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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Osae SP, Chastain DB, Young HN. Pharmacist role in addressing health disparities—Part 2: Strategies to move toward health equity. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sharmon P. Osae
- College of Pharmacy University of Georgia Albany Georgia USA
| | | | - Henry N. Young
- College of Pharmacy University of Georgia Athens Georgia USA
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Lewis J, Nguyen T, Althobaiti H, Alsheikh MY, Borsari B, Cooper S, Kim DS, Seoane-Vazquez E. Impact of an Advanced Practice Pharmacist Type 2 Diabetes Management Program: A Pilot Study. Innov Pharm 2019; 10:10.24926/iip.v10i4.2237. [PMID: 34007588 PMCID: PMC8051896 DOI: 10.24926/iip.v10i4.2237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the impact of an Advanced Practice Pharmacist (APh) on lowering hemoglobin A1c (HbA1c) in patients with type 2 diabetes within a patient centered medical home (PCMH) and to classify the types of therapeutic decisions made by the APh. METHODS This was a retrospective study using data from electronic health records. The study evaluated a partnership between Chapman University School of Pharmacy and Providence St. Joseph Heritage Healthcare that provided diabetes management by an Advanced Practice Pharmacist in a PCMH under a collaborative practice agreement. Change in the HbA1c was the primary endpoint assessed in this study. The type of therapeutic decisions made by the APh were also evaluated. Descriptive analysis and Wilcoxon signed ranktest were used to analyze data. RESULTS The study included 35 patients with diagnosis of type 2 diabetes mellitus managed by an APh from May 2017 to December 2017. Most of the patients were 60-79 years old (68.5%), 45.7% were female, and 45.7% were of Hispanic/Latino ethnicity. The average HbA1cwas 8.8%±1.4% (range=6.0%-12.4%) and 7.5%±1.4% (range=5.5%-12.4%) at the initial and final APh visit, respectively (p<0.0001). Therapeutic decisions made by the APh included drug dose increase (35.5% of visits), drug added (16.4%), drug dose decrease (6.4%), drug switch (5.5%), and drug discontinuation (1.8%). CONCLUSION The Advanced Practice Pharmacist's interventions had a significant positive impact on lowering HbA1c in patients with type 2 diabetes mellitus in a PCMH. The most common therapeutic decisions made by the APh included drug dose increase and adding a new drug.
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Affiliation(s)
| | | | | | | | | | | | - David S. Kim
- Providence St. Joseph Health Physician Enterprise
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McNamara A, Chan LLS, Wong SL. Primary Care Provider Perceptions of Pharmacist Services in an Urban, Safety Net Health System. J Pharm Pract 2019; 33:790-798. [PMID: 30979341 DOI: 10.1177/0897190019838422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While pharmacists have provided services in a multidisciplinary, primary care setting for decades, few publications have yet to evaluate providers' impressions of- these services. An anonymous 14-item survey distributed to nonresident primary care providers aimed to identify clinical pharmacist services that are most and least helpful to primary care providers, identify barriers to pharmacy services, and develop recommendations to improve pharmacy services in primary care. The most important pharmacist contribution identified by providers is medication management, whereas the least important contributions are case conference, panel management, quality improvement, and transition of care. The primary reasons for referrals to pharmacists included inadequately controlled chronic diseases, poor or questionable adherence, longer visits for more in-depth discussion, and complex regimen requiring frequent monitoring or titration. Providers favored pharmacists working in direct patient care versus indirect patient care activities. Although many providers perceived no barriers to pharmacist service access, pharmacists' presence and visibility were 2 barriers identified. Most providers preferred comprehensive to disease-specific medication management.
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Affiliation(s)
- Anusha McNamara
- 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Lenny L S Chan
- 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - Shirley L Wong
- Department of Clinical Pharmacy, School of Pharmacy, 209683University of California, San Francisco, San Francisco, CA, USA
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The development of a role description and competency map for pharmacists in an interprofessional care setting. Int J Clin Pharm 2019; 41:391-407. [DOI: 10.1007/s11096-019-00808-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
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dos Santos Júnior GA, Ramos SF, Pereira AM, Dosea AS, Araújo EM, Onozato T, Pimentel DMM, de Lyra DP. Perceived barriers to the implementation of clinical pharmacy services in a metropolis in Northeast Brazil. PLoS One 2018; 13:e0206115. [PMID: 30346979 PMCID: PMC6197690 DOI: 10.1371/journal.pone.0206115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/08/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND CLinical pharmacy services (CPS) are professional services provided by pharmacists, who use their skills and knowledge to take an active role in patient health. These services have expanded in health systems around the world. However, it is important to have a comprehensive understanding of factors that may hinder the implementation of CPS in health systems. OBJECTIVE To identify pharmacists' and managers' perceptions of barriers regarding the implementation of CPS in some public health units in a metropolis in Northeast Brazil. METHODS This is a qualitative study based on focus groups and semi-structured, face-to-face, in-depth interviews. Participants were health-system pharmacists and managers, selected based on their direct participation in the implementation process. Focus groups were carried out with the pharmacists, and interviews were carried out with managers. The audio and videos were transcribed verbatim in full, and were independently analyzed using content analysis. This study was approved by the Brazilian Committee of Ethics in Research and all participants signed informed consent forms. FINDINGS There were two focus groups and five interviews. The discussions generated 240 minutes of recordings. The health-system pharmacists and managers expressed barriers were allocated into five categories to facilitate a comprehensive understanding of the implementation of CPS; these barriers were related to: the local healthcare networks, the healthcare team, the pharmacists, the implementation process, and the patients. CONCLUSIONS This study revealed the perceptions of barriers associated with the participants involved in the implementation of CPS in some public health units in a metropolis in Northeast Brazil. The barriers reflect the challenges to be overcome in the CPS implementation process in the health systems.
