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Saeed H, Martini ND, Scahill S. Exploring telepharmacy: A bibliometric analysis of past research and future directions. Res Social Adm Pharm 2024; 20:805-819. [PMID: 38714397 DOI: 10.1016/j.sapharm.2024.04.017] [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: 11/21/2023] [Revised: 03/30/2024] [Accepted: 04/29/2024] [Indexed: 05/09/2024]
Abstract
This bibliometric review analyzes the evolution of telepharmacy research, significantly amplified by the COVID-19 pandemic. By employing bibliometric analysis, the study aims to provide a comprehensive overview of the current state and emerging trends in telepharmacy. This approach helps in identifying key areas of growth, predominant themes, and potential gaps in the literature. Utilizing data from 330 papers (1981-2023) sourced from Scopus and analyzed with Bibliometrix™, this study applies both performance analysis and science mapping methods to examine the telepharmacy literature. The findings reveal a consistent growth in telepharmacy research, with an 8.07 % average annual growth rate. Performance analysis highlights key authors, influential works, and leading journals and countries in the field. Document co-citation analysis identifies four developmental phases of telepharmacy: emergence, take-off, expansion, and future trajectory by uncovering the intellectual structure of the field. Co-words analysis elucidates evolving conceptual structures and significant subfields over time. These findings serve to inform practitioners and researchers about the evolving landscape of telepharmacy, guiding future research and practice in this increasingly important field.
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Affiliation(s)
- Hina Saeed
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Nataly Dominica Martini
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Shane Scahill
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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2
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Wang RC, Lipin DI, Swoboda TK, Sambamoorthi U. A Comparative Analysis of Healthcare Quality Perception Among Different Vulnerable Populations with and without Telehealth Utilization: A Cross-Sectional Study from the Health Information National Trends Survey. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02116-8. [PMID: 39102175 DOI: 10.1007/s40615-024-02116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The COVID-19 pandemic led to a rapid expansion of telehealth utilization in medicine. However, the quality measures associated with telehealth use remain unclear, particularly among vulnerable populations. This study aims to investigate the impact of telehealth on individuals' perception of overall quality care among vulnerable patient populations. METHODS This cross-sectional study utilized Health Information National Trends Survey data. The individuals' overall perception of healthcare quality was compared between populations that had at least one telehealth visit and non-telehealth users, who all had the option of utilizing telehealth. This comparison focused on vulnerable populations, considering differences in race and ethnicity (non-Hispanic white vs. non-Hispanic black/Hispanic individuals) and socioeconomic status (high vs. low). Multivariable logistic regressions were employed to ascertain the association between individuals' overall perceptions of quality care with and without telehealth utilization. RESULTS A total of 2920 participants, representing an unweighted population of 114,608,302, were analyzed. The adjusted odds ratio (AOR) for at least one telehealth visit associated with individuals' overall perception of quality care among the entire survey population was 0.76 with a 95% CI of 0.51-1.13 (p = 0.173). The AOR was 0.83 (95% CI 0.39-1.77, p = 0.618) among the non-White population, and the AOR was 0.71 (95% CI 0.29-1.78, p = 0.462) among individuals with low SES. CONCLUSIONS Although telehealth utilization has both its limitations and advantages compared to traditional clinical visits, no statistically significant differences in individuals' overall perception of quality care were identified among telehealth and non-telehealth users. These findings were also consistent across various vulnerable populations.
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Affiliation(s)
- Richard C Wang
- St. Mark's School of Texas, 10600 Preston Rd, Dallas, TX, 75230, USA.
| | - Daniel I Lipin
- St. Mark's School of Texas, 10600 Preston Rd, Dallas, TX, 75230, USA
| | - Thomas K Swoboda
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, 657 N. Town Center Drive, Las Vegas, NV, 89144, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, Texas Center for Health Disparity, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Dohrn A, Hoskins R, Collier L, Kennelty K. Evaluation of a Telehealth-Based Pharmacist Led Chronic Care Management Program. J Pharm Pract 2024; 37:933-939. [PMID: 37595956 DOI: 10.1177/08971900231196624] [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] [Indexed: 08/20/2023]
Abstract
Background: Clinical pharmacy services improve several patient chronic disease outcomes. This review evaluates a pharmacist-led chronic care management (CCM) program partnered with a health system for patient outcomes and sustainability. Methods: A mixed methods evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was completed. Patient A1c and blood pressure readings were retrospectively collected from the electronic health record from August 2018-April 2022. Patients that completed >4 CCM visits with a diagnosis of diabetes and/or hypertension were included. Results: 557 patients enrolled, 53 had uncontrolled systolic blood pressure (SBP), SBP >130 mmHg. Average SBP at baseline was 141.0 mmHg and average SBP at 6 months was 130.2 mmHg, (P < .001). 76 patients had uncontrolled diabetes, A1c > 7%. Average A1c at baseline = 9.1% and average A1c at 6 months = 8.3%, (P < .001). 4464 CCM visits with 247 disease-state targeted patients were completed over 44-month with a 100% adoption rate across clinic locations. Implementation facilitators included patient medication cost concerns, disease burden, provider revenue generation, CCM dedicated software, streamlined call process, and remote EMR access. Implementation barriers included provider discomfort "selling the program," potential patient costs, unclear need from patient, pharmacists not considered providers, pharmacist cost, multi-platform software, reprioritized stakeholder support, and lack of partner site diversification. Program maintenance showed revenue generation was $5925.31-$8879.89 from August 2021-May 2022 and profitability was $3385.61-$1614.23. Conclusion: This study provides lessons learned, strategies for implementation, and ideas for process efficiencies leading to maintenance of a telehealth pharmacist-led CCM service.
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Affiliation(s)
- Ashley Dohrn
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Rachel Hoskins
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Lauren Collier
- The University of Iowa College of Pharmacy, Iowa City, IA USA
| | - Korey Kennelty
- The University of Iowa College of Pharmacy, Iowa City, IA USA
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Chang H, Zhou J, Chen Y, Wang X, Wang Z. Comparative effectiveness of eHealth interventions on the exercise endurance and quality of life of patients with COPD: A systematic review and network meta-analysis. J Clin Nurs 2024; 33:3711-3720. [PMID: 38937908 DOI: 10.1111/jocn.17225] [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: 08/02/2023] [Revised: 01/25/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
AIMS To compare the effectiveness of different types of eHealth interventions in improving exercise endurance and quality of life in chronic obstructive pulmonary disease (COPD) patients. BACKGROUND COPD is a chronic airway disease characterized by persistent respiratory symptoms and airflow limitation. eHealth interventions have been accepted and recognized by healthcare professionals and COPD patients as an effective alternative to pulmonary rehabilitation. However, it is not clear which eHealth interventions are effective and preferred for exercise endurance and quality of life in COPD patients. DESIGN A systematic review and network meta-analysis based on PRISMA-NMA. METHODS We searched nine electronic databases to identify randomized controlled trials addressing the effect of eHealth interventions on the exercise endurance and quality of life of COPD patients from their inception to 30 October 2022. First, a random-effects model was chosen to conduct a traditional meta-analysis to directly investigate the efficacy of different eHealth interventions. Next, a network meta-analysis was performed to evaluate the relative efficacy of the eHealth interventions for COPD. The quality of the data was assessed using the Cochrane Risk of Bias tool. RESULTS Fifty-one studies containing six eHealth interventions (telemonitoring, application [APP], web-based interventions, phone calls, virtual reality and combined interventions [≥two types]) were included in the final analysis. Network meta-analysis showed that telemonitoring, APP, web-based interventions and combined interventions improved exercise endurance in COPD patients, with telemonitoring being the most effective. Web-based interventions and apps are effective in improving the quality of life, and web-based interventions are the most effective. CONCLUSIONS This study confirms that eHealth interventions can improve exercise endurance and quality of life in COPD patients. In the future, healthcare professionals can promote the use of telemedicine in COPD patients to enhance their exercise endurance and quality of life according to their individual needs. RELEVANCE TO CLINICAL PRACTICE This evidence suggests that eHealth interventions can improve exercise endurance and quality of life in COPD patients. Therefore, in the future, eHealth interventions could be used to maximize their effectiveness in improving exercise endurance and quality of life in COPD patients.
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Affiliation(s)
- Hui Chang
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Jia Zhou
- School of Nursing, Peking University, Beijing, China
| | - Yundi Chen
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Xiuhong Wang
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Kassem AB, Al Meslamani AZ, Elmaghraby DH, Magdy Y, AbdElrahman M, Hamdan AM, Mohamed Moustafa HA. The pharmacists' interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic. J Pharm Policy Pract 2024; 17:2372040. [PMID: 39011356 PMCID: PMC11249153 DOI: 10.1080/20523211.2024.2372040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Healthcare systems in developing countries faced significant challenges during COVID-19, grappling with limited resources and staffing shortages. Assessment of the impact of pharmaceutical care expertise, particularly in critical care units during the pandemics, in developing countries remains poorly explored. The principal aim of our study was to assess the impact of the Drug and Therapeutics Committee (DTC), comprising clinical pharmacists, on the incidence, types, and severity of medication errors and associated costs in using COVID-19 medications, especially antibiotics. Methods An interventional pre-post study was carried out at a public isolation hospital in Egypt over 6 months. Results Out of 499 medication orders, 238 (47.7%) had medication errors, averaging 2.38 errors per patient. The most frequent were prescribing errors (44.9%), specifically incorrect drug choice (57.9%), excessive dosage (29.9%), treatment duplication (4.5%), inadequate dosage (4.5%), and overlooked indications (3.6%). Linezolid and Remdesivir were the most common medications associated with prescribing errors. Pharmacists intervened 315 times, primarily discontinuing medications, reducing doses, introducing new medications, and increasing doses. These actions led to statistically significant cost reductions (p < 0.05) and better clinical outcomes; improved oxygen saturation, decreased fever, stabilised respiratory rates, and normalised white blood cell counts. So, clinical pharmacist interventions made a notable clinical and economic difference (66.34% reduction of the expenses) in antibiotics usage specifically and other medications used in COVID-19 management during the pandemic. Conclusion Crucially, educational initiatives targeting clinical pharmacists can foster judicious prescribing habits.
