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Faulkner W, DiScala SL, Quellhorst JA, Dakroub B. Implementation of a Pilot PharmD Medication Optimization Telehealth Clinic Within a Veterans Affairs System. Sr Care Pharm 2024; 39:193-201. [PMID: 38685620 DOI: 10.4140/tcp.n.2024.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Background Patients older than 65 years of age with an anticipated life-expectancy of 12 months or less may have complex medication regimens and an increased risk of adverse drug reactions, and drug-drug interactions. Within the Department of Veterans Affairs, a commonly used medication optimization model is known as the VIONE methodology. Objective This project aimed to pilot implementation of board-certified clinical pharmacist practitioners utilizing the VIONE model within a patient-aligned care team targeting patients 65 years of age and older. Methods The population was identified through the VIONE dashboards. Veteran inclusion criteria included five or more medications, a VIONE risk score of 5 or greater, and CAN scores of greater than 90. The project team reached out via telephone to the patients for a medication regimen review and a 14-day follow-up call. Primary outcomes were quantity of medications discontinued per patient, classes of medications that were discontinued, number and encounter time spent, and cost avoidance over 1 year. Secondary outcomes were VIONE classification of medications, VIONE discontinuation reason, number of recommendations given and accepted by primary provider, and safety analysis. Results There were 53 patients who were successfully contacted via telephone. The top four most discontinued medication classes included 1) vitamins/supplements, 2) ophthalmology medications, 3) gastrointestinal medications, and 4) non-controlled analgesic medications. During the project period the potential cost avoidance over 1 year was $17,716. CONCLUSION: This project demonstrated that usage of VIONE methodology ensures medication optimization with minimal harm and provides significant cost savings in the ambulatory care setting.
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Affiliation(s)
- Wesley Faulkner
- West Palm Beach Veterans Affairs Healthcare System, West Palm Beach, Florida
| | - Sandra L DiScala
- West Palm Beach Veterans Affairs Healthcare System, West Palm Beach, Florida
| | | | - Belal Dakroub
- West Palm Beach Veterans Affairs Healthcare System, West Palm Beach, Florida
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Krumm L, Bausewein C, Rémi C. Drug Therapy Safety in Palliative Care-Pharmaceutical Analysis of Medication Processes in Palliative Care. PHARMACY 2023; 11:160. [PMID: 37888505 PMCID: PMC10610412 DOI: 10.3390/pharmacy11050160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
Pharmacotherapy plays a crucial role in symptom management in palliative care and is associated with risks potentially leading to drug-related problems (DRP). Pharmacists can identify DRPs and advise prescribers on optimizing drug therapy. The aim of this study was to identify DRP in a palliative care unit (PCU) and evaluate corresponding pharmaceutical interventions. A non-randomized before-and-after study in a PCU starts with a control phase, an interphase, and an intervention phase. Primary endpoint: DRP, including pharmaceutical interventions and their acceptance. The medication of all inpatients was recorded at set time points, assessed for potential and manifest DRP, and categorized. In the control phase, the ward pharmacist did not interfere with the clinical team. In the intervention phase, the pharmacist could intervene when a DRP was identified and give recommendations. During the 12-month period, 284 patients were included (control phase n = 138; intervention phase n = 146) and 1079 DRPs were identified (control phase n = 634; intervention phase n = 445). The number of DRPs/patient was significantly reduced by the pharmacist's interventions between the control and intervention phases (4 vs. 3 DRPs, p = 0.001). Overall acceptance of pharmaceutical interventions by prescribers was very high (227/256; 88%). DRPs are hardly preventable. With a clinical pharmacist as a member of the palliative care team, it is possible to reduce the number of DRPs and identify potential problems earlier.
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Affiliation(s)
- Lisa Krumm
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University, 81377 Munich, Germany
- Helios Dr. Horst Schmidt Hospital, 65199 Wiesbaden, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University, 81377 Munich, Germany
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Kusmaul N, Roberts AR, Hector P, Galambos C, Zimmerman S, Bern-Klug M, Connolly R, Wang X, Herman C. Social Workers Critical to Honoring Commitments to Residents and Families in Long-Term Care. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:811-821. [PMID: 36809984 DOI: 10.1080/01634372.2023.2181904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Social workers have been at the forefront of research and advocacy to improve nursing home care for several decades. However, United States (U.S.) regulations have not kept pace with professional standards, as nursing home social services workers are still not required to have a degree in social work and many are assigned caseloads that are untenable for providing quality psychosocial and behavioral health care. The National Academies of Sciences, Engineering, and Medicine (NASEM)'s recently published interdisciplinary consensus report, The National Imperative to Improve Nursing Home Quality: Honoring our Commitment to Residents, Families, and Staff (NASEM, 2022) makes recommendations for changing these regulations, reflecting years of social work scholarship and policy advocacy. In this commentary, we highlight the NASEM report recommendations for social work and chart a course for continuing scholarship and policy advocacy to improve resident outcomes.
