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Ali ZZ, Skouteris H, Pirotta S, Hussainy SY, Low YL, Mazza D, Assifi AR. Interventions to Expand Community Pharmacists' Scope of Practice. PHARMACY 2024; 12:95. [PMID: 38921971 PMCID: PMC11207271 DOI: 10.3390/pharmacy12030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The role of community pharmacists has evolved beyond the dispensing of medicines. The aim of this scoping review was to describe the interventions that expand the pharmacist's scope of practice within a community pharmacy setting and assess their effectiveness. METHODS We performed a scoping review to identify randomised controlled trials (RCTs), published worldwide from 2013 to 2024, which focused on interventions designed to expand pharmacists' scope of practice in the community. The review was undertaken in accordance with the Joanna Briggs Institute methodology for scoping reviews. To address the aim of this scoping review, the included RCTs were mapped to themes influenced by the Professional Practice Standards 2023 as developed by the Pharmaceutical Society of Australia: medication management, collaborative care and medication adherence. RESULTS Twelve studies demonstrated the potential to expand community pharmacists' scope of practice. Two RCTs resulted in no effect of the intervention. One RCT (conducted in Italy) led to an actual change to community pharmacists' scope of practice, with a statistically significant improvement in the proportion of patients with controlled asthma. CONCLUSIONS On the whole, this scoping review synthesised the findings of peer-reviewed RCT studies that revealed expanding community pharmacists' scope of practice may result in improved patient outcomes, a reduced burden for the healthcare system, and greater productivity.
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Affiliation(s)
- Zaynah Zureen Ali
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (Y.L.L.); (D.M.)
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (H.S.); (S.P.)
| | - Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (H.S.); (S.P.)
| | - Safeera Yasmeen Hussainy
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Yi Ling Low
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (Y.L.L.); (D.M.)
| | - Danielle Mazza
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (Y.L.L.); (D.M.)
| | - Anisa Rojanapenkul Assifi
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (Y.L.L.); (D.M.)
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Liu S, Tsuyuki RT. Do we need to separate pharmacy advocacy organizations? Can Pharm J (Ott) 2024; 157:99-100. [PMID: 38737358 PMCID: PMC11086730 DOI: 10.1177/17151635241241039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
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Lee TA, King M, Young SW, Tsuyuki RT. Community Pharmacy-Based Blood Pressure Screening in Newfoundland and Labrador, Canada for World Hypertension Day 2022: A Cross-Sectional Study. CJC Open 2024; 6:728-734. [PMID: 38846443 PMCID: PMC11150944 DOI: 10.1016/j.cjco.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/08/2023] [Indexed: 06/09/2024] Open
Abstract
Background High blood pressure (BP) is a leading cause of cardiovascular and stroke-related events. Office-based BP measurement has declined in recent years due to the COVID-19 pandemic, which may have resulted in higher rates of undetected and uncontrolled hypertension. To gain a better idea of adult BP levels in Newfoundland and Labrador, we engaged community pharmacists in BP screening on World Hypertension Day. Methods Data collection and BP screening occurred on May 17, 2022. Pharmacists and pharmacy students collected 3 seated BP readings from participants, using an automated device. The average of readings 2 and 3 was used to estimate BP, with elevated BP defined as ≥ 140/90 mm Hg, or ≥ 130/80 mm Hg for individuals with diabetes. Data on participant demographics, access to primary care, medical history, and antihypertensive use were also collected. Data analysis included descriptive statistics and logistic regression techniques. Results A total of 460 participants were included in the analysis. The mean age was 56.3 years (standard deviation: 16.95); 63.3% (n = 291) were female; and 43.7% (n = 201) reported having hypertension. Elevated BP was identified in 27% (n = 123). Of those with elevated BP, 41.5% (n = 51) had no history of diagnosed hypertension. Age, sex, and diabetes were statistically significant predictors of elevated BP in the multivariable model. Conclusions A large proportion of participants in our study had elevated BP. Targeted measures are needed to improve the detection, treatment, and control of high BP in Newfoundland and Labrador. Community pharmacists can support BP care.
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Affiliation(s)
- Tiffany A. Lee
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Melanie King
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Stephanie W. Young
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Ross T. Tsuyuki
- Faculty of Medicine (Cardiology), University of Alberta, Edmonton, Alberta, Canada
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Hias J, Defieuw L, Vanassche T, Verhamme P, Van der Linden L. Therapy and guideline adherence at a multidisciplinary hypertension clinic: A prospective, observational study. Vascul Pharmacol 2024; 154:107271. [PMID: 38159830 DOI: 10.1016/j.vph.2023.107271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Hypertension is highly prevalent and remains one of the most frequent and preventable causes of cardiovascular morbidity and mortality. Yet, suboptimal blood pressure control is common. Hypertension clinics might play an important role in improving target attainment, by targeting drug therapy adherence, improving guideline compliance and by involving pharmacists. OBJECTIVES We aimed to characterize patient drug therapy adherence, prescriber guideline compliance and pharmacist interventions at the hypertension clinic. METHODS A prospective observational study was performed at the hypertension clinic of a large, academic hospital. Adult Dutch-speaking patients were eligible for inclusion. Following data were collected: patient demographics, medication use, patient adherence to prescribed antihypertensive drug therapies according to the BAASIS tool and prescriber compliance to the 2018 European Society of Cardiology (ESC) hypertension guidelines. RESULTS A cohort of 108 patients was included with 51.9% male and aged 65 (IQR: 52-75) years. In total, 104 patients took at least 1 antihypertensive drug and 46 patients (44.2%) were classified as non-adherent with regard to their antihypertensive treatment; 82 patients (78.8%) had suboptimal blood pressure control. Compliance with the ESC guidelines was 66.3% prior to the consultation at the clinic and significantly increased to 77.9% thereafter (p = 0.0015). The clinical pharmacist performed a medication review for 27 patients with a total of 44 recommendations and an acceptance rate of 59.1%. CONCLUSION A visit to the multidisciplinary hypertension clinic improved prescriber guideline compliance and the use of single pill combinations. Involvement of a clinical pharmacist could be beneficial to further improve patient drug therapy adherence and guideline compliance.
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Affiliation(s)
- Julie Hias
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Hospital Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Lise Defieuw
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Hospital Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
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Pestka DL, Murphy D, Huynh P, Rechtzigel JA, Kjos S, Ellich LM, Kaplan AN, Taylor BC, Atwood M, Polsfuss BA, Lee JY, Ishani A. Pharmacist-driven outreach initiative to increase prescribing of sodium-glucose cotransporter-2 inhibitors in eligible VHA patients with chronic kidney disease: a study protocol. BMC Nephrol 2024; 25:14. [PMID: 38182983 PMCID: PMC10770983 DOI: 10.1186/s12882-023-03446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at increased risk for multiple adverse events, several of which have been proven to be less likely with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i). As a result, guidelines now recommend SGLT2i be given to those with mild to moderate CKD and type 2 diabetes. The objective of this study is to evaluate if a pharmacist-driven SGLT2i prescribing initiative among eligible patients with CKD and diabetes within the VA could more rapidly improve the adoption of SGLT2i via a pragmatic approach aligned with learning health systems. METHODS Eligible patients will be identified through an established VA diabetes dashboard. Veterans with an odd social security number (SSN), which is effectively a random number, will be the intervention group. Those with even SSNs will serve as the control while awaiting a second iteration of the same interventional program. The intervention will be implemented in a rolling fashion across one Veterans Integrated Service Network. Our primary outcome is initiation of an SGLT2i. Secondary outcomes will include medication adherence and safety-related outcomes. DISCUSSION This project tests the impact of a pharmacist-driven medication outreach initiative as a strategy to accelerate initiation of SGLT2i. The results of this work will not only illustrate the effectiveness of this strategy for SGLT2is but may also have implications for increasing other guideline-concordant care. Furthermore, the utilization of SSNs to select Veterans for the first wave of this program has created a pseudo-randomized interventional trial supporting a pragmatic learning health system approach. TRIAL REGISTRATION ISRCTN12374636.
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Affiliation(s)
- Deborah L Pestka
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA.
| | - Daniel Murphy
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Pearl Huynh
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Jessica A Rechtzigel
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Shari Kjos
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Lisa Marie Ellich
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Adam N Kaplan
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Melissa Atwood
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Beth A Polsfuss
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Joseph Y Lee
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Areef Ishani
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, USA
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Sperl-Hillen JM, Haapala JL, Dehmer SP, Chumba LN, Ekstrom HL, Truitt AR, Asche SE, Werner AM, Rehrauer DJ, Pankonin MA, Pawloski PA, O'Connor PJ. Protocol of a patient randomized clinical trial to improve medication adherence in primary care. Contemp Clin Trials 2024; 136:107385. [PMID: 37956792 PMCID: PMC10922408 DOI: 10.1016/j.cct.2023.107385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Enhanced awareness of poor medication adherence could improve patient care. This article describes the original and adapted protocols of a randomized trial to improve medication adherence for cardiometabolic conditions. METHODS The original protocol entailed a cluster randomized trial of 28 primary care clinics allocated to either (i) medication adherence enhanced chronic disease care clinical decision support (eCDC-CDS) integrated within the electronic health record (EHR) or (ii) usual care (non-enhanced CDC-CDS). Enhancements comprised (a) electronic interfaces printed for patients and clinicians at primary care encounters that encouraged discussion about specific medication adherence issues that were identified, and (b) pharmacist phone outreach. Study subjects were individuals who at an index visit were aged 18-74 years and not at evidence-based care goals for hypertension (HTN), diabetes mellitus (DM), or lipid management, along with low medication adherence (proportion of days covered [PDC] <80%) for a corresponding medication. The primary study outcomes were improved medication adherence and clinical outcomes (BP and A1C) at 12 months. Protocol adaptation became imperative in response to major implementation challenges: (a) the availability of EHR system-wide PDC calculations that superseded our ability to limit PDC adherence information solely to intervention clinics; (b) the unforeseen closure of pharmacies committed to conducting the pharmacist outreach; and (c) disruptions and clinic closures due to the Covid-19 pandemic. CONCLUSION This manuscript details the protocol of a study to assess whether enhanced awareness of medication adherence issues in primary care settings could improve patient outcomes. The need for protocol adaptation arose in response to multiple implementation challenges.
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Affiliation(s)
| | | | | | | | | | | | | | - Ann M Werner
- HealthPartners Institute, Bloomington, MN, United States
| | - Dan J Rehrauer
- HealthPartners Health Plan, Bloomington, MN, United States; HealthPartners Medical Group, Bloomington, MN, United States
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Chiang V, Guirguis L, Warren AL, Topps D, Anderson SJ, Hecker KG. Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100357. [PMID: 38023635 PMCID: PMC10663664 DOI: 10.1016/j.rcsop.2023.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Prescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice. Objectives To explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. Methods Eight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed. Results There were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations. Conclusions This study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.
