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Alhashimi L, Cordwin DJ, Guidi J, Hummel SL, Koelling TM, Dorsch MP. Differences in the Approach to Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction: A Survey of Cardiologists, Internists, and Pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2024; 2024:881-887. [PMID: 39247388 PMCID: PMC11378981 DOI: 10.1002/jac5.2013] [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: 02/28/2024] [Accepted: 06/11/2024] [Indexed: 09/10/2024]
Abstract
Introduction Guideline-directed medical therapy (GDMT) has significantly improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, GDMT prescribing remains suboptimal. The purpose of this study was to survey cardiologists, internists, and pharmacists on their approach to GDMT prescribing. Methods A survey containing 20 clinical vignettes of patients with HFrEF was answered by 127 cardiologists, 68 internists, and 89 pharmacists. Each vignette presented options for adjusting GDMT. Responses were dichotomized to the answer of interest. A mixed-effect model was used to calculate the odds of changing GDMT between pharmacists and physicians. Results Pharmacists were more likely to make changes to GDMT compared with internists (92.1% vs 82%; odds ratio [OR] 3.02 [1.50-6.06]; p=0.002). In medically-naïve patients, pharmacists were more likely to initiate beta-blockers than internists (45.4% vs 32.0%; OR 2.19 [1.00-4.79], p=0.049). Pharmacists were more likely than both internists and cardiologists to initiate mineralocorticoid receptor antagonists (34.4% vs 11.5%; OR 4.95 [2.41-10.18]; p<0.001 and 34.4% vs 13.9%; OR 3.95 [2.16-7.21]; p<0.001). Pharmacists were more likely than both internists and cardiologists to titrate beta-blockers (30.9% vs 16.4%; OR 3.15 [1.92-5.19]; p<0.001 and 30.9% vs 22.0%; OR 1.88 [0.18-2.87]; p=0.0030). Pharmacists were more likely than internists to titrate angiotensin receptor-neprilysin inhibitors (ARNI) (61.8% vs 34.1%; OR 3.54 [1.50-8.39]; p=0.004). Conclusions The survey results show pharmacists were more likely to make any adjustments to GDMT than internists and cardiologists. Pharmacists prefer adding spironolactone and titrating beta-blockers compared with cardiologists and internists. Compared with only internists, pharmacists were more likely to initiate beta-blockers and titrate the dose of ARNI.
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Affiliation(s)
- Lana Alhashimi
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - David J Cordwin
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Guidi
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott L Hummel
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
- VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Todd M Koelling
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
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Shaw L, Briscoe S, Nunns MP, Lawal HM, Melendez-Torres GJ, Turner M, Garside R, Thompson Coon J. What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map. BMJ Open 2024; 14:e072502. [PMID: 38401904 PMCID: PMC10895245 DOI: 10.1136/bmjopen-2023-072502] [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: 02/10/2023] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES We aimed to map the systematic review evidence available to inform the optimal prescribing of statins and antihypertensive medication. DESIGN Systematic umbrella review and evidence and gap map (EGM). DATA SOURCES Eight bibliographic databases (Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Health Management Information Consortium, MEDLINE ALL, PsycINFO, Conference Proceedings Citation Index-Science and Science Citation Index) were searched from 2010 to 11 August 2020. Update searches conducted in MEDLINE ALL 2 August 2022. We searched relevant websites and conducted backwards citation chasing. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We sought systematic reviews of quantitative or qualitative research where adults 16 years+ were currently receiving, or being considered for, a prescription of statin or antihypertensive medication. Eligibility criteria were applied to the title and abstract and full text of each article independently by two reviewers. DATA EXTRACTION AND SYNTHESIS Quality appraisal was completed by one reviewer and checked by a second. Review characteristics were tabulated and incorporated into an EGM based on a patient care pathway. Patients with lived experience provided feedback on our research questions and EGM. RESULTS Eighty reviews were included within the EGM. The highest quantity of evidence focused on evaluating interventions to promote patient adherence to antihypertensive medication. Key gaps included a lack of reviews synthesising evidence on experiences of specific interventions to promote patient adherence or improve prescribing practice. The evidence was predominantly of low quality, limiting confidence in the findings from individual reviews. CONCLUSIONS This EGM provides an interactive, accessible format for policy developers, service commissioners and clinicians to view the systematic review evidence available relevant to optimising the prescribing of statin and antihypertensive medication. To address the paucity of high-quality research, future reviews should be conducted and reported according to existing guidelines and address the evidence gaps identified above.