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Affiliation(s)
- Amira B. Kassem
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - 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
| | - Dina H. Elmaghraby
- Kafr El Dawar General Hospital, Department of infectious disease, Ministry of Health, Beheira, Egypt
| | - Yosr Magdy
- Kafr El Dawar General Hospital, Department of infectious disease, Ministry of Health, Beheira, Egypt
| | - Mohamed AbdElrahman
- Clinical Pharmacy Department, College of Pharmacy, Al-Mustaqbal University, Babylon, Iraq
- Clinical pharmacy Department, Badr University Hospital, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Ahmed M.E. Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
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Thurston MM, Dupree LH, Shogbon Nwaesei A, Newsom LC. Incorporation of Innovative Strategies for Patient Education in Pharmacist-Led Transition of Care Initiatives. Ann Pharmacother 2024; 58:657-660. [PMID: 37817556 DOI: 10.1177/10600280231204118] [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] [Indexed: 10/12/2023] Open
Abstract
As patients transition between health care settings, they are at an increased risk of adverse events and medication errors as a result of medication changes and miscommunication. Pharmacists have traditionally provided transitions of care (TOC) services, including patient education, in a face-to-face manner with the goal of reducing medication errors and enhancing patient safety and understanding. However, changes in care delivery models, a burdened health care workforce, and diminishing resources necessitate innovative approaches for the provision of patient education within TOC. Pharmacists should consider novel approaches to expand scope, reduce barriers, and creatively use existing resources to optimize patient education in TOC.
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Affiliation(s)
- Maria Miller Thurston
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, GA, USA
| | - Lori H Dupree
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, GA, USA
| | - Angela Shogbon Nwaesei
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, GA, USA
| | - Lydia C Newsom
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, GA, USA
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Rogers JE, Zadlo J, Leung CH, Nguyen V, Leung M, Mace M, Covert W, Smack M, Sirisaengtaksin A, Diao S, Fang Z, Landgraf Oholendt A. Direct Clinical Pharmacist-Patient Telephone Follow-Up: A Focus on GI Medical Oncology Symptom Management. JCO Oncol Pract 2024; 20:808-815. [PMID: 38412400 DOI: 10.1200/op.23.00452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
PURPOSE GI medical oncology care presents unique medication challenges. Here, we captured our clinical pharmacy specialists' (CPSs) involvement in patients with GI cancers starting cycle 1 of a new treatment. METHODS Our quality initiative was performed in three stages (preintervention, intervention, and postintervention). Preintervention: retrospective baseline data collection from May to December 2019. Intervention: one-time telephone encounters were conducted by a CPS between March 15 and June 11, 2021. The primary objective of the quality improvement initiative was to increase patient interaction with a CPS to 80%. Postintervention: data collection to review the impact of CPS telephone encounters. RESULTS Preintervention: we reviewed the electronic health records of 262 patients. Sixty nine percent of patients reported at least one adverse event (AE; range 1-6 AEs) at the first physician follow-up after treatment start. Most reported AEs (78%) were considered modifiable within the scope of CPS practice. Postintervention: during the intervention, 92% of patients (n = 389) received a telehealth encounter with the CPS. At the encounter, 315 patients (81%) reported at least one AE. CPS provided recommendations and/or additional education for 88% of reported AEs. Medication lists required correction 75% of the time. The median time for CPS encounters (including documentation) was 40 minutes. CONCLUSION During a 3-month period, this quality improvement initiative successfully provided an early CPS-based telehealth intervention to identify and make initial recommendations for management of AEs for patients on cycle 1 of systemic therapy for GI cancer.
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Affiliation(s)
- Jane E Rogers
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Zadlo
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cheuk Hong Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Van Nguyen
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Leung
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Morgan Mace
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendy Covert
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Makenna Smack
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amanda Sirisaengtaksin
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stacy Diao
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhou Fang
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrea Landgraf Oholendt
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ryan M, Poke T, Ward EC, Carrington C, Snoswell CL. A systematic review of synchronous telepharmacy service models for adult outpatients with cancer. Res Social Adm Pharm 2024; 20:25-33. [PMID: 38490859 DOI: 10.1016/j.sapharm.2024.02.016] [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: 09/14/2023] [Revised: 01/21/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Telephone and videoconsults are known synchronous telepharmacy modalities being used to respond to the demand for outpatient pharmacy services. However, little is known about the evidence for cancer telepharmacy service models. OBJECTIVES To review existing evidence regarding synchronous telepharmacy service models for adult outpatients with cancer, with a secondary focus on outcomes, enablers, and barriers. METHODS A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and EMBASE in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient. During article selection in Covidence, an extra inclusion criterion of synchronous cancer-focused services was applied; data extraction and narrative analysis were then performed. RESULTS From 2129 non-duplicate articles, 8 were eligible for inclusion, describing 7 unique patient populations. The service models included pre-treatment medication history taking, adherence monitoring, toxicity assessment, and discharge follow-up. Studies found synchronous telepharmacy services can improve timeliness of care, optimise workload management, and provide individualised and convenient efficacy monitoring and counselling. One study of 177 patients on immune checkpoint inhibitors found 38% of the 726 telephone consults involved at least one intervention. When videoconsults were compared directly with telephone consults for pre-treatment medication history, it was found scheduled videoconsults had a significantly higher success rate than unscheduled telephone consults, and that videoconsults also represented increased funding and equivalent time efficiency. When telephone follow-up was compared to no follow-up, improved treatment adherence was seen, and progression-free survival was significantly higher for the telephone group (6.1 months vs 3.7 months, p = 0.001). Reported enablers included physician buy-in, staff resources, and correct utilisation of technology, while identified barriers included time investment required and technical issues. CONCLUSION Both telephone and videoconsult modalities are being used to deliver synchronous telepharmacy services across a range of outpatient services. Although more evidence is needed, data to date supports positive service benefits and enhanced care.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia; Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Tara Poke
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia.
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Suite 304, 3rd Floor, Buranda Village, Corner Cornwall Street and Ipswich Road, Buranda, Brisbane, QLD, 4102, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, 84a Services Rd, St Lucia, Brisbane, QLD, 4067, Australia.
| | - Christine Carrington
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia; School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia.
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Nguyen OT, Mason A, Charles D, Sprow O, Naso C, Turner K, Nahleh OA, Khanna N, Hong YR, Tabriz AA, Spiess P, Bottiglieri S. Patient and caregiver experience with telepharmacy in cancer care to support beginning systemic therapy: A qualitative study. J Oncol Pharm Pract 2024; 30:442-450. [PMID: 37312504 DOI: 10.1177/10781552231181911] [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] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Although the COVID-19 pandemic spurred telehealth adoption for many specialties and care team roles, the patient and caregiver experience for telepharmacy visits has been relatively understudied. To our knowledge, there is a paucity of studies that have attempted to qualitatively evaluate this. This study aimed to qualitatively assess the patient and caregiver experience of telepharmacy visits in a cancer center. METHODS Semistructured interviews were conducted with 21 patients with cancer and seven caregivers that had attended a telepharmacy visit between December 1, 2021, and May 24, 2022. The interviews assessed visit content, overall satisfaction, system experience, visit quality, and future preferences for pharmacy visits as telehealth versus in-person. We used both deductive and inductive coding to identify themes. RESULTS Telepharmacy delivery was generally well-received. Reasons for having the telepharmacy visit included reviewing chemotherapy procedures, side effects to expect during treatment, providing education on recently prescribed medications, offering dietary recommendations (e.g., avoiding grapefruit juice), and performing medication reconciliation. Participants were receptive to having pharmacy visits through telehealth due to the perceived lack of a need to have a physical exam and prior relationship with the pharmacist. Participants also highlighted the main reason for the telepharmacy visits was primarily to provide patient education, which participants felt was suitable for telehealth. CONCLUSIONS The patient and caregiver experience of telepharmacy is influenced by several factors, such as ease of connectivity, communicating effectively with the pharmacist, and timing of the telepharmacy visit (e.g., immediately after picking up medications from the pharmacy). Participants' recommendations to improve telepharmacy delivery included health systems raising awareness of telepharmacy services and providing a list of questions to patients to guide discussions.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Arianna Mason
- Participant, Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Dannelle Charles
- Participant, Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Olivia Sprow
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Cristina Naso
- Virtual Health Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Science, University of South Florida, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Omar Abu Nahleh
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Neel Khanna
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Science, University of South Florida, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Philippe Spiess
- Virtual Health Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Salvatore Bottiglieri
- Department of Medical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Alkhuzaee F, Alsharif S, Shukry M. Telemedicine-based medical care compared to in-person medical care for warfarin follow-up: A retrospective propensity score matching cohort study. Am J Health Syst Pharm 2024; 81:e166-e173. [PMID: 38070197 DOI: 10.1093/ajhp/zxad311] [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] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Telemedicine is underutilized in Saudi Arabia, which is a matter of concern, especially since previous literature has showed its equivalence with office visits in providing access to care and convenience for patients while reducing anticoagulation-related bleeding events when appropriate measures are followed. The purpose of this study is to analyze the efficacy of telehealth-based care compared to in-person visit care for warfarin follow-up. METHODS The authors conducted a retrospective chart review comparing the mean percentage of time in the therapeutic range (TTR) of international normalized ratio (INR) values among patients prescribed warfarin from July 2019 to November 2020 at King Faisal Specialist Hospital & Research Center - Jeddah Branch whose anticoagulant therapy was managed via telemedicine or through in-person clinic visits. A subcohort analysis of outcomes in the telemedicine and in-person groups was performed using propensity score matching, and descriptive analysis was done for the entire cohort. RESULTS A total of 350 patient records were included in this retrospective study. Matched analysis for 148 patients using propensity score matching showed that the mean (SD) percentages of TTR were 62.82% (19.46%) and 70.61% (19.83%) in the telemedicine and in-person groups, respectively (P = 0.017). There was no statistical difference in the incidence of major or minor bleeding events, thromboembolic events, and hospital readmission between the two groups. CONCLUSION The study results showed that patients on oral anticoagulation therapy managed through a telemedicine method had a lower overall TTR percentage than a matched group of patients managed through in-person anticoagulant clinic visits, thus demonstrating that using a telemedicine approach alone for warfarin follow-up may not help patients to maintain their INR target level.