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Affiliation(s)
- Vincent Chiang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Canada
| | - Amy L. Warren
- Faculty of Veterinary Medicine, University of Calgary, Canada
| | - David Topps
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Sarah J. Anderson
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Canada
| | - Kent G. Hecker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
- Faculty of Veterinary Medicine, University of Calgary, Canada
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Dixon DL, Johnston K, Patterson J, Marra CA, Tsuyuki RT. Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States. JAMA Netw Open 2023; 6:e2341408. [PMID: 37921763 PMCID: PMC10625044 DOI: 10.1001/jamanetworkopen.2023.41408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Pharmacist-led interventions can significantly improve blood pressure (BP) control. The long-term cost-effectiveness of pharmacist-prescribing interventions implemented on a large scale in the US remains unclear. Objective To estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the US. Design, Setting, and Participants This economic evaluation included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION) (2009 to 2013). In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023. Main Outcomes and Measures Cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). CV risk was calculated using Framingham risk equations. Costs were based on the reimbursement rate for level 1 encounters, medication costs from published literature, and event costs from national surveys and pricing data sets. Quality of life was determined using a published catalog of EQ-5D utility values. One-way sensitivity analyses were used to assess alternative reimbursement values, a reduced time horizon of 5 years, alternative assumptions for BP reduction, and the assumption of no benefit to the intervention after 10 years. The model was expanded to the US population to estimate population-level cost and health impacts. Results Assumed demographics were mean (SD) age, 64 (12.5) years, 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mm Hg. Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years. Conclusion and Relevance These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value. The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the US; however, reimbursement limitations remain a barrier.
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Affiliation(s)
- Dave L. Dixon
- Department of Pharmacotherapy and Outcomes Science, Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, Vancouver, British Columbia, Canada
| | - Julie Patterson
- Department of Pharmacotherapy and Outcomes Science, Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond
| | - Carlo A. Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Ross T. Tsuyuki
- Department of Medicine (Cardiology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Luque del Moral R, Gastelurrutia MA, Martinez-Martinez F, Jacomé JA, Dago A, Suarez B, Fikri-Benbrahim N, Martí M, Nuñez C, Sierra-Alarcón S, Fernandez-Gomez FJ. Effect of Pharmaceutical Intervention in Pharmacologically Treated Hypertensive Patients-A Cluster-Randomized Clinical Trial: AFPRES-CLM Study. J Pers Med 2023; 13:1484. [PMID: 37888095 PMCID: PMC10608270 DOI: 10.3390/jpm13101484] [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: 09/14/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Evaluate the effect of a community pharmaceutical intervention on the control of blood pressure in hypertensive patients treated pharmacologically. METHODS A cluster-randomized clinical trial of 6 months was carried out. It was conducted in the Autonomous Community of Castilla-La Mancha (Spain). Sixty-three community pharmacies and 347 patients completed the study. Intervention patients received the community pharmaceutical intervention based on a protocol that addresses the individual needs of each patient related to the control of their blood pressure, which included Health Education, Pharmacotherapy Follow-up and 24 h Ambulatory Blood Pressure Measurement. Control patients received usual care in the community pharmacy. RESULTS The pharmaceutical intervention resulted in better control of blood pressure (85.8% vs. 66.3% p < 0.001), lower use of emergencies (p = 0.002) and improvement trends in the physical components of quality of life, measured by SF-36 questionnaire, after 6 months of pharmaceutical intervention. No significant changes were observed for any of these variables in the control group. There were also detected 354 negative medication-related outcomes that were satisfactorily resolved in a 74.9% of the cases and 330 healthcare education interventions and 29 Ambulatory Blood Pressure Monitorings were performed in order to increase adherence to pharmacological treatment and minimize Negative Outcomes associated with Medication and prevent medication-related problems. CONCLUSIONS Community pharmaceutical intervention can increase hypertensive patients with controlled blood pressure, after 6 months, compared with usual care.
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Affiliation(s)
- Raúl Luque del Moral
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
- Council of Official Associations of Pharmaceutics of Castilla-La Mancha, 45005 Toledo, Spain
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
| | - Miguel A. Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Julio A. Jacomé
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Ana Dago
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Blanca Suarez
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
- Council of Official Associations of Pharmaceutics of Castilla-La Mancha, 45005 Toledo, Spain
| | - Narjis Fikri-Benbrahim
- Pharmaceutical Care Research Group, University of Granada, 18011 Granada, Spain; (M.A.G.); (F.M.-M.); (B.S.); (N.F.-B.)
| | - Mercé Martí
- Pharmaceutical Care Foundation, 08017 Barcelona, Spain; (J.A.J.); (A.D.); (M.M.)
| | - Cristina Nuñez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
| | - Sandra Sierra-Alarcón
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
| | - Francisco-José Fernandez-Gomez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, CEIR Campus Mare Nostrum, University of Murcia, Campus de Ciencias de la Salud, 30120 Murcia, Spain; (C.N.); (F.-J.F.-G.)
- Murcia Research Institute of Health Sciences (IMIB), 30120 Murcia, Spain
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Joudeh AI, Elderawy NM, Alhitmi MA, Alnuaimi AS, Aabdien M, Alotaibi M, Alsaadi M, Selim N, Ismail MF. Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study. Medicine (Baltimore) 2023; 102:e34751. [PMID: 37746967 PMCID: PMC10519559 DOI: 10.1097/md.0000000000034751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Primary health care is integral to diagnosing and managing hypertension. This study aimed to assess the knowledge, attitude, practice, priority, and confidence of primary care physicians in Qatar toward hypertension diagnosis and management, and to measure the determinants of good knowledge, desirable attitudes, and desirable practices. We conducted a cross-sectional web-based survey using a modified version of the World Hypertension League Questionnaire during the period from August 30th to October 23rd, 2020. All primary care physicians working in any of Qatar's 27 publicly run primary healthcare centers were invited to participate in the survey. Out of the 450 primary care physicians working at that time, 197 completed the study questionnaire with a response rate of 43.8%. Most respondents stated that they followed local or international treatment guidelines for hypertension management (96.4%). Primary care physicians were highly confident and prioritized hypertension management. The overall desirable practice score was 73.8%, with the highest score (95.4%) for assessing adherence to antihypertensive medications, whereas the lowest desirable practice score was 33.5% for counseling on home blood pressure monitoring. Fifty-one-point eight percentage and 62.4% correctly identified 140 mm Hg and 90 mm Hg as the systolic and diastolic blood pressure threshold for diagnosing hypertension in most patients. The lowest knowledge scores were for hypertension epidemiology in Qatar and recommended dietary modification for hypertensive patients. Respondents had positive attitudes toward task sharing with nonphysician healthcare workers for most items (58.9%-78.2%), except for drug prescriptions (30.5%). Primary care physicians in Qatar had positive attitudes, with high overall confidence and conviction (priority) scores toward hypertension. However, their knowledge scores and certain practices were suboptimal. Healthcare policymakers in Qatar should raise primary care physicians awareness of the current burden of untreated hypertension in the country by organizing targeted educational programs and emphasizing the importance of following national clinical practice guidelines in the diagnosis and management of hypertension.
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Affiliation(s)
- Anwar I. Joudeh
- Department of Internal Medicine, Alkhor Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Mohamed Aabdien
- Department of Medical Education, Community Medicine Training Program, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Nagah Selim
- Primary Health Care Corporation, Doha, Qatar
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Baral N, Volgman AS, Seri A, Chelikani V, Isa S, Javvadi SLP, Paul TK, Mitchell JD. Adding Pharmacist-Led Home Blood Pressure Telemonitoring to Usual Care for Blood Pressure Control: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 203:161-168. [PMID: 37499595 DOI: 10.1016/j.amjcard.2023.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
Health systems have been quickly adopting telemedicine throughout the United States, especially since the onset of the COVID-19 pandemic. However, there are limited data on whether adding pharmacist-led home blood pressure (BP) telemonitoring to office-based usual care improves BP. We searched PubMed/MEDLINE and Embase for randomized controlled trials from January 2000 until April 2022, comparing studies on pharmacist-led home BP telemonitoring with usual care. Six randomized controlled trials, including 1,550 participants, satisfied the inclusion criteria. There were 774 participants in the pharmacist-led telemonitoring group and 776 in the usual care group. The addition of pharmacist-led telemonitoring to usual care was associated with a significant decrease in systolic BP (mean difference -8.09, 95% confidence interval -11.15 to -5.04, p <0.001, I2 = 72%) and diastolic BP (mean difference -4.19, 95% confidence interval -5.58 to -2.81, p <0.001, I2 = 42%) compared with usual care. In conclusion, this meta-analysis showed that adding pharmacist-led home BP telemonitoring to usual care achieves better BP control than usual care alone.
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Affiliation(s)
- Nischit Baral
- Department of Internal Medicine, McLaren Flint, Michigan State University College of Human Medicine, Flint, Michigan
| | - Annabelle Santos Volgman
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Amith Seri
- Department of Internal Medicine, McLaren Flint, Michigan State University College of Human Medicine, Flint, Michigan
| | - Vijaya Chelikani
- Department of Internal Medicine, McLaren Flint, Michigan State University College of Human Medicine, Flint, Michigan
| | - Sakiru Isa
- Department of Internal Medicine, McLaren Flint, Michigan State University College of Human Medicine, Flint, Michigan
| | - Sri L P Javvadi
- Department of Internal Medicine, McLaren Flint, Michigan State University College of Human Medicine, Flint, Michigan
| | - Timir K Paul
- Department of Cardiovascular Sciences, University of Tennessee College of Medicine Nashville, Ascension St. Thomas Hospital, Nashville, Tennessee
| | - Joshua D Mitchell
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
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12
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Lavenue A, Simoneau I, Mahajan N, Srirangan K. Development and Implementation of Workshops to Optimize the Delivery of Vaccination Services in Community Pharmacies: Thinking beyond COVID-19. PHARMACY 2023; 11:129. [PMID: 37624084 PMCID: PMC10458354 DOI: 10.3390/pharmacy11040129] [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: 06/17/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Vaccines are widely recognized as the most economically efficient strategy to combat infectious diseases. Community pharmacists, being highly accessible healthcare professionals, have the potential to significantly contribute to the promotion and facilitation of vaccination uptake. In Canada, the jurisdiction of healthcare falls under provincial legislation, leading to variations in the extent of pharmacist practice throughout the country. While some pharmacists in Canada already functioned as immunizers, Québec pharmacists gained the authority to prescribe and administer vaccines in March 2020 amidst the COVID-19 pandemic. Our workshop aimed to equip pharmacists in Québec with the necessary guidance to optimize vaccinations, emphasizing the importance of maintaining and expanding immunization services beyond influenza and COVID-19 vaccines in the future. During the workshop, pharmacists had the opportunity to exchange valuable insights and best practices regarding workflow optimization, identifying areas for improvement in competency, effectively reaching vulnerable population groups, and integrating allied team members into their practice. Participants were also asked to develop a plan of action to help implement practice change beyond the workshop. Interactive workshops centered around discussions like these serve as catalysts for advancing the pharmacy profession, uniting professionals with a collective aim of enhancing patient care.
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Affiliation(s)
- Arnaud Lavenue
- Toc Toc Communications, 104-7030 Rue Marconi, Montréal, QC H2S 3K1, Canada; (I.S.); (N.M.); (K.S.)
| | - Isabelle Simoneau
- Toc Toc Communications, 104-7030 Rue Marconi, Montréal, QC H2S 3K1, Canada; (I.S.); (N.M.); (K.S.)
| | - Nikita Mahajan
- Toc Toc Communications, 104-7030 Rue Marconi, Montréal, QC H2S 3K1, Canada; (I.S.); (N.M.); (K.S.)