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Affiliation(s)
- Liz Shaw
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Simon Briscoe
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Michael P Nunns
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Hassanat Mojirola Lawal
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - G J Melendez-Torres
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Malcolm Turner
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
- NIHR ARC South West Peninsula Patient and Public Engagement Group, University of Exeter, Exeter, UK
| | - Ruth Garside
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
- European Centre for Environment and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
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Bagyawantha NMY, Coombes ID, Gawarammana I, Fahim M. Impact of a clinical pharmacist on optimising the quality use of medicines according to the acute coronary syndrome (ACS) secondary prevention guidelines and medication adherence following discharge in patients with ACS in Sri Lanka: a prospective non-randomised controlled trial study protocol. BMJ Open 2023; 13:e059413. [PMID: 36759028 PMCID: PMC9923319 DOI: 10.1136/bmjopen-2021-059413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a clinical pharmacist to the medical and nursing team providing care to patients with ACS on the continuation of quality use of the patients' medicine after discharge. STUDY DESIGN This protocol outlines a prospective, non-blinded, non-randomised, controlled interventional study. STUDY SETTING The study will be conducted at the professorial medical wards of a tertiary care teaching hospital in Sri Lanka. PARTICIPANTS Sample size will be 746 patients in both control and intervention arms. Patients diagnosed with ACS who are 18 years old or above and expected to visit the hospital for their routine clinic follow-ups after discharge will be recruited and randomised 1:1 to either the intervention group or the control group. Patients who are diagnosed and suffering from psychological disorders will be excluded from this study. INTERVENTIONS The planned interventions that will be delivered at discharge include review and optimisation of medications, assessing patient adherence and providing discharge medication counselling. Data will be collected at recruitment, 1 month, 3 months and 6 months' time intervals in both groups. Improvement of patients' medication adherence, reduction of hospital readmissions, reduction of drug-related problems, the attitude of doctors and nurses towards clinical pharmacy services and the cost-effectiveness of the clinical pharmacy services will be the major outcomes of this study. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the ethics review committee, Faculty of Medicine, University of Peradeniya (2019/EC/26) and the trial is registered at the Sri Lanka Clinical Trials Registry. The results of this study will be disseminated via conference proceedings, journal publications and thesis presentations. TRIAL REGISTRATION NUMBER SLCTR/2019/039.
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Affiliation(s)
- Nanayakkara Muhandiramalaya Yasakalum Bagyawantha
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Central, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian D Coombes
- School of Pharmacy, The University of Queensland, Saint Lucia, Queensland, Australia
- Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER), Brisbane, Queensland, Australia
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka
| | - Mohamed Fahim
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Hoo JX, Yang YF, Tan JY, Yang J, Yang A, Lim LL. Impact of multicomponent integrated care on mortality and hospitalization after acute coronary syndrome: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:258-267. [PMID: 35687013 PMCID: PMC10131244 DOI: 10.1093/ehjqcco/qcac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 04/28/2023]
Abstract
AIMS Multicomponent integrated care is associated with sustained control of multiple cardiometabolic risk factors among patients with type 2 diabetes. There is a lack of data in patients with acute coronary syndrome (ACS). We aimed to examine its efficacy on mortality and hospitalization outcomes among patients with ACS in outpatient settings. METHODS AND RESULTS A literature search was conducted on PubMed, EMBASE, Ovid and Cochrane library databases for randomized controlled trials, published in English language between January 1980 and November 2020. Multicomponent integrated care defined as two or more quality improvement strategies targeting different domains (the healthcare system, healthcare providers and patients) for one month or more. The study outcomes were all-cause and cardiovascular-related mortality, hospitalization and emergency department visits. We pooled the risk ratio (RR) with 95% confidence interval (CI) for the association between multicomponent integrated care and study outcomes using the Mantel-Haenszel test. 74 trials (n = 93,278 patients with ACS) were eligible. The most common quality improvement strategies were team change (83.8%), patient education (62.2%) and facilitated patient-provider relay (54.1%). Compared with usual care, multicomponent integrated care was associated with reduced risks for all-cause mortality (RR 0.83, 95% CI 0.77-0.90; p<0.001; I2 = 0%), cardiovascular mortality (RR 0.81, 95% CI 0.73-0.89; p<0.001; I2 = 24%) and all-cause hospitalization (RR 0.88, 95% CI, 0.78-0.99; p = 0.040; I2 = 58%). The associations of multicomponent integrated care with cardiovascular-related hospitalization, emergency department visits and unplanned outpatient visits were not statistically significant. CONCLUSIONS In outpatient settings, multicomponent integrated care can reduce risks for mortality and hospitalization in patients with ACS.
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Affiliation(s)
- Jia-Xin Hoo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ya-Feng Yang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jia-Yin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Hong Kong SAR, China
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Tsige AW, Yikna BB, Altaye BM. Drug-Related Problems Among Ambulatory Heart Failure Patients on Follow-Up at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Ther Clin Risk Manag 2021; 17:1165-1175. [PMID: 34785901 PMCID: PMC8591109 DOI: 10.2147/tcrm.s337256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose The purpose of this study was to assess drug-related problems (DRPs) among ambulatory heart failure (HF) patients attending at medical referral clinic of Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted among 344 HF patients. Drug-related problems were classified using modified Cipolle’s DRP classification schemes and drug–drug interactions were assessed using Micromedex, up-to-date, and drug.com drug–drug interaction checkers. The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics were used to summarize patients’ characteristics. Univariable and multivariable binary logistic regression analysis was performed to identify associated factors with dependent variables. P < 0.05 was considered statistically significant. Results The mean age of the study participants was 53.38 ± 18.84 years and nearly half (45%) were in the age group of 31–60 years. Drug-related problems were found in 80.8% of HF patients. A total of 416 DRPs were identified. Adverse drug reaction (35.58%) was the top DRPs identified followed by the need for additional drug therapy (30.53%) and ineffective drug therapy (26.9%), respectively. Diuretics (45%), beta-blockers (BBs) (12.42%), and angiotensin-converting enzyme inhibitors (ACEIs) (10%) were the commonly used drug classes by study participants. The presence of comorbidity (p ˂ 0.001) and level of education of study participants (p = 0.03) had a significant association with the occurrence of DRPs. Conclusion The prevalence of DRPs among ambulatory HF patients was high. The presence of comorbidity and the educational level of study participants had a significant association with the occurrence of DRPs. Checking potential drug–drug interactions before starting a new therapy, monitoring adverse drug reactions, ensuring sustainable availability of medications, and regular education programs are recommended to minimize DRPs.