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Affiliation(s)
- Genival Araujo dos Santos Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - André Mascarenhas Pereira
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Aline Santana Dosea
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Elton Matos Araújo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Thelma Onozato
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
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Ramos SF, Santos Júnior GAD, Pereira AM, Dosea AS, Rocha KSS, Pimentel DMM, Lyra-Jr DPD. Facilitators and strategies to implement clinical pharmacy services in a metropolis in Northeast Brazil: a qualitative approach. BMC Health Serv Res 2018; 18:632. [PMID: 30103749 PMCID: PMC6090582 DOI: 10.1186/s12913-018-3403-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background Clinical Pharmacy Services (CPS) are a reality in many health systems around the world. However, there are few studies that discuss the facilitators and the strategies to implement CPS in healthcare systems. In this way, the objective of this study was to identify the facilitators and strategies involved in the CPS implementation process in some public health units in a metropolis in the Northeast Brazil. Methods A qualitative study was carried out with health-system pharmacists and managers who experienced the implementation of CPS. Therefore, focus groups were conducted with pharmacists, and the interviews with the managers. The discussions were carried out through semi-structured scripts and were recorded in audio and videos, after the signature of the consent form. The recordings were transcribed and analyzed independently through content analysis, followed by consensus meetings between researchers. Results Two focus groups were conducted, with an average of seven pharmacists per group, and five interviews with local health managers. Participants reported 39 facilitators who were related to the categories: local healthcare network, healthcare team, pharmacists and implementation process of the CPS. And 21 strategies attributed to the following categories: local healthcare network, pharmacists and implementation process of the CPS. Conclusions This study identified facilitators and strategies of the implementation of CPS. Most of the positive experiences were related to the clinical skills and proactive attitudes of pharmacists. These findings may support pharmacists and health managers to implement CPS in health systems. Electronic supplementary material The online version of this article (10.1186/s12913-018-3403-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil
| | - Genival Araujo Dos Santos Júnior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil
| | - André Mascarenhas Pereira
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil
| | - Aline Santana Dosea
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil
| | - Kérilin Stancine Santos Rocha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil
| | - Déborah Mônica Machado Pimentel
- Department of Medicine, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil
| | - Divaldo Pereira de Lyra-Jr
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, Zip code: 49100-000, Brazil.
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Moreno G, Lonowski S, Fu J, Chon JS, Whitmire N, Vasquez C, Skootsky SA, Bell DS, Maranon R, Mangione CM. Physician experiences with clinical pharmacists in primary care teams. J Am Pharm Assoc (2003) 2017; 57:686-691. [DOI: 10.1016/j.japh.2017.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
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Truong H, Kroehl ME, Lewis C, Pettigrew R, Bennett M, Saseen JJ, Trinkley KE. Clinical pharmacists in primary care: Provider satisfaction and perceived impact on quality of care provided. SAGE Open Med 2017. [PMID: 28638617 PMCID: PMC5472232 DOI: 10.1177/2050312117713911] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate primary care provider satisfaction and perceived impact of clinical pharmacy services on the disease state management in primary care. METHODS A cross-sectional survey with 24 items and 4 domains was distributed anonymously to pharmacy residency program directors across the United States who were requested to forward the survey to their primary care provider colleagues. Primary care providers were asked to complete the survey. RESULTS A total of 144 primary care providers responded to the survey, with 130 reporting a clinical pharmacist within their primary care practice and 114 completing the entire survey. Primary care providers report pharmacists positively impact quality of care (mean = 5.5 on Likert scale of 1-6; standard deviation = 0.72), high satisfaction with pharmacy services provided (5.5; standard deviation = 0.79), and no increase in workload as a result of clinical pharmacists (5.5; standard deviation = 0.77). Primary care providers would recommend clinical pharmacists to other primary care practices (5.7; standard deviation = 0.59). Primary care providers perceived specific types of pharmacy services to have the greatest impact on patient care: medication therapy management (38.6%), disease-focused management (29.82%), and medication reconciliation (11.4%). Primary care providers indicated the most valuable disease-focused pharmacy services as diabetes (58.78%), hypertension (9.65%), and pain (11.4%). CONCLUSION Primary care providers report high satisfaction with and perceived benefit of clinical pharmacy services in primary care and viewed medication therapy management and disease-focused management of diabetes, hypertension, and pain as the most valuable clinical pharmacy services. These results can be used to inform development or expansion of clinical pharmacy services in primary care.
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Affiliation(s)
- Havan Truong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Miranda E Kroehl
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Carmen Lewis
- School of Medicine, University of Colorado, Aurora, CO, USA
| | | | | | - Joseph J Saseen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
| | - Katy E Trinkley
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
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