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Affiliation(s)
- Fahad Alkhuzaee
- Quality and Medication Safety Department, Pharmaceutical Services Administration, King Abdullah Medical City in Holy Capital, Makkah, Saudi Arabia
| | - Sahar Alsharif
- Clinical and Operational Support Pharmacy, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center - Jeddah, Jeddah, Saudi Arabia
| | - Murooj Shukry
- Medication Safety & Clinical Support Pharmacy, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center - Jeddah, Jeddah, Saudi Arabia
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El Ansari W, Saad MO. Virtual Care? Telepharmacy in Critical Care Settings for Patient-Centered Care and Multidisciplinary Collaboration: A Scoping Review of Activities, Benefits, Economic Impact, Challenges, and Knowledge Gaps. Telemed J E Health 2024; 30:21-35. [PMID: 37406291 DOI: 10.1089/tmj.2023.0067] [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] [Indexed: 07/07/2023] Open
Abstract
Background: Very few studies have investigated telepharmacy (TP) in critical care. This scoping review undertook this task. Methods: We searched the following five electronic databases (PubMed, Embase, WoS, Scopus, CINAHL). Data were extracted from the articles and mapped out. Arksey and O'Malley's 6-step framework was used, and data synthesis identified activities, benefits, economic impact, challenges, and knowledge gaps of TP in critical care. Results: Out of 77 reports retrieved, 14 were included in the review as per inclusion criteria. Eight studies (57%) were published since 2020, and 9 (64%) were from the United States. Tele-ICU was in place before TP implementation in six studies (43%). TP used a range of synchronous/asynchronous communications. Studies reported wide assortment of reactive/scheduled TP activities. Patient outcomes were evaluated in one study of sedation-related TP interventions but they were not different despite improved compliance with sedation protocol. Most common clinical interventions/drugs included glycemic, electrolyte, and antimicrobial therapy management and antithrombotic agents among others. Acceptance of TP interventions was 75% or more in four studies and 51-55% in two studies. Benefits of TP included resolved drug-related problems, increased compliance with guidelines, maintained interactions with other health care providers, and patient safety among others. Three studies (21%) reported cost avoidance with TP interventions. Challenges included communication, intervention documentation, tracking implementation of recommendations, and monetary/financial and legislative/regulatory issues. Knowledge gaps comprised lack of frameworks for implementation/evaluation of TP in critical care, methodological aspects, lack of patient-specific outcomes, as well as institution/health-system aspects, and documentation systems, cost, legislative, and sustainability issues. Conclusions: TP in critical care is underpublished, and comprehensive frameworks for its implementation and evaluation remain lacking. Assessments are needed to evaluate the effect of TP in critical care on patient-specific outcomes, its economic and legal dimensions, methods to sustain it, as well as the role of documentation systems, collaboration models, and institutional characteristics.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Piskorz D, Alcocer L, López Santi R, Puente Barragán A, Múnera A, Molina DI, Galván Oseguera H, Barroso WS, Palomo S, Díaz-Díaz E, Cardona-Muñoz E, Wyss F, Ponte Negretti C, Rosas Peralta M, Chávez Mendoza A, Alvares López H, Patiño EP, Guerra López A, Escudero X, Enciso JM. Blood pressure telemonitoring and telemedicine, a Latin America perspective. Blood Press 2023; 32:2251586. [PMID: 37635629 DOI: 10.1080/08037051.2023.2251586] [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: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To share a Latin-American perspective of the use of telemedicine, together with blood pressure measurements outside the medical office, as a potential contribution to improving access to the health system, diagnosis, adherence, and persistence in hypertension treatment. MATERIAL AND METHODS A document settled by a Writing Group of Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Epidemiology and Cardiovascular Prevention Council of the Interamerican Society of Cardiology, and National Cardiologist Association of Mexico. RESULTS In almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality. Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension. The clinical practitioner has seen increased evidence that the use of out-of-office blood pressure (BP) measurement and telemedicine are helpful tools to keep patients and physicians in contact and promote better pharmacological adherence and BP control. A survey carried out by medical and scientific institutions showed that practitioners are up-to-date with telemedicine, had internet access, and had hardware availability. CONCLUSIONS A transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension.
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Affiliation(s)
| | - Luis Alcocer
- Mexico Institute of Cardiovascular Health, Mexico City, Mexico
| | | | | | - Ana Múnera
- Rosario Tesoro Clinic-Cardioestudio, Medellin, Colombia
| | | | | | | | - Silvia Palomo
- Group of Mexico Hypertension Experts Group, Mexico City, Mexico
| | | | | | - Fernando Wyss
- Cardiovascular Services and Technology of Guatemala, Guatemala, Guatemala
| | | | | | - Adolfo Chávez Mendoza
- Cardiology Hospital, National Medical Center XXI Century, Mexico Institute of Social Security, Mexico City, Mexico
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Nkemdirim Okere A, Balogun A, Smith A, Stevens J. Association between pharmacist-led telehealth services and improvements in cardiovascular outcomes among patients with cardiovascular risk factors: A scoping review. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200206. [PMID: 37663032 PMCID: PMC10472224 DOI: 10.1016/j.ijcrp.2023.200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Background Cardiovascular disease is the leading cause of death globally. Despite the effectiveness of lifestyle changes and recommended therapeutics, access to primary care and treatments to improve cardiovascular risk-factors (CRFs) remains challenging. Pharmacists and telehealth services have been proposed as potential solutions to overcome these barriers. Methods PubMed, OVID, and CINAHL databases were searched from January 2006 to March 2023. The primary outcomes were changes from baseline in systolic/diastolic blood pressure, glycated hemoglobin (A1c), cholesterol levels, and adherence to any patient counseling. Only studies conducted in the United States and Canada were included in the review. Results Of 110 screened bibliographic records, 14 studies were included in the review. The pharmacist-led telehealth interventions included medication therapy management, medication reviews, and counseling on lifestyle changes. Nine studies reported significant improvements with intervention, 7 studies on CRFs and 2 studies on medication adherence at the 12-month follow-up, when pharmacist-led telehealth services were compared to usual care or historical data (p < 0.05). Conclusion This scoping review provides evidence for continued support to the development and implementation of pharmacist-led telehealth services in primary cardiovascular care. The findings suggest that pharmacist-led telehealth interventions can improve cardiovascular outcomes and adherence to drug and non-drug therapy among patients with CRFs. However, because of lack of published randomized clinical studies on patients with CRFs residing in underserved communities, future directions in research should focus on exploring the implementation of pharmacist-led telehealth services in rural or underserved communities, utilizing various payment models to enhance accessibility and feasibility.
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Affiliation(s)
- Arinze Nkemdirim Okere
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
| | - Aliyah Balogun
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
| | - Angela Smith
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
| | - Jade Stevens
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL, 32307, USA
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Kapoor A, Patel P, Mbusa D, Pham T, Cicirale C, Tran W, Beavers C, Javed S, Wagner J, Swain D, Crawford S, Darling C, ItoFuKunaga M, McManus D, Mazor K, Gurwitz J. Multicomponent Pharmacist Intervention Did Not Reduce Clinically Important Medication Errors for Ambulatory Patients Initiating Direct Oral Anticoagulants. J Gen Intern Med 2023; 38:3526-3534. [PMID: 37758967 PMCID: PMC10713923 DOI: 10.1007/s11606-023-08315-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/30/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Anticoagulants including direct oral anticoagulants (DOACs) are among the highest-risk medications in the United States. We postulated that routine consultation and follow-up from a clinical pharmacist would reduce clinically important medication errors (CIMEs) among patients beginning or resuming a DOAC in the ambulatory care setting. OBJECTIVE To evaluate the effectiveness of a multicomponent intervention for reducing CIMEs. DESIGN Randomized controlled trial. PARTICIPANTS Ambulatory patients initiating a DOAC or resuming one after a complication. INTERVENTION Pharmacist evaluation and monitoring based on the implementation of a recently published checklist. Key elements included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests. CONTROL Coupons and assistance to increase the affordability of DOACs. MAIN MEASURE Anticoagulant-related CIMEs (Anticoagulant-CIMEs) and non-anticoagulant-related CIMEs over 90 days from DOAC initiation; CIMEs identified through masked assessment process including two physician adjudication of events presented by a pharmacist distinct from intervention pharmacist who reviewed participant electronic medical records and interview data. ANALYSIS Incidence and incidence rate ratio (IRR) of CIMEs (intervention vs. control) using multivariable Poisson regression modeling. KEY RESULTS A total of 561 patients (281 intervention and 280 control patients) contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs (0.95 per 100 person-days). Failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs were the most common anticoagulant-related CIMEs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients (IRR 1.17; 95% CI 0.98-1.42) or non-anticoagulant-related CIMEs (IRR 1.05; 95% CI 0.80-1.37). CONCLUSION A multi-component intervention in which clinical pharmacists implemented an evidence-based DOAC Checklist did not reduce CIMEs. NIH TRIAL NUMBER NCT04068727.
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Affiliation(s)
- Alok Kapoor
- UMass Chan Medical School, Worcester, MA, USA.
- UMass Memorial Medical Center, Worcester, MA, USA.
| | - Parth Patel
- UMass Chan Medical School, Worcester, MA, USA
| | | | - Thu Pham
- UMass Chan Medical School, Worcester, MA, USA
| | - Carrie Cicirale
- Barnes-Jewish Hospital, One Barnes Jewish Hospital Plaza, St. Louis, MO, USA
| | - Wenisa Tran
- UMass Memorial Medical Center, Worcester, MA, USA
| | | | - Saud Javed
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Medical Center, Worcester, MA, USA
| | | | - Dawn Swain
- Bouve College of Health Sciences, Northeastern University , Boston, MA, USA
- Beverly Hospital, Beverly, MA, USA
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Chad Darling
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Medical Center, Worcester, MA, USA
| | - Mayuko ItoFuKunaga
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Medical Center, Worcester, MA, USA
| | - David McManus
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Medical Center, Worcester, MA, USA
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Bakema R, Smirnova D, Biri D, Kocks JWH, Postma MJ, de Jong LA. The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review. J Med Internet Res 2023; 25:e42474. [PMID: 37751232 PMCID: PMC10565624 DOI: 10.2196/42474] [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: 09/05/2022] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. METHODS We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. RESULTS Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.