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Affiliation(s)
- Abate Wondesen Tsige
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Berhan Begashaw Yikna
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhanetensay Masresha Altaye
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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6
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Arunmanakul P, Chaiyakunapruk N, Phrommintikul A, Ruengorn C, Permsuwan U. Cost-effectiveness analysis of pharmacist interventions in patients with heart failure in Thailand. J Am Pharm Assoc (2003) 2021; 62:71-78. [PMID: 34756525 DOI: 10.1016/j.japh.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with heart failure (HF) are likely to have multiple diseases with complex therapy regimens. Pharmacist intervention in HF treatment can reduce all-cause mortality and hospitalization, but the economic outcome is not known. OBJECTIVE This study aimed to assess the cost-effectiveness of pharmacist contribution in HF setting compared with usual care. METHODS A decision analytical model was developed to estimate the cost and outcome from a health care system perspective in Thailand. Clinical inputs were obtained from literature review. Pharmacist costs, hospitalization cost for HF, risk of hospitalization death, risk of nonhospitalization death, and readmission rate were based on data from Thailand. The cost and outcome were discounted at 3% annually. OUTCOME MEASURES The incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2020. A series of sensitivity analysis was also performed. RESULTS Pharmacist intervention incurred higher total costs than usual care, because total cost of pharmacists was 186,040 THB (5936 USD) whereas usual care cost was 151,654 THB (4839 USD). It also provided more quality-adjusted life years (QALYs) than usual care, from 2.4 to 2.8. In addition, patient life years (LY) were increasing from 3.3-3.8. This yielded an ICER of 77,398 THB/LY (2467 USD/LY) or 103,037 THB/QALYs (3,288 USD/QALYs). This ICER is considered to be cost-effective at the willingness-to-pay level of 160,000 THB/QALY (5191.87 USD). CONCLUSION At this current situation in Thailand, pharmacists may represent good value for the nation's limited health care resources. The information should be used in national policies to plan for pharmacist work force implementation and production line in the near future.
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Neville HL, Mann K, Killen J, Callaghan M. Pharmacist Intervention to Improve Medication Adherence in Patients with Acute Coronary Syndrome: The PRIMA-ACS Study. Can J Hosp Pharm 2021; 74:350-360. [PMID: 34602623 DOI: 10.4212/cjhp.v74i4.3198] [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: 11/10/2022]
Abstract
Background Despite ample evidence of benefit, adherence to secondary prevention medication therapy after acute coronary syndrome (ACS) is often suboptimal. Hospital pharmacists are uniquely positioned to improve adherence by providing medication education at discharge. Objective To determine whether a standardized counselling intervention at hospital discharge significantly improved patients' adherence to cardiovascular medications following ACS. Methods This single-centre, prospective, nonrandomized comparative study enrolled patients with a primary diagnosis of ACS (January 2014 to July 2015). Patients who received standardized discharge counselling from a clinical pharmacist were compared with patients who did not receive counselling. At 30 days and 1 year after discharge, follow-up patient surveys were conducted and community pharmacy refill data were obtained. Adherence was assessed using pharmacy refill data and patient self-reporting for 5 targeted medications: acetylsalicylic acid, P2Y purinoceptor 12 (P2Y12) inhibitors, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, β-blockers, and statins. Thirty-day and 1-year medication utilization, cardiovascular readmission rates, and all-cause mortality were also assessed. Results Of the 259 patients enrolled, 88 (34.0%) received discharge counselling. Medication data were obtained for 253 patients (97.7%) at 30 days and 242 patients (93.4%) at 1 year. At 1 year after discharge, there were no statistically significant differences between patients who did and did not receive counselling in terms of rates of nonadherence (11.9% versus 18.4%, p = 0.19), cardiovascular readmission (17.6% versus 22.3%, p = 0.42), and all-cause mortality (3.4% versus 4.2%, p > 0.99). Overall medication nonadherence was 2.8% (7/253) at 30 days and 16.1% (39/242) at 1 year. Conclusions Discharge medication counselling provided by hospital pharmacists after ACS was not associated with significantly better medication adherence at 1 year. Higher-quality evidence is needed to determine the most effective and practical interventions to ensure that patients adhere to their medication regimens and achieve positive outcomes after ACS.
