an IPE care model that integrates pharmacy students by pairing them with family medicine residents on an inpatient adult family medicine teaching service. Implementation of a paired-IPE model changed both professions' perception of their roles within the team and appreciation of training requirements. Larger studies could be done to further evaluate the outcomes of this and similar models.
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Affiliation(s)
- Becky S Linn
- University of Wyoming, Laramie, WY | Fort Collins Family Medicine Residency, Fort Collins, CO
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Mohammed RA, Marouf BH. Physicians’ attitude towards community pharmacists’ contribution in the treatment decision making. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e201095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Wagner ML, McCarthy C, Bateman MT, Simmons D, Prioli KM. Pharmacists improve diabetes outcomes: a randomized controlled trial. J Am Pharm Assoc (2003) 2021; 62:775-782.e3. [PMID: 35027281 DOI: 10.1016/j.japh.2021.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/15/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a growing shortage of primary care physicians. Pharmacists can fill the gap, and interdisciplinary teams are being evaluated as part of health care reform. OBJECTIVE This study aimed to determine whether adding a pharmacist to an interprofessional health team will improve diabetes outcomes. METHODS In this 2-phase pilot study, Medicaid-eligible patients with diabetes were randomized to receive standard of care (control arm) or standard of care plus the care of a pharmacist (intervention arm) for 12 months (phase 1). The primary outcome was change in glycated hemoglobin (A1C) from baseline. Secondary outcomes included identifying and correcting medication therapy problems (MTPs) for comorbid conditions, adherence to preventive care visits, health care utilization, self-rated health, and satisfaction surveys. After phase 1, patients in the control arm who did not achieve an A1C of < 8% were eligible to enroll into phase 2 where they received treatment with a pharmacist for 6 months. RESULTS Of the 239 patients enrolled, 122 completed phase 1. At 12 months, intervention patients' mean A1C was 1.85 percentage point (pp) below baseline versus 0.94 pp for control (between-group difference 0.91 pp; P = 0.0218). Most control patients (79%) who completed phase 1 and enrolled into phase 2 improved their A1C by more than 1 pp (P < 0.01). The pharmacists completed 806 patient visits and identified 2638 MTPs. Intervention patients were more adherent to preventive care visits with nutrition (P = 0.043), ophthalmology (P = 0.002), and dentistry (P = 0.007). For intervention patients, 78% rated their experience with the pharmacist as excellent whereas, for control patients, 37% rated their experience with their provider as excellent. CONCLUSION Pharmacist comanagement of patients with diabetes can significantly improve glucose control and patient satisfaction. Creative payment models were used to include pharmacists in the interprofessional patient care team.
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McDermott K. Utilizing diagnostic pharmacists to support Family Medicine Walk-In clinics during the COVID-19 pandemic. J Am Pharm Assoc (2003) 2021; 62:612-619. [PMID: 34802944 PMCID: PMC8539209 DOI: 10.1016/j.japh.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022]
Abstract
Background During the coronavirus 2019 (COVID-19) pandemic, physician focus shifted from continuity of care to pandemic duties. However, patients still required in-person visits for acute or chronic complaints. Specially trained pharmacists were utilized to alleviate Family Medicine Walk-In (FMWI) provider shortages. Objective To describe the innovative practice utilizing diagnostic pharmacists in FMWI, evaluate their impact on provider time, compare workload with traditional advanced practice providers (APPs), and evaluate type of visits and medications prescribed. Practice description Pharmacists at an Indian Health Service medical center staffed FMWI 2.5 days per week to alleviate provider shortages during the COVID-19 pandemic. The privileged pharmacist had a diagnostic scope like APPs. Non-privileged pharmacists provided care to patients utilizing current protocols and were required to present all new complaints to providers. Practice innovation The facility utilized pharmacists that have completed or were progressing through the local diagnostic training program to alleviate provider shortages. Evaluation methods The absolute number of visits by pharmacists was determined and the number of provider hours shifted to pharmacy estimated. The number of visits by provider type was calculated and compared. ICD-10 codes were evaluated for purpose of visits. New prescriptions written by pharmacists were categorized and reimbursement rates determined. Results Pharmacists were responsible for 677 visits during 88 clinic days, with an estimated 338 provider hours shifted to pharmacists. Pharmacists saw 5.8 patients per day, APPs 5.2, and physicians 5.7. Pharmacists primarily evaluated hypertension, diabetes, musculoskeletal, and infectious disease complaints. New prescription categories included pain management, endocrine, cardiovascular, and infectious disease. The single billable pharmacist was reimbursed $77,945. Conclusion Diagnostic pharmacists in FMWI have allowed providers to shift to other pandemic duties and demonstrate similar workload as APPs. Most visits and prescriptions fall within known pharmacist practice. Pharmacists in this setting pay for the existence of this position and remain integrated in FMWI.
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Karampatakis GD, Patel N, Stretch G, Ryan K. Patients' experiences of pharmacists in general practice: an exploratory qualitative study. BMC FAMILY PRACTICE 2021; 22:48. [PMID: 33673805 PMCID: PMC7935482 DOI: 10.1186/s12875-021-01393-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/09/2021] [Indexed: 02/02/2023]
Abstract
Background Since 2015, pharmacists have been integrating into English general practices and more recently into primary care networks. General practice-based pharmacists provide a range of patient-facing services, such as medication reviews, management of long-term conditions and minor ailments, prescribing duties and answering queries over the telephone. Literature reports patients’ satisfaction with general practice-based pharmacists’ services, however, previous research captured only limited experiences. The aim of the current study was to pursue an extensive exploration of patients’ experiences of pharmacists in general practice. Methods General practice-based pharmacists, working in practices in West London, Surrey and Berkshire, handed invitation packs to patients seen during consultations. Patients that wanted to take part in the study were invited to undertake a qualitative, in-depth, face-to-face, semi-structured interview within the practice with which each patient was registered. Interviews lasted from 15 min to more than 1 h and were audio-recorded. Recruitment continued until data saturation. Audio-recordings were transcribed verbatim and transcripts analysed thematically. Results Twenty participants were interviewed. Four themes were discerned: awareness (“I had been coming to this practice for 24 years and I didn’t know that there was a pharmacist”); accessibility (“People ring for a GP [general practitioner] appointment … it’s Monday and they [receptionist] tells you ‘We can slot you in on Friday’ … with a pharmacist on board, they can [instantly] look at you”); interactions (“I’ve always had a really good interaction with them [pharmacists] and they listen and they take on board what I’m trying to say”); and feedback (“It’s easier [to collect feedback instantly] because I could have forgotten half of what they [pharmacists] have told me in an hour or so’s time”). Conclusions Findings indicate that pharmacists’ integration into general practices could improve accessibility to, and the quality of, care received. The findings will assist policy development to provide general practice-based pharmacists’ services as per patients’ needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01393-0.
