PharmValCalc: A calculator tool to forecast population health pharmacist impact

Comprehensive Medication Management Services with a Holistic Point of View, a Scoping Review

Implementing Comprehensive Medication Management (CMM) services uncovered the importance of the totality of the patient's perspective in this process. The holistic approach takes into account the physical, mental and emotional well-being of individuals, as well as their socioeconomic circumstances. The aim of this study was to characterize the scientific evidence associated with CMM services that included this holistic approach. A scoping review was conducted based on Arksey and O'Malley's method. Searches were performed in Google Scholar for papers published between 2010 and 2020 in English, Spanish and Portuguese. Study design, health contexts, sample of patients, results obtained, barriers and facilitators, and the integration of a holistic approach were determined. Two hundred and eighteen papers were evaluated, most of which focused on the implementation of this service through prospective observational studies. A minority of studies reported on a holistic approach, a smaller number examined the effect of social determinants of health, the patient's medication experiences and the pharmacotherapy outcomes from the patient's perspective. Despite the progress achieved, most of the referents do not yet reflect a broader view of the patient's life situation and its relationship to pharmacotherapy and the ways in which the pharmacist implements holistic elements to solve or prevent drug-related problems.

Primary Care Pharmacist Practice Models Shape the Comprehensive Medication Management Process

Pharmacists are well positioned to collaborate with primary care providers (PCPs) to conduct comprehensive medication management (CMM). However, depending on organizational needs and pharmacist staffing resources, different pharmacist practice models have been implemented. In this commentary, we (1) describe 2 common pharmacist practice models in primary care settings, (2) explain variations in the CMM process based on 2 practice models, and (3) outline outcomes and implications of this expanded CMM process. By tailoring the CMM process to their practice model, pharmacists can follow consistent delivery of CMM services to create a common understanding among patients, PCPs, and other care team members.

Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review

Background

The health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety.

Methods

Our systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis.

Results

The searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used.

Conclusion

This review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.

PCImpact: A modeling tool for forecasting impact of primary care pharmacist services

BACKGROUND

The role of the pharmacist in primary care (PC) has expanded to focus on medication optimization and management for chronic conditions. However, identifying the optimal pharmacist practice model to maximize pharmacist workload capacity, patient care quality, and PC provider satisfaction remains a challenge. PC clinical and administrative leaders could benefit from pharmacist impact forecasts to justify initiating new or optimizing/expanding current pharmacist services.

OBJECTIVES

(1) To describe the development of a PC pharmacist services modeling tool, PCImpact (2) To discuss the use of PCImpact by PC leaders to initiate, optimize, or expand integrated pharmacist services.

METHODS

PCImpact was developed and internally tested with 6 clinical/administrative leaders within a federally qualified health center and health system-affiliated primary care organization by: (1) identifying pharmacist practice models, (2) obtaining data input values for PCImpact, and (3) calculating PCImpact output values. Two types of pharmacist practice models are defined: population health (PH) and direct patient care (DPC). In the PH models, a centralized pharmacist performs one-time, comprehensive or targeted medication reviews with no direct patient interaction. PC providers review and implement pharmacist recommendations. In DPC models, an embedded pharmacist in a PC practice performs patient visits with or without collaborative practice agreements with PC providers. Default values for all PCImpact data inputs were obtained/tested through literature reviews and discussions with pharmacy and physician leaders, including pharmacist and PC provider time required, and implementation percentage of pharmacist recommendations. PCImpact calculates: (1) pharmacist workload capacity, (2) PC provider time impact, and (3) patient care impact.

CONCLUSIONS

PCImpact presents a novel method to objectively forecast the impact of PH and DPC pharmacist services in 2 PC settings. PCImpact outputs showed that a DPC pharmacist practice model can save PC provider time and impact a greater number of patients compared to a PH pharmacist practice model.