- School of Pharmacy, University of Waterloo, 10A Victoria Street S., Kitchener, ON N2G 1C5, Canada
| | - Kajan Srirangan
- Toc Toc Communications, 104-7030 Rue Marconi, Montréal, QC H2S 3K1, Canada; (I.S.); (N.M.); (K.S.)
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de Souza Cazarim M, Cruz-Cazarim ELC, Boyd K, Wu O, Nunes AA. Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression. Pharmaceuticals (Basel) 2023; 16:845. [PMID: 37375792 DOI: 10.3390/ph16060845] [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: 03/30/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients' outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66-1.0; (p < 0.001). Twenty-seven studies (65.9%) had MTM-PC models outlined by the clinical team, showing as characteristics the mean of 10.0 ± 10.7 months of follow-up of hypertensive patients, with 7.7 ± 4.9 consultations. Instruments to assess the quality of life measured the enhancement by 13.4 ± 10.7% (p = 0.047). The findings of the meta-analysis show a mean reduction of -7.71 (95% CI, -10.93 to -4.48) and -3.66 (95% CI, -5.51 to -1.80), (p < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life.
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Affiliation(s)
- Maurilio de Souza Cazarim
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora 36036-900, MG, Brazil
| | - Estael Luzia Coelho Cruz-Cazarim
- Department of Pharmaceutical Service, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-903, SP, Brazil
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Altacílio Aparecido Nunes
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, SP, Brazil
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Babashahi S, Carey N, Jani Y, Hart K, Hounsome N. Costs, consequences and value for money in non-medical prescribing: a scoping review. BMJ Open 2023; 13:e067907. [PMID: 37130673 PMCID: PMC10163523 DOI: 10.1136/bmjopen-2022-067907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Non-medical prescribing (NMP) is a key feature of the UK healthcare system that refers to the legal prescribing rights granted to nurses, pharmacists and other non-medical healthcare professionals who have completed an approved training programme. NMP is deemed to facilitate better patient care and timely access to medicine. The aim of this scoping review is to identify, synthesise and report the evidence on the costs, consequences and value for money of NMP provided by non-medical healthcare professionals. DESIGN Scoping review DATA SOURCES: MEDLINE, Cochrane Library, Scopus, PubMed, ISI Web of Science and Google Scholar were systematically searched from 1999 to 2021. ELIGIBILITY CRITERIA Peer-reviewed and grey literature written in English were included. The research was limited to original studies evaluating economic values only or both consequences and costs of NMP. DATA EXTRACTION AND SYNTHESIS The identified studies were screened independently by two reviewers for final inclusion. The results were reported in tabular form and descriptively. RESULTS A total of 420 records were identified. Of these, nine studies evaluating and comparing NMP with patient group discussions, general practitioner-led usual care or services provided by non-prescribing colleagues were included. All studies evaluated the costs and economic values of prescribing services by non-medical prescribers, and eight assessed patient, health or clinical outcomes. Three studies showed pharmacist prescribing was superior in all outcomes and cost saving at a large scale. Others reported similar results in most health and patient outcomes across other non-medical prescribers and control groups. NMP was deemed resource intensive for both providers and other groups of non-medical prescribers (eg, nurses, physiotherapists, podiatrists). CONCLUSIONS The review demonstrated the need for quality evidence from more rigorous methodological studies examining all relevant costs and consequences to show value for money in NMP and inform the commissioning of NMP for different groups of healthcare professionals.
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Affiliation(s)
- Saeideh Babashahi
- Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Yogini Jani
- Centre for Medicines Optimisation Research and Education, UCLH NHS Foundation Trust and UCL School of Pharmacy, London, UK
| | - Kath Hart
- Department of Nutritional Sciences, School of Biosciences & Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Natalia Hounsome
- Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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15
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Holland R, Bond C, Alldred DP, Arthur A, Barton G, Birt L, Blacklock J, Blyth A, Cheilari S, Daffu-O'Reilly A, Dalgarno L, Desborough J, Ford J, Grant K, Harry B, Hill H, Hughes C, Inch J, Maskrey V, Myint P, Norris N, Poland F, Shepstone L, Spargo M, Turner D, Watts L, Zermansky A, Wright D. Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial. BMJ 2023; 380:e071883. [PMID: 36787910 PMCID: PMC9926330 DOI: 10.1136/bmj-2022-071883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes. DESIGN Cluster randomised controlled trial, with clusters based on triads of a pharmacist independent prescriber, a general practice, and one to three associated care homes. SETTING Care homes across England, Scotland, and Northern Ireland, their associated general practices, and pharmacy independent prescribers, formed into triads. PARTICIPANTS 49 triads and 882 residents were randomised. Participants were care home residents, aged ≥65 years, taking at least one prescribed drug, recruited to 20 residents/triad. INTERVENTION Each pharmacy independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits over six months. Pharmacy independent prescribers developed a pharmaceutical care plan for each resident, did medicines reviews/reconciliation, trained staff, and supported with medicines related procedures, deprescribing, and authorisation of prescriptions. Participants in the control group received usual care. MAIN OUTCOMES MEASURES The primary outcome was fall rate/person at six months analysed by intention to treat, adjusted for prognostic variables. Secondary outcomes included quality of life (EQ-5D by proxy), Barthel score, Drug Burden Index, hospital admissions, and mortality. Assuming a 21% reduction in falls, 880 residents were needed, allowing for 20% attrition. RESULTS The average age of participants at study entry was 85 years; 70% were female. 697 falls (1.55 per resident) were recorded in the intervention group and 538 falls (1.26 per resident) in the control group at six months. The fall rate risk ratio for the intervention group compared with the control group was not significant (0.91, 95% confidence interval 0.66 to 1.26) after adjustment for all model covariates. Secondary outcomes were not significantly different between groups, with exception of the Drug Burden Index, which significantly favoured the intervention. A third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. No adverse events or safety concerns were identified. CONCLUSIONS Change in the primary outcome of falls was not significant. Limiting follow-up to six months combined with a small proportion of interventions predicted to affect falls may explain this. A significant reduction in the Drug Burden Index was realised and would be predicted to yield future clinical benefits for patients. This large trial of an intensive weekly pharmacist intervention with care home residents was also found to be safe and well received. TRIAL REGISTRATION ISRCTN 17847169.
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Affiliation(s)
- Richard Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Linda Birt
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Annie Blyth
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Lindsay Dalgarno
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Joanna Ford
- Geriatric Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Bronwen Harry
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Helen Hill
- Stow Healthcare Ltd, Bury St. Edmunds, UK
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Jacqueline Inch
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Phyo Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nigel Norris
- School of Education and Lifelong Learning, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Maureen Spargo
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - David Wright
- School of Healthcare, University of Leicester, Leicester, UK
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16
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Isenor JE, Cossette B, Murphy AL, Breton M, Mathews M, Moritz LR, Buote R, McCarthy L, Woodill L, Morrison B, Guénette L, Marshall EG. Community pharmacists' expanding roles in supporting patients before and during COVID-19: An exploratory qualitative study. Int J Clin Pharm 2023; 45:64-78. [PMID: 36289174 PMCID: PMC9607833 DOI: 10.1007/s11096-022-01430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Timely access and attachment to a primary healthcare provider is associated with better population health outcomes. In Canada, community pharmacists are highly accessible and patients struggling to access a family physician or nurse practitioner (i.e., "unattached") may seek care from a community pharmacist. Community pharmacists took on additional roles during the COVID-19 pandemic; however, little is known about how community pharmacists managed the needs of attached and unattached patients before and during the COVID-19 pandemic. AIM To describe Nova Scotian community pharmacists' roles in caring for unattached patients before and during the COVID-19 pandemic and identifying barriers and facilitators to optimizing patient access. METHOD Semi-structured interviews with community pharmacists (n = 11) across the province of Nova Scotia (Canada) were conducted. RESULTS Five key themes were noted: (1) rising pressure on pharmacists to meet unique health needs of attached and unattached patients; (2) what pharmacists have to offer (e.g., accessibility, trustworthiness); (3) positioning pharmacists in the system (e.g., how pharmacists can address gaps in primary healthcare); (4) pharmacist wellbeing; and, (5) recommendations for practice post-pandemic (e.g., maintain some policy changes made during the COVID-19 pandemic). CONCLUSION Before and during the pandemic, community pharmacists played a significant and increasing role providing care to patients, especially unattached patients. With growing numbers of unattached patients, it is vital that community pharmacists are supported to provide services to care for the health needs of patients.
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Affiliation(s)
- Jennifer E. Isenor
- grid.55602.340000 0004 1936 8200College of Pharmacy and Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Benoit Cossette
- grid.86715.3d0000 0000 9064 6198Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Andrea L. Murphy
- grid.55602.340000 0004 1936 8200College of Pharmacy and Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Mylaine Breton
- grid.86715.3d0000 0000 9064 6198Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Maria Mathews
- grid.39381.300000 0004 1936 8884Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren R. Moritz
- grid.55602.340000 0004 1936 8200Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Richard Buote
- grid.55602.340000 0004 1936 8200Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Lisa McCarthy
- grid.417293.a0000 0004 0459 7334Institute for Better Health, Trillium Health Partners, Mississauga, ON Canada ,grid.17063.330000 0001 2157 2938Leslie Dan Faculty of Pharmacy and Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Lisa Woodill
- Pharmacy Association of Nova Scotia, Dartmouth, NS Canada
| | - Bobbi Morrison
- grid.264060.60000 0004 1936 7363St. Francis Xavier University, Antigonish, NS Canada
| | - Line Guénette
- grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy and CHU de Québec Research Centre, Université Laval, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy, Université Laval, Québec, QC Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Canada.
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Liu C, Patel K, Cernero B, Baratt Y, Dandan N, Marshall O, Li H, Efird L. Expansion of Pharmacy Services During COVID-19: Pharmacists and Pharmacy Extenders Filling the Gaps Through Telehealth Services. Hosp Pharm 2022; 57:349-354. [PMID: 35615491 PMCID: PMC9125115 DOI: 10.1177/00185787211032360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Purpose: The Coronavirus 2019 (COVID-19) pandemic created a significant disruption in healthcare. In our health-system located in New York City, the provision of care in the ambulatory care setting moved to a remote model virtually overnight. We describe interventions made during the pandemic to transform ambulatory care pharmacy through expansion of telehealth services. Summary: In March of 2020, the closure of primary care clinics and provider appointment cancellations due to inpatient redeployment created a void. Collaboration with other health care providers and development of standardized telehealth workflows served as a conduit for creating new roles and opportunities for pharmacy team members. Three main interventions where the pharmacy team filled gaps include; (1) Expansion of pharmacist telemedicine visits for high-risk patients to improve access to primary care visits, (2) Partnership with nursing to create a centralized refill call center workflow, (3) Integration of pharmacy extenders into the prior authorization process to prevent medication access issues. Existing collaborative practice agreements for chronic disease management were utilized. A virtual pharmacist model for patient care contributed to an increase in telehealth visits from 51 in 2019 to 2997 total visits in 2020. In addition, the health-system refill call center expanded its services through collaboration with our pharmacy team. Pharmacists and pharmacy interns partnered with nurse practitioners to improve the call center workflow and address the significant increase in refill requests during the outbreak. Furthermore, a prior authorization process was created across multiple ambulatory care clinics to expedite medication access and prevent delays in therapy. Conclusion: Our ambulatory care pharmacy team leveraged technology, innovative workflows, and collaborative teamwork to catalyze a shift in pharmacists' and pharmacy extenders' roles in healthcare delivery to expeditiously meet patients' needs during a pandemic.