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Affiliation(s)
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK.
| | - Graham Stretch
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ, UK
| | - Kath Ryan
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
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Macedo LA, de Oliveira Santos Silva R, Silvestre CC, Alcântara TDS, de Magalhães Simões S, Lyra DP. Effect of pharmacists' interventions on health outcomes of children with asthma: A systematic review. J Am Pharm Assoc (2003) 2021; 61:e28-e43. [PMID: 33608222 DOI: 10.1016/j.japh.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022]
Abstract
METHODS A literature search was performed in January 23, 2018 at the Embase, LILACS, OpenThesis, PubMed, Cochrane Library, and Web of Science databases through January 23, 2018, using keywords related to "asthma," "pharmacist," and "children." This systematic review followed the methodologic standards recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included intervention studies on the effect of pharmacists' interventions on pediatric patients with asthma, performed in hospital or ambulatory care settings, with presenting process and outcome indicators as a result of pharmacists' interventions. The methodologic quality of the included studies was assessed independently by 2 researchers. The Cohen kappa index was used to measure the degree of agreement between the 2 investigators. RESULTS The search yielded 3671 records, of which 5 were included in this review. Most of these studies were conducted in the United States (n = 2) and in outpatient clinics (n = 4). All studies described components of pharmacists' interventions. The most reported category concerning pharmacists' work process was the initial assessment of patients' conditions, with the assessment of outcomes (at baseline and follow-up) as the only category present in all studies. The most assessed outcomes at baseline were asthma control, emergency department visits, medication use and technique, and adherence to asthma therapy. At follow-up, emergency department visits were the most evaluated outcome (n = 2), and no study assessed economic outcomes. The average consultation time ranged from 20 to 45 minutes, and the number of encounters ranged from 2 to 3. CONCLUSION This study highlighted the limited number of studies, most with low quality, on the impact of the pharmacist on pediatric asthma. The most assessed outcome was the number of emergency department visits, with positive results after interventions. Heterogeneity regarding assessed outcomes and work processes was noted, which limited comparison of the results and interventions.
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Albassam A, Almohammed H, Alhujaili M, Koshy S, Awad A. Perspectives of primary care physicians and pharmacists on interprofessional collaboration in Kuwait: A quantitative study. PLoS One 2020; 15:e0236114. [PMID: 32687539 PMCID: PMC7371165 DOI: 10.1371/journal.pone.0236114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
Collaborative practice between physicians and pharmacists has a positive effect on healthcare outcomes. Understanding the local data related to this collaboration is vital in establishing efficient collaboration. Therefore, this study was designed to assess the collaborative relationships between physicians and pharmacists working in the primary healthcare centres regarding their attitudes and experiences, preferred methods of communication, perceptions related to the role of pharmacists, areas of potential further collaboration, and perceived barriers. A cross-sectional study was conducted using two parallel pretested self-administered questionnaires on a sample of 518 randomly selected physicians and pharmacists. Descriptive and comparative analyses were used in data analysis. The overall response rate was 86.3%. Although over 98% of respondents agreed that physician-pharmacist collaboration improves patient outcomes, more than half of the physicians (52.1%) and pharmacists (55.7%) had never practised collaboratively. Both groups preferred to communicate face-to-face (76.7%) or via telephone (76.5%). Both professions showed good agreement on pharmacists' roles related to managing side effects, improving adherence, assisting in dosage adjustment, providing advice regarding drug interactions, and providing drug information to physicians. They indicated disagreements on the importance of dispensing of prescriptions and providing advice to physicians regarding modification of drug therapy. Both groups expressed overall positive perceptions of the potential for further collaboration in areas related to the clinical roles of pharmacists, which were significantly higher among those with practice experience of < 10 years and those aged < 40 years (p<0.05). The top four perceived barriers to collaborative practice were lack of time (84.1%), lack of financial compensation (76.3%), lack of face-to-face communication (68.9%), and the possible fragmentation of patient care by the involvement of multiple healthcare professionals (68.9%). The present findings provide valuable input that could be a catalyst to enhance or establish physician-pharmacist collaboration in primary healthcare settings in Kuwait.
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Affiliation(s)
- Abdullah Albassam
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait, Kuwait
| | - Hamad Almohammed
- Drug and Food Control Administration, Ministry of Health, Kuwait, Kuwait
| | - Malak Alhujaili
- Department of Pharmacy, Jaber Alahmad Polyclinic, Ministry of Health, Kuwait, Kuwait
| | - Samuel Koshy
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait, Kuwait
| | - Abdelmoneim Awad
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait, Kuwait
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Fletcher MJ, Tsiligianni I, Kocks JWH, Cave A, Chunhua C, Sousa JCD, Román-Rodríguez M, Thomas M, Kardos P, Stonham C, Khoo EM, Leather D, van der Molen T. Improving primary care management of asthma: do we know what really works? NPJ Prim Care Respir Med 2020; 30:29. [PMID: 32555169 PMCID: PMC7300034 DOI: 10.1038/s41533-020-0184-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
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Affiliation(s)
- Monica J Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W H Kocks
- General Practitioners Research Institute, 59713 GH, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Andrew Cave
- Department of Family Medicine, 6-10 University Terrace, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Chi Chunhua
- Peking University First Hospital, Beijing, China
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- 33ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel Román-Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Mike Thomas
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, SO16 5ST, UK
| | - Peter Kardos
- Respiratory, Allergy and Sleep Unit at Red Cross Maingau Hospital, Friedberger Anlage 31-32, 60316, Frankfurt, Germany
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - David Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Karampatakis GD, Patel N, Stretch G, Ryan K. Community pharmacy teams' experiences of general practice-based pharmacists: an exploratory qualitative study. BMC Health Serv Res 2020; 20:431. [PMID: 32423485 PMCID: PMC7236450 DOI: 10.1186/s12913-020-05245-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
Background In England, since 2015, there has been a formal drive to integrate pharmacists into general practice as a new healthcare service. Research efforts have offered insights into how general practice-based professionals and patients view the service, however, they took no account of community pharmacy teams’ opinions. There have been anecdotal statements about opposition from community pharmacies to the service, due to fears of losing business. The aim of the current study was to identify the experiences and perceptions of community pharmacy teams regarding pharmacists’ presence in general practice. Methods The National Health Service Choices website was used to identify community pharmacies within a radius of two miles from eight West London general practices. The search resulted in 104 community pharmacies which were all contacted via telephone. Pharmacy staff who verbally expressed their interest to participate were then provided with the study’s documents. Qualitative, face-to-face, semi-structured interviews were conducted inside the pharmacy from which each participant was recruited. Interviews lasted 30 to 45 min and were audio-recorded. Audio-recordings were transcribed verbatim and transcripts analysed thematically. Results Forty-eight community pharmacy staff participated. Four themes were discerned: awareness (“I knew that [pharmacists] have already been implemented [in general practice] but I haven’t really followed it … where does the pharmacist role come?”); interactions (“I’m just so pleased that there’s a pharmacist professional in the general practice … because we speak the same language!”); patient care (“if I was a patient knowing that there is a general practitioner and a pharmacist [in general practice], I would … think ‘nothing can go wrong at the moment’”); and funding challenges (“if general practices take on the extra responsibility of stop smoking or flu vaccination campaigns … financially, this would affect this pharmacy”). Conclusions The current study revealed the perceived impact of general practice-based pharmacists on community pharmacies would be improved communication between pharmacies and practices. Findings will inform policy so that any future framing of pharmacists’ presence in general practice considers the needs of community pharmacies.
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Affiliation(s)
| | - Nilesh Patel
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
| | - Graham Stretch
- Ealing GP Federation, 179C Bilton Road, Perivale, Greenford, Middlesex, UB6 7HQ, UK
| | - Kath Ryan
- School of Pharmacy, University of Reading, Whiteknights Campus, PO Box 226, Reading, RG6 6AP, UK
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18
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Turner KM, Nelson CA, Pestka DL, Sorensen TD. Identification of critical factors for forming collaborative relationships between physicians and pharmacists. Am J Health Syst Pharm 2020; 76:1238-1247. [PMID: 31369113 DOI: 10.1093/ajhp/zxz123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to identify and describe strategies that have successfully achieved collaboration among physicians and pharmacists providing comprehensive medication management (CMM) to support development of CMM services. METHODS A 2-phase, mixed-methods approach was employed to identify successful strategies for building pharmacist-physician relationships in primary care clinic settings. Phase I used a qualitative approach to identify strategies deemed successful in building relationships with physicians. An advisory group of pharmacists with experience building CMM practices assisted in the development of minimum criteria characterizing pharmacists as having strong collaborative relationships. Semi-structured interviews were conducted with 10 interviewees meeting established criteria. Researchers coded interview transcripts and identified the resulting strategies. Phase II employed a survey instrument to determine how frequently identified strategies are used and evaluate the relative level of perceived impact of each strategy, which was distributed to a national audience of pharmacists practicing in ambulatory care settings. Responses from pharmacists meeting prespecified criteria were included in the analysis. RESULTS Thirty-three strategies were identified and grouped into 8 themes. In phase II, 104 survey respondents met defined criteria and were eligible to endorse use of identified strategies and rate their relative influence. CONCLUSIONS Thirty-three strategies were identified and grouped into 8 themes to aid pharmacists practicing CMM in developing stronger collaborative relationships with physician colleagues. A national sampling found many of these strategies were employed by a majority of pharmacists, who had found them to be influential in creating collaborative relationships.
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Affiliation(s)
- Kyle M Turner
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT
| | | | - Deborah L Pestka
- Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN
| | - Todd D Sorensen
- Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN
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19
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Kim E, Ndege PK, Jackson E, Clauw DJ, Ellingrod VL. Patient perspectives on medication self-management in rural Kenya: a cross-sectional survey. Int J Qual Health Care 2019; 31:353-358. [PMID: 30256956 DOI: 10.1093/intqhc/mzy187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/04/2018] [Accepted: 08/26/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The presence of HIV, tuberculosis and non-communicable diseases result in a double burden of disease in the East African community. Most studies have focused on urban Nairobi and western Kenya, leading to a lack of information on rural regions that make up 75% of the population. This study determined baseline rates and barriers to medication self-management in rural Meru County. DESIGN A cross-sectional, descriptive community survey focused on Meru, Kenya. SETTING Participants were surveyed at a local Kithoka dispensary and the government operated Meru Level 5 Hospital. PARTICIPANTS Seventy-five chronic illness patients between June 2016 and July 2016. INTERVENTION Twelve-question Measures of Drug Self-Management Scale (MeDS). MAIN OUTCOME MEASURE Baseline rates of medication self-management. A score of 10 or more defined 'adequate' medication drug self-management. RESULTS The average MeDS score was 8.16 ± 2.4, indicating inadequate medication self-management. There was no significant difference across age (P = 0.75), and between the scores of males and females (8.1 ± 2.4 and 8.2 ± 2.5, respectively, P = 0.89). Minor side effects and the idea that taking medicines disrupt life were highly associated with inadequate drug self-management (r = 0.58). Forgetfulness and non-adherence had the highest correlation (r = 0.64). Cost is a large barrier, with 64% agreeing that they have a hard time paying for their medicines. CONCLUSIONS All questions on the MeDS survey had statistically significant correlations with the overall score, while gender and age did not. The MeDS questionnaire showed to be an effective tool to evaluate risk of long-term non-adherence globally in rural populations.
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Affiliation(s)
- Erika Kim
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, USA
| | - Peter K Ndege
- Eastern Community Medical Consultants Clinic, Meru, Kenya
| | - Elizabeth Jackson
- Department of Cardiology, University of Alabama Birmingham, UAB School of Medicine, FOT 1203 1720 2nd Ave. S. Birmingham, AL, USA
| | - Daniel J Clauw
- Department of Anesthesiology, School of Medicine, University of Michigan, 1500 E. Medical Center Drive, UH1 H247, SPC 5048 Ann Arbor, MI, USA.,Michigan Institute for Clinical and Health Research, 1600 Huron Parkway, Building 400 Ann Arbor, MI, USA
| | - Vicki L Ellingrod
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, USA.,Michigan Institute for Clinical and Health Research, 1600 Huron Parkway, Building 400 Ann Arbor, MI, USA
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20
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Haslam L, Gardner DM, Murphy AL. A retrospective analysis of patient care activities in a community pharmacy mental illness and addictions program. Res Social Adm Pharm 2019; 16:522-528. [PMID: 31327736 DOI: 10.1016/j.sapharm.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Bloom Program, a community pharmacy-based mental health and addictions care program, was developed and implemented to optimize pharmacists' care of eligible patients. Characterizing pharmacists' activities in the Bloom Program can facilitate program quality improvement and contribute more broadly to the knowledge base regarding pharmacists' roles and contributions to patient care. OBJECTIVES To characterize the patient care activities of the pharmacists in the Bloom Program. METHODS A retrospective analysis of patient charts for participants enrolled in the program for three months or longer was conducted. Using all available documentation, pharmacists' activities were coded into eight non-mutually exclusive categories: navigation/resource support, urgent triage, medication management, collaboration/communication, education, social support, self-care, and other. RESULTS 2055 activities from 1144 patient care encounters were identified for 126 participants (48 ± 16 years of age, 61% female, 5 regular medications). Medication management was coded most often per encounter (73%). Each of social support, collaboration/communication, and education were coded in 20-25% of encounters. Frequency of navigation/resources, self-care, and urgent triage were 16.6%, 13.5%, and 2.8%, respectively. Non-medication management activities represented 59.4% of all pharmacist patient care services. CONCLUSIONS Medication management activities were coded in over 70% of patient encounters for pharmacists delivering a community pharmacy-based mental illness and addictions program. However, this accounted for 40.6% of activities with an average of 1.8 activities per encounter. Other activities were identified frequently (e.g., education, collaboration, social support, navigation and resource support) and help to characterize the nature of pharmacist-patient encounters and facilitates a better understanding of the role of the pharmacist in mental illness and addictions patient care.
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Affiliation(s)
- Lauren Haslam
- Dalhousie Medical School, Dalhousie University, Halifax, Nova Scotia, PO Box 15000, B3H 4R2, Canada.
| | - David M Gardner
- Department of Psychiatry, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E2, Canada.
| | - Andrea Lynn Murphy
- College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
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21
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Lutfiyya MN, Chang LF, McGrath C, Dana C, Lipsky MS. The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018. PLoS One 2019; 14:e0218578. [PMID: 31242239 PMCID: PMC6594675 DOI: 10.1371/journal.pone.0218578] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/03/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction If interprofessional collaborative practice is to be an important component of healthcare reform, then an evidentiary base connecting interprofessional education to interprofessional practice with significantly improved health and healthcare outcomes is an unconditional necessity. This study is a scoping review of the current peer reviewed literature linking interprofessional collaborative care and interprofessional collaborative practice to clearly identified healthcare and/or patient health-related outcomes. The research question for this review was: What does the evidence from the past decade reveal about the impact of Interprofessional collaborative practice on patient-related outcomes in the US healthcare system? Materials and methods A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was followed. Results Of an initial 375 articles retrieved 20 met review criteria. The most common professions represented in the studies reviewed were physicians, pharmacists and nurses. Primary care was the most common care delivery setting and measures related to chronic disease the most commonly measured outcomes. No study identified negative impacts of interprofessional collaborative practice. Eight outcome categories emerged from a content analysis of the findings of the reviewed studies. Conclusions The results suggest a need for more research on the measurable impact of interprofessional collaborative practice and/or care on patient health-related outcomes to further document its benefits and to explore the models, systems and nature of collaborations that best improve population health, increase patient satisfaction, and reduce cost of care.