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Affiliation(s)
- Heather L Neville
- , BScPharm, MSc, FCSHP, is with Nova Scotia Health, Halifax, Nova Scotia
| | - Kelsey Mann
- , BScPharm, was, at the time of this study, with Nova Scotia Health, Halifax, Nova Scotia
| | - Jessica Killen
- , BScPharm, ACPR, is with Nova Scotia Health, Halifax, Nova Scotia
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Hawkins EJ, Lott AM, Danner AN, Malte CA, Hagedorn HJ, Berger D, Donovan LM, Sayre GG, Mariano AJ, Saxon AJ. Primary Care and Mental Health Prescribers, Key Clinical Leaders, and Clinical Pharmacist Specialists' Perspectives on Opioids and Benzodiazepines. PAIN MEDICINE 2021; 22:1559-1569. [PMID: 33661287 DOI: 10.1093/pm/pnaa435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Due to increased risks of overdose fatalities and injuries associated with coprescription of opioids and benzodiazepines, healthcare systems have prioritized deprescribing this combination. Although prior work has examined providers' perspectives on deprescribing each medication separately, perspectives on deprescribing patients with combined use is unclear. We examined providers' perspectives on coprescribed opioids and benzodiazepines and identified barriers and facilitators to deprescribing. DESIGN Qualitative study using semistructured interviews. SETTING One multisite Veterans Affairs (VA) healthcare system in the United States of America. SUBJECTS Primary care and mental health prescribers, key clinical leaders, clinical pharmacist specialists (N = 39). METHODS Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Themes were identified iteratively, through a multidisciplinary team-based process. RESULTS Analyses identified four themes related to barriers and facilitators to deprescribing: inertia, prescriber self-efficacy, feasibility of deprescribing/tapering, and promoting deprescribing, as well as a fifth theme, consequences of deprescribing. Results highlighted the complexity of deprescribing when multiple prescribers are involved, a need for additional support and time, and concerns about patients' reluctance to discontinue these medications. Facilitators included agreement with the goal of deprescribing and fear of negative consequences if medications are continued. Providers spoke to how deprescribing efforts impaired patient-provider relationships and informed their decisions not to start patients on these medications. CONCLUSIONS Although providers agree with the goal, prescribers' belief in a limited deprescribing role, challenges with coordination among prescribers, concerns about insufficient time and patients' resistance to discontinuing these medications need to be addressed for efforts to be successful.
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Affiliation(s)
- Eric J Hawkins
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Aline M Lott
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Anissa N Danner
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Carol A Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Hildi J Hagedorn
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.,Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Douglas Berger
- General Medicine Service, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lucas M Donovan
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - George G Sayre
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Anthony J Mariano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.,VA Northwest Veterans Integrated Service Network (VISN 20), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Andrew J Saxon
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Implementing Nonphysician Provider Guideline-Directed Medical Therapy Heart Failure Clinics: A Multi-National Imperative. J Card Fail 2021; 27:896-906. [PMID: 34364666 DOI: 10.1016/j.cardfail.2021.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 01/01/2023]
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Schumacher PM, Becker N, Tsuyuki RT, Griese-Mammen N, Koshman SL, McDonald MA, Bouvy M, Rutten FH, Laufs U, Böhm M, Schulz M. The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta-analysis. ESC Heart Fail 2021; 8:3566-3576. [PMID: 34240570 PMCID: PMC8497358 DOI: 10.1002/ehf2.13508] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/22/2022] Open
Abstract
Aims Patients with heart failure (HF) have poor outcomes, including poor quality of life, and high morbidity and mortality. In addition, they have a high medication burden due to the multiple drug therapies now recommended by guidelines. Previous reviews, including studies in hospital settings, provided evidence that pharmacist care improves outcomes in patients with HF. Because most HF is managed outside of hospitals, we aimed to synthesize the evidence for pharmacist care in outpatients with HF. Methods and results We conducted a systematic literature search in PubMed of randomized controlled trials (RCTs) and integrated the evidence on patient outcomes in a meta‐analysis. We found 24 RCTs performed in 10 countries, including 8029 patients. The data revealed consistent improvements in medication adherence (independent of the measuring instrument) and knowledge, physical function, and disease and medication management. Sixteen RCTs were included in meta‐analyses. Differences in all‐cause mortality (odds ratio (OR) = 0.97 [95% CI, 0.84–1.12], Q‐statistic, P = 0.49, I2 = 0%), all‐cause hospitalizations (OR = 0.86 [0.73–1.03], Q‐statistic, P = 0.01, I2 = 45.5%), and HF hospitalizations (OR = 0.89 [0.77–1.02], Q‐statistic, P = 0.11, I2 = 0%) were not statistically significant. We also observed an improvement in the standardized mean difference for generic quality of life of 0.75 ([0.49–1.01], P < 0.01), with no indication of heterogeneity (Q‐statistic, P = 0.64; I2 = 0%). Conclusions Results indicate that pharmacist care improves medication adherence and knowledge, symptom control, and some measures of quality of life in outpatients with HF. Given the increasing complexity of guideline‐directed medical therapy, pharmacists' unique focus on medication management, titration, adherence, and patient teaching should be considered part of the management strategy for these vulnerable patients.
