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Chandran MM, Cohen E, Doligalski CT, Bowman LJ, Kaiser TE, Taber DJ. The measure of impact: Proposal of quality metrics for solid organ transplant pharmacy practice. Am J Transplant 2024; 24:164-176. [PMID: 37923084 DOI: 10.1016/j.ajt.2023.10.027] [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: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
As healthcare continues its transition toward value-based care, it is increasingly important for transplant pharmacists to demonstrate their impact on patient care, health-related outcomes, and healthcare costs. Evidence-based quality and performance metrics are recognized as crucial tools for measuring the value of service. Yet, there is a lack of well-developed and agreed-upon specific metrics for many clinical pharmacy specialties, including solid organ transplantation. To address this need, a panel of transplant pharmacy specialists conducted a detailed literature review and engaged in several panel discussions to identify quality metrics to be considered for assessing the value of clinical pharmacy services provided to solid organ transplant recipients and living donors. The proposed metrics are based on the Donabedian model and are categorized to coincide with the typical phases of transplant care. The measures focus on key issues that arise in transplant recipients related to medication therapy, including adverse drug events, nonadherence, and clinical outcomes attributable to medication therapy management. This article proposes a comprehensive set of measures, any number of which transplant pharmacists can adopt and measure over time to objectively gauge the value of services they are providing to transplant recipients, the transplant center, and the overall healthcare system.
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Affiliation(s)
- Mary Moss Chandran
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
| | - Elizabeth Cohen
- Department of Transplant, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Lyndsey J Bowman
- Department of Pharmacy, Tampa General Hospital, Tampa, Florida, USA
| | - Tiffany E Kaiser
- Division of Digestive Diseases, Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Lichvar A, Chandran MM, Do V, Rendulic T, Szczepanik A, Pierce D, Park JM. Entrustable professional activities for pharmacy students: A primer for solid organ transplant preceptors. Am J Health Syst Pharm 2021; 78:zxab320. [PMID: 34350946 DOI: 10.1093/ajhp/zxab320] [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: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The role of a solid organ transplant pharmacist is multifaceted and translates to diverse experiential and elective learning experiences that can be provided to pharmacy learners. Here we provide a guide to integrating pharmacy students into patient care and other pharmacist activities in solid organ transplantation. SUMMARY Thoughtful incorporation of learners into clinical practice and clinical research creates a positive learning environment for pharmacy students that can foster the development of core skills necessary for students to become "practice-ready" and "team-ready" pharmacy graduates and can equip them with valuable skills to incorporate into the specialty practice areas and careers they pursue. To help develop these educational experiences, attention to the list of core entrustable professional activities (EPAs) established by the American Association of Colleges of Pharmacy can help create a rich environment of learning with carefully cultivated tasks. Furthermore, learners can serve as transplant pharmacist extenders to assist in overall patient care and multidisciplinary involvement on the transplant team. This article serves as a "how-to" guide for applying the EPA framework to integrating pharmacy students in patient care and other pharmacist activities in solid organ transplantation and other specialty practice areas. CONCLUSION As pharmacy preceptors design and operationalize their teaching to incorporate EPAs, they can benefit from recommendations tailored to specialty practice areas such as solid organ transplantation. Students may start and finish these experiences at different EPA levels, but continuance of training will allow them to achieve the final EPA level across the 6 EPA domains.
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Affiliation(s)
- Alicia Lichvar
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, and Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Vincent Do
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Trisann Rendulic
- Department of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Amanda Szczepanik
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - Dana Pierce
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeong M Park
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, and Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
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Duwez M, Chanoine S, Lepelley M, Vo TH, Pluchart H, Mazet R, Allenet B, Pison C, Briault A, Saint-Raymond C, Camara B, Claustre J, Bedouch P. Clinical evaluation of pharmacists' interventions on multidisciplinary lung transplant outpatients' management: results of a 7-year observational study. BMJ Open 2020; 10:e041563. [PMID: 33247028 PMCID: PMC7703423 DOI: 10.1136/bmjopen-2020-041563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Lung transplant (LT) recipients require multidisciplinary care because of the complexity of therapeutic management. Pharmacists are able to detect drug-related problems and provide recommendations to physicians through pharmacists' interventions (PIs). We aimed at assessing the clinical impact of PIs on therapeutic management in LT outpatients. DESIGN Data were collected prospectively from an LT recipients cohort during 7 years. A multidisciplinary committee assessed retrospectively the clinical impact of accepted PIs. SETTING French University Hospital. PARTICIPANTS LT outpatients followed from 2009 to 2015. PRIMARY OUTCOME MEASURES Clinical impact of PIs performed by pharmacists using the CLEO tool and the Pareto chart. RESULTS 1449 PIs led to a change in patient therapeutic management and were mainly related to wrong dosage (39.6%) and untreated indication (19.6%). The clinical impact of PIs was 'avoids fatality', 'major' and 'moderate', in 0.1%, 7.0% and 57.9%, respectively. Immunosuppressants, antimycotics for systemic use and antithrombotic agents had the greatest clinical impact according to the Pareto chart. PIs related to drug-drug interactions (10%) mainly had a moderate and major clinical impact (82.3%, p<0.0001). CONCLUSION Clinical pharmacists play a key role for detecting drug-related problems mostly leading to a change in therapeutic management among LT outpatients. Our study provides a new insight to analyse the clinical impact of PIs in order to target PIs which have most value and contribute to patient care through interdisciplinary approach.
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Affiliation(s)
| | - Sébastien Chanoine
- Pharmacy, CHUGA, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, Grenoble, France
| | | | - Thi Ha Vo
- Pharmacy Faculty, Pham Ngoc Thach Medical University, Hochiminh, Viet Nam
| | | | | | - Benoit Allenet
- Pharmacy, CHUGA, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, Grenoble, France
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | - Amandine Briault
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | | | - Boubou Camara
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | - Johanna Claustre
- Service Hospitalier Universitaire Pneumologie Physiologie, CHUGA, Grenoble, France
| | - Pierrick Bedouch
- Pharmacy, CHUGA, Grenoble, France
- TIMC-IMAG UMR5525, CNRS, Grenoble, France
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Pilch NA, Park JM, Lichvar A, Kane C, Bowman L, Melaragno JI, Sobhanian M, Perez C, Trofe‐Clark J, Fleming JN. Observations from a systematic review of pharmacist‐led research in solid organ transplantation: An opinion paper of the American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicole A. Pilch
- College of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Jeong M. Park
- College of Pharmacy University of Michigan Ann Arbor Michigan USA
| | - Alicia Lichvar
- Department of Pharmacy Practice and Surgery University of Illinois at Chicago Chicago Illinois USA
| | - Clare Kane
- Department of Pharmacy Northwestern Memorial Hospital Chicago Illinois USA
| | - Lyndsey Bowman
- Department of Pharmacy Tampa General Hospital Tampa Florida USA
| | | | - Minoosh Sobhanian
- Department of Pharmacy Memorial Hermann‐Texas Medical Center Houston Texas USA
| | - Caroline Perez
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Jennifer Trofe‐Clark
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Department of Pharmacy Services Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - James N. Fleming
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
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Maldonado AQ, Hall RC, Pilch NA, Ensor CR, Anders S, Gilarde JA, Tichy EM. ASHP Guidelines on Pharmacy Services in Solid Organ Transplantation. Am J Health Syst Pharm 2019; 77:222-232. [DOI: 10.1093/ajhp/zxz291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Reed C Hall
- University Health System, San Antonio, TX
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | | | | | - Stephanie Anders
- Transplant Pharmacy Services, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Eric M Tichy
- Supply Chain Management, Mayo Clinic, Rochester, MN
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Sin JH, Li H, Jandovitz N, King M, Tsapepas DS. Dynamic Interplay of Pharmacy Learners During a Solid Organ Transplantation Learning Experience. J Pharm Pract 2017. [DOI: 10.1177/0897190017715392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Institutions with established clinical pharmacy services have the ability to offer focused patient care learning experiences, often led by a clinical specialist, for pharmacy residents and pharmacy students. Since all parties are continually involved in professional development and lifelong learning, the aforementioned groups can all be considered “pharmacy learners.” By utilizing the dynamic interplay and collaboration between pharmacy learners through direct and nondirect patient care activities, experiential and educational opportunities may be improved and enhanced for each learner. A tiered learning approach engages individuals in areas such as direct patient care, patient education, presentations, research projects, career development, and the feedback process. We describe our experience during a solid organ transplantation learning experience using a layered learning practice model that included a clinical pharmacy specialist, a postgraduate year 2 specialty pharmacy resident, a postgraduate year 1 pharmacy resident, and a pharmacy student.
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Affiliation(s)
- Jonathan H. Sin
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Hanlin Li
- Department of Pharmacy, NewYork–Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Nicholas Jandovitz
- Department of Pharmacy, NewYork–Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Madeline King
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, USA
| | - Demetra S. Tsapepas
- Department of Pharmacy, NewYork–Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
- Division of Abdominal Transplantation, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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