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Affiliation(s)
- May Nawal Lutfiyya
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States of America
| | - Linda Feng Chang
- Department of Family and Community Medicine, University of Illinois-Chicago, College of Medicine at Rockford, Rockford, Illinois, United States of America
- * E-mail:
| | - Cynthia McGrath
- Saint Anthony College of Nursing, Rockford, Ilinois, United States of America
| | - Clark Dana
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States of America
| | - Martin S. Lipsky
- Office of the Chancellor, Roseman University of Health Sciences, South Jordan, Utah, United States of America
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22
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Mubarak N, Hatah E, Khan TM, Zin CS. A systematic review and meta-analysis of the impact of collaborative practice between community pharmacist and general practitioner on asthma management. J Asthma Allergy 2019; 12:109-153. [PMID: 31213852 PMCID: PMC6538034 DOI: 10.2147/jaa.s202183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/28/2019] [Indexed: 01/10/2023] Open
Abstract
Objective: This systematic review aims to investigate the impact of collaborative practice between community pharmacist (CP) and general practitioner (GP) in asthma management. Methods: A systematic search was performed across 10 databases (PubMed, Medline/Ovid, CINAHL, Scopus, Web of Science, Cochrane central register of controlled trials, PsycARTICLES®, Science Direct, Education Resource Information Centre, PRO-Quest), and grey literature using selected MeSH and key words, such as "community pharmacist", "general practitioner", and "medicine use review". The risk of bias of the included studies was assessed by Cochrane risk of bias tool. All studies reporting any of the clinical, humanistic, and economical outcomes using collaborative practice between CPs and GPs in management of asthma, such as CPs conducting medications reviews, patient referrals or providing education and counseling, were included. Results: A total of 23 studies (six RCTs, four C-RCT, three controlled interventions, seven pre-post, and three case control) were included. In total, 11/14 outcomes were concluded in favor of CP-GP collaborative interventions with different magnitude of effect size. Outcomes, such as asthma severity, asthma control, asthma symptoms, PEFR, SABA usage, hospital visit, adherence, and quality of life (QoL) (Asthma Quality-of-Life Questionnaire [AQLQ]; Living with Asthma Questionnaire [LWAQ]) demonstrated a small effect size (d≥0.2), while inhalation technique, ED visit, and asthma knowledge witnessed medium effect sizes (ES) (d≥0.5). In addition to that, inhalation technique yielded large ES (d≥0.8) in RCTs subgroup analysis. However, three outcomes, FEV, corticosteroids usage, and preventer-to-reliever ratio, did not hold significant ES (d<0.2) and, thus, remain inconclusive. The collaboration was shown to be value for money in the economic studies in narrative synthesis, however, the limited number of studies hinder pooling of data in meta-analysis. Conclusion: The findings from this review established a comprehensive evidence base in support of the positive impact of collaborative practice between CP and GP in the management of asthma.
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Affiliation(s)
- Naeem Mubarak
- Kulliyyah of Pharmacy, Department of Pharmacy Practice, International Islamic University, Kuantan, Malaysia.,Lahore Pharmacy College, Lahore Medical & Dental College, University of Health Sciences, Lahore, Pakistan
| | - Ernieda Hatah
- Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Che Suraya Zin
- Kulliyyah of Pharmacy, Department of Pharmacy Practice, International Islamic University, Kuantan, Malaysia
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23
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Ndefo UA, Davis PN, Henry A. Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma. J Am Pharm Assoc (2003) 2019; 59:521-526. [PMID: 31036527 DOI: 10.1016/j.japh.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers' knowledge of asthma is described. DESIGN This study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients' homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SETTING A local Medicaid managed care organization. PARTICIPANTS Pediatric African American patients (4-17 years old) with uncontrolled asthma. MAIN OUTCOME MEASURES Outcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. RESULTS Overall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. CONCLUSION Rates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.
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Deeks LS, Kosari S, Boom K, Peterson GM, Maina A, Sharma R, Naunton M. The Role of Pharmacists in General Practice in Asthma Management: A Pilot Study. PHARMACY 2018; 6:pharmacy6040114. [PMID: 30326642 PMCID: PMC6306779 DOI: 10.3390/pharmacy6040114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 01/16/2023] Open
Abstract
Background: Asthma is principally managed in general practice. Appropriate prescribing and medication use are essential, so general practice pharmacists appear suitable to conduct asthma management consultations. This pilot study aimed to evaluate the asthma management role of a pharmacist in general practice. Methods: Analysis of an activity diary and stakeholder interviews were conducted to identify interventions in asthma management; determine whether asthma control changed following pharmacist input; and determine acceptability of asthma management review by a pharmacist in one general practice in Canberra, Australia. Results: Over 13 months, the pharmacist saw 136 individual patients. The most common activities were asthma control assessment; recommendations to adjust medication or device; counselling on correct device use; asthma action plan development and trigger avoidance. For patients with multiple consultations, the mean Asthma Control Test score improved from the initial to last visit (14.4 ± 5.2 vs. 19.3 ± 4.7, n = 23, p < 0.0001). Eight of the 19 (42%) patients moved from having poor to well-controlled asthma. Case studies and qualitative data indicated probable hospital admission avoidance and stakeholder acceptability of asthma management by a practice pharmacist. Conclusions: This pilot study demonstrated it is feasible, acceptable and potentially beneficial to have a general practice pharmacist involved in asthma management. Fuller evaluation is warranted.
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Affiliation(s)
- Louise S Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2601, Australia.
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2601, Australia.
| | - Katja Boom
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2601, Australia.
| | - Gregory M Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2601, Australia.
- Faculty of Health, University of Tasmania, Hobart, TAS 7001, Australia.
| | - Aaron Maina
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2601, Australia.
| | - Ravi Sharma
- UCL School of Pharmacy, London WC1N 1AX, UK.
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, Canberra, ACT 2601, Australia.
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Collaborative practice agreement in solid organ transplantation. Int J Clin Pharm 2018; 40:474-479. [DOI: 10.1007/s11096-018-0604-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
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Lampkin SJ, Gildon B, Benavides S, Walls K, Briars L. Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients. J Pediatr Pharmacol Ther 2018; 23:4-17. [PMID: 29491747 PMCID: PMC5823491 DOI: 10.5863/1551-6776-23.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/11/2022]
Abstract
Pediatric clinical pharmacists are an integral part of the health care team. By practicing in an ambulatory care clinic, they can reduce the risk of medication errors, improve health outcomes, and enhance patient care. Unfortunately, because of limited data, misconceptions surrounding the role of pharmacists, and reimbursement challenges, there may be difficulty in establishing or expanding pediatric clinical pharmacy services to an ambulatory care setting. The purpose of this paper is to provide an overview of considerations for establishing or expanding pharmacy services in a pediatric ambulatory care clinic. The primer will discuss general and pediatric-specific pharmacy practice information, as well as potential barriers, and recommendations for identifying a practice site, creating a business plan, and integrating these services into a clinic setting.