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Affiliation(s)
- Pia M Schumacher
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Nicolas Becker
- Personality Psychology and Psychological Assessment, Saarland University, Saarbrücken, Germany
| | - Ross T Tsuyuki
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nina Griese-Mammen
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Sheri L Koshman
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A McDonald
- Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Marcel Bouvy
- Department of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Michael Böhm
- Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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11
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Speirits IA, Boyter AC, Dunlop E, Gray K, Moir L, Forsyth P. Patient experiences of pharmacist independent prescriber-led post-myocardial infarction left ventricular systolic dysfunction clinics. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:55-60. [PMID: 32786143 DOI: 10.1111/ijpp.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Left ventricular systolic dysfunction (LVSD) is common following myocardial infarction (MI). Pharmacological management of secondary prevention is known to be sub-optimal. Integration of pharmacists into clinical teams improves prescribing and quantitative outcomes. Few data have been published on patient views of pharmacist input. We aimed to explore patient experiences of attending a dedicated pharmacist independent prescriber (PIP)-led clinic. METHODS Semi-structured face-to-face interviews. Participants were aged ≥18 years with new incident MI and echocardiographically confirmed LVSD. Patients were recruited from three pharmacist-led clinics at point of clinic discharge. Interviews were transcribed verbatim. Thematic analysis was undertaken. KEY FINDINGS Twelve patients were recruited, median age 67.5 years and ten male. Six core themes were identified: multidisciplinary working; satisfaction; confidence in the pharmacist; comparative care; prescribing behaviours; and monitoring. Pharmacist clinics complemented other established post-MI services, and participants perceived benefits obtained through effective inter-professional working. Participants welcomed dedicated appointment time, the opportunity to ask questions and address problems. Pharmacist explanations of condition and medicines, prescribing at the point of care and monitoring were beneficial and reduced patient stress. CONCLUSIONS This study demonstrates that a PIP-led post-MI LVSD clinic delivers a positive initial patient experience. More research is needed to understand the longer-term patient experiences, the impact of such models on medication taking behaviours and the experiences of carers and other members of the multidisciplinary team.
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Affiliation(s)
| | - Anne C Boyter
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Emma Dunlop
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Kimberly Gray
- Pharmacy Services, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Lynsey Moir
- Pharmacy Services, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Paul Forsyth
- Pharmacy Services, NHS Greater Glasgow & Clyde, Glasgow, UK
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12
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El Hadidi S, Rosano G, Tamargo J, Agewall S, Drexel H, Kaski JC, Niessner A, Lewis BS, Coats AJS. Potentially Inappropriate Prescriptions in Heart Failure with Reduced Ejection Fraction (PIP-HFrEF). EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 8:187-210. [PMID: 32941594 DOI: 10.1093/ehjcvp/pvaa108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a chronic debilitating and potentially life-threatening condition. Heart Failure patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of ESC guidelines, ESC position papers, scientific evidence, and experts' opinions.
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Affiliation(s)
- Seif El Hadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Egypt
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Heinz Drexel
- VIVIT Institute, Landeskrankenhaus Feldkirch, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Andrew J S Coats
- Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
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13
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Abdelmessih E, Simpson MD, Cox J, Guisard Y. Exploring the Health Care Challenges and Health Care Needs of Arabic-Speaking Immigrants with Cardiovascular Disease in Australia. PHARMACY (BASEL, SWITZERLAND) 2019; 7:pharmacy7040151. [PMID: 31717927 PMCID: PMC6958385 DOI: 10.3390/pharmacy7040151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022]
Abstract
The Arabic-speaking immigrant group, which makes up the fourth largest language group in Australia, has a high prevalence of cardiovascular disease. The objective of this study was to explore the health care challenges and needs of Arabic-speaking immigrants with cardiovascular disease (CVD), using a comparative approach with English-speaking patients with CVD as the comparable group. Methods: Participants were recruited from community settings in Melbourne, Australia. Face-to-face semi-structured individual interviews were conducted at the recruitment sites. All interviews were audio-taped, transcribed, and coded thematically. Results: 29 participants with CVD were recruited; 15 Arabic-speaking and 14 English-speaking. Arabic-speaking immigrants, and to a lesser extent English-speaking patients with CVD may have specific health care challenges and needs. Arabic-speaking immigrants’ health care needs include: effective health care provider (HCP)-patient communication, accessible care, participation in decision-making, and empowerment. English-speaking participants viewed these needs as important for CVD management. However, only a few English-speaking participants cited these needs as unmet health care needs. Conclusion: This study suggests that Arabic-speaking immigrants with CVD may have unique needs including the need for privacy, effective HCP-patient communication that takes into account patients’ limited English proficiency, and pharmacist-physician collaboration. Therefore, there may be a need to identify a health care model that can address these patients’ health care challenges and needs. This, in turn, may improve their disease management and health outcomes.
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Affiliation(s)
- Erini Abdelmessih
- School of Biomedical Sciences, Charles Sturt University, Leeds Parade, Orange 2800, Australia; (M.-D.S.); (J.C.)
- Correspondence:
| | - Maree-Donna Simpson
- School of Biomedical Sciences, Charles Sturt University, Leeds Parade, Orange 2800, Australia; (M.-D.S.); (J.C.)
| | - Jennifer Cox
- School of Biomedical Sciences, Charles Sturt University, Leeds Parade, Orange 2800, Australia; (M.-D.S.); (J.C.)
