1
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Khalil K, Lyons J, Teuteberg JJ, Henricksen EJ. The Impact of the COVID-19 Pandemic on the Transplant Pharmacist Workforce. J Pharm Pract 2024; 37:296-300. [PMID: 36206374 PMCID: PMC9548482 DOI: 10.1177/08971900221131906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: The COVID-19 pandemic has placed an unprecedented strain on the US healthcare system, greatly impacting transplant centers. Objective: The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Methods: A survey was disseminated electronically to assess the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Respondents were asked to give background regarding transplant center, patient, population, and departmental staffing. Results: There were 67 total respondents from 56 transplant centers. In response to the COVID-19 pandemic, 55% of centers reported stopping non-life saving transplants, and a majority (89%) stopped living donor transplants altogether. The banning of caregivers on-site during education, reduction of bedside education teaching, and cancelling of group teaching classes occurred at 46%, 40%, and 22% of centers, respectively. Consequently, 42% of pharmacists surveyed felt that their confidence in patient and caregiver's understanding of medications had decreased since these changes have been implemented. Conclusions: Pharmacist perception of patient and caregiver understanding of transplant medications has decreased since before the COVID-19 pandemic. As health systems strategize resource allocation throughout the pandemic, the importance of patient education must be prioritized to sustain and improve transplant outcomes.
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Affiliation(s)
- Karen Khalil
- Department of Pharmacy, NYU Langone Health, New York, NY, USA
| | - John Lyons
- Department of Pharmacy, Loyola University Medical
Center, Maywood, IL, USA
| | - Jeffrey J. Teuteberg
- Department of Medicine and Section
of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, Stanford University, CA, USA
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2
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Chandran MM, Cohen E, Doligalski CT, Bowman LJ, Kaiser TE, Taber DJ. The measure of impact: Proposal of quality metrics for solid organ transplant pharmacy practice. Am J Transplant 2024; 24:164-176. [PMID: 37923084 DOI: 10.1016/j.ajt.2023.10.027] [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: 07/14/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
As healthcare continues its transition toward value-based care, it is increasingly important for transplant pharmacists to demonstrate their impact on patient care, health-related outcomes, and healthcare costs. Evidence-based quality and performance metrics are recognized as crucial tools for measuring the value of service. Yet, there is a lack of well-developed and agreed-upon specific metrics for many clinical pharmacy specialties, including solid organ transplantation. To address this need, a panel of transplant pharmacy specialists conducted a detailed literature review and engaged in several panel discussions to identify quality metrics to be considered for assessing the value of clinical pharmacy services provided to solid organ transplