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Finkelstein RJ, Parker CP, Levy BT, Carter BL, Kennelty K. Development of a centralized, remote clinical pharmacy service to enhance primary care. Pharm Pract (Granada) 2021; 19:2348. [PMID: 33777264 PMCID: PMC7979315 DOI: 10.18549/pharmpract.2021.1.2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
More than 50% of Americans possess at least one chronic condition and
another 25% suffer from two or more, leaving primary care teams tasked to
care for the chronic, acute, and preventive care needs of their large patient
panels. Pharmacists can reduce the burden on busy providers by effectively
managing chronic diseases as members of health care teams. Many private
physician practices lack the resources to include pharmacists on their teams. A
centralized, remote clinical pharmacy services model allows pharmacists to
remotely manage chronic disease in patients in collaboration with primary care
providers. The purpose of this report is to describe how a centralized, remote
clinical pharmacy team was developed, trained, and effectively integrated into
multiple, diverse primary care settings across the U.S.
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Affiliation(s)
- Rachel J Finkelstein
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa . Iowa City ( United States ).
| | - Christopher P Parker
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa . Iowa City ( United States ).
| | - Barcey T Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, Department of Epidemiology, College of Public Health, University of Iowa . Iowa City ( United States ).
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa . Iowa City ( United States ).
| | - Korey Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa . Iowa City ( United States ).
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Kennelty KA, Engblom NJ, Carter BL, Hollingworth L, Levy BT, Finkelstein RJ, Parker CP, Xu Y, Jackson KL, Dawson JD, Dorsey KK. Dissemination of a telehealth cardiovascular risk service: The CVRS live protocol. Contemp Clin Trials 2021; 102:106282. [PMID: 33444781 DOI: 10.1016/j.cct.2021.106282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medical clinics are increasingly hiring clinical pharmacists to improve management of cardiovascular disease (CVD). However, the limited number of clinical pharmacists employed in a clinic may not impact the large number of complex patients needing the services. We have developed a remote telehealth service provided by clinical pharmacists to complement CVD services provided by on-site clinical pharmacists and aid sites without a clinical pharmacist. This cardiovascular risk service (CVRS) has been studied in two NIH-funded trials, however, we identified barriers to optimal intervention implementation. The purpose of this study is to examine how to implement the CVRS into medical offices and see if the intervention will be sustained. METHODS This is a 5-year, pragmatic, cluster-randomized clinical trial in 13 primary care clinics across the US. We randomized clinics to receive CVRS or usual care and will enroll 325 patient subjects and 288 key stakeholder subjects. We have obtained access to the electronic medical records (EMRs) of all study clinics to recruit subjects and provide the pharmacist intervention. The intervention is staggered so that after 12 months, the usual care sites will receive the intervention for 12 months. Follow-up will be accomplished though medical record abstraction at baseline, 12 months, 24 months, and 36 months. CONCLUSIONS This study will enroll subjects through 2021 and results will be available in 2024. This study will provide unique information on how the CVRS provided by remote clinical pharmacists can be effectively implemented in medical offices, many of which already employ on-site clinical pharmacists. CLINICAL TRIAL REGISTRATION INFORMATION NCT03660631: http://clinicaltrials.gov/ct2/show/NCT03660631.
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Affiliation(s)
- Korey A Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, United States; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, United States.
| | - Nels J Engblom
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, United States
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, United States; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, United States
| | - Liz Hollingworth
- Department of Educational Policy and Leadership Studies, College of Education, University of Iowa, United States
| | - Barcey T Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, United States; Department of Epidemiology, College of Public Health, University of Iowa, United States
| | - Rachel J Finkelstein
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, United States
| | - Christopher P Parker
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, United States
| | - Yinghui Xu
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, United States
| | - Kayla L Jackson
- Department of Educational Policy and Leadership Studies, College of Education, University of Iowa, United States
| | - Jeffrey D Dawson
- Department of Biostatistics, College of Public Health, University of Iowa, United States
| | - Kathryn K Dorsey
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, United States
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A pharmacist intervention for monitoring and treating hypertension using bidirectional texting: PharmText BP. Contemp Clin Trials 2020; 98:106169. [PMID: 33038500 DOI: 10.1016/j.cct.2020.106169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND New approaches are needed to better monitor blood pressure (BP) between physician visits, especially for patients in rural areas or for those who lack transportation. We have developed a custom-built bi-directional texting platform for home BP measurements that can then be managed by clinical pharmacists located remotely. The purpose of this study is to evaluate whether the BP texting approach combined with a pharmacist-based intervention improves BP management and to determine if the approach is cost effective. METHODS This study is a randomized, prospective trial in four primary care offices that serve patients in rural areas. Subjects will receive standardized research BP measurements at baseline, 6 and 12 months. The primary outcome will be differences between the intervention and control group in mean systolic BP at 12 months. Secondary outcomes will include systolic BP at 6 months; diastolic BP at 6 and 12 months, number of medication changes and costs. CONCLUSIONS This study plans to enroll subjects through 2022, follow-up will be completed in 2023 and results will be available in 2024. This study will provide information on whether a combined approach using texting of home BP values and a pharmacist-based telehealth services can improve BP control.