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Affiliation(s)
- Catherine Liu
- NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
- College of Pharmacy, New York, NY, USA
| | - Khusbu Patel
- St. John’s University College of Pharmacy and Allied Health, New York, NY, USA
| | | | | | - Nadine Dandan
- NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Olga Marshall
- NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Hanlin Li
- NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Leigh Efird
- NewYork-Presbyterian Hospital, New York, NY, USA
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18
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Hayashi M, Mahmoud SH, Hamdy DA. The Efficacy of a Didactic and Case-Based Pharmacogenomics Education Program on Improving the Knowledge and Confidence of Alberta Pharmacists. Pharmgenomics Pers Med 2022; 15:409-427. [PMID: 35496350 PMCID: PMC9045709 DOI: 10.2147/pgpm.s348851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/03/2022] [Indexed: 12/22/2022] Open
Abstract
Background Pharmacogenomics (PGx) is the study of how genetic variations for functional proteins, such as metabolizing enzymes and drug receptors, impact drug pharmacokinetics and pharmacodynamics. In theory, pharmacists are well suited to utilize PGx in tailoring medications to patient genetics when providing medication therapy management services. However, PGx education needs to reach pharmacists prior to implementation. The aim of this study is to develop and evaluate a PGx course for pharmacists. Methods A PGx education program was created and offered synchronously (virtual) and asynchronously (self-study) to pharmacists in Alberta, Canada. Lectures were delivered by experts live (virtual) with a question-and-answer period for synchronous sessions. These sessions were recorded for asynchronous delivery. Six case studies were discussed in large and small groups (“breakout rooms”) in synchronous sessions, and provided for self-study in the asynchronous subgroup. Topics included genetic and PGx concepts; therapeutic applications; ethical, legal, and social considerations; and practical implementation. Pre- and post-course surveys measured self-rated knowledge using a 5-point Likert Scale and tested objective knowledge with a graded quiz. Results Thirty-six pharmacists completed the course and both surveys. Participants reported backgrounds in community (88.9%) and hospital (38.9%) practice. Prior education in PGx was reported by 44.4% from degree programs and 27.8% from continuing education. Overall responses to statements about confidence in PGx moved from a median of “Disagree” at baseline to “Agree” after receiving PGx education (2-point difference [1,2] on 5-point Likert Scale; p < 0.001), indicating an increase in self-assessed competency in PGx. Likewise, mean participant grades on the knowledge quiz improved (20.8±21.9% pre-course vs 70.2±19.1% post-course, p < 0.001). There was no difference in these results between synchronous and asynchronous groups. Conclusion A didactic and case-based PGx education program was effective at increasing pharmacist knowledge and confidence in PGx in both synchronous and asynchronous environments. Knowledge gained can be utilized in delivery of patient-centered, personalized medication therapy management in the pharmacy setting.
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Affiliation(s)
- Meagan Hayashi
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Dalia A Hamdy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.,AbEx Health Services LTD, Fort, Saskatchewan, AB, Canada.,AbEx Pharmacy Beaumont Ltd, Beaumont, AB, Canada
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19
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Goswami S, Rosenthal M, Nair S, Inguva S, Al Hamarneh YN, Tsuyuki RT. Retrospective Application of the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to Promote Future Implementation Success in Community Pharmacy Clinical Interventions. J Am Pharm Assoc (2003) 2022; 62:1631-1637.e3. [DOI: 10.1016/j.japh.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/15/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
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20
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Vordenberg SE, Kim J, Serlin DC, Fan AL, Mi Choe H. Pharmacist engagement in a community pharmacy hypertension management program in collaboration with an academic medical center. Am J Health Syst Pharm 2022; 79:1110-1114. [PMID: 35278307 DOI: 10.1093/ajhp/zxac081] [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: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To explore the perceptions of pharmacists and administrators who had an integral role in designing and operationalizing an integrated community pharmacist hypertension management program with collaboration between an academic medical center and a regional chain community pharmacy. SUMMARY Community pharmacists (n = 3), ambulatory care pharmacists (n = 2), medical directors (n = 2), and health-system (n = 1) and pharmacy (n = 1) administrators reported positive experiences engaging with the hypertension management program. Strengths of the program included comprehensive training by the ambulatory care pharmacists, community pharmacist access to the electronic health record (EHR), and primary care providers who were receptive to referring patients and accepting recommendations from the community pharmacists. All participants felt that the program had a positive outlook and saw opportunity for expansion, such as extended hours of operation, new locations, and additional pharmacists. CONCLUSION Pharmacists are well positioned to extend hypertension management programs from primary care clinics into local pharmacists if they have appropriate training, access to the EHR, and ongoing support from collaborating primary care offices. Additional research using implementation science methods is needed to further test the scalability and replicability of the program among different patient populations, community pharmacies, and health systems.
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Affiliation(s)
- Sarah E Vordenberg
- University of Michigan College of Pharmacy, Ann Arbor, MI, and University of Michigan Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI, USA
| | - Jae Kim
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - David C Serlin
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Audrey L Fan
- Michigan Medicine-Northville Health Center, Northville, MI, USA
| | - Hae Mi Choe
- University of Michigan College of Pharmacy, Ann Arbor, MI, Michigan Medicine-Pharmacy Innovations and Partnerships, Ann Arbor, MI, and Michigan Medicine-University of Michigan Medical Group, Ann Arbor, MI, USA
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Mulrooney M, Smith M, Sobieraj D, Shipley B, Miech E. Factors Influencing Primary Care Organization Commitment to Technical Assistance Services for Clinical Pharmacist Integration Using Configurational Comparative Methods. J Am Pharm Assoc (2003) 2022; 62:1564-1571. [DOI: 10.1016/j.japh.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
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22
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Stone R, Oganesyan A, Marco N, Smith R, Hoffman J. The Impact of a Pharmacist-Led Hypertension Medication Management Program on Older People in a Skilled Nursing Facility. Sr Care Pharm 2022; 37:62-72. [PMID: 35082011 DOI: 10.4140/tcp.n.2022.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To illustrate the impact of a pharmacist-led hypertension medication management program on skilled nursing facility residents. Design Sixteen-week retrospective, observational study. Setting Long-term care, local skilled nursing facility. Patients, Participants Subjects with a diagnosis of hypertension and treated with at least one antihypertensive medication were identified using electronic health records. The subjects also needed to be enrolled in the Hypertension Medication Management Program, and were excluded if receiving hospice or psychiatric treatment or had active infection with COVID-19. Initially, 120 residents were eligible with 54 in an intervention and 66 in a control group. At 16-weeks, a total of 67 residents remained after some were lost to follow-up. Interventions Under a collaborative practice agreement, a pharmacist optimized medications, ordered monitoring of vital signs, and relevant labs in conjunction with standard physician care (intervention): these subjects were compared to those who received standard physician care alone (control). Results There was a significant difference in the proportion of subjects who attained treatment goals for diastolic BP, but not for systolic BP or mean arterial pressure. The proportion of subjects in the intervention group who had falls, hospitalization or death was not significantly different between groups. diastolic pressure (90.9% and 38.0%; P < 0.0001; 86.7% and 32.4%; P < 0.0001) but not for systolic and mean arterial pressure at 8 and 16 weeks. For secondary endpoints, there was clinical significance in de-prescribing incidence (P < 0.0001) but not for fall events, hospitalizations, and death. However, control group had 11% more falls and 1.2% more hospitalizations. Conclusion A pharmacist-led hypertension program appeared to impact skilled nursing facility residents by allowing attainment of maintaining diastolic blood pressure, goals de-prescribing events, and reducing fall incidence and hospitalization. The intervention has the potential to promote de-prescribing but does not appear to have increased the prevalence of serious adverse outcomes relative to standard practice.
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Affiliation(s)
- Rachel Stone
- 1 Western University of Health Sciences, Pomona, California
| | | | | | - Rick Smith
- 2 Los Angeles Jewish Home, Reseda, California
| | - Janice Hoffman
- 1 Western University of Health Sciences, Pomona, California
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23
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The first nationwide implementation of pharmaceutical care practices through a continuing professional development approach for community pharmacists. Int J Clin Pharm 2022; 44:1223-1231. [PMID: 35699862 PMCID: PMC9194772 DOI: 10.1007/s11096-022-01413-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Noncommunicable diseases account for the majority of all deaths and impose a high socioeconomic burden, causing disability and premature deaths. Pharmacists can contribute to the prevention and management of these diseases through the provision of pharmaceutical care services. AIM The aim of this study was to implement a nationwide practice developed by the Turkish Pharmacists' Association aiming to realize pharmaceutical care provision of standard quality to patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension at community pharmacies through a continuing professional development approach. SETTING Community pharmacies in Turkey. DEVELOPMENT A project with the involvement of all community pharmacists who were willing to participate was developed. After piloting, the 'project' turned into a 'practice' with a focus on asthma, chronic obstructive pulmonary disease, diabetes and hypertension management. IMPLEMENTATION The training process occurred as a peer-training activity. Consultants and academic staff trained the trainer pharmacists during a 3-day course. Community pharmacists (n = 6161) received training regarding pharmaceutical care, asthma, chronic obstructive pulmonary disease, diabetes and hypertension from their peer trainers (n = 341) and began to practice pharmaceutical care and follow-up of patients' outcomes on a regular basis. EVALUATION Among all community pharmacists in Turkey (n = 26,177), 24% attended training. Among these pharmacists, 21% started to implement practice. With community pharmacists' contribution to patient care, significant improvements in the majority of the outcome parameters regarding asthma, chronic obstructive pulmonary disease, diabetes and hypertension management were noted. CONCLUSION This first nationwide practice showed us that community pharmacists can help improve the health outcomes of patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension through the provision of pharmaceutical care services.