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Affiliation(s)
- Robbert Bakema
- Nederlandse Service Apotheek Beheer BV, 's-Hertogenbosch, Netherlands
| | - Daria Smirnova
- Asc Academics, Groningen, Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Despina Biri
- Asc Academics, Groningen, Netherlands
- Victoria Hospital, Kirkcaldy, United Kingdom
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, Netherlands
- Groningen Research Institute Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Lisa A de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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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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Clay-Williams R, Hibbert P, Carrigan A, Roberts N, Austin E, Fajardo Pulido D, Meulenbroeks I, Nguyen HM, Sarkies M, Hatem S, Maka K, Loy G, Braithwaite J. The diversity of providers' and consumers' views of virtual versus inpatient care provision: a qualitative study. BMC Health Serv Res 2023; 23:724. [PMID: 37400807 DOI: 10.1186/s12913-023-09715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. METHODS We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. RESULTS Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. CONCLUSIONS Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
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Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- Centre for Elite Performance, Macquarie University, Expertise & Training, Sydney, NSW, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
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Henriksen BT, Krogseth M, Andersen RD, Davies MN, Nguyen CT, Mathiesen L, Andersson Y. Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. J Orthop Surg Res 2023; 18:434. [PMID: 37312222 DOI: 10.1186/s13018-023-03906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. METHODS Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. RESULTS The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (- 0.44 (95% confidence interval - 0.72, - 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients). CONCLUSION The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy. TRIAL REGISTRATION NCT03695081.
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Affiliation(s)
- Ben Tore Henriksen
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway.
- Division of Surgery, Vestfold Hospital Trust, Tonsberg, Norway.
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Maria Krogseth
- Old Age Psychiatry Research Network, Telemark Vestfold, Vestfold Hospital Trust, Tonsberg, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maren Nordsveen Davies
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
| | - Caroline Thy Nguyen
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Tromso, Tromso, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Yvonne Andersson
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
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Hiskey O, McKeirnan K, Frazier C. Ambulatory Care Pharmacists' Perception of Telehealth Services in the Wake of the COVID-19 Pandemic: Identifying Barriers and Best Practices for the Older Patient and Beyond. Sr Care Pharm 2023; 38:193-207. [PMID: 37185142 DOI: 10.4140/tcp.n.2023.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Background Telehealth practice in the ambulatory care pharmacy setting has seen extensive expansion because of the COVID-19 pandemic. Historically, evaluations of pharmacy-driven telehealth services have shown positive patient outcomes and high patient satisfaction, but little was known about pharmacist provider satisfaction. Additionally, barriers to telehealth practice have been highlighted with the widespread expansion of telehealth. With the push to continue high rates of telehealth use postpandemic, evaluation of current ambulatory care pharmacist telehealth practices is needed. Objective This study aimed to evaluate ambulatory care pharmacists' perception of the telehealth services they provide, including barriers patients experience, solutions to address these barriers, and perceptions of the quality of care provided through telehealth. Methods Ambulatory care pharmacists in Washington State were recruited to participate in a 16-item key informant interview. The Technology Acceptance Model was the theoretical framework applied to the interview questions and used to evaluate common themes emerging from the interviews. Results Common themes from the interviews included positive and negative attributes to telehealth care, pharmacist preferences for a video telehealth platform, technology access and use barriers for patients accessing telehealth, technology support from the provider's organization as an avenue to address these barriers, and patient-specific characteristics allowing high-quality health care through telehealth. Conclusion Using these described common ideals, ambulatory care pharmacist telehealth best practices can be developed, including a personalized approach to this care. As we emerge from the COVID-19 pandemic, actively addressing common barriers as well as successfully identifying appropriate telehealth candidates will be essential in providing high-quality virtual care.
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Affiliation(s)
- Olivia Hiskey
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacotherapy, Spokane, Washington
| | - Kimberly McKeirnan
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacotherapy, Spokane, Washington
| | - Cheyenne Frazier
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacotherapy, Spokane, Washington
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Hedderson MM, Boller M, Xu F, Lee C, Sridhar S, Greenberg M. Pregnancy post-bariatric surgery: Improved outcomes with telephonic nutritional management program. Obes Res Clin Pract 2023; 17:144-150. [PMID: 36906488 DOI: 10.1016/j.orcp.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Pregnancies post-bariatric surgery are increasingly common. It is important to understand how to manage prenatal care in this high-risk population to optimize perinatal outcomes. OBJECTIVE To determine among pregnancies post-bariatric surgery whether participation in a telephonic nutritional management program was associated with improved perinatal outcomes and nutritional adequacy. STUDY DESIGN Retrospective cohort study of pregnancies post-bariatric surgery from 2012 to 2018. Participation in a telephonic management program with nutritional counseling, monitoring and nutritional supplement adjustment. Modified Poisson Regression estimated the relative risk using propensity score methods to account for baseline differences between the patients who participated in the program and patients who did not. RESULTS 1575 pregnancies occurred post-bariatric surgery, of which 1142 (72.5 % of pregnancies) participated in the telephonic nutritional management program. Participants in the program were less likely than non-participants to have a preterm birth (aRR 0.48, 95 % CI 0.35-0.67), preeclampsia (aRR 0.43, 95 % CI (0.27-0.69)), gestational hypertension (aRR 0.62, 95 % CI 0.41-0.93), and to have neonates admitted to a Level 2 or 3 (aRR 0.61, 95 % CI0.39-0.94; aRR 0.66, 95 % CI 0.45-0.97, respectively), after adjusting for the propensity score to account for baseline differences. Risk of cesarean delivery, gestational weight gain, glucose intolerance and birthweight did not differ by participation. Among 593 pregnancies with nutritional labs available, participants in the telephonic program were less likely to have nutritional inadequacy in late pregnancy (aRR 0.91, 95 % CI 0.88-0.94). CONCLUSION Participation in a telephonic nutritional management program post-bariatric surgery was associated with improved perinatal outcomes and nutritional adequacy.
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Affiliation(s)
- Monique M Hedderson
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Marie Boller
- The Permanente Medical Group, United States of America
| | - Fei Xu
- Kaiser Permanente Northern California Division of Research, United States of America
| | - Catherine Lee
- Kaiser Permanente Northern California Division of Research, United States of America
| | - Sneha Sridhar
- Kaiser Permanente Northern California Division of Research, United States of America
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21
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Livori AC, Prosser A, Levkovich B. Clinical outcome measures in the assessment of impact of pharmacists in cardiology ambulatory care: A systematic review. Res Social Adm Pharm 2023; 19:432-444. [PMID: 36253283 DOI: 10.1016/j.sapharm.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
AIMS Pharmacists are involved in the care of patients with cardiac disease within the ambulatory setting across multiple modes of delivery and practice settings. There is a lack of consensus surrounding the assessments used to measure the impact of pharmacist care. This heterogeneity may undermine confidence and limit utilisation of pharmacists in cardiology ambulatory care. A systematic review was conducted to understand how pharmacist interventions in cardiology ambulatory care were assessed and the impacts of these interventions on patient-centred outcomes. METHODS AND RESULTS A comprehensive search was conducted of MEDLINE, CINAHL Plus, Cochrane Register of Randomised Controlled Trials and EMBASE from 2000 to 2020 with search terms involving pharmacist interventions among cardiology patients in the ambulatory care setting; with studies restricted to randomised controlled trials. Search results were independently screened by two reviewers. The Cochrane Risk of Bias in Randomised Trials tool was used for quality assessment of the included studies. Assessments of pharmacist impact were analysed and compared to established quality indicators of cardiology care. The search produced 3380 individual studies, following screening, 26 studies involving 9013 participants met inclusion criteria. Across the 26 included studies, eleven different intervention types were identified. Four main outcome measures assessing the impact of these interventions were identified: direct measure of cardiovascular disease risk factor, major adverse cardiovascular events, medication adherence, validated risk score for cardiovascular events. There was a high degree of variance in both the way these interventions influenced the outcome as well the outcome measures selected to assess the impact of the intervention. Of the 26 studies, sixteen listed positive impacts on primary outcomes and the remaining 10 listed neutral effects. CONCLUSION Several outcome measures have been used to assess the impact of pharmacist intervention in cardiology ambulatory care. Aligning outcome measures with known indicators of cardiology care quality, as well as more detailed descriptions of intervention, will provide clinicians vital information in designing effective and measurable interventions in cardiology ambulatory care.
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Affiliation(s)
- Adam C Livori
- Ballarat Health Services, Victoria, Australia; Monash University, Victoria, Australia.
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22
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Roberts N, Carrigan A, Clay-Williams R, Hibbert PD, Mahmoud Z, Pomare C, Fajardo Pulido D, Meulenbroeks I, Knaggs GT, Austin EE, Churruca K, Ellis LA, Long JC, Hutchinson K, Best S, Nic Giolla Easpaig B, Sarkies MN, Francis Auton E, Hatem S, Dammery G, Nguyen MT, Nguyen HM, Arnolda G, Rapport F, Zurynski Y, Maka K, Braithwaite J. Innovative models of healthcare delivery: an umbrella review of reviews. BMJ Open 2023; 13:e066270. [PMID: 36822811 PMCID: PMC9950590 DOI: 10.1136/bmjopen-2022-066270] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. DESIGN Umbrella review. SETTING Interventions delivered inside and outside of acute care settings. PARTICIPANTS Children and adults with one or more identified acute or chronic health conditions. DATA SOURCES PsycINFO, Ovid MEDLINE and CINAHL. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. RESULTS A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. CONCLUSIONS A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/PS6ZU.
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Affiliation(s)
- Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- LEMNA, F-44000, Universite de Nantes, Nantes, France
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mai-Tran Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Vila M, Rosa Oliveira V, Agustí A. Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review. Med Clin (Barc) 2023; 160:355-363. [PMID: 36801105 DOI: 10.1016/j.medcli.2023.01.008] [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: 12/14/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.