| | - Yann Guisard
- School of Science, Charles Sturt University, Leeds Parade, Orange 2800, Australia;
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14
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Lee SY, Cho E. A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea. ACTA ACUST UNITED AC 2019. [DOI: 10.24304/kjcp.2019.29.3.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- So Young Lee
- College of Pharmacy, Sookmyung Women’s University, Seoul 04310, Republic of Korea
| | - Eun Cho
- College of Pharmacy, Sookmyung Women’s University, Seoul 04310, Republic of Korea
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15
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Schulz M, Griese‐Mammen N, Böhm M, Laufs U. Letter on ‘Pharmacy‐based interdisciplinary intervention for patients with chronic heart failure: results of the PHARM‐CHF randomized controlled trial’: reply. Eur J Heart Fail 2019; 22:565-566. [DOI: 10.1002/ejhf.1613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Martin Schulz
- Department of MedicineABDA – Federal Union of German Associations of Pharmacists Berlin Germany
- Drug Commission of German Pharmacists (AMK) Berlin Germany
- Institute of Pharmacy, Freie Universität Berlin Berlin Germany
| | - Nina Griese‐Mammen
- Department of MedicineABDA – Federal Union of German Associations of Pharmacists Berlin Germany
| | - Michael Böhm
- Department of Internal Medicine III – CardiologyAngiology and Intensive Care Medicine, University Hospital of Saarland, Saarland University Homburg/Saar Germany
| | - Ulrich Laufs
- Department of CardiologyUniversity Hospital, Leipzig University Leipzig Germany
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16
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Forsyth P, Warren A, Thomson C, Bateman J, Greenwood E, Williams H, Khatib R, Hadland R, McGlynn S, Khan N, Duggan C, Beezer J. A competency framework for clinical pharmacists and heart failure. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:424-435. [PMID: 30028562 DOI: 10.1111/ijpp.12465] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 06/01/2018] [Indexed: 01/28/2023]
Abstract
Abstract
Objectives
Heart failure is an escalating ‘pandemic’ with malignant outcomes. Clinical pharmacist heart failure services have been developing for the past two decades. However, little clarity is available on the additional advanced knowledge, skills and experience needed for pharmacists to practice safely and competently. We aimed to provide an expert consensus on the minimum competencies necessary for clinical pharmacists to deliver appropriate care to patients with heart failure.
Methods
There were four methodological parts; (1) establishing a project group from experts in the field; (2) review of the literature, including existing pharmacy competency frameworks in other specialities and previous heart failure curricula from other professions; (3) consensus building, including developing, reviewing and adapting the contents of the framework; and (4) write-up and dissemination to widen the impact of the project.
Key findings
The final framework defines minimum competencies relevant to heart failure for four different potential levels of specialism: all pharmacists regardless of role (Stage 1); all patient-facing clinical pharmacists (Stage 2); clinical pharmacists with specific planned roles in the care of heart failure patients (Stage 3); and regionally/nationally/internationally recognised expert pharmacists with a direct specialism in heart failure (Stage 4).
Conclusions
The framework delivers the vital first step needed to help standardise care, give pharmacists a blueprint for career progression and continuing professional development and bring clarity to the role of the pharmacist. Future collaboration between professional bodies and training providers is needed to develop structured programmes to align with the framework and facilitate training and resultant accreditation.
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Affiliation(s)
- Paul Forsyth
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Alison Warren
- Brighton and Sussex University Hospitals NHS Trust, Brighton and Hove Clinical Commissioning Group, Brighton, UK
| | | | | | | | - Helen Williams
- NHS Southwark Clinical Commissioning Group and Medicines Use and Safety Team, Specialist Pharmacy Services, London, UK
| | - Rani Khatib
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rocco Hadland
- Wrexham Maelor Hospital, NHS Betsi Cadwaladr University Health Board, Bangor, UK
| | - Steve McGlynn
- Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Nazish Khan
- NHS Royal Wolverhampton Hospital, Wolverhampton, UK
| | | | - Janine Beezer
- City Hospitals Sunderland Foundation Trust, Sunderland, UK
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17
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Huitema AA, Harkness K, Heckman GA, McKelvie RS. The Spoke-Hub-and-Node Model of Integrated Heart Failure Care. Can J Cardiol 2018; 34:863-870. [DOI: 10.1016/j.cjca.2018.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
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18
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Nguyen T, Nguyen TH, Nguyen PT, Tran HT, Nguyen NV, Nguyen HQ, Ha BN, Pham TT, Taxis K. Pharmacist-Led Intervention to Enhance Medication Adherence in Patients With Acute Coronary Syndrome in Vietnam: A Randomized Controlled Trial. Front Pharmacol 2018; 9:656. [PMID: 29977205 PMCID: PMC6021484 DOI: 10.3389/fphar.2018.00656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Patient adherence to cardioprotective medications improves outcomes of acute coronary syndrome (ACS), but few adherence-enhancing interventions have been tested in low-income and middle-income countries. Objectives: We aimed to assess whether a pharmacist-led intervention enhances medication adherence in patients with ACS and reduces mortality and hospital readmission. Methods: We conducted a randomized controlled trial in Vietnam. Patients with ACS were recruited, randomized to the intervention or usual care prior to discharge, and followed 3 months after discharge. Intervention patients received educational and behavioral interventions by a pharmacist. Primary outcome was the proportion of adherent patients 1 month after discharge. Adherence was a combined measure of self-reported adherence (the 8–item Morisky Medication Adherence Scale) and obtaining repeat prescriptions on time. Secondary outcomes were (1) the proportion of patients adherent to medication; (2) rates of mortality and hospital readmission; and (3) change in quality of life from baseline assessed with the European Quality of Life Questionnaire – 5 Dimensions – 3 Levels at 3 months after discharge. Logistic regression was used to analyze data. Registration: ClinicalTrials.gov (NCT02787941). Results: Overall, 166 patients (87 control, 79 intervention) were included (mean age 61.2 years, 73% male). In the analysis excluding patients from the intervention group who did not receive the intervention and excluding all patients who withdrew, were lost to follow-up, died or were readmitted to hospital, a greater proportion of patients were adherent in the intervention compared with the control at 1 month (90.0% vs. 76.5%; adjusted OR = 2.77; 95% CI, 1.01–7.62) and at 3 months after discharge (90.2% vs. 77.0%; adjusted OR = 3.68; 95% CI, 1.14–11.88). There was no significant difference in median change of EQ-5D-3L index values between intervention and control [0.000 (0.000; 0.275) vs. 0.234 (0.000; 0.379); p = 0.081]. Rates of mortality, readmission, or both were 0.8, 10.3, or 11.1%, respectively; with no significant differences between the 2 groups. Conclusion: Pharmacist-led interventions increased patient adherence to medication regimens by over 13% in the first 3 months after ACS hospital discharge, but not quality of life, mortality and readmission. These results are promising but should be tested in other settings prior to broader dissemination.