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Xyrichis A, Reeves S, Zwarenstein M. Examining the nature of interprofessional practice: An initial framework validation and creation of the InterProfessional Activity Classification Tool (InterPACT). J Interprof Care 2017; 32:416-425. [PMID: 29236560 DOI: 10.1080/13561820.2017.1408576] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The practice of, and research on interprofessional working in healthcare, commonly referred to as teamwork, has been growing rapidly. This has attracted international policy support flowing from the growing belief that patient safety and quality of care can only be achieved through the collective effort of the multiple professionals caring for a given patient. Despite the increasing policy support, the evidence for effectiveness lags behind: while there are supporting analytic epidemiological studies, few reliable intervention studies have been published and so we have yet to confirm a causal link. We argue that this lag in evidence development may be because interprofessional terms (e.g. teamwork, collaboration) remain conceptually unclear, with no common terminology or definitions, making it difficult to distinguish interventions from each other. In this paper, we examine published studies from the last decade in order to elicit current usage of terms related to interprofessional working; and, in so doing, undertake an initial empirical validation of an existing conceptual framework by mapping its four categories (teamwork, collaboration, coordination and networking) against the descriptions of interprofessional interventions in the included studies. We searched Medline and Embase for papers describing interprofessional interventions using a standard approach. We independently screened papers and classified these under set categories following a thematic approach. Disagreements were resolved through consensus. Twenty papers met our inclusion criteria. Identified interprofessional work interventions fall into a range, from looser to tighter links between members. Definitions are inconsistently and inadequately applied. We found the framework to be a helpful and practical tool for classifying such interventions more consistently. Our analysis enabled us to scrutinise the original dimensions of the framework, confirm their usefulness and consistency, and reveal new sub-categories. We propose a slightly revised typology and a classification tool (InterPACT) for future validation, with four mutually exclusive categories: teamwork, collaboration, coordination and networking. Consistent use, further examination and refinement of the new typology and tool may lead to greater clarity in definition and design of interventions. This should support the development of a reliable and coherent evidence base on interventions to promote interprofessional working in health and social care.
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Affiliation(s)
- Andreas Xyrichis
- a Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care , King's College London , London , UK
| | - Scott Reeves
- b Faculty of Health, Social Care and Education , Kingston University & St George's, University of London , London , UK
| | - Merrick Zwarenstein
- c Department of Family Medicine, Schulich School of Medicine & Dentistry , Western University , London , ON , Canada
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Barry AR. Development of a Pharmacist REferral Program in a primary cARE clinic (PREPARE): A prospective cross-sectional study. Can Pharm J (Ott) 2017; 150:206-215. [PMID: 28507656 DOI: 10.1177/1715163517702167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing demand for ambulatory health care services has led to the development of primary care multidisciplinary teams that include pharmacists. The objective of this study was to characterize referrals to a pharmacist in a primary care clinic (PCC) based in Chilliwack, British Columbia. METHODS This prospective cross-sectional study included all patients referred to the PCC pharmacist over 12 months (May 2015 to April 2016). Data regarding the source/reason for referral, patient demographics, medical problems/medications and number/category of identified drug therapy concerns (DTCs) were collected. RESULTS A total of 137 referrals were received. Mean age was 60 years and 59% were female. Twenty patients (15%) did not attend their appointment. Fifty-eight percent were new clinic patients identified using a Medication Risk Assessment Questionnaire (MRAQ), 30% were from PCC clinicians and 12% were from community family physicians. The most common reason for referral was for a medication review (82%). Median number of medical problems and medications per patient were 7 (interquartile range [IQR] 5) and 11 (IQR 7.5), respectively. A total of 460 DTCs were identified (median 4 per patient, IQR 3.5), of which 34% were medication without an indication and 28% an untreated indication. DISCUSSION AND CONCLUSION The most common source of referrals to a PCC pharmacist was for medication reviews of new patients using an MRAQ. Most referred patients had multiple medical problems and polypharmacy, and few were referred for disease-specific management. The number of DTCs per patient was variable and, despite polypharmacy being commonplace, almost one-third of patients had an untreated indication.
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Affiliation(s)
- Arden R Barry
- Lower Mainland Pharmacy Services, Chilliwack, and the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
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29
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Hazen ACM, de Bont AA, Boelman L, Zwart DLM, de Gier JJ, de Wit NJ, Bouvy ML. The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review. Res Social Adm Pharm 2017; 14:228-240. [PMID: 28506574 DOI: 10.1016/j.sapharm.2017.04.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. OBJECTIVES This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. METHODS In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services. RESULTS Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%. CONCLUSIONS Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits of clinical pharmacy services for patients with multiple medications and comorbidities, full integration of non-dispensing pharmacists should be promoted.
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Affiliation(s)
- Ankie C M Hazen
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Antoinette A de Bont
- Institute of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
| | - Lia Boelman
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Dorien L M Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Johan J de Gier
- Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Antonius Deusinglaan 1, Building 3214, 9713 AV, Groningen, The Netherlands.
| | - Niek J de Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Marcel L Bouvy
- Department of Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
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30
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Carter BL, Ardery G. Avoiding Pitfalls With Implementation of Randomized Controlled Multicenter Trials: Strategies to Achieve Milestones. J Am Heart Assoc 2016; 5:e004432. [PMID: 27993832 PMCID: PMC5210445 DOI: 10.1161/jaha.116.004432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA
- Department of Family Medicine, College of Medicine, University of Iowa, Iowa City, IA
| | - Gail Ardery
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA
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31
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Tilly-Gratton A, Lamontagne A, Blais L, Bacon SL, Ernst P, Grad R, Lavoie KL, McKinney ML, Desplats E, Ducharme FM. Physician agreement regarding the expansion of pharmacist professional activities in the management of patients with asthma. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:335-342. [PMID: 27774739 DOI: 10.1111/ijpp.12320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma control remains suboptimal in Canada. Expansion of pharmacist's professional activities offers the opportunity to improve the interdisciplinary management of patients with asthma. OBJECTIVE The aim of this study was to determine the level of agreement of physicians regarding the expansion of pharmacists' professional activities in the management of asthma patients. METHODS We conducted a survey of randomly selected Quebec physicians in family medicine, paediatrics and emergency medicine. A 102-item questionnaire, including 10 questions regarding pharmacist's expanded professional activities, was sent using the Tailored Design Method. Questions were answered on a 6-point Likert-like scale (0 - strong disagreement to 5 - strong agreement). RESULTS With a 56% response rate, 421 (250 family medicine, 115 paediatric and 56 emergency medicine) physicians participated; the median years of practice (25%, 75%) was 13 (5-21) years and 69% of respondents were women. Physicians were in favour of the expansion of pharmacist's professional activities with strong endorsement rates (rating of ≥4 on a maximum of 5) exceeding 60% for all but three activities: suggesting a written action plan to the physician (55%), adjusting the dose of prescribed asthma medication to achieve a therapeutic target (52%) and offering spirometry testing in pharmacies (45%). Emergency physicians, physicians with fewer years of practice, and those with a favourable perception of an interprofessional approach were associated with higher endorsement of these activities. CONCLUSION Physicians are favourable to the expansion of pharmacist activities in the management of patients with asthma. More complex activities were less frequently endorsed. The characteristics of strong intenders have been identified.