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Affiliation(s)
- Marc Vila
- Equipo de Asistencia Primaria Vic , Vic, Barcelona, España; Cátedra Salud Respiratoria, Universidad de Barcelona, Barcelona, España; Equipo de investigación de Metodología, Métodos, Modelos y Resultados de las Ciencias Sociales y de la Salud (M3O), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), España.
| | - Vinicius Rosa Oliveira
- Equipo de investigación de Metodología, Métodos, Modelos y Resultados de las Ciencias Sociales y de la Salud (M3O), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), España
| | - Alvar Agustí
- Cátedra Salud Respiratoria, Universidad de Barcelona, Barcelona, España; Instituto Respiratorio, Hospital Clínico, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; CIBER Enfermedades Respiratorias, España
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24
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Marrs JC, Formea CM, Abdalla M, Brual RL, Crowe SJ, Freibert KH, Herink MC, Hoffman AR, Philbrick AM, Prescott GM, Shahdoost Moghadam S, Zhou C. Call to action: Clinical pharmacist roles and opportunities in health disparities research. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2023. [DOI: 10.1002/jac5.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Joel C. Marrs
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | - Maha Abdalla
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | | | | | | | - Crystal Zhou
- American College of Clinical Pharmacy Lenexa Kansas USA
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25
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Sugita H, Sato MT, Hasegawa T, Noma H, Ota E, Toyoda S. Clinical effectiveness of telepharmacy services in patients with non-communicable diseases in ambulatory care settings. Hippokratia 2023. [DOI: 10.1002/14651858.cd015136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Hideki Sugita
- Department of Hospital Pharmaceutics, School of Pharmacy; Showa University; Tokyo Japan
| | - Miki Takenaka Sato
- Department of Clinical Pharmacy; School of Pharmacy, Showa University; Tokyo Japan
| | - Takeshi Hasegawa
- Showa University Research Administration Center (SURAC); Showa University; Tokyo Japan
| | - Hisashi Noma
- Department of Data Science; The Institute of Statistical Mathematics; Tokyo Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science; St Luke's International University; Chuo-ku Japan
| | - Shunsuke Toyoda
- Department of Inpatient Pharmacy; PIH Hospital-Whittier; Whittier California USA
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26
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Telepharmacy services to support patients with epilepsy in Thailand: A descriptive study. Heliyon 2023; 9:e13361. [PMID: 36816228 PMCID: PMC9932735 DOI: 10.1016/j.heliyon.2023.e13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/13/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Background Telepharmacy shows an effective option to provide pharmacy services in several settings. It could improve patients' outcomes and save costs. However, the impact of a telepharmacy services in low resource settings remains limited. Objectives This study assessed the feasibility and effect of telepharmacy services on patient-reported clinical and economic outcomes among patients with epilepsy in Thailand. Methods A prospective descriptive study was conducted at a university hospital. Patients with epilepsy visiting the clinic from February 2021-December 2021 were included. Telepharmacy services were provided by hospital pharmacists through an application platform. Patients met a pharmacist synchronously using a video conference feature embedded in our developed website. Patients were interviewed for improved clinical symptoms, drug-related problems (DRPs), and health and social behaviors. Travel costs, food and accommodation costs and productivity costs due to hospital visits were also evaluated. Results A total of 80 patients were included. Of those, 39 patients (48.75%) were men, averaging 35.44 ± 15.09 years old. A total of 22 patients (27.50%) reported better clinical symptoms after the telepharmacy service. Sixty-four DRPs (69.56%) were observed, along with 28 health and social behavior problems (30.44%). The most common DRPs were adverse drug reactions (20/64; 69.56%), followed by patients' non-adherence (20/64; 31.25%). Sixty-six problems (68.04%) were corrected during the telepharmacy service. From the patient's perspective, the average direct nonmedical cost per visit was 1257 ± 857 THB/visit. Travel costs were the major cost driver, accounting for 67.7% of the total cost. Cost savings averaged 6511 ± 4996 THB/year or 54.75% of usual care. Conclusion Telepharmacy services are likely to improve patient outcomes, detect DRPs, and effectively provide cost-savings. However, further studies hosting a larger number of participants are warranted to assess the impacts of telepharmacy services.
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Hou J, Li JF, Yan XJ, Zhang YL, Zhang MY, Zhang Y. The Effect of Clinical Pharmacist Intervention on Renal Function Impairment in Patients with Antimicrobial-Induced Acute Kidney Injury in ICU. Patient Prefer Adherence 2023; 17:711-718. [PMID: 36960183 PMCID: PMC10027847 DOI: 10.2147/ppa.s397873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the improvement effect of clinical pharmacist intervention on renal function impairment in patients with antimicrobial-induced acute kidney injury (AKI). METHODS A total of 145 patients with AKI caused by antibiotics admitted to the ICU department were selected as the research subjects. The patients were divided into the control group (n=57) and the intervention group (n=88) according to whether there were ICU specialist clinical pharmacists involved in clinical treatment. The renal function outcome and infection control were evaluated in the two groups. RESULTS The proportion of renal function outcome in the intervention group was 88.6%, which was significantly higher than that in the control group. However, there was no statistically significant difference in infection control between the two groups. For the intervention group, the clinical pharmacists adopted three intervention methods: dose adjustment, drug replacement and CRRT treatment, respectively, according to the disease conditions of AKI patients. Among them, dose adjustment and drug replacement were the most frequently used intervention methods. In addition, the proportion of renal function outcome was higher in the group of patients who changed antibiotics and underwent CRRT, which were 93.1% and 100%, respectively. The adjusted-dose group had the highest infection control rate at 82.1%. However, there were no statistically significant differences in renal function outcomes and infection control among the three interventions. CONCLUSION Clinical pharmacists participating in the clinical treatment of patients with antimicrobial-induced AKI in ICU can effectively improve the renal function of patients.
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Affiliation(s)
- Jia Hou
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Jin-Feng Li
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Xiu-Juan Yan
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Yong-Liang Zhang
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Meng-Yu Zhang
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
| | - Yuan Zhang
- Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of China
- Correspondence: Yuan Zhang, Department of Pharmacy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70 Heping Road, Huancui District, Weihai City, Shandong Province, 264200, People’s Republic of China, Tel +86-18660377685, Email
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28
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Isenor JE, Cossette B, Murphy AL, Breton M, Mathews M, Moritz LR, Buote R, McCarthy L, Woodill L, Morrison B, Guénette L, Marshall EG. Community pharmacists' expanding roles in supporting patients before and during COVID-19: An exploratory qualitative study. Int J Clin Pharm 2023; 45:64-78. [PMID: 36289174 PMCID: PMC9607833 DOI: 10.1007/s11096-022-01430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Timely access and attachment to a primary healthcare provider is associated with better population health outcomes. In Canada, community pharmacists are highly accessible and patients struggling to access a family physician or nurse practitioner (i.e., "unattached") may seek care from a community pharmacist. Community pharmacists took on additional roles during the COVID-19 pandemic; however, little is known about how community pharmacists managed the needs of attached and unattached patients before and during the COVID-19 pandemic. AIM To describe Nova Scotian community pharmacists' roles in caring for unattached patients before and during the COVID-19 pandemic and identifying barriers and facilitators to optimizing patient access. METHOD Semi-structured interviews with community pharmacists (n = 11) across the province of Nova Scotia (Canada) were conducted. RESULTS Five key themes were noted: (1) rising pressure on pharmacists to meet unique health needs of attached and unattached patients; (2) what pharmacists have to offer (e.g., accessibility, trustworthiness); (3) positioning pharmacists in the system (e.g., how pharmacists can address gaps in primary healthcare); (4) pharmacist wellbeing; and, (5) recommendations for practice post-pandemic (e.g., maintain some policy changes made during the COVID-19 pandemic). CONCLUSION Before and during the pandemic, community pharmacists played a significant and increasing role providing care to patients, especially unattached patients. With growing numbers of unattached patients, it is vital that community pharmacists are supported to provide services to care for the health needs of patients.
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Affiliation(s)
- Jennifer E. Isenor
- grid.55602.340000 0004 1936 8200College of Pharmacy and Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Benoit Cossette
- grid.86715.3d0000 0000 9064 6198Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Andrea L. Murphy
- grid.55602.340000 0004 1936 8200College of Pharmacy and Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Mylaine Breton
- grid.86715.3d0000 0000 9064 6198Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Maria Mathews
- grid.39381.300000 0004 1936 8884Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren R. Moritz
- grid.55602.340000 0004 1936 8200Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Richard Buote
- grid.55602.340000 0004 1936 8200Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Lisa McCarthy
- grid.417293.a0000 0004 0459 7334Institute for Better Health, Trillium Health Partners, Mississauga, ON Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy and Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Lisa Woodill
- Pharmacy Association of Nova Scotia, Dartmouth, NS Canada
| | - Bobbi Morrison
- grid.264060.60000 0004 1936 7363St. Francis Xavier University, Antigonish, NS Canada
| | - Line Guénette
- grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy and CHU de Québec Research Centre, Université Laval, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy, Université Laval, Québec, QC Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Canada.
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Liu Y, Su Y, Li X. Analyzing the Spatial Equity of Walking-Based Chronic Disease Pharmacies: A Case Study in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:278. [PMID: 36612596 PMCID: PMC9819594 DOI: 10.3390/ijerph20010278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Chronic diseases place a substantial financial burden on both the patient and the state. As chronic diseases become increasingly prevalent with urbanization and aging, primary chronic disease pharmacies should be planned to ensure that patients receive an equitable distribution of resources. Here, the spatial equity of chronic disease pharmacies is investigated. In this study, planning radiuses and Web mapping are used to assess the walkability and accessibility of planned chronic disease pharmacies; Lorenz curves are used to evaluate the match between the service area of the pharmacies and population; location quotients are used to identify the spatial differences of the allocation of chronic disease pharmacies based on residents. Results show that chronic disease pharmacies have a planned service coverage of 38.09%, an overlap rate of 58.34%, and actual service coverage of 28.05% in Wuhan. Specifically, chronic disease pharmacies are spatially dispersed inconsistently with the population, especially the elderly. The allocation of chronic disease pharmacies is directly related to the standard of patients' livelihood. Despite this, urban development does not adequately address this group's equity in access to medication. Based on a case study in Wuhan, China, this study aims to fill this gap by investigating the spatial equity of chronic disease medication purchases.