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24
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Santschi V, Wuerzner G, Pais B, Chiolero A, Schaller P, Cloutier L, Paradis G, Burnier M. Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial. Front Cardiovasc Med 2021; 8:760662. [PMID: 34760950 PMCID: PMC8572997 DOI: 10.3389/fcvm.2021.760662] [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: 08/18/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: We evaluated the effect on long term blood pressure (BP) of an interprofessional team-based care (TBC) intervention, involving nurses, pharmacists, and physicians, compared to usual care. Methods: We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC or usual care (UC). In the TBC group, nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle, support medication adherence, and provide health education for 6 months. After each visit, they wrote a report to the physician who could adjust antihypertensive therapy. The outcome was the intention-to-treat difference in mean daytime ambulatory blood pressure measurement (ABPM) and control (<135/85 mmHg) at 6 and 12 months. Results: Eighty-nine patients (60 men/29 women; mean (SD) age: 61(12) year) were randomized to TBC (n = 43) or UC (n = 46). At baseline, mean (SD) BP was 144(10)/90(8) mmHg and 147(12)/87(11) mmHg in the TBC and UC groups. At 6 months, the between-groups difference in daytime systolic ABPM was−3 mmHg [95% confidence interval (CI):−10 to +4; p = 0.45]; at 12 months, this difference was−7 mmHg [95% CI:−13 to−2; p = 0.01]. At 6 months, the between-groups difference in daytime diastolic ABPM was +2 mmHg [95% CI:−1 to +6; p = 0.20]; at 12 months, this difference was−2 mmHg [95% CI:−5 to +2; 0.42]. Upon adjustment for baseline covariates including baseline BP, the between-groups differences at 6 and 12 months were maintained. At 6 months, there was no difference in BP control. At 12 months, the TBC group tended to have a better control in systolic BP (p = 0.07) but not in diastolic BP (p = 0.33). Conclusion: While there was not significant effect on BP at 6 months of follow-up, the TBC intervention can help decrease long-term systolic BP among uncontrolled hypertensive patients.
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Affiliation(s)
- Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Bruno Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Gilles Paradis
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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25
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So R, Al Hamarneh YN, Oleksyn C, Purschke M, Tsuyuki RT. Impact of a "Pharmacist First" innovative workflow plan in patients with hypertension and/or diabetes. Can Pharm J (Ott) 2021; 154:376-380. [PMID: 34777646 PMCID: PMC8581804 DOI: 10.1177/17151635211016498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Usual community pharmacy workflow, whereby patients might see a pharmacist at the end of the dispensing process, is not conducive to proactive patient-centred care. The objective of this study was to evaluate the impact of the "Pharmacist First" (P1st) workflow model on blood pressure and glycemic control in patients with hypertension and/or diabetes. This retrospective review was set in 2 community pharmacies that use the P1st model in the Greater Edmonton Region. The population entailed patients with hypertension and/or type 1 or 2 diabetes who received care via the P1st workflow model. The P1st workflow model places the patient in immediate contact with the pharmacist. The pharmacist first assesses prescription appropriateness, reviews relevant laboratory tests, discusses chronic disease control and addresses any questions or concerns the patient has before passing the prescription to be filled by a technician. This allows issues or concerns to be identified and addressed up front, rather than waiting until the prescription is filled and the patient is ready to leave the pharmacy. The primary outcome assessed in this study was change in blood pressure and/or A1C from baseline to the last follow-up visit. We reviewed 215 patient records. The mean age was 69.4 years (standard deviation 12.5), 51.2% of patients were male, 57.7% had hypertension, 5.6% had diabetes, and 36.7% had both. Median follow-up time was 4.2 months (interquartile range 2.5-9.3). In 203 patients with hypertension, systolic blood pressure was reduced from 139.83 mmHg to 131.26 mmHg (p < 0.001) and diastolic blood pressure from 80.26 mmHg to 76.86 mmHg (p < 0.001). In 87 patients with diabetes, A1C changed from 7.4% to 7.2% (p = ns). The P1st workflow model demonstrated significant improvements in blood pressure. Further investigation is needed to evaluate the effectiveness of this model with a control group, longer follow-up and evaluation of the patient experience.
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Affiliation(s)
| | | | | | - Mary Purschke
- Mainstreet Home Health Pharmacy, Stony Plain, Alberta
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26
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Sola J, Vybornova A, Fallet S, Polychronopoulou E, Wurzner-Ghajarzadeh A, Wuerzner G. Validation of the optical Aktiia bracelet in different body positions for the persistent monitoring of blood pressure. Sci Rep 2021; 11:20644. [PMID: 34667230 PMCID: PMC8526831 DOI: 10.1038/s41598-021-99294-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 12/05/2022] Open
Abstract
The diagnosis of hypertension and the adjustment of antihypertensive drugs are evolving from isolated measurements performed at the physician offices to the full phenotyping of patients in real-life conditions. Indeed, the strongest predictor of cardiovascular risk comes from night measurements. The aim of this study was to demonstrate that a wearable device (the Aktiia Bracelet) can accurately estimate BP in the most common body positions of daily life and thus become a candidate solution for the BP phenotyping of patients. We recruited 91 patients with BP ranging from low to hypertensive levels and compared BP values from the Aktiia Bracelet against auscultatory reference values for 4 weeks according to an extended ISO 81060-2 protocol. After initializing on day one, the observed means and standard deviations of differences for systolic BP were of 0.46 ± 7.75 mmHg in the sitting position, − 2.44 ± 10.15 mmHg in the lying, − 3.02 ± 6.10 mmHg in the sitting with the device on the lap, and − 0.62 ± 12.51 mmHg in the standing position. Differences for diastolic BP readings were respectively of 0.39 ± 6.86 mmHg, − 1.93 ± 7.65 mmHg, − 4.22 ± 6.56 mmHg and − 4.85 ± 9.11 mmHg. This study demonstrates that a wearable device can accurately estimate BP in the most common body positions compared to auscultation, although precision varies across positions. While wearable persistent BP monitors have the potential to facilitate the identification of individual BP phenotypes at scale, their prognostic value for cardiovascular events and its association with target organ damage will need cross-sectional and longitudinal studies. Deploying this technology at a community level may be also useful to drive public health interventions against the epidemy of hypertension.
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Affiliation(s)
- Josep Sola
- Aktiia SA, Rue du Bassin 8a, 2000, Neuchâtel, Switzerland.
| | - Anna Vybornova
- Aktiia SA, Rue du Bassin 8a, 2000, Neuchâtel, Switzerland
| | - Sibylle Fallet
- Aktiia SA, Rue du Bassin 8a, 2000, Neuchâtel, Switzerland
| | - Erietta Polychronopoulou
- Service of Nephrology and Hypertension, CHUV - Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arlene Wurzner-Ghajarzadeh
- Service of Nephrology and Hypertension, CHUV - Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, CHUV - Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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27
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Marshall EG, Breton M, Cossette B, Isenor J, Mathews M, Ayn C, Smithman MA, Stock D, Frymire E, Edwards L, Green M. Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study. JMIR Res Protoc 2021; 10:e29984. [PMID: 34559672 PMCID: PMC8516155 DOI: 10.2196/29984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
Background The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. Objective The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. Methods The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. Results This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. Conclusions To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. International Registered Report Identifier (IRRID) DERR1-10.2196/29984
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Affiliation(s)
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Benoit Cossette
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Jennifer Isenor
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Caitlyn Ayn
- Primary Care Research Unit, Dalhousie Family Medicine, Halifax, NS, Canada
| | - Mélanie Ann Smithman
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - David Stock
- Primary Care Research Unit, Dalhousie Family Medicine, Halifax, NS, Canada
| | - Eliot Frymire
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | | | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,School of Policy Studies, Queen's University, Kingston, ON, Canada
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28
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Cao VF, Cowley E, Koshman SL, MacGillivray J, Sidsworth M, Turgeon RD. Pharmacist‐led optimization of heart failure medications: A systematic review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Vivien F.S. Cao
- Department of Pharmacy Vancouver General Hospital Vancouver Canada
| | - Emily Cowley
- Department of Pharmacy Alberta Health Services Edmonton Canada
| | - Sheri L. Koshman
- Division of Cardiology, Department of Medicine University of Alberta Edmonton Canada
| | | | | | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences University of British Columbia Vancouver Canada
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29
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Watson KE, Tsuyuki RT, Beahm NP, Sedore R, Bell A. Assessment of the educational competencies for the Hypertension Canada Professional Certification Program (HC-PCP) designed for implementation of hypertension guidelines into primary care. Can Pharm J (Ott) 2021; 154:271-277. [PMID: 34345320 PMCID: PMC8282914 DOI: 10.1177/17151635211016493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The uptake of clinical practice guidelines into practice is limited for many chronic conditions, including hypertension. The aim of this study was to ascertain the importance of the educational competencies for the development of the Hypertension Canada Professional Certification Program (HC-PCP) among frontline, primary care professionals (e.g., pharmacists, physicians, nurses). METHODS A group of hypertension experts developed 15 competencies believed to be important for primary care professionals to master when providing hypertension management. These competencies were surveyed for consensus by frontline clinicians through the Hypertension Canada e-newsletter in 2018. Clinicians were asked to rank the importance of each competency for a primary care provider to acquire when undertaking a certification in hypertension management, using a Likert scale from 1 (not important) to 5 (very important). RESULTS A total of 121 clinicians responded to the survey. Of these, 38% were pharmacists, 31.4% were registered nurses, 10.7% were physicians and 7% were nurse practitioners. There was at least 1 respondent from each Canadian province and territory, except for the Northwest Territories. All 15 competencies received a mean rank of at least 4. The competency with the highest ranking was Competency 6: Ability to screen and identify hypertension (mean 4.83 [0.04]). The competencies with the lowest average ranks were Competency 1: Demonstrates a sound knowledge of the epidemiology of hypertension (mean 4.07 [0.85]) and Competency 5: Demonstrates an understanding of the validation process for blood pressure devices (mean 4.15 [0.08]). CONCLUSIONS Clinicians generally ranked all 15 competencies to be of high importance for a provider who is certified in hypertension management to possess. These competencies and the current Hypertension Canada guidelines were used as the foundation for the development of an education program called the Hypertension Canada Professional Certification Program. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
| | - Ross T. Tsuyuki
- EPICORE Centre, University of Alberta,
Edmonton, Alberta
- Hypertension Canada, Toronto
| | - Nathan P. Beahm
- Department of Medicine, and the Faculty of
Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton,
Alberta
| | | | - Alan Bell
- Department of Family and Community Medicine,
University of Toronto, Toronto, Ontario
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30
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Wright DJ, Blyth A, Maskrey V, Norris N, Bond CM, Hughes CM, Alldred DP, Holland RC. Development and feasibility testing of an evidence-based training programme for pharmacist independent prescribers responsible for the medicines-related activities within care homes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:376-384. [PMID: 34018561 DOI: 10.1093/ijpp/riab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/20/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The UK pharmacists with independent prescribing rights (pharmacist independent prescribers [PIPs]) are authorised to prescribe within their areas of competence. To enable PIPs to provide pharmaceutical care to residents in care homes and assume responsibility for medicines management, a process for development and assessment of competence is required. The aim of this research was to develop a training and accreditation process (training programme) to enable PIPs to operate safely and effectively within care homes. METHODS Located in England, Scotland and Northern Ireland across four sites and based on a systematic review, it consisted of four phases: (1) initial stakeholder engagement, (2) uni-professional focus groups and interviews, (3) expert panel consensus and (4) feasibility testing. Four PIPs were trained each to provide pharmaceutical care to 10 care home residents. An expert panel synthesised the evidence at each stage to develop each iteration of the training programme. Content analysis was used throughout. RESULTS Differences in baseline knowledge of PIPs required inclusion of a Personal Development Framework and the provision of a mentor. Face-to-face training focussed on managing medicines for a complex older person, minimising prescribing costs and supporting people without capacity. Provision of time to understand local context and develop relationships with care homes and general practitioners was identified as a central requirement. PIPs were assessed for competency via viva. Feasibility testing demonstrated that the derived training programme was acceptable, practical and effective. DISCUSSION The model seemed to work, but due to small numbers, larger-scale testing of the training programme is now required.