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Affiliation(s)
- Audrey Tilly-Gratton
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - Alexandrine Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - Lucie Blais
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, QC, Canada.,Montreal Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
| | - Pierre Ernst
- Department of Pulmonary Medicine, Jewish General Hospital, Montreal, QC, Canada.,Division of Clinical Epidemiology (MUHC) Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Martha L McKinney
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Eve Desplats
- Applied Clinical Research Unit, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
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Moaddeb J, Mills R, Haga SB. Community pharmacists' experience with pharmacogenetic testing. J Am Pharm Assoc (2003) 2016; 55:587-594. [PMID: 26409205 DOI: 10.1331/japha.2015.15017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Appendix 1 Statements of knowledge of correct medication use Appendix 2 Statements of self-efficacy of correct medication use Appendix 3 Statements of skills of correct medication use To characterize the experiences and feasibility of offering pharmacogenetic (PGx) testing in a community pharmacy setting. DESIGN Pharmacists were invited to complete a survey about PGx testing for each patient who was offered testing. If the patient consented, pharmacists were also asked to complete a follow-up survey about the process of returning PGx testing results to patients and follow-up with the prescribing provider. SETTING Community pharmacies in North Carolina from August through November 2014. PARTICIPANTS Pharmacists at five community pharmacies. MAIN OUTCOME MEASURES Patient consent for testing, time to introduce PGx testing initially and communicate results, interpretation of test results, and recommended medication changes. RESULTS Of the 69 patients offered testing, 56 (81%) consented. Pre-test counseling typically lasted 1-5 minutes (81%), and most patients (55%) did not have any questions about the testing. Most pharmacists reported test results to patients by phone (84%), with discussions taking less than 1 minute (48%) or 1-5 minutes (52%). Most pharmacists believed the patients understood their results either very well (54%) or somewhat well (41%). Pharmacists correctly interpreted 47 of the 53 test results (89%). All of the incorrect interpretations were for patients with test results indicating a dosing or drug change (6/19; 32%). Pharmacists reported contacting the ordering physician for four patients to discuss results indicating a dosage or drug change. CONCLUSION The provision of PGx services in a community pharmacy setting appears feasible, requiring little additional time from the pharmacist, and many patients seem interested in PGx testing. Additional training may be necessary to improve test result interpretation, as well as for communication with both patients and ordering physicians.
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Affiliation(s)
- Jivan Moaddeb
- Clinical Pharmacist, Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Rachel Mills
- Clinical Research Coordinator and Genetic Counselor, Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.
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Olivera CMX, Vianna EO, Bonizio RC, de Menezes MB, Ferraz E, Cetlin AA, Valdevite LM, Almeida GA, Araujo AS, Simoneti CS, de Freitas A, Lizzi EA, Borges MC, de Freitas O. Asthma self-management model: randomized controlled trial. HEALTH EDUCATION RESEARCH 2016; 31:639-652. [PMID: 27473571 DOI: 10.1093/her/cyw035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/25/2016] [Indexed: 06/06/2023]
Abstract
Information for patients provided by the pharmacist is reflected in adhesion to treatment, clinical results and patient quality of life. The objective of this study was to assess an asthma self-management model for rational medicine use. This was a randomized controlled trial with 60 asthmatic patients assigned to attend five modules presented by a pharmacist (intervention group) and 59 patients in the control group. Data collection was performed before and after this 4-month intervention and included an evaluation of asthma knowledge, lifestyle, inhaler techniques, adhesion to treatment, pulmonary function and quality of life. An economic viability analysis was also performed. The intervention group obtained an increase in asthma knowledge scores of 58.3-79.5% (P < 0.001). In this group, there was also an increase in the number of individuals who practiced physical exercise (36-43%), in the number of correct replies regarding the use of inhalers, in the percentage of adherent patients, and in quality of life scores for all domains. We concluded that this asthma self-management model was effective in improving the quality of life of asthma patients.
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Affiliation(s)
- Carolina M X Olivera
- Department of Pharmaceutical Sciences, Pharmacy School, Ribeirão Preto 14040-903, Brazil
| | | | - Roni C Bonizio
- Department of Accounting, School of Economy, Administration and Accounting, Ribeirão Preto 14040-905, Brazil
| | | | - Erica Ferraz
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | - Andrea A Cetlin
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | | | | | - Ana S Araujo
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | | | - Amanda de Freitas
- Department of Social Medicine, Medical School, Ribeirão Preto 14049-900, Brazil and
| | - Elisangela A Lizzi
- Department of Mathematics, Federal University of Technology, Curitiba, 80230-901, Brazil
| | - Marcos C Borges
- Department of Medicine, Medical School, Ribeirão Preto 14049-900, Brazil
| | - Osvaldo de Freitas
- Department of Pharmaceutical Sciences, Pharmacy School, Ribeirão Preto 14040-903, Brazil
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Lu D, Qiao Y, Johnson KC, Wang J. Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma. J Asthma 2016; 54:504-513. [PMID: 27676212 DOI: 10.1080/02770903.2016.1238927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma is one of the most frequently targeted chronic diseases in the medication therapy management (MTM) programs of the Medicare prescription drug (Part D) benefits. Although racial and ethnic disparities in meeting eligibility criteria for MTM services have been reported, little is known about whether there would be similar disparities among adults with asthma in the United States. METHODS Adult patients with asthma (age ≥ 18) from Medical Expenditure Panel Survey (2011-2012) were analyzed. Bivariate analyses were conducted to compare the proportions of patients who would meet Medicare MTM eligibility criteria between non-Hispanic Blacks (Blacks), Hispanics and non-Hispanic Whites (Whites). Survey-weighted logistic regression was performed to adjust for patient characteristics. Main and sensitivity analyses were conducted to cover the entire range of the eligibility thresholds used by Part D plans in 2011-2012. RESULTS The sample included 4,455 patients with asthma, including 2,294 Whites, 1,218 Blacks, and 943 Hispanics. Blacks and Hispanics had lower proportions of meeting MTM eligibility criteria than did Whites (P < 0.001). According to the main analysis, Blacks and Hispanics had 36% and 32% lower, respectively, likelihood of MTM eligibility than Whites (odds ratio [OR]: 0.64, 95% confidence interval [CI]: 0.45-0.90; OR: 0.68, 95% CI: 0.47-0.98, respectively). Similar results were obtained in sensitivity analyses. CONCLUSIONS There are racial and ethnic disparities in meeting Medicare Part D MTM eligibility criteria among adult patients with asthma. Future studies should examine the implications of such disparities on health outcomes of patients with asthma and explore alternative MTM eligibility criteria.
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Affiliation(s)
- Degan Lu
- a Department of Respiratory Medicine , Shandong Provincial Qianfoshan Hospital, Shandong University , Shandong , China
| | - Yanru Qiao
- b University of Tennessee College of Pharmacy , Memphis , TN , USA
| | - Karen C Johnson
- c Department of Preventive Medicine , University of Tennessee Health Science Center College of Medicine , Memphis , TN , USA
| | - Junling Wang
- b University of Tennessee College of Pharmacy , Memphis , TN , USA
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Martins SM, Salibe-Filho W, Tonioli LP, Pfingesten LE, Braz PD, McDonnell J, Williams S, do Carmo D, de Sousa JC, Pinnock H, Stelmach R. Implementation of 'matrix support' (collaborative care) to reduce asthma and COPD referrals and improve primary care management in Brazil: a pilot observational study. NPJ Prim Care Respir Med 2016; 26:16047. [PMID: 27536853 PMCID: PMC4989903 DOI: 10.1038/npjpcrm.2016.47] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 11/08/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented 'matrix support': a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157-87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems.