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Affiliation(s)
- Yue Liu
- School of Natural and Built Environment, Queen’s University Belfast, Belfast BT9 5AG, UK
| | - Yuwei Su
- School of Urban Design, Wuhan University, Wuhan 430072, China
| | - Xiaoyu Li
- Department of Landscape Architecture & Urban Planning, Texas A&M University, College Station, TX 77843, USA
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30
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Allen K, Flewelling AJ, Munro L, Naylor H. Telephone versus In-Person Pharmacist-Led Medication Reviews in Home Dialysis Patients: Evaluating Quality of Care and Patient Satisfaction. PHARMACY 2022; 11:pharmacy11010001. [PMID: 36649011 PMCID: PMC9844329 DOI: 10.3390/pharmacy11010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic required pharmacists in a provincial Home Dialysis Clinic to adapt from in-person to telephone-based medication reviews. Studies have shown that in-person pharmacist interventions in patients with chronic kidney disease (CKD) lead to a reduction of drug therapy problems (DTPs), however, it's unknown if telephone interventions provide similar outcomes. The purpose of this study was to evaluate whether differences in quality of care exist between in-person vs. telephone medication reviews in home dialysis patients and to evaluate patient satisfaction with telephone medication reviews. Data from the two most recent in-person medication reviews was compared with the two most recent telephone medication reviews for each patient (n = 46). There were no statistically significant differences in DTPs identified between in-person and telephone medication reviews (p = 0.431). Physician acceptance of pharmacist recommendations was higher for in-person medication reviews (p = 0.009). Patients were satisfied with the care they received with pharmacist-led telephone medication reviews, however, 29% (n = 7) would prefer an in-person medication review once per year with telephone medication reviews the rest of the time. Overall, patients were satisfied with the care they received from telephone medication reviews.
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Affiliation(s)
- Kelsey Allen
- Department of Pharmacy, Nova Scotia Health, Aberdeen Hospital, New Glasgow, NS B2H 3S6, Canada
| | - Andrew J. Flewelling
- Department of Research Services, Horizon Health Network, Hilyard Place, 560 Main St., Suite A-200, Saint John, NB E2K 1J5, Canada
| | - Lauren Munro
- BioScript Pharmacy Ltd., 105-10 Ragged Lake Blvd, Halifax, NS B3S 1C2, Canada
| | - Heather Naylor
- Department of Pharmacy, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB E2L 4L2, Canada
- Correspondence:
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Li X, Hu J, Yao Y, Zuo C, Wang Z, Li X, Lv Q. Evaluation of pharmacist-led telemedicine medication management for hypertension established patients during COVID-19 pandemic: A pilot study. Front Public Health 2022; 10:1091484. [PMID: 36589937 PMCID: PMC9800920 DOI: 10.3389/fpubh.2022.1091484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Aim To evaluate the impact of a telemedicine medication management service in patients with hypertension. Methods Participants were allocated to either a telemedicine service (N = 173) or usual care (UC) (N = 179). The primary outcome was blood pressure (BP) reduction from baseline to the 6-month follow-up visit, the proportion of the target BP achievement, overall adherence to prescribed medication as well as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Results At 6 months, BP was controlled in 89.6% (n = 155) of intervention patients and 78.8% (n = 141) of UC patients (OR = 1.14, 95% CI = 1.04-1.25, P = 0.006), giving a mean difference of -6.0 (-13.0 to -2.5 mmHg) and -2.0 mmHg (-4.0 to -0.1 mmHg) in SBP and DBP, respectively. 17.9% (n = 31) of the patients in the intervention group were non-adherent with medications, compared with 29.1% (n = 52) in the UC group (P = 0.014). The composite clinical endpoints were reached by 2.9% in the intervention group and 4.5% in the control group with no significant differences (OR = 1.566, 95% CI = 0.528-4.646). Conclusion Telemedicine medication management for hypertension management had led to better BP control and medication adherence improvement than UC during COVID-19 epidemic, resulting in a reduction of overall adverse cardiovascular events occurrence.
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Affiliation(s)
- Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jialu Hu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Yao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengchun Zuo
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zi Wang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Xiaoyu Li ✉
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China,Qianzhou Lv ✉
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Cen ZF, Tang PK, Hu H, Cavaco AC, Zeng L, Lei SL, Ung COL. Systematic literature review of adopting eHealth in pharmaceutical care during COVID-19 pandemic: recommendations for strengthening pharmacy services. BMJ Open 2022; 12:e066246. [PMID: 36418133 PMCID: PMC9684285 DOI: 10.1136/bmjopen-2022-066246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The study aimed to determine how eHealth was adopted in pharmaceutical care (PC), the outcome reported and the contextual factors. DESIGN Systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Literature was searched in six databases including PubMed, Scopus, Medline, Web of Science, Science Direct and China National Knowledge Infrastructure. ELIGIBILITY CRITERIA Studies which reported the usage experiences of eHealth in any aspects of PC by pharmacists during the COVID-19 pandemic, written in English or Chinese, and published in peer-reviewed journals between December 2019 and March 2022 were included. Opinion articles, conference abstracts, correspondence, letters and editorials were excluded. DATA EXTRACTION AND SYNTHESIS The literature search was completed on 15 April 2022. Two researchers independently conducted the literature search and extracted the data into an Excel table informed by the logic model with the key components of goals, input, activities, output and contextual factors. RESULTS Forty-three studies were included in this review. During the COVID-19 pandemic, hospital pharmacists, community pharmacists and specialist pharmacists in 17 countries continued to educate, consult, monitor and manage the patients and the general public via phone calls, videoconferences, mobile applications, social media, websites and/or enhanced interoperability of electronic medical records. Assuring the continuity of pharmacy care, reduced need for hospital visits, and improved work accuracy and efficiency were the benefits of eHealth mostly reported. Contextual factors affecting the adoption of eHealth were multifaceted, prompting supporting actions at the levels of government, hospital/pharmacy, pharmacists and patients. CONCLUSION This study revealed the wide adoption of eHealth in PC during the pandemic and the emerging evidence for its importance. Proper adoption of eHealth will help reshape the mode of pharmacy services to ensure continuity, quality and efficiency of care amid the challenges of the pandemic. PROSPERO REGISTRATION NUMBER CRD42022299812.
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Affiliation(s)
- Zhi Feng Cen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
| | - Pou Kuan Tang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR China
| | | | - Luoxin Zeng
- Department of Pharmacy, Kiang Wu Hospital, Macao SAR, China
| | - Sut Leng Lei
- Department of Pharmacy, Kiang Wu Hospital, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR China
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Khader H, Alsayed A, Hasoun LZ, Alnatour D, Awajan D, Alhosanie TN, Samara A. Pharmaceutical care and telemedicine during COVID-19: A cross-sectional study based on pharmacy students, pharmacists, and physicians in Jordan. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e90748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lack of access to the patient medical record (90.6%) was the major barrier for the integration of pharmaceutical care into practice. The majority of participants (93.0%) encouraged creating a website that provides pharmaceutical care. Furthermore, 45.1% would pay for such a service if present. Moreover, the majority (89.8%) agreed that creating a comprehensive database for patients’ data will help in decreasing medical errors. Among the four aspects of pharmaceutical care (technical, psychosocial, communication and administrative) that were assessed for students and pharmacist’s, general weakness in all aspects was noticed. This study highlights that absence of proper documentation of patient medical information raises the risk of medical problems and is considered the most documented barrier for the integration of pharmaceutical care. This emphasizes the future role of telemedicine and the availability of a specialized website and database repository that stores patient’s information to ensure the continuity of care even during pandemics.
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Burrell A, Zrubka Z, Champion A, Zah V, Vinuesa L, Holtorf AP, Di Bidino R, Earla JR, Entwistle J, Boltyenkov AT, Braileanu G, Kolasa K, Roydhouse J, Asche C. How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1469-1479. [PMID: 36049797 DOI: 10.1016/j.jval.2022.04.1730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article. METHODS PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores. RESULTS The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms. CONCLUSIONS To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.
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Affiliation(s)
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | | | - Vladimir Zah
- HEOR, Z Rx Outcomes Research Inc, Mississauga, ON, Canada
| | | | | | - Rosella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | | | - George Braileanu
- National Institute for Health and Care Excellence, Manchester, England, UK
| | - Katarzyna Kolasa
- Health Economics and Healthcare Management, Kozminski University, Warszawa, Poland
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Carl Asche
- University of Illinois College of Medicine, Chicago, IL, USA
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Camoni N, Cirio S, Salerno C, Balian A, Bruni G, D’Avola V, Cagetti MG. COVID-19 Pandemic and Remote Consultations in Children: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9787. [PMID: 36011421 PMCID: PMC9407809 DOI: 10.3390/ijerph19169787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Telemedicine is becoming a standard method of consultation, and the COVID-19 pandemic has increased its need. Telemedicine is suitable for non-communicable diseases (NCDs) in the pediatric population, as these are chronic conditions that affect many children worldwide. The aim of this study was to analyze the bibliometric parameters of publications on the use of telemedicine for the most common NCDs in children before and after the COVID-19 pandemic. Following the electronic search, 585 records were selected. "Metabolic diseases" was the most frequent topic before and after the pandemic, accounting for 34.76% in 2017-2019 and 33.97% in 2020-2022. The average IF of the journals from which records were retrieved was 5.46 ± 4.62 before and 4.58 ± 2.82 after the pandemic, with no significant variation. The number of citations per reference averaged 14.71 ± 17.16 in 2017-2019 (95% CI: 12.07; 17.36) and 5.54 ± 13.71 in 2020-2022 (95% CI: 4.23; 6.86). Asthma, metabolic diseases, and neurodevelopmental disorders were the most explored topics. A relevant finding concerns the increasing number of observational studies after the pandemic, with a reduction of the interventional studies. The latter type of study should be recommended as it can increase the evaluation of new strategies for the management of NCDs.