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Affiliation(s)
- David J Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Annie Blyth
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Vivienne Maskrey
- School of Medicine, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Nigel Norris
- School of Education, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Christine M Bond
- General Practice & Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - David P Alldred
- School of Healthcare, University of Leeds, Leeds, UK
- Yorkshire and Humber NIHR Patient Safety Translational Research Centre/University of Leeds, Leeds, UK
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31
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Stewart B, Brody A, Garwood CL, Zhang L, Levy PD. Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study. Innov Pharm 2021; 12. [PMID: 34345511 PMCID: PMC8326696 DOI: 10.24926/iip.v12i2.3895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. Methods: This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. Results: There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). Conclusion: The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.
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Affiliation(s)
- Brittany Stewart
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University
| | - Aaron Brody
- Department of Emergency Medicine, School of Medicine and Integrative Biosciences Center, Wayne State University
| | - Candice L Garwood
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Department of Pharmacy, Harper University Hospital, Detroit Medical Center
| | - Liying Zhang
- Epidemiology Research Design Core, Department of Family Medicine and Public Health Sciences, Wayne State University
| | - Phillip D Levy
- Department of Emergency Medicine, School of Medicine and Integrative Biosciences Center, Wayne State University
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Perceptions of Independent Pharmacist Prescribing among Health Authority- and Community-Based Pharmacists in Northern British Columbia. PHARMACY 2021; 9:pharmacy9020092. [PMID: 33922521 PMCID: PMC8167577 DOI: 10.3390/pharmacy9020092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022] Open
Abstract
Pharmacists across Canada have varying degrees of ability to prescribe medications depending on their jurisdiction of licensure. The purpose of this study was to the evaluate attitudes, beliefs, and perceptions of independent pharmacist prescribing among health authority- and community-based pharmacists. This prospective, cross-sectional online survey assessed the perceptions of independent pharmacist prescribing of health authority and community pharmacists practising in northern British Columbia (BC), which was defined as within the geographical boundaries of Northern Health. Responses were analysed using descriptive statistics and a regression analysis. There were 45 respondents to the survey: 22 community pharmacists and 23 health authority pharmacists. Both community and health authority pharmacists held positive perceptions of independent pharmacist prescribing and did not identify any barriers to incorporating independent pharmacist prescribing into their practice. Respondents were highly likely to apply for independent pharmacist prescribing authority, if available. Pharmacists in BC are currently not able to independently prescribe schedule I medications. The provincial regulatory body has proposed a framework for a Certified Pharmacist Prescriber designation, which if approved would allow pharmacists to prescribe in collaborative practice settings. This study provides some insight into the perception of pharmacists in northern BC in pursuing this designation, which may be valuable for planning purposes in case of adoption of the framework. These results are also likely applicable to other non-urban practice settings in Canada. Pharmacists in northern BC perceived independent pharmacist prescribing positively and a high proportion were likely to apply for this authority if it were permitted via legislation.
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33
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Turgeon RD, Partovi N, Dahri K, Kuyper L, Au C. Development of a pharmacist-led internal medicine outpatient consult service. Can Pharm J (Ott) 2021; 154:83-86. [PMID: 33868518 DOI: 10.1177/1715163520985548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ricky D Turgeon
- Faculty of Pharmaceutical Sciences (Turgeon, Partovi, Dahri, Au), University of British Columbia, Vancouver.,Division of General Internal Medicine (Kuyper), University of British Columbia, Vancouver.,Department of Pharmacy (Turgeon, Partovi, Dahri, Au), Vancouver General Hospital, Vancouver, BC
| | - Nilu Partovi
- Faculty of Pharmaceutical Sciences (Turgeon, Partovi, Dahri, Au), University of British Columbia, Vancouver.,Division of General Internal Medicine (Kuyper), University of British Columbia, Vancouver.,Department of Pharmacy (Turgeon, Partovi, Dahri, Au), Vancouver General Hospital, Vancouver, BC
| | - Karen Dahri
- Faculty of Pharmaceutical Sciences (Turgeon, Partovi, Dahri, Au), University of British Columbia, Vancouver.,Division of General Internal Medicine (Kuyper), University of British Columbia, Vancouver.,Department of Pharmacy (Turgeon, Partovi, Dahri, Au), Vancouver General Hospital, Vancouver, BC
| | - Laura Kuyper
- Faculty of Pharmaceutical Sciences (Turgeon, Partovi, Dahri, Au), University of British Columbia, Vancouver.,Division of General Internal Medicine (Kuyper), University of British Columbia, Vancouver.,Department of Pharmacy (Turgeon, Partovi, Dahri, Au), Vancouver General Hospital, Vancouver, BC
| | - Charles Au
- Faculty of Pharmaceutical Sciences (Turgeon, Partovi, Dahri, Au), University of British Columbia, Vancouver.,Division of General Internal Medicine (Kuyper), University of British Columbia, Vancouver.,Department of Pharmacy (Turgeon, Partovi, Dahri, Au), Vancouver General Hospital, Vancouver, BC
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Al Hamarneh YN, Marra C, Gniadecki R, Keeling S, Morgan A, Tsuyuki R. R xIALTA: evaluating the effect of a pharmacist-led intervention on CV risk in patients with chronic inflammatory diseases in a community pharmacy setting: a prospective pre-post intervention study. BMJ Open 2021; 11:e043612. [PMID: 33762234 PMCID: PMC7993291 DOI: 10.1136/bmjopen-2020-043612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed. OBJECTIVE To evaluate the effect of a pharmacist-led intervention on CV risk in patients with inflammatory conditions. METHODS DESIGN: Prospective pre-postintervention. SETTING 17 community pharmacies across Alberta. POPULATION Adults with inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, systemic lupus erythematosus, psoriasis vulgaris) who had at least one uncontrolled risk factor (A1C, blood pressure, LDL-cholesterol or current tobacco users). INTERVENTION All patients enrolled in the study received: physical and laboratory assessment, individualised CV risk assessment and education regarding this risk, treatment recommendations, prescription adaptation and prescribing where necessary to meet treatment targets, regular communication with the patient's treating physician(s) and regular follow-up with all patients every month for 6 months. OUTCOMES Primary: change in estimated CV risk (risk of a major CV event in the next 10 years) after 6 months. Secondary: change in individual risk factors (blood pressure, LDL-cholesterol, A1C and tobacco cessation) over a 6-month period. RESULTS We enrolled 99 patients. The median age was 66.41 years (IQR 57.64-72.79), More than half of them (61%) were female and more than three-quarters (86%) were Caucasians. After adjusting for age, sex and ethnicity and centre effect, there was a reduction of 24.5% in CV risk (p<0.001); including a reduction of 0.3 mmol/L in LDL-c (p<0.001), 10.7 mm Hg in systolic blood pressure (p<0.001), 1.25% in A1C (p<0.001). There was a non-significant trend towards tobacco cessation. CONCLUSION This is the first study on CV risk reduction in patients with inflammatory conditions in a community pharmacy setting. RxIALTA provides evidence for the benefit of pharmacist care on global cardiovascular risk reduction as well as the individual cardiovascular risk factors in patients with inflammatory conditions. TRIAL REGISTRATION NUMBER NCT03152396.
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Affiliation(s)
| | - Carlo Marra
- Faculty of Pharmacy, University of Otago, Dunedin, New Zealand
| | | | | | | | - Ross Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Miller MJ, Pammett RT. A scoping review of research on Canadian team-based primary care pharmacists. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:106-115. [PMID: 33729533 DOI: 10.1093/ijpp/riaa021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES An ageing population with an increasing prevalence of chronic disease and complex medication regimens has placed a strain on healthcare systems in Canada. A limited number of team-based primary care pharmacists are integrated into primary care clinics across the country, working alongside other members of the health care team to identify and resolve drug therapy problems and improve outcomes. While many studies have been completed in the area, the extent of research on integrated team-based primary care pharmacists in Canada is unknown. The objectives of this work were to describe the literature that exists surrounding pharmacists in a primary health care team setting in Canada. A scoping review of research focusing on pharmacists in team-based primary health care settings in Canada was performed. Thematic analysis was then performed to categorize the identified studies. KEY FINDINGS The search identified 874 articles, of which 93 met inclusion criteria relevant to the objective. From these 93 studies, 4 themes and 23 subthemes were identified, with some studies having more than one theme or subtheme. Themes identified were the following: primary care pharmacist scope of practice (n = 79 studies), collaboration/communication within the primary care setting (n = 26), chronic disease management (n = 24) and 'other' (n = 15). SUMMARY This research quantified and categorized 93 studies on pharmacists in interprofessional primary care teams in Canada. As this is an expanding role for pharmacists in Canada, understanding the current state of the literature is an important consideration when developing future team-based primary care roles.
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Affiliation(s)
| | - Robert T Pammett
- Northern Health Authority, Prince George, British Columbia, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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36
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Watson KE, Al Hamarneh YN, Rabi D, Daskalopoulou SS, Tsuyuki RT. Hypertension Canada's 2020 hypertension guidelines for pharmacists: An update. Can Pharm J (Ott) 2021; 154:19-25. [PMID: 33598055 DOI: 10.1177/1715163520975809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kaitlyn E Watson
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Yazid N Al Hamarneh
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Doreen Rabi
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
| | | | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Alberta
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Varas-Doval R, Saéz-Benito L, Gastelurrutia MA, Benrimoj SI, Garcia-Cardenas V, Martinez-Martínez F. Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies. BMC Health Serv Res 2021; 21:156. [PMID: 33596906 PMCID: PMC7890900 DOI: 10.1186/s12913-021-06150-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.
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Affiliation(s)
- R Varas-Doval
- Spanish General Pharmaceutical Council, Villanueva 11, 28001, Madrid, Spain.
| | - L Saéz-Benito
- Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, Zaragoza, Spain.,Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - M A Gastelurrutia
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - S I Benrimoj
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - V Garcia-Cardenas
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain.,Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Sydney, NSW, Australia
| | - F Martinez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
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Primary care provider perceptions of an integrated community pharmacy hypertension management program. J Am Pharm Assoc (2003) 2020; 61:e107-e113. [PMID: 33353833 DOI: 10.1016/j.japh.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/20/2020] [Accepted: 11/29/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Trained community pharmacists provided hypertension (HTN) management services in collaboration with a patient-centered medical home (PCMH). OBJECTIVE To explore primary care provider (PCP) perceptions of a HTN management program in which patients at the PCMH with elevated blood pressure could choose to receive follow-up care with a trained community pharmacist at a chain community pharmacy. METHODS We conducted informal interviews with 8 PCPs with a range of level of involvement with the collaborative HTN management program to inform the development of a 13-question online survey that was distributed to PCPs at 10 participating Michigan Medicine PCMH clinics. The primary outcome was the percent of PCPs who reported that the program improved their patient's blood pressure. Secondary outcomes included awareness of the program, alternative follow-up strategies, PCP satisfaction, and barriers to using the program. RESULTS A total of 39 PCPs (30.0%) responded to the survey. More than one-half (n = 21 of 39, 53.9%) of respondents reported that at least 1 of their patients had seen a trained community pharmacist for HTN management services. Almost all of these PCPs (n = 19 of 21, 90.5%) reported being satisfied with the program, and 80.9% (n = 17 of 21) agreed that it helped patients improve their blood pressure control. The most common barriers identified were patients preferring to follow up directly with their PCP (n = 18 of 39, 46.2%), PCPs being more comfortable with patients having a visit with an embedded ambulatory care pharmacist (n = 16 of 39, 41.0%), and a lack of written materials to share with patients about the program (n = 15 of 39, 38.5%). CONCLUSION PCPs who used the integrated community pharmacy HTN management program were satisfied with the program and thought that it resulted in improved blood pressure control. PCPs may benefit from written information to share with their patients as well as education to increase their awareness of the program and its beneficial effect on patient blood pressure.