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Affiliation(s)
- Sonia Maria Martins
- Department of Community Health of the Faculty of Medicine of ABC (FMABC), São Bernardo do Campo, São Paulo, Brazil
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
| | - William Salibe-Filho
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
- Pulmonology Service of the University São Camilo Medical School, São Paulo, Brazil
| | - Luís Paulo Tonioli
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
| | - Luís Eduardo Pfingesten
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
| | - Patrícia Dias Braz
- Respiratory Group Brazilian Society of Family and Community Medicine (SBMFC), São Bernardo do Campo, São Paulo, Brazil
- PHC Division-Health Secretary, São Bernardo do Campo, São Paulo, Brazil
| | - Juliet McDonnell
- International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK
| | - Siân Williams
- International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK
| | - Débora do Carmo
- Specialized Department, São Bernardo do Campo, São Paulo, Brazil
| | - Jaime Correia de Sousa
- Community Health, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal, Horizonte Family Health Unit, Matosinhos, Portugal
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Rafael Stelmach
- Pulmonary Division-Heart Institute (InCor)—Hospital da Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Musselman KT, Moczygemba LR, Pierce AL, Plum MBF, Brokaw DK, Kelly DL. Development and Implementation of Clinical Pharmacist Services Within an Integrated Medical Group. J Pharm Pract 2016; 30:75-81. [DOI: 10.1177/0897190015617667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In 2012, pharmacists were integrated into a medical group to provide direct patient care, drug information activities, and health care provider education. The medical group encompasses 40 primary care and 60 specialty offices in Virginia. Objective: To describe the development and implementation of clinical pharmacist services integrated within a medical group. Methods: Pharmacists’ roles and responsibilities, type and number of patient encounters, and identification of strategies to facilitate implementation are described. Results: From June 2012 to December 2014, pharmacists had 809 patient encounters, which included patient-centered education, medication consults, Medicare annual wellness visits, senior care visits, and comprehensive medication reviews. Pharmacists addressed 403 drug information requests from nurse navigators, providers, and administrators. Pharmacists also have roles in risk management, quality improvement initiatives, and operations that benefit the medical group. Strategies to facilitate implementation include working with organizational leadership, identifying a physician champion, and establishing credibility by being responsive to practice needs and responding to requests in a timely manner to build trust within the health care team. Conclusion: Integration of pharmacists within health care teams involves more than direct patient care activities. Pharmacists should be involved at the organizational level to have a broader impact on patient and practice levels.
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Affiliation(s)
- Kerri T. Musselman
- Bon Secours Medical Group, Bon Secours Virginia Health System, Midlothian, VA, USA
| | | | - Andrea L. Pierce
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary-Beth F. Plum
- Bon Secours Medical Group, Bon Secours Virginia Health System, Suffolk, VA, USA
| | - Deborah K. Brokaw
- Bon Secours Medical Group, Bon Secours Virginia Health System, Midlothian, VA, USA
| | - David L. Kelly
- Bon Secours Medical Group, Bon Secours Virginia Health System, Mechanicsville, VA, USA
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37
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Mohammed MA, Moles RJ, Chen TF. Impact of Pharmaceutical Care Interventions on Health-Related Quality-of-Life Outcomes: A Systematic Review and Meta-analysis. Ann Pharmacother 2016; 50:862-81. [PMID: 27363846 DOI: 10.1177/1060028016656016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate the impact of pharmaceutical care (PC) interventions on health-related quality of life (HRQoL) and determine sensitivity of HRQoL measures to PC services. DATA SOURCES MEDLINE, EMBASE, International Pharmaceutical Abstracts, PubMed, Global Health, PsychINFO, CINAHL, and Web of Science (January 2005 to September 2015) were searched. STUDY SELECTION AND DATA EXTRACTION Original English-language articles were included if PC impact on HRQoL was evaluated and reported using validated HRQoL measures. DATA SYNTHESIS A total of 31 randomized controlled trials, 9 nonrandomized studies with comparison groups, and 8 before-after studies were included. PC interventions resulted in significant improvement in 1 domain and ≥3 domains of HRQoL measures in 66.7% and 27.1% of the studies, respectively. There was a significant improvement in at least 1 domain in 18 of 32 studies using generic and 16 of 21 studies using disease-specific measures. When the Short Form 36 Items Health Survey (SF-36) measure was used, PC interventions had a moderate impact on social functioning (standardized mean difference [SMD] = 0.59; 95% CI = 0.14, 1.04), general health (SMD = 0.36; 95% CI = 0.12, 0.59), and physical functioning (SMD = 0.30; 95% CI = 0.11, 0.48). The pooled data on heart failure-specific (SMD = -0.17; 95% CI = -0.43, 0.09), asthma-specific (SMD = 0.17; 95% CI = -0.03, 0.36), and chronic obstructive pulmonary disease-specific (SMD = -0.09; 95% CI = -0.37, 0.19) measures indicated no significant impact of PC on HRQoL. CONCLUSIONS PC interventions can significantly improve at least 1 domain of HRQoL. Existing measures may have minimal to moderate sensitivity to PC interventions, with evidence pointing more toward social functioning, general health, and physical functioning of the SF-36 measure. However, evidence generated from current non-PC-specific HRQoL measures is insufficient to judge the impact of PC interventions on HRQoL. The development of a suitable HRQoL measure for PC interventions may help generate better evidence for the contribution of pharmacist services to improving HRQoL.
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Carter BL. Primary Care Physician-Pharmacist Collaborative Care Model: Strategies for Implementation. Pharmacotherapy 2016; 36:363-73. [PMID: 26931738 DOI: 10.1002/phar.1732] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) trial recently found that a pharmacist intervention for hypertension could be implemented in diverse medical offices. In this issue of Pharmacotherapy, the article by Brian Isetts and colleagues discusses the complexity of the patient population, the specific functions the pharmacists performed, and the time estimates from billing records used to quantify time spent during face-to-face patient encounters. This invited commentary will discuss findings from the CAPTION trial and provide recommendations for strategies to implement similar interventions for patients with other chronic medical conditions seen in primary care practices.
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Affiliation(s)
- Barry L Carter
- The Patrick E. Keefe Professor of Pharmacy, Department of Pharmacy Practice and Science, College of Pharmacy and Professor, University of Iowa, Iowa City, Iowa.,Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Isetts BJ, Buffington DE, Carter BL, Smith M, Polgreen LA, James PA. Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension. Pharmacotherapy 2016; 36:374-84. [PMID: 26893135 DOI: 10.1002/phar.1727] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
STUDY OBJECTIVE Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists' work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists' work in the management of hypertension with a physician-pharmacist collaborative model. DESIGN Descriptive analysis of the components of pharmacists' work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial. MEASUREMENTS AND MAIN RESULTS This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists' work to understand pharmacists' relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients' blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point). CONCLUSION Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists' work in value-based financing and population management.
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Affiliation(s)
- Brian J Isetts
- Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Daniel E Buffington
- College of Medicine and Pharmacy, University of South Florida, Tampa, Florida
| | - Barry L Carter
- The Patrick E. Keefe Professor in Pharmacy, The Department of Pharmacy Practice and Science College of Pharmacy, and Professor, The University of Iowa, Iowa City, Iowa.,Department of Family Medicine, The Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Marie Smith
- Henry A. Palmer, Professor at the University of Connecticut School of Pharmacy, Storrs, Connecticut
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Paul A James
- The Donald J. and Anna M. Ottilie Chair and Professor in the Department of Family Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Krass I. Quasi experimental designs in pharmacist intervention research. Int J Clin Pharm 2016; 38:647-54. [PMID: 26825756 DOI: 10.1007/s11096-016-0256-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/17/2016] [Indexed: 12/01/2022]
Abstract
Background In the field of pharmacist intervention research it is often difficult to conform to the rigorous requirements of the "true experimental" models, especially the requirement of randomization. When randomization is not feasible, a practice based researcher can choose from a range of "quasi-experimental designs" i.e., non-randomised and at time non controlled. Objective The aim of this article was to provide an overview of quasi-experimental designs, discuss their strengths and weaknesses and to investigate their application in pharmacist intervention research over the previous decade. Results In the literature quasi experimental studies may be classified into five broad categories: quasi-experimental design without control groups; quasi-experimental design that use control groups with no pre-test; quasi-experimental design that use control groups and pre-tests; interrupted time series and stepped wedge designs. Quasi-experimental study design has consistently featured in the evolution of pharmacist intervention research. The most commonly applied of all quasi experimental designs in the practice based research literature are the one group pre-post-test design and the non-equivalent control group design i.e., (untreated control group with dependent pre-tests and post-tests) and have been used to test the impact of pharmacist interventions in general medications management as well as in specific disease states. Conclusion Quasi experimental studies have a role to play as proof of concept, in the pilot phases of interventions when testing different intervention components, especially in complex interventions. They serve to develop an understanding of possible intervention effects: while in isolation they yield weak evidence of clinical efficacy, taken collectively, they help build a body of evidence in support of the value of pharmacist interventions across different practice settings and countries. However, when a traditional RCT is not feasible for logistical and/or ethical reasons researchers should endeavour to use the more robust of the quasi experimental designs.