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Pass LE, Kennelty K, Carter BL. Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study. BMJ Open 2019; 9:e029976. [PMID: 31685497 PMCID: PMC6858190 DOI: 10.1136/bmjopen-2019-029976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/01/2019] [Accepted: 09/13/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Individuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults' experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments in this population to inform future interventions delivering services. DESIGN We conducted a qualitative study of barriers and facilitators to mental healthcare access. 19 interviews were analysed deductively for barriers using a modified version of Penchansky and Thomas's theory of access as an analytical framework. SETTING This study was conducted remotely using telephonic interviews. Patients were located in various rural Iowa towns and cities. PARTICIPANTS 15 rural Iowan older adults with multiple physical comorbidities as well as anxiety and/or depression. RESULTS We found that while patients in this study often felt that their mental health was important to address, they experienced multiple, but overlapping, barriers to services that delayed care or broke their continuity of receiving care, including limited knowledge of extant services and how to find them, difficulties obtaining referrals and unsatisfactory relationships with mental health service providers. CONCLUSIONS Our findings indicate that intervention across multiple domains of access is necessary for successful long-term management of mental health disorders for patients with multiple chronic comorbidities in Iowa.
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Affiliation(s)
- Lauren Elizabeth Pass
- Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Korey Kennelty
- Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
- Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Barry L Carter
- Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa, USA
- Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
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Di Palo KE, Patel K, Kish T. Risk Reduction to Disease Management: Clinical Pharmacists as Cardiovascular Care Providers. Curr Probl Cardiol 2019; 44:276-293. [DOI: 10.1016/j.cpcardiol.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 07/21/2018] [Indexed: 01/22/2023]
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Carter BL, Levy B, Gryzlak B, Xu Y, Chrischilles E, Dawson J, Vander Weg M, Christensen A, James P, Polgreen L. Cluster-Randomized Trial to Evaluate a Centralized Clinical Pharmacy Service in Private Family Medicine Offices. Circ Cardiovasc Qual Outcomes 2019; 11:e004188. [PMID: 29884657 DOI: 10.1161/circoutcomes.117.004188] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of clinical pharmacists in primary care has improved the control of several chronic cardiovascular conditions. However, many private physician practices lack the resources to implement team-based care with pharmacists. The purpose of this study was to evaluate whether a centralized, remote, clinical pharmacy service could improve guideline adherence and secondary measures of cardiovascular risk in primary care offices in rural and small communities. METHODS AND RESULTS This study was a prospective trial in 12 family medicine offices cluster randomized to either the intervention or usual care. The intervention was delivered for 12 months, and subjects had research visits at baseline and 12 months. The primary outcome was adherence to guidelines, and secondary outcomes included changes in key cardiovascular risk factors and preventative health measures. We enrolled 302 subjects. There was no improvement in the Guideline Advantage score from baseline to 12 months in the control group (64.7% versus 63.1%, respectively; P=0.21). There was a statistically significant improvement in the intervention group from 63.3% at baseline to 67.8% at 12 months (P=0.02). The estimated benefit of the intervention was 5.0%±2.4% (95% confidence interval=-0.5% to 10.4%; P=0.07). Several criteria were significantly better for intervention subjects, including appropriate statin therapy (P<0.001), body mass index, screening (P<0.001), and alcohol screening (P<0.001). Only 13.7% of subjects with diabetes mellitus had hemoglobin A1c at goal at baseline, and this increased to 30.8% and 21.0% in the intervention and control group, respectively, at 12 months (P=0.10). CONCLUSIONS The centralized, remote pharmacist intervention was successfully implemented. The improvements in outcomes were modest, in part because of higher than expected baseline guideline adherence. Future studies of this model should focus on patients with uncontrolled conditions at high risk for cardiovascular events. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT 01983813.
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Affiliation(s)
- Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.) .,Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.)
| | - Barcey Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.).,Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)
| | - Brian Gryzlak
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.).,Department of Epidemiology, College of Public Health (B.L., B.G., E.C.)
| | - Yinghui Xu
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (B.L.C., B.L., Y.X.)
| | | | - Jeffrey Dawson
- Department of Biostatistics, College of Public Health (J.D.)
| | - Mark Vander Weg
- Department of Internal Medicine, Carver College of Medicine (M.V.W., A.C.).,Department of Psychological and Brain Sciences, College of Liberal Arts and Sciences (M.V.W., A.C.).,University of Iowa. Iowa City Veterans Administration Health Care System (M.V.W.)
| | - Alan Christensen
- Department of Internal Medicine, Carver College of Medicine (M.V.W., A.C.).,Department of Psychological and Brain Sciences, College of Liberal Arts and Sciences (M.V.W., A.C.)
| | - Paul James
- Department of Family Medicine, University of Washington, Seattle (P.J.)
| | - Linnea Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy (B.L.C., B.G., L.P.)