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DeRemer CE, Reiter J, Olson JL. Transitioning ambulatory care pharmacy services to telemedicine while maintaining multidisciplinary collaborations. Am J Health Syst Pharm 2020; 78:371-375. [DOI: 10.1093/ajhp/zxaa427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christina E DeRemer
- Department of Pharmacotherapy and Translational Research University of Florida College of Pharmacy Gainesville, FL, USA
| | - Jennifer Reiter
- Indiana University Health Southern Indiana Physicians Ellettsville, IN, USA
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40
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Woit C, Yuksel N, Charrois TL. Pharmacy and medical students' competence and confidence with prescribing: A cross-sectional study. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:1311-1319. [PMID: 32867929 DOI: 10.1016/j.cptl.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Previous research has shown that prescribing competence is weakly correlated with prescribing confidence. This questions whether undergraduate programs adequately prepare students and junior practitioners for safe and rational prescribing. The goal of this project was to investigate whether there are differences in prescribing competence and confidence between fourth year pharmacy and medical students at the University of Alberta. METHODS A cross-sectional design measured prescribing competence using five case scenarios and prescribing confidence with a survey. All fourth-year pharmacy and medical students at the University of Alberta were eligible to participate. Answers to the cases were graded based on therapeutic appropriateness and inclusion of all legal requirements. The confidence survey assessed self-rated confidence of both assessment and prescribing skills. Chi-square tests were used to compare frequencies of prescribing errors and self-rated confidence. The Spearman correlation coefficient was used to explore the correlation between prescribing competence and confidence for both cohorts independently. RESULTS Thirty-one pharmacy students and 16 medical students (response rate 24% and 10%, respectively) completed the assessment between December 2018 and March 2019. Pharmacy students had significantly more appropriate prescriptions and fewer inappropriate prescriptions than medical students. Both rated themselves as confident or very confident with prescribing, however neither group consistently included all the legal requirements of a prescription. There were no significant correlations between competence and confidence. CONCLUSIONS There are differences in prescribing competence and confidence between pharmacy and medical students. This assessment identified deficits in prescribing skills that could be targeted by future educational initiatives.
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Affiliation(s)
- Cassandra Woit
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Nese Yuksel
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Theresa L Charrois
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
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41
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Necyk C, Johnson JA, Minhas-Sandhu J, Tsuyuki RT, Eurich DT. Evaluation of comprehensive annual care plans by pharmacists in Alberta for patients with complex conditions. J Am Pharm Assoc (2003) 2020; 60:1029-1036.e1. [PMID: 32962900 DOI: 10.1016/j.japh.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the population of patients who received a pharmacist-billed comprehensive annual care plan (CACP) in Alberta and to evaluate any changes in health care use for such patients, including physician visits, hospitalizations, and emergency department (ED) visits. METHODS We used administrative data from Alberta Health to identify all individuals in Alberta who received a pharmacist CACP between July 1, 2012, and March 31, 2015. Two control patients were identified for each CACP patient, matched on age, sex, provider, date of service, and qualifying conditions. Controlled interrupted time series analyses were used to evaluate changes in physician visits, all-cause and ambulatory care-sensitive condition (ACSC)-related hospitalizations, and ED visits in the 12 months before and after the CACP index date. RESULTS Between July 1, 2012, and March 31, 2015, 188,640 pharmacy CACPs were billed in Alberta. Of these, 137,178 CACP patients were matched to 241,658 control patients. Those who received a CACP were associated with an overall decrease in all-cause hospitalizations, ACSC-related ED visits, and physician visits (181, 144, and 1206 events per 10,000 people, respectively, P < 0.05) compared with controls. However, among those who received a CACP, all-cause ED visits and ACSC-related hospitalizations increased by 40.1 and 8 visits per 10,000, respectively (P < 0.05), compared with controls. CONCLUSION The uptake of the pharmacy CACP remuneration model has been substantial since 2012. Overall, the CACP philosophy of a single yearly assessment has demonstrated limited impact on major health care use.
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Nakanishi M, Mizuno T, Mizokami F, Koseki T, Takahashi K, Tsuboi N, Katz M, Lee JK, Yamada S. Impact of pharmacist intervention for blood pressure control in patients with chronic kidney disease: A meta-analysis of randomized clinical trials. J Clin Pharm Ther 2020; 46:114-120. [PMID: 32949161 DOI: 10.1111/jcpt.13262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Hypertension (HTN) and chronic kidney disease (CKD) are recognized as silent killers because they are asymptomatic conditions that contribute to the burden of multiple comorbidities. The achievement of a blood pressure (BP) goal can dramatically reduce the risks of CKD. In this study, we aimed to assess the effectiveness of pharmacist intervention on BP control in patients with CKD and evaluate the usefulness of home-based BP telemonitoring. METHODS The terms "chronic kidney disease," "pharmacist," "BP" and "randomized controlled trial (RCT)" were used five databases to search for information regarding pharmacist intervention on BP control in patients with CKD. The inclusion criteria were as follows: (a) studies for adult patients with uncontrolled HTN and (b) studies with adequate data for meta-analysis. The primary outcome was an evaluation of achievement of BP goal in patients with CKD. The secondary outcome was usefulness of home-based BP telemonitoring by pharmacists in patients with CKD. RESULTS AND DISCUSSION Six RCTs were identified and included in the meta-analysis with a total of 2573 patients (mean age 66.0 years and 63.9% male). Pharmacist interventions resulted in significantly better BP control vs usual care (OR = 1.53, 95% CI = 1.15-2.04, P < .01). Pharmacist interventions using home-based BP telemonitoring were significantly superior to control/usual care (OR = 2.03, 95% CI = 1.49-2.77, P < .01), whereas pharmacist interventions without home-based BP telemonitoring did not significantly improve BP control compared to that with control/usual care (OR = 1.30, 95% CI = 0.97-1.75, P = .08). Home-based BP telemonitoring supported team-based care for HTN in these studies. In addition, patient self-monitoring with telemedicine devices might enhance patients' abilities to manage their condition by pharmacist instruction. WHAT IS NEW AND CONCLUSION The findings of this meta-analysis showed that pharmacist interventions with home-based BP telemonitoring improve BP control among adult patients with CKD.
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Affiliation(s)
- Masanori Nakanishi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan.,Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomohiro Mizuno
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takenao Koseki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuo Takahashi
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Michael Katz
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Jeannie K Lee
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
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Barton A, Dersch-Mills D, Saunders S, Mysak T, Zuk D. Pharmacist Prescribing in Pediatric and Neonatal Acute Care: An Observational Study. J Pediatr Pharmacol Ther 2020; 25:600-605. [DOI: 10.5863/1551-6776-25.7.600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
The intent of this project was to objectively describe the frequency of pharmacist prescribing in acute care pediatrics and neonatology and to determine the medications most often prescribed by pharmacists practicing in a jurisdiction that permits pharmacists' prescribing.
METHODS
This was a subgroup analysis of a retrospective observational study using prescribing data from an electronic medical record system used in 5 acute care hospitals (1 pediatric, 4 primarily adult but with pediatric and neonatal units) within Calgary, Alberta, Canada.
RESULTS
Considering orders for pediatric or neonatal patients only, there was a mean (SD) of 126 (226) prescriptions per pharmacist per year, with a wide range (1–1101 per year). Considering only the 9 clinical pharmacist full-time equivalents (FTEs) assigned to pediatrics and/or neonatology (i.e., not including dispensary pharmacist FTE), this represents 572 prescriptions per clinical pharmacist FTE per year (726 in pediatrics and 380 in neonatology). The most common medication classes on pediatric units included anti-infective agents, central nervous system agents, and gastrointestinal agents. In NICUs, blood formation, coagulation and thrombosis agents (mainly iron), electrolytes, caloric and water balance agents (primarily sodium supplements), and vitamins were also commonly prescribed by pharmacists.
CONCLUSIONS
As the scope of pharmacy practice expands to include prescribing, health team leadership can use these data to support incorporation of this role into practice. Prescribing pharmacists can ensure appropriate use of many medications used in acutely ill infants and children, potentially improving efficiency and quality of care.
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Campbell NRC, Dattani S, Bell A, Gelfer M, Cloutier L, Petrella R, Lindsay P, Leung AA, McLean D, Kaczorowski J, Tsuyuki RT. Urgent need to increase the rates of diagnosing, treating and controlling hypertension in older women: A call for action. Can Pharm J (Ott) 2020; 153:264-269. [PMID: 33110465 DOI: 10.1177/1715163520947006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Norm R C Campbell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Shelita Dattani
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alan Bell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Mark Gelfer
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Lyne Cloutier
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Robert Petrella
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Patrice Lindsay
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alexander A Leung
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Donna McLean
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Janusz Kaczorowski
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Ross T Tsuyuki
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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Abdallah O, Ageeb RA, Elkhalifa WHI, Zolezzi M, El-Awaisi A, Diab MI, Awaisu A. Evaluating prescribing competencies covered in a Canadian-accredited undergraduate pharmacy program in Qatar: a curriculum mapping process. BMC MEDICAL EDUCATION 2020; 20:253. [PMID: 32762671 PMCID: PMC7409697 DOI: 10.1186/s12909-020-02109-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/09/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the existing Bachelor of Science in Pharmacy [BSc (Pharm)] curriculum at Qatar University College of Pharmacy (QU CPH), for addressing international prescribing competencies. METHODS The Australian National Prescribing Service (NPS MedicineWise) Competencies Required to Prescribe Medicines framework (the Prescribing Competencies Framework) was used in the BSc (Pharm) curriculum mapping process. The NPS MedicineWise Prescribing Competencies Framework outlines seven competency areas that are essential for pharmacist prescribing. The first mapping activity assessed the learning outcomes (LOs) of 62 courses within the BSc (Pharm) curriculum for covering and addressing the NPS MedicineWise competencies. The second mapping activity involved matching the LOs identified to address the NPS MedicineWise prescribing competencies, to the 2017 Association of Faculties of Pharmacy of Canada (AFPC) educational outcomes, on which the QU CPH BSc (Pharm) program is based. The AFPC educational outcomes address seven key program-level learning outcomes. RESULTS The QU CPH BSc (Pharm) curriculum addresses most of the prescribing competencies listed in the NPS MedicineWise Prescribing Competencies Framework. However, gaps were identified in the curricular content and in the LOs that were related, but not restricted, to the following: electronic prescribing, physical examinations/preparing patients for investigations, and policies/procedures and quality assurace related to prescribing. Other gaps identified include legislative and workplace requirements for obtaining consent to access confidential patient's health information. CONCLUSION The curriculum mapping exercise provided evidence that, for the most part, the existing BSc (Pharm) curriculum at QU CPH prepares pharmacy graduates for prescribing. However, there are areas that need better alignment between the taught curriculum and training on prescribing in practice. The results of this study are important to consider if pharmacist prescribing is to be implemented in Qatar.