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Affiliation(s)
- Nicole Camoni
- Department of Restorative, Preventive and Paediatric Dentistry, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Claudia Salerno
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Araxi Balian
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Dental and Stomatology Unit, Cittadella Hospital, AULSS 6 Euganea, 35013 Cittadella, Italy
| | - Giulia Bruni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Valeria D’Avola
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Timony P, Houle SKD, Gauthier A, Waite NM. Geographic distribution of Ontario pharmacists: A focus on rural and northern communities. Can Pharm J (Ott) 2022; 155:267-276. [PMID: 36081922 PMCID: PMC9445509 DOI: 10.1177/17151635221115411] [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] [Indexed: 11/20/2022]
Abstract
Introduction: Canadians living in rural and northern communities face particular health needs and challenges in accessing primary care services. Ontario pharmacists are increasingly able to optimize patient care with a broadening scope of practice; this was highlighted during the COVID-19 pandemic. This study explores the geographic distribution of pharmacists to evaluate their potential to deliver health care in rural and northern Ontario communities. Methods: A secondary analysis of the Ontario College of Pharmacists’ registry data was undertaken, with all Part A pharmacists who had at least 1 patient care practice site included in the analysis. Full-time equivalent (FTE) hours worked at each practice site were calculated and compared with the population distribution. Ratios of FTEs per 1000 residents by census subdivision (which represents communities) were calculated and compared by geography, north vs south and urban vs rural (further subdivided by metropolitan-influenced zones). Results: The greatest availability of pharmacist FTEs was found in urban communities (with slightly better availability in the north), whereas the lowest availability was found in the most rural communities. A more granular observation revealed that northern communities were more likely to have no local pharmacist access (72%) compared with southern communities (24%). Discussion: Rural and northern communities are underserved. Novel approaches to overcoming the rural pharmacist care gap include rural practice incentives, targeted enrollment of rural students, increased rural exposure in pharmacy schools and the utilization of new technologies such as telepharmacy and drone medication deliveries.
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Farzadeh S, Noviasky JA, Brangman SA, Yuksel JM. Impact of a Clinical Pharmacist Telehealth Service in a Geriatrics Assessment Clinic. Sr Care Pharm 2022; 37:293-303. [DOI: 10.4140/tcp.n.2022.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective Evaluate the impact of a telepharmacy service at a geriatrics assessment clinic. Design Retrospective, single-center, nonblinded cohort study. Setting Geriatrics assessment clinic. Patients The intervention/pharmacist
and the control/no-pharmacist (provider) group included patients new to the clinic 50 years of age or older from over the span of 4 months. Patients who the pharmacist was unable to reach and those who missed appointments with the provider were excluded. Interventions The
pharmacist phoned new patients approximately one week prior and one week after their first appointments with a provider. Main Outcome Measure Primary outcome: number of drug-related problems (DRPs) detected by the pharmacist compared with the provider. Secondary outcomes:
number of medication history discrepancies, accepted medication-related recommendations, potentially inappropriate medications (PIMs) deprescribed, and adverse drug reactions (ADRs) detected. Results In the intervention/pharmacist (n = 204) vs control/no pharmacist (n =
200) groups, the number of DRPs was significantly greater (338 vs 218; P = 0.031) and driven by unnecessary drug therapies, doses too high, ADRs, and drug-drug interactions (230 vs 147, P = 0.045; 37 vs 7, P = 0.010; 36 vs 17, P = 0.023; 32 vs 1, P = 0.003,
respectively). The difference in number of recommendations made by the pharmacist vs medication changes made by the provider was significant: 457 vs 319, P < 0.001, respectively. Conclusions The addition of a clinical pharmacist conducting telepharmacy at a geriatrics
assessment clinic had a positive impact on patient care as it relates to DRPs, deprescribing PIMs, and optimizing medication adherence.
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Gartland M, Cahn P, DeJesus E, Diaz RS, Grossberg R, Kozal M, Kumar P, Molina JM, Mendo Urbina F, Wang M, Du F, Chabria S, Clark A, Garside L, Krystal M, Mannino F, Pierce A, Ackerman P, Lataillade M. Week 96 Genotypic and Phenotypic Results of the Fostemsavir Phase 3 BRIGHTE Study in Heavily Treatment-Experienced Adults Living with Multidrug-Resistant HIV-1. Antimicrob Agents Chemother 2022; 66:e0175121. [PMID: 35502922 PMCID: PMC9211436 DOI: 10.1128/aac.01751-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In the phase 3 BRIGHTE study in heavily treatment-experienced adults with multidrug-resistant HIV-1, fostemsavir plus optimized background therapy (OBT) resulted in sustained rates of virologic suppression through 96 weeks. HIV-1 RNA <40 copies/mL was achieved in 163/272 (60%) Randomized Cohort (RC) participants (with 1 or 2 remaining approved fully active antiretrovirals) and 37/99 (37%) Non-randomized Cohort (NRC) participants (with 0 fully active antiretrovirals). Here we report genotypic and phenotypic analyses of HIV-1 samples from 63/272 (23%) RC participants and 49/99 (49%) NRC participants who met protocol-defined virologic failure (PDVF) criteria through Week 96. The incidence of PDVF was as expected in this difficult-to-treat patient population and, among RC participants, was comparable regardless of the presence of predefined gp120 amino acid substitutions that potentially influence phenotypic susceptibility to temsavir (S375H/I/M/N/T, M426L, M434I, M475I) or baseline temsavir 50% inhibitory concentration fold change (IC50 FC). The incidence of PDVF was lower among participants with higher overall susceptibility score to newly used antiretrovirals (OSS-new), indicating that OSS-new may be a preferred predictor of virologic outcome in heavily treatment-experienced individuals. Predefined gp120 substitutions, most commonly M426L or S375N, were emergent on treatment in 24/50 (48%) RC and 33/44 (75%) NRC participants with PDVF, with related increases in temsavir IC50 FC. In BRIGHTE, PDVF was not consistently associated with treatment-emergent genotypic or phenotypic changes in susceptibility to temsavir or to antiretrovirals in the initial OBT. Further research will be needed to identify which factors are most likely to contribute to virologic failure in this heavily treatment-experienced population (ClinicalTrials.gov, NCT02362503).
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Affiliation(s)
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | | | - Ricardo Sobhie Diaz
- Infectious Diseases Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Michael Kozal
- Department of Internal Medicine, Infectious Diseases Section, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Princy Kumar
- Department of Medicine and Microbiology, Georgetown University Medical Center, Washington, DC, USA
| | - Jean-Michel Molina
- University of Paris, Saint-Louis and Lariboisière Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Marcia Wang
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Fangfang Du
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | | | | | | | - Amy Pierce
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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Howard O, Thomas A, Henry H, Wallace J. Impact of a Pharmacist-led Outpatient Telemedicine Clinic on Chronic Obstructive Pulmonary Disease in a Veteran Population. J Am Pharm Assoc (2003) 2022; 62:1919-1924. [DOI: 10.1016/j.japh.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/25/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
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Howell CW, Walroth TA, Beam DM, Geik CA, Howell MM, Macik MR, Schmelz AN, DiRenzo BM. Pharmacoeconomic, Medication Access, and Patient-Satisfaction Analysis of a Pharmacist-Managed VTE Clinic Compared to Primary Care Physician Outpatient Therapy. J Pharm Pract 2022; 35:212-217. [PMID: 35484867 DOI: 10.1177/0897190020966210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Venous thromboembolism (VTE) is a common medical condition often treated with direct oral anticoagulants (DOACs). Current literature supports outpatient treatment of select, low-risk VTE patients by a pharmacist with DOACs; however, no studies exist to demonstrate if a pharmacist-managed VTE clinic provides financial benefit compared to physician-managed outpatient care. To compare the financial implications and patient satisfaction of pharmacist-managed VTE care versus outpatient VTE care by a primary care physician. A single-center retrospective chart review was conducted on all patients seen at a pharmacist-managed VTE clinic for safety and reimbursement outcomes between August 1, 2018 and July 31, 2019. These data points were used to assess the primary endpoint of net gain per patient visit and secondary outcomes, including patient satisfaction score. The primary outcome median (IQR) for net gain per visit was $16.57 (16.57, 16.57) for the pharmacist-managed group and $64.37 (47.04, 64.37) in the physician-managed group with a 95% CI of 39.13-47.80. The median cost to the organization per visit was $4.96 (4.96, 4.96) for the pharmacist-managed group and $39.41 (23.65, 39.41) for the physician managed group with a 95% CI of 26.57-34.45. Statistical difference was also found for a secondary outcome of percentage of days covered for the pharmacist-managed group compared to the physician managed group, median (IQR) 100% (76,100) vs 92.2% (67.2, 98.9) respectfully, with a p-value of 0.043. The pharmacist-managed VTE clinic, although financially sustainable, provides significantly less net revenue per patient than physician managed clinics, demonstrating the need for increased payer recognition for pharmacists.
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Affiliation(s)
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Daren M Beam
- Indiana University, School of Medicine, Indianapolis, IN, USA
| | | | - Molly M Howell
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Monica R Macik
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | | | - Baely M DiRenzo
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Miller MJ, Kane-Gill SL. Pandemic stimulates a variety of telepharmacy applications: Considerations for implementation, sustainability, and future directions. Am J Health Syst Pharm 2022; 79:918-920. [PMID: 35381057 DOI: 10.1093/ajhp/zxac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these 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.
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Affiliation(s)
- Michael J Miller
- Mid-Atlantic Permanente Research Institute (MAPRI), Rockville, MD, USA
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, and Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Digital pharmacists: the new wave in pharmacy practice and education. Int J Clin Pharm 2022; 44:775-780. [PMID: 35380393 PMCID: PMC8981193 DOI: 10.1007/s11096-021-01365-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/11/2021] [Indexed: 11/15/2022]
Abstract
Pharmacists now face the biggest challenges in the history of the profession: the use of digital technologies in pharmacy practice and education and the outbreak of coronavirus disease 2019. Worldwide, pharmaceutical care and pharmacy education via digital technologies have significantly increased and will be incorporated into patient care and the teaching–learning process, respectively. Thus, in this new era of pharmacy practice and education, curricula should promote the development of specific competencies for the cognitive, conscious, and effective use of digital tools. This requires the training of “disruptive” educators, who are capable of using teaching–learning methods adapted to the digital environment and educational processes suitable for stimulating the use of effective disruptive technologies. This commentary argues that the pharmacy profession can no longer wait for the slow integration of digital technologies into pharmacy practice and education.