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Affiliation(s)
- Nancy Kusmaul
- Social Work, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | | | - Paige Hector
- Paige Ahead Healthcare Education and Consulting, Tucson, Arizona, USA
| | - Colleen Galambos
- Helen Bader School of Social Welfare, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Sheryl Zimmerman
- Social Work, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Robert Connolly
- Retired CMS Health Insurance Analyst, Marriottsville, Maryland, USA
| | - Xiaochuan Wang
- Social Work, University of Central Florida, Orlando, Florida, USA
| | - Chris Herman
- National Association of Social Workers, Washington, DC, USA
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Pharmacists' clinical roles and activities in inpatient hospice and palliative care: a scoping review. Int J Clin Pharm 2023:10.1007/s11096-023-01535-7. [PMID: 36773207 PMCID: PMC9918816 DOI: 10.1007/s11096-023-01535-7] [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: 06/28/2022] [Accepted: 01/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Pharmacists contribute to medication safety by providing their services in various settings. However, standardized definitions of the role of pharmacists in hospice and palliative care (HPC) are lacking. AIM The purpose of this scoping review was to provide an overview of the evidence on the role of pharmacists and to map clinical activities in inpatient HPC. METHOD We performed a scoping review according to the PRISMA-ScR extension in CINAHL, Embase, and PubMed. We used the American Society of Hospital Pharmacists (ASHP) Guidelines on the Pharmacist's Role in Palliative and Hospice Care as a framework for standardized categorization of the identified roles and clinical activities. RESULTS After screening 635 records (published after January 1st, 2000), the scoping review yielded 23 publications reporting various pharmacy services in HPC. The articles addressed the five main categories in the following descending order: 'Medication order review and reconciliation', 'Medication counseling, education and training', 'Administrative Roles', 'Direct patient care', and 'Education and scholarship'. A total of 172 entries were mapped to the subcategories that were added to the main categories. CONCLUSION This scoping review identified a variety of pharmacists' roles and clinical activities. The gathered evidence will help to establish and define the role of pharmacists in inpatient hospice and palliative care.
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Cook H, Walker KA, Felton Lowry M. Deprescribing Interventions by Palliative Care Clinical Pharmacists Surrounding Goals of Care Discussions. J Palliat Med 2022; 25:1818-1823. [PMID: 35704875 DOI: 10.1089/jpm.2021.0560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Palliative care (PC) pharmacists can play an important role in optimizing medications for patients with serious illnesses by aligning patients' goals with their treatment regimens. Objectives: The objectives of this study were to (1) quantify successful pharmacist deprescribing interventions incorporated in the hospital discharge plan and (2) describe deprescribing interventions by medication class, reason for discontinuation, and perception of patient/caregiver understanding and acceptance. Methods: This pilot study included 45 inpatient PC consultations and collected data on deprescribing interventions performed by PC clinical pharmacists in Maryland and Washington, D.C., U.S. Descriptive statistics were used to analyze outcomes. Results: Eighty-two percent of recommendations were successfully implemented during hospitalization and included in the discharge plan. Medication classes recommended for discontinuation included vitamins/supplements (20%), antidiabetics (13%), antiplatelets (10%), anticoagulants (10%), statins (10%), antihypertensives (7%), proton pump inhibitors/H2 blockers (7%), antibiotics (5%), dementia medications (1%), and antidepressants (1%). Top reasons for discontinuation included pill burden, unacceptable treatment burden, and potential harm outweighs potential benefit. Conclusions: Results of this study demonstrate PC pharmacists' deprescribing recommendations have a high rate of successful implementation by the primary inpatient care team.
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Affiliation(s)
- Heather Cook
- Department of Palliative Care, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
| | - Kathryn A Walker
- MedStar Health, Columbia, Maryland, USA.,University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Maria Felton Lowry
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.,UPMC Palliative and Supportive Institute, Pittsburgh, Pennsylvania, USA
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Wernli U, Hischier D, Meier CR, Jean-Petit-Matile S, Panchaud A, Kobleder A, Meyer-Massetti C. Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis. Am J Hosp Palliat Care 2022:10499091221130758. [PMID: 36168963 DOI: 10.1177/10499091221130758] [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] Open
Abstract
BACKGROUND In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends. OBJECTIVES To explore prescription trends and describe changes to drug regimens in inpatient hospice care. DESIGN We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice. SETTING/SUBJECTS Prescription records of all patients (≥ 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion. RESULTS Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death. CONCLUSIONS Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.
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Affiliation(s)
- Ursina Wernli
- Clinical Pharmacology and Toxicology, 27252Inselspital University Hospital Bern, Bern, Switzerland.,Graduate School for Health Sciences, 27210University of Bern, Bern, Switzerland
| | - Désirée Hischier
- Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
| | - Christoph R Meier
- Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
| | | | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), 27210University of Bern, Bern, Switzerland
| | - Andrea Kobleder
- Institute of Applied Nursing Science, 112888Eastern Switzerland University of Applied SciencesOST, St Gallen, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, 27252Inselspital University Hospital Bern, Bern, Switzerland.,Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
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Lundby C, Pottegård A. Considerations regarding choice of primary outcome in clinical trials in deprescribing. Br J Clin Pharmacol 2021; 88:3032-3034. [PMID: 34363621 DOI: 10.1111/bcp.14990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Carina Lundby
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.,ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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