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Kennelty KA, Polgreen LA, Carter BL. Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature. Curr Hypertens Rep 2018; 20:1. [PMID: 29349522 DOI: 10.1007/s11906-018-0803-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. RECENT FINDINGS Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics. Little information was found on factors influencing sustainability of team-based care interventions to improve BP control. Future work is needed to determine the best populations to target with team-based BP programs and how to implement team-based approaches utilizing pharmacists in diverse clinical settings. Future studies need to not only identify unmet clinical needs but also address reimbursement issues and stakeholder engagement that may impact sustainment of team-based care interventions.
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Affiliation(s)
- Korey A Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA.
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Yang R, Carter BL, Gums TH, Gryzlak BM, Xu Y, Levy BT. Selection bias and subject refusal in a cluster-randomized controlled trial. BMC Med Res Methodol 2017; 17:94. [PMID: 28693427 PMCID: PMC5504663 DOI: 10.1186/s12874-017-0368-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background Selection bias and non-participation bias are major methodological concerns which impact external validity. Cluster-randomized controlled trials are especially prone to selection bias as it is impractical to blind clusters to their allocation into intervention or control. This study assessed the impact of selection bias in a large cluster-randomized controlled trial. Methods The Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE) study examined the impact of a remote pharmacist-led intervention in twelve medical offices. To assess eligibility, a standardized form containing patient demographics and medical information was completed for each screened patient. Eligible patients were approached by the study coordinator for recruitment. Both the study coordinator and the patient were aware of the site’s allocation prior to consent. Patients who consented or declined to participate were compared across control and intervention arms for differing characteristics. Statistical significance was determined using a two-tailed, equal variance t-test and a chi-square test with adjusted Bonferroni p-values. Results were adjusted for random cluster variation. Results There were 2749 completed screening forms returned to research staff with 461 subjects who had either consented or declined participation. Patients with poorly controlled diabetes were found to be significantly more likely to decline participation in intervention sites compared to those in control sites. A higher mean diastolic blood pressure was seen in patients with uncontrolled hypertension who declined in the control sites compared to those who declined in the intervention sites. However, these findings were no longer significant after adjustment for random variation among the sites. After this adjustment, females were now found to be significantly more likely to consent than males (odds ratio = 1.41; 95% confidence interval = 1.03, 1.92). Conclusions Though there appeared to be a higher consent rate for females than for males, the overall impact of potential selection bias and refusal to participate was minimal. Without rigorous methodology, selection bias may be a threat to external validity in cluster-randomized trials. Trial registration NCT01983813. Date of registration: Oct. 28, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0368-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rochelle Yang
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA, 52242, USA
| | - Barry L Carter
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA, 52242, USA. .,Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Tyler H Gums
- Department of Health Outcomes and Pharmacy Practice, University of Texas, Austin, TX, USA
| | - Brian M Gryzlak
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Yinghui Xu
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Barcey T Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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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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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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Carter BL, Coffey CS, Chrischilles EA, Ardery G, Ecklund D, Gryzlak B, Vander Weg MW, James PA, Christensen AJ, Parker CP, Gums T, Finkelstein RJ, Uribe L, Polgreen LA. A Cluster-Randomized Trial of a Centralized Clinical Pharmacy Cardiovascular Risk Service to Improve Guideline Adherence. Pharmacotherapy 2015; 35:653-62. [PMID: 26111939 DOI: 10.1002/phar.1603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Numerous studies have demonstrated the value of including pharmacists in team-based care to improve adherence to cardiovascular (CV) guidelines, medication adherence, and risk factor control. However, there is limited information on whether these models can be successfully implemented more widely in diverse settings and populations. The purpose of this study is to evaluate whether a centralized, web-based cardiovascular risk service (CVRS) managed by clinical pharmacists will improve guideline adherence in multiple primary care medical offices with diverse geographic and patient characteristics. METHODS This study is a prospective trial in 20 primary care offices stratified by the percent of under-represented minorities and then randomized to either the CVRS intervention or usual care. The intervention will last for 12 months and all subjects will have research visits at baseline and 12 months. The primary outcome is the difference in guideline adherence between groups. Data will also be abstracted from the medical record at 24 months to determine if the intervention effect is sustained after it is discontinued. CONCLUSIONS Patient enrollment will continue through 2016, with results expected in 2019. This study will provide information on whether a distant, centralized CVRS can be implemented in large numbers of medical offices, if it is effective in diverse populations, and if there is a long-term sustained effect.
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Affiliation(s)
- Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa.,Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | | | | | - Gail Ardery
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Dixie Ecklund
- Department of Biostatistics, College of Public Health, Iowa City, Iowa
| | - Brian Gryzlak
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa.,Department of Epidemiology, College of Public Health, Iowa City, Iowa
| | - Mark W Vander Weg
- Iowa City Veterans Administration, Iowa City, Iowa.,Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,Department of Psychology, College of Liberal Arts, The University of Iowa, Iowa City, Iowa
| | - Paul A James
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
| | - Alan J Christensen
- Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.,Department of Psychology, College of Liberal Arts, The University of Iowa, Iowa City, Iowa
| | - Christopher P Parker
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Tyler Gums
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Rachel J Finkelstein
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, Iowa City, Iowa
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
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