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Niznik J, Ferreri SP, Armistead L, Urick B, Vest MH, Zhao L, Hughes T, McBride JM, Busby-Whitehead J. A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial. Trials 2022; 23:256. [PMID: 35379307 PMCID: PMC8981935 DOI: 10.1186/s13063-022-06164-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Opioids and benzodiazepines (BZDs) are some of the most commonly prescribed medications that contribute to falls in older adults. These medications are challenging to appropriately prescribe and monitor, with little guidance on safe prescribing of these medications for older patients. Only a handful of small studies have evaluated whether reducing opioid and BZD use through deprescribing has a positive impact on outcomes. Leveraging the strengths of a large health system, we evaluated the impact of a targeted consultant pharmacist intervention to deprescribe opioids and BZDs for older adults seen in primary care practices in North Carolina. Methods We developed a toolkit and process for deprescribing opioids and BZDs in older adults based on a literature review and guidance from an interprofessional team of pharmacists, geriatricians, and investigators. A total of fifteen primary care practices have been randomized to receive the targeted consultant pharmacist service (n = 8) or usual care (n = 7). The intervention consists of several components: (1) weekly automated reports to identify chronic users of opioids and BZDs, (2) clinical pharmacist medication review, and (3) recommendations for deprescribing and/or alternate therapies routed to prescribers through the electronic health record. We will collect data for all patients presenting one of the primary care clinics who meet the criteria for chronic use of opioids and/or BZDs, based on their prescription order history. We will use the year prior to evaluate baseline medication exposures using morphine milligram equivalents (MMEs) and diazepam milligram equivalents (DMEs). In the year following the intervention, we will evaluate changes in medication exposures and medication discontinuations between control and intervention clinics. Incident falls will be evaluated as a secondary outcome. To date, the study has enrolled 914 chronic opioid users and 1048 chronic BZD users. We anticipate that we will have 80% power to detect a 30% reduction in MMEs or DMEs. Discussion This clinic randomized pragmatic trial will contribute valuable evidence regarding the impact of pharmacist interventions to reduce falls in older adults through deprescribing of opioids and BZDs in primary care settings. Trial registration Clinicaltrials.govNCT04272671. Registered on February 17, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06164-5.
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Young N, Tokumaru S, Goo R. Training Future Pharmacists to Optimize the Healthcare Workforce. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:28-30. [PMID: 35495074 PMCID: PMC9036450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many efforts are taking place to improve the quality of healthcare and reduce healthcare cost. Pharmacists play a key role in optimizing the healthcare workforce, and colleges of pharmacy are adapting to this need by emphasizing skills needed to improve quality health measures, interprofessional collaboration and communication, and supplying quality drug information. The University of Hawai'i at Hilo Daniel K. Inouye College of Pharmacy has incorporated additional pharmacy practice experience electives to teach pharmacy students to analyze and optimize workflow, identify high-risk patients in need of intervention, and work collaboratively with providers to decrease patient burden. The pharmacy curriculum has also increased the number of interprofessional educational events for enhancing interprofessional collaboration and communication, including in a telehealth setting. Furthermore, the college of pharmacy has increased the number of drug information assignments and practical exams to increase competency and the speed of providing quality, evidence-based drug information to providers. This article presents on overview of the health care workforce needs and examples of the increased efforts to train future pharmacists in Hawai'i to improve healthcare access and quality of patient care, as well as decrease healthcare costs.
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Affiliation(s)
- Nicole Young
- Department of Pharmacy Practice, The Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo; Hilo, HI
| | - Sheri Tokumaru
- Department of Pharmacy Practice, The Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo; Hilo, HI
| | - Roy Goo
- Department of Pharmacy Practice, The Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo; Hilo, HI
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Hart S, Campbell C, Divine H, McIntosh T, Dicks M, Schadler A, Kebodeaux C. Participation of Limited English Proficiency Patients in Pharmacist Diabetes Management via Telehealth. J Am Pharm Assoc (2003) 2022; 62:1394-1399. [DOI: 10.1016/j.japh.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
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Snoswell CL, Cossart AR, Chevalier B, Barras M. Benefits, challenges and contributors to the introduction of new hospital-based outpatient clinic pharmacist positions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100119. [PMID: 35478521 PMCID: PMC9029912 DOI: 10.1016/j.rcsop.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/08/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pharmacists working within interprofessional teams in the outpatient setting are well placed to address medication-related problems before and after hospital admission. Therefore, exploration of these roles is warranted. Objective(s) To explore pharmacists' and other health professionals' perspectives of the impact of pharmacists working within interprofessional teams in outpatient clinics. Furthermore, we endeavoured to identify both the challenges and contributors to success with the introduction of pharmacists into these settings. Methods This qualitative study involved semi-structured interviews with both hospital outpatient clinic pharmacists and other clinic health professionals to gain an in-depth understanding of how the introduction of pharmacists into clinics impacted clinic processes, patient care, and relationships with other health professionals. Participants were recruited from the outpatient clinics who had recently added a pharmacist to their service. Participants involved in setting up the roles were invited to participate in a voluntary interview, the transcripts from which were analysed into themes and sub-themes using an inductive and deductive approach. Results A total of 34 staff were interviewed of which 68% were female and 74% were aged between 31 and 50 years. The cohort included 16 outpatient pharmacists, nine pharmacist team leaders, five clinic nurses and four clinic doctors (specialist consultant or registrar). Three overall themes were identified: the benefits, the contributors, and the challenges of introducing clinical pharmacy services to outpatient clinics. When establishing a clinic role, pharmacists' awareness, adaptability, and strong communication were shown to be key traits to building rapport and trustworthiness with the established clinic team. Conclusions When pharmacists are integrated into multidisciplinary outpatient clinics they and their colleagues believe that they provide benefits to the patients and the clinics. Decision makers need to be cognizant of factors that contribute to, as well as those that impede, the successful implementation of outpatient pharmacist roles.
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Affiliation(s)
- Centaine L. Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Corresponding author at: Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Amelia R. Cossart
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Bernadette Chevalier
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Baron K, Herbst J, McNicol M, Stephan E, Abdel-Rasoul M, Wise K. Evaluation of a remote hybrid staffing model for ambulatory clinical pharmacists in a pediatric health system during the COVID-19 pandemic. Am J Health Syst Pharm 2022; 79:852-859. [PMID: 35088067 PMCID: PMC8807309 DOI: 10.1093/ajhp/zxac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose To describe and quantify patient care activities performed by ambulatory clinical pharmacists supporting medical specialty clinics in a pediatric health system utilizing a hybrid staffing model during the coronavirus disease 2019 (COVID-19) pandemic. Methods Five ambulatory clinical pharmacists, integrated within a health-system specialty pharmacy (HSSP), utilized a web-based data collection tool to record time spent performing patient care activities over a 2-week period. Work location (onsite or offsite) of the pharmacist was reported for each activity. Activities were classified as direct or indirect patient care. Direct patient care activities were subcategorized as telemedicine appointments, in-person clinic appointments, HSSP call center work, medication access support, electronic medical record consults, and previsit planning/postvisit documentation. Administrative tasks and precepting were considered indirect patient care activities. Results A total of 1,190 activities were completed, with 77% of all activities performed offsite. Direct and indirect patient care activities accounted for 871 (73.2%) and 319 (26.8%) of total activities, respectively. No activity took longer for the pharmacists to complete offsite versus onsite. Conclusion Using a hybrid staffing model employed by a pediatric health system, ambulatory clinical pharmacists were able to efficiently provide a high volume of direct patient care activities even when working offsite. Rapid adaptation and implementation of telemedicine services was critical for pharmacists to continue to provide essential services within pediatric medical specialty clinics.
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Affiliation(s)
- Kristen Baron
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - James Herbst
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan McNicol
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Emily Stephan
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, and Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, OH, USA
| | - Kelly Wise
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH, USA
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Putman B, Coucke L, Vanoverschelde A, Mehuys E, Lahousse L. Community pharmacist counseling improves adherence and asthma control: a nationwide study. BMC Health Serv Res 2022; 22:112. [PMID: 35081939 PMCID: PMC8790878 DOI: 10.1186/s12913-022-07518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pharmaceutical counseling (PC) interventions have been shown to improve adherence to controller medication and asthma control. However, the real-life impact of these PC interventions in difficult-to-control asthma patients remains unclear. We aimed to assess the effectiveness of PC interventions in real life using nationwide claims data. Methods Demographics and drugs use of patients who received ICS in 2017 with or without pharmaceutical counseling were retrieved from a Belgian claims database. Asthma-related drug use from 1 year before first ICS dispensing in 2017 (reference period) was compared with 1 year after. Outcomes were usage of inhaled corticosteroids (ICS) in defined daily doses (DDD), proportion of users of short-acting beta-agonist (SABA), antibiotics, oral corticosteroids (OCS), asthma biologicals and controller-to-total (CTT) ratio. Results The study population consisted of difficult-to-control asthma patients aged 5–40 years with at least the first interview within 90 days after first ICS dispensing (n = 1350). ICS usage increased significantly in the year after PC intervention compared with the reference period (+ 43.3 DDD/patient, p < 0.05). A nominal decrease was observed in the proportion of SABA (48.0 to 46.2%) and antibiotics (54.5 to 52.7%) after PC intervention compared with the reference period. CTT ratio significantly increased from 0.671 to 0.749 (p < 0.05). The proportion of biological users was nominally lower in the intervention group compared with a control group (n = 50,477) in the post-intervention time period (0.22% versus 0.30%). Conclusions This first nationwide study among difficult-to-control asthma patients suggests that community pharmacist counseling is effective in real life to improve controller adherence and asthma control. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07518-0.
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Affiliation(s)
- Barbara Putman
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000, Ghent, Belgium
| | - Louise Coucke
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000, Ghent, Belgium
| | - Anna Vanoverschelde
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000, Ghent, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000, Ghent, Belgium
| | - Lies Lahousse
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000, Ghent, Belgium.
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