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Affiliation(s)
- Oraib Abdallah
- Mental Health Services, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Rwedah Anwar Ageeb
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | | | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Alla El-Awaisi
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | | | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
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Bufalino VJ, Bleser WK, Singletary EA, Granger BB, O'Brien EC, Elkind MSV, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N. Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative. Circ Cardiovasc Qual Outcomes 2020; 13:e006780. [PMID: 32683982 DOI: 10.1161/circoutcomes.120.006780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is one of the leading causes of morbidity and mortality in the United States. While age-adjusted stroke mortality was falling, it has leveled off in recent years due in part to advances in medical technology, health care options, and population health interventions. In addition to adverse trends in stroke-related morbidity and mortality across the broader population, there are sociodemographic inequities in stroke risk. These challenges can be addressed by focusing on predicting and preventing modifiable upstream risk factors associated with stroke, but there is a need to develop a practical framework that health care organizations can use to accomplish this task across diverse settings. Accordingly, this article describes the efforts and vision of the multi-stakeholder Predict & Prevent Learning Collaborative of the Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. This article presents a framework of a potential upstream stroke prevention program with evidence-based implementation strategies for predicting, preventing, and managing stroke risk factors. It is meant to complement existing primary stroke prevention guidelines by identifying frontier strategies that can address gaps in knowledge or implementation. After considering a variety of upstream medical or behavioral risk factors, the group identified 2 risk factors with substantial direct links to stroke for focusing the framework: hypertension and atrial fibrillation. This article also highlights barriers to implementing program components into clinical practice and presents implementation strategies to overcome those barriers. A particular focus was identifying those strategies that could be implemented across many settings, especially lower-resource practices and community-based enterprises representing broad social, economic, and geographic diversity. The practical framework is designed to provide clinicians and health systems with effective upstream stroke prevention strategies that encourage scalability while allowing customization for their local context.
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Affiliation(s)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Elizabeth A Singletary
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Bradi B Granger
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Emily C O'Brien
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Robert S Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Mark B McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., E.A.S., B.B.G., E.C.O., M.H.L., R.S.S., M.B.M.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
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Wright DJ, Maskrey V, Blyth A, Norris N, Alldred DP, Bond CM, Desborough J, Hughes CM, Holland RC. Systematic review and narrative synthesis of pharmacist provided medicines optimisation services in care homes for older people to inform the development of a generic training or accreditation process. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:207-219. [PMID: 31713918 PMCID: PMC7317947 DOI: 10.1111/ijpp.12591] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop a training programme to enable pharmacists with prescribing rights to assume responsibility for the provision of pharmaceutical care within care homes, a systematic review and narrative synthesis was undertaken to identify reported approaches to training pharmacists and use this literature to identify potential knowledge requirements. METHODS A PROSPERO-registered systematic review was performed using key search terms for care homes, pharmacist, education, training and pharmaceutical care. Papers reporting primary research focussed on care of the older person within the care home setting were included. No restrictions were placed on methodology. Two researchers independently reviewed titles, abstracts and papers. Agreement on inclusion was reached through consensus. Data on titles, training and activities undertaken were extracted and knowledge requirements identified. Findings were synthesised and reported narratively. KEY FINDINGS Fifty-nine papers were included, most of which were uncontrolled service evaluations. Four papers reported an accreditation process for the pharmacist. Thirteen papers reported providing tools or specific training on a single topic to pharmacists. The main clinical and therapeutic areas of activity (requiring codified knowledge) were dementia, pain, antipsychotic and cardiovascular medication. Provision of pharmaceutical care, effective multidisciplinary working and care home staff training represented the main areas of practical knowledge. CONCLUSIONS Information regarding training and accreditation processes for care home pharmacists is limited. This study provides insight into potential codified and practical knowledge requirements for pharmacists assuming responsibility for the provision of pharmaceutical care within care homes. Further work involving stakeholders is required to identify the cultural knowledge requirements and to develop a training and accreditation process.
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Affiliation(s)
- David John Wright
- School of PharmacyUniversity of East AngliaNorwich Research ParkNorwichUK
| | - Vivienne Maskrey
- School of MedicineUniversity of East AngliaNorwich Research ParkNorwichUK
| | - Annie Blyth
- School of PharmacyUniversity of East AngliaNorwich Research ParkNorwichUK
| | - Nigel Norris
- School of Education & Lifelong LearningUniversity of East AngliaNorwich Research ParkNorwichUK
| | | | - Christine M. Bond
- Centre of Academic and Primary CareThe Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - James Desborough
- School of PharmacyUniversity of East AngliaNorwich Research ParkNorwichUK
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Abdul Aziz YH, Heydon SJ, Duffull SB, Marra CA. What free services do pharmacists offer? Investigating the provision of unfunded pharmacy services in community pharmacies. Res Social Adm Pharm 2020; 17:588-594. [PMID: 32461164 DOI: 10.1016/j.sapharm.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Globally, pharmacists report to be providing free or partially subsidised patient-focused services in order to meet healthcare needs of their communities. Budget cuts to pharmacy contracts are reported to challenge the provision of such services. Limited information exists identifying the types of unfunded services provided in community pharmacies. OBJECTIVES To identify the types of services which pharmacists report to provide that are not reimbursed by the government, insurance companies or paid for by the patient. METHODS Semi-structured focus group discussions with pharmacists were conducted stimulating narratives from community pharmacists across New Zealand about the types of unfunded pharmacy services they provide. Discussions were audio recorded and transcribed verbatim. Inductive coding of the data was carried out using QSR International Nvivo 11 for Windows. A semantic thematic analysis was carried out. RESULTS Twenty-four pharmacists took part in the focus groups across five regions in both the North and South Islands of New Zealand. Key themes identified from focus groups were: 'Standalone unfunded services', 'Services funded elsewhere' and 'Leakages from the current funding model'. Pharmacists reported that unfunded patient-focused services accounted for 15%-50% of their daily activities. Pharmacists stated that they believed these services often led to reduction of disease progression, hospitalisations and improved quality of life. Pharmacists also stated that given budget cuts, these services are not sustainable. CONCLUSIONS Pharmacists report to offer many professional services without remuneration. In some cases, these services make up a substantial part of the pharmacist's time. Further budgetary constraints and increased competition may put these services at risk of being lost. Findings from this study can be applied to unfunded pharmacy services elsewhere, as worldwide pharmacy faces many similar challenges, particularly where there are budget cuts and decreasing revenue in other jurisdictions.
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Affiliation(s)
| | - Susan J Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | | | - Carlo A Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Stallings AM, Dixon C, Carter A, Ali A, Herring C. Evaluation of a Pharmacist-Managed Hypertension Clinic in a Rural Primary Care Setting. J Pharm Pract 2020; 34:844-849. [PMID: 32452264 DOI: 10.1177/0897190020926841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe clinical pharmacy services provided in a rural North Carolina primary care clinic and assess the impact of these services on systolic and diastolic blood pressures in patients with uncontrolled hypertension. METHODS This single-center, retrospective study evaluated change in systolic and diastolic blood pressures from baseline, percentage of patients with blood pressure reductions, percentage at The Eight Joint National Committee (JNC 8) goal blood pressure, percentage at care gap closure defined as obtaining a blood pressure <140/90 mm Hg, and time to reach care gap closure. RESULTS The mean change in systolic blood pressure was -20.1 mm Hg (14.716-25.418, P < .0001) and the mean change in diastolic blood pressure was -8.8 mm Hg (5.449-12.117, P < .0001). Eighty percent of patients experienced blood pressure reductions from baseline, 51% met their respective JNC 8 goal blood pressure, and 48% met care gap closure. The average time to reach care gap closure was 23 weeks. CONCLUSION When embedded within a primary care clinic in a rural setting, a pharmacist-managed hypertension clinic significantly improved both systolic and diastolic blood pressures of patients with uncontrolled hypertension.
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Affiliation(s)
- Ashley M Stallings
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Candace Dixon
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Amanda Carter
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Asima Ali
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Charles Herring
- Department of Pharmacy, Campbell College of Pharmacy and Health Sciences, Buies Creek, NC, USA
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50
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Shin J, Moczygemba LR, Barner JC, Garza A, Linedecker-Smith S, Srinivasa M. Patient experience with clinical pharmacist services in Travis County Federally Qualified Health Centers. Pharm Pract (Granada) 2020; 18:1751. [PMID: 32377276 PMCID: PMC7194041 DOI: 10.18549/pharmpract.2020.2.1751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/13/2020] [Indexed: 11/14/2022] Open
Abstract
Background Positive patient experiences with care have been linked to improved health outcomes. Patient experience surveys can provide feedback about the level of patient-centered care provided by clinical pharmacists and information about how to improve services. Objectives Study objectives are: 1) To describe patient experience with clinical pharmacist services in a federally qualified health center (FQHC). 2) To determine if demographic or health-related factors were associated with patient experience. Methods This cross-sectional survey included adult patients who were English or Spanish speaking, and completed a clinical pharmacist visit in March or April 2018. Patient experience was evaluated, on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with 10 items using four domains: pharmacist-patient interaction information provision, support for self-care, and involvement in decision making. In addition, one item was used to rate the overall experience. Demographic and health-related variables were also collected. Eligible patients completed the survey after their clinical pharmacist visit. Descriptive and inferential statistics, as well as Cronbach's alpha for scale reliability, were employed. Results Respondents (N=99) were 55.4 (SD=12.1) years and 53.1% were women. Overall, patients rated their experiences very high with the 10-item scale score of 4.8 (SD=0.4) out of 5 points and the overall experience rating of 4.9 (SD=0.4) out of 5 points. With the exception of race, there were no differences between patient experience and demographic and health-related variables. African Americans had significantly (p=0.0466) higher patient experience scores compared to Hispanics. Conclusions Patients receiving care in a FQHC highly rated their experience with clinical pharmacists. This indicates that clinical pharmacists provided a high level of patient-centered care to a diverse group.
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Affiliation(s)
- Jennifer Shin
- PharmD. Clinical Pharmacist Specialist. Memorial Hermann-Texas Medical Center. Houston, TX (United States).
| | - Leticia R Moczygemba
- PharmD, PhD. Associate Professor. Health Outcomes Division, College of Pharmacy, University of Texas. Austin, TX (United States).
| | - Jamie C Barner
- PhD. Professor and Division Head. Health Outcomes Division, College of Pharmacy, University of Texas. Austin, TX (United States).
| | - Aida Garza
- PharmD, CDE, BCACP. Associate Pharmacy Director, Pharmacy Residency Program Director. CommUnityCare Health Centers. Austin, TX (United States).
| | - Sara Linedecker-Smith
- PharmD, BCACP. Clinical Pharmacist. CommUnityCare Health Centers. Austin, TX (United States).
| | - Maaya Srinivasa
- PharmD, BCACP, CDE. Clinical Pharmacist. CommUnityCare Health Centers. Austin, TX (United States).
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