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Affiliation(s)
- Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Thao H Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phu T Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ha T Tran
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ngoc V Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hoa Q Nguyen
- Department of Clinical Pharmacy, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Ban N Ha
- Heart Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tam T Pham
- Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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19
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Curry LA, Brault MA, Cherlin E, Smith M. Promoting integration of pharmacy expertise in care of hospitalized patients with acute myocardial infarction. Am J Health Syst Pharm 2018; 75:962-972. [PMID: 29752256 DOI: 10.2146/ajhp170727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE The substantive integration of pharmacists into quality-improvement initiatives aimed at improving the care of hospitalized patients with acute myocardial infarction (AMI) is described. METHODS A 2-year, mixed-methods, interventional study was conducted in 10 U.S. hospitals, directed at promoting the use of evidence-based strategies and fostering domains of hospital organizational culture associated with lower risk-standardized mortality rates (RSMRs) for patients with AMI. The adoption of 5 evidence-based strategies associated with reducing RSMRs for AMI was measured at baseline, 12, and 24 months. Data were collected via face-to-face interviews conducted at each hospital. Ethnographic observations were conducted at baseline and 18 months. RESULTS Significant changes in the use of evidence-based strategies were observed over the 2-year study period (p = 0.02), with the mean number of strategies used per hospital increasing from 2.4 at baseline to 3.9 at 24 months. Innovative approaches for integrating pharmacotherapy and pharmacy practice expertise included information technology solutions, targeted rounding for patients with AMI, medication-bridging programs, and education of patients with AMI. CONCLUSION A mixed-methods interventional study in 10 hospitals examined the substantive integration of pharmacists into quality-improvement initiatives aimed at improving the care of patients with AMI. The investigation revealed the ability of this integration to meet clinical challenges by generating novel, feasible solutions that were tailored for specific hospital contexts. Inclusion of pharmacists strengthened relationships across disciplines and allowed pharmacists to become routinely embedded in broader quality efforts.
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Affiliation(s)
- Leslie A Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT .,Yale Global Health Leadership Institute, Yale University, New Haven, CT
| | - Marie A Brault
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.,Yale Global Health Leadership Institute, Yale University, New Haven, CT
| | - Emily Cherlin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.,Yale Global Health Leadership Institute, Yale University, New Haven, CT
| | - Marie Smith
- University of Connecticut School of Pharmacy, Storrs, CT
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20
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Cheng JW. Current perspectives on the role of the pharmacist in heart failure management. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:1-11. [PMID: 29594034 PMCID: PMC5863893 DOI: 10.2147/iprp.s137882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pharmacists play an important role within a multidisciplinary health care team in the care of patients with heart failure (HF). It has been evaluated and documented that pharmacists providing medication reconciliation especially during transition of care, educating patients on their medications, and providing collaborative medication management lead to positive changes in the patient outcomes, including but not limited to decreasing in hospitalizations and read-missions. It is foreseeable that pharmacist roles will continue to expand as new treatment and innovative care are developed for HF patients. I reviewed published role of pharmacists in the care of HF patients. MEDLINE and Current Content database (both from 1966 – December 31, 2017) were utilized to identify peer-reviewed clinical trials, descriptive studies, and review articles published in English using the following search terms: pharmacists, clinical pharmacy, HF, and cardiomyopathy. Citations from available articles were also reviewed for additional references. Preliminary search revealed 31 studies and 55 reviews. They were further reviewed by title and abstract as well as full text to remove irrelevant articles. At the end, 24 of these clinical trials and systematic reviews are described in the following text and Table 1 summarizes 16 pertinent clinical trials. Some roles that are currently being explored include medication management in patients with mechanical circulatory support for end-stage HF, where pharmacokinetics and pharmacodynamics of medications can change, medication management in ambulatory intravenous diuretic clinics, and comprehensive medication management in patients’ home settings. Pharmacists should continue to explore and prospectively evaluate their role in the care of this patient population, including documenting their interventions, and impact to economic and patient outcomes.