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Affiliation(s)
- Ines Krass
- Faculty of Pharmacy, A15, University of Sydney, Camperdown, NSW, 2006, Australia.
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Rotta I, Souza TT, Salgado TM, Correr CJ, Fernandez-Llimos F. Characterization of published randomized controlled trials assessing clinical pharmacy services around the world. Res Social Adm Pharm 2016; 13:201-208. [PMID: 26846907 DOI: 10.1016/j.sapharm.2016.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
A critical analysis of the research on clinical pharmacy services with regards to study characteristics has not been undertaken since 1998. However, several meta-analyses have been conducted to demonstrate the impact of pharmacists' interventions in specific medical conditions. These meta-analyses present high heterogeneity in part because the interventions are poorly and inconsistently described in primary studies. The aim of this article is to present the characteristics of randomized control trials (RCTs) that assess clinical pharmacy services to identify areas of improvement in future pharmacy practice research studies. Different emphasis of research across geographic regions of the world were also examined. During these 40 years, 520 articles reporting 439 RCTs assessing clinical pharmacy services were published. Of the 439 studies, 77.7% (n = 341) were published in the year 2000 or thereafter, 41.46% (n = 182) were conducted in the US, 27.56% (n = 121) in Europe, and 30.98% (n = 136) in the rest of the world. Studies in pharmacy practice have improved in terms of design, with an increase in the number of published RCTs after 2000. However, the small sample size of RCTs is still an issue. After 2000, a significantly higher proportion of studies were conducted in community pharmacy, targeting specific medical conditions, and with a higher number of patients randomized to the intervention group. Conversely, a significantly smaller proportion of studies were conducted in the hospital and targeted a single recipient after 2000. Studies conducted in the US had significantly more intervention arms, focused mostly on a specific medical condition, and were performed in primary care. Different health care systems' organization and policies may influence clinical pharmacy services research across countries.
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Affiliation(s)
- Inajara Rotta
- Post-Graduate Program of Pharmaceutical Sciences, Federal University of Parana, Av. Prof. Lothário Meissner, 652, Jardim Botânico, 80210-170 Curitiba, Paraná, Brazil
| | - Thais Teles Souza
- Post-Graduate Program of Pharmaceutical Sciences, Federal University of Parana, Av. Prof. Lothário Meissner, 652, Jardim Botânico, 80210-170 Curitiba, Paraná, Brazil
| | - Teresa M Salgado
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St, 48109 Ann Arbor, MI, USA
| | - Cassyano J Correr
- Department of Pharmacy, Federal University of Parana, Av. Prof. Lothário Meissner, 652, Jardim Botânico, 80210-170 Curitiba, Paraná, Brazil
| | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social-Pharmacy, Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal.
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Gums T, Carter B, Foster E. Cluster randomized trials for pharmacy practice research. Int J Clin Pharm 2015; 38:607-14. [PMID: 26715549 DOI: 10.1007/s11096-015-0205-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/22/2015] [Indexed: 11/29/2022]
Abstract
Introduction Cluster randomized trials (CRTs) are now the gold standard in health services research, including pharmacy-based interventions. Studies of behaviour, epidemiology, lifestyle modifications, educational programs, and health care models are utilizing the strengths of cluster randomized analyses. Methodology The key property of CRTs is the unit of randomization (clusters), which may be different from the unit of analysis (individual). Subject sample size and, ideally, the number of clusters is determined by the relationship of between-cluster and within-cluster variability. The correlation among participants recruited from the same cluster is known as the intraclass correlation coefficient (ICC). Generally, having more clusters with smaller ICC values will lead to smaller sample sizes. When selecting clusters, stratification before randomization may be useful in decreasing imbalances between study arms. Participant recruitment methods can differ from other types of randomized trials, as blinding a behavioural intervention cannot always be done. When to use CRTs can yield results that are relevant for making "real world" decisions. CRTs are often used in non-therapeutic intervention studies (e.g. change in practice guidelines). The advantages of CRT design in pharmacy research have been avoiding contamination and the generalizability of the results. A large CRT that studied physician-pharmacist collaborative management of hypertension is used in this manuscript as a CRT example. The trial, entitled Collaboration Among Pharmacists and physicians To Improve Outcomes Now (CAPTION), was implemented in primary care offices in the United States for hypertensive patients. Limitations CRT design limitations include the need for a large number of clusters, high costs, increased training, increased monitoring, and statistical complexity.
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Carter BL, Coffey CS, Ardery G, Uribe L, Ecklund D, James P, Egan B, Vander Weg M, Chrischilles E, Vaughn T. Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control. Circ Cardiovasc Qual Outcomes 2015; 8:235-43. [PMID: 25805647 DOI: 10.1161/circoutcomes.114.001283] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/30/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate if a physician/pharmacist collaborative model would be implemented as determined by improved blood pressure (BP) control in primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control could be sustained. METHODS AND RESULTS Prospective, cluster-randomized trial of 32 primary care offices stratified and randomized to control, 9-month intervention (brief), and 24-month intervention (sustained). We enrolled 625 subjects with uncontrolled hypertension; 54% from racial/ethnic minority groups and 50% with diabetes mellitus or chronic kidney disease. The primary outcome of BP control at 9 months was 43% in intervention offices (n=401) compared with 34% in the control group (n=224; adjusted odds ratio, 1.57 [95% confidence interval, 0.99-2.50]; P=0.059). The adjusted difference in mean systolic/diastolic BP between the intervention and control groups for all subjects at 9 months was -6.1/-2.9 mm Hg (P=0.002 and P=0.005, respectively), and it was -6.4/-2.9 mm Hg (P=0.009 and P=0.044, respectively) in subjects from racial or ethnic minorities. BP control and mean BP were significantly improved in subjects from racial minorities in intervention offices at 18 and 24 months (P=0.048 to P<0.001) compared with the control group. CONCLUSIONS Although the results of the primary outcome (BP control) were negative, the key secondary end point (mean BP) was significantly improved in the intervention group. Thus, the findings for secondary end points suggest that team-based care using clinical pharmacists was implemented in diverse primary care offices and BP was reduced in subjects from racial minority groups. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00935077.
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Affiliation(s)
- Barry L Carter
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
| | - Christopher S Coffey
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Gail Ardery
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Liz Uribe
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Dixie Ecklund
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Paul James
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Brent Egan
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Mark Vander Weg
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Elizabeth Chrischilles
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
| | - Thomas Vaughn
- From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.)
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