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Affiliation(s)
- Judy Wm Cheng
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Brigham and Women's Hospital, Boston, MA, USA
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21
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Kang JE, Yu JM, Choi JH, Chung IM, Pyun WB, Kim SA, Lee EK, Han NY, Yoon JH, Oh JM, Rhie SJ. Development and clinical application of an evidence-based pharmaceutical care service algorithm in acute coronary syndrome. J Clin Pharm Ther 2018; 43:366-376. [PMID: 29468708 DOI: 10.1111/jcpt.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug therapies are critical for preventing secondary complications in acute coronary syndrome (ACS). The purpose of this study was to develop and apply a pharmaceutical care service (PCS) algorithm for ACS and confirm that it is applicable through a prospective clinical trial. METHODS The ACS-PCS algorithm was developed according to extant evidence-based treatment and pharmaceutical care guidelines. Quality assurance was conducted through two methods: literature comparison and expert panel evaluation. The literature comparison was used to compare the content of the algorithm with the referenced guidelines. Expert evaluations were conducted by nine experts for 75 questionnaire items. A trial was conducted to confirm its effectiveness. Seventy-nine patients were assigned to either the pharmacist-included multidisciplinary team care (MTC) group or the usual care (UC) group. The endpoints of the trial were the prescription rate of two important drugs, readmission, emergency room (ER) visit and mortality. RESULTS AND DISCUSSION The main frame of the algorithm was structured with three tasks: medication reconciliation, medication optimization and transition of care. The contents and context of the algorithm were compliant with class I recommendations and the main service items from the evidence-based guidelines. Opinions from the expert panel were mostly positive. There were significant differences in beta-blocker prescription rates in the overall period (P = .013) and ER visits (four cases, 9.76%, P = .016) in the MTC group compared to the UC group, respectively. WHAT IS NEW AND CONCLUSION We developed a PCS algorithm for ACS based on the contents of evidence-based drug therapy and the core concept of pharmacist services.
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Affiliation(s)
- J E Kang
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, National Medical Center, Seoul, Korea
| | - J M Yu
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - J H Choi
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Konkuk University Medical Center, Seoul, Korea
| | - I-M Chung
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - W B Pyun
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - S A Kim
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - E K Lee
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - N Y Han
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - J-H Yoon
- College of Pharmacy, Pusan National University, Busan, Korea
| | - J M Oh
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - S J Rhie
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea.,College of Pharmacy, Ewha Womans University, Seoul, Korea
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22
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Omboni S, Caserini M. Effectiveness of pharmacist's intervention in the management of cardiovascular diseases. Open Heart 2018; 5:e000687. [PMID: 29344376 PMCID: PMC5761304 DOI: 10.1136/openhrt-2017-000687] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The pharmacist may play a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes. Systematic reviews of randomised controlled and observational studies have documented an improved control of hypertension, dyslipidaemia or diabetes, smoking cessation and reduced hospitalisation in patients with heart failure, following a pharmacist’s intervention. Limited proof for effectiveness is available for humanistic (patient satisfaction, adherence and knowledge) and economic outcomes. A multidisciplinary approach, including medical input plus a pharmacist, specialist nurse or both, and a greater involvement of community rather than hospital pharmacists, seems to represent the most efficient and modern healthcare delivery model. However, further well-designed research is demanded in order to quantitatively and qualitatively evaluate the impact of pharmacist’s interventions on cardiovascular disease and to identify specific areas of impact of collaborative practice. Such research should particularly focus on the demonstration of a sensitivity to community pharmacist’s intervention. Since pharmacy services are easily accessible and widely distributed in the community setting, a maximum benefit should be expected from interventions provided in this context.
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Affiliation(s)
- Stefano Omboni
- Department of Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
| | - Marina Caserini
- Department of Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
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23
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El Hajj MS, Jaam MJ, Awaisu A. Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: A systematic review. Res Social Adm Pharm 2017. [PMID: 28641999 DOI: 10.1016/j.sapharm.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of collaborative and multidisciplinary health care on the outcomes of care in patients with acute coronary syndromes (ACS) is well-established in the literature. However, there is lack of high quality evidence on the role of pharmacist care in this setting. OBJECTIVE This systematic review aimed to evaluate the impact of pharmacist care on patient outcomes (readmission, mortality, emergency visits, and medication adherence) in patients with ACS at or post-discharge. METHODS The following electronic databases and search engines were searched from their inception to September 2016: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science, Scopus, Campbell Library, Database of Abstracts of Reviews of Effects (DARE), Health System Evidence, Global Health Database, Joanna Briggs Institute Evidence-Based Practice Database, Academic Search Complete, ProQuest, PROSPERO, and Google Scholar. Studies were included if they evaluated the impact of pharmacist's care (compared with no pharmacist's care or usual care) on the outcomes of rehospitalization, mortality, and medication adherence in patients post-ACS discharge. Comparison of the outcomes with relevant statistics was summarized and reported. RESULTS A total of 17 studies [13 randomized controlled trials (RCTs) and four non-randomized clinical studies] involving 8391 patients were included in the review. The studies were of variable quality (poor to good quality) or risk of bias (moderate to critical risk). The nature and intensity of pharmacist interventions varied among the studies including medication reconciliation, medication therapy management, discharge medication counseling, motivational interviewing, and post-discharge face-to-face or telephone follow-up. Pharmacist-delivered interventions significantly improved medication adherence in four out of 12 studies. However, these did not translate to significant improvements in the rates of readmissions, hospitalizations, emergency visits, and mortality among ACS patients. CONCLUSIONS Pharmacist care of patients discharged after ACS admission was not associated with significant improvement in medication adherence or reductions in readmissions, emergency visits, and mortality. Future studies should use well-designed RCTs to assess the short- and long-terms effects of pharmacist interventions in ACS patients.
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Affiliation(s)
| | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar.
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Parajuli DR, Franzon J, McKinnon RA, Shakib S, Clark RA. Role of the Pharmacist for Improving Self-care and Outcomes in Heart Failure. Curr Heart Fail Rep 2017; 14:78-86. [DOI: 10.1007/s11897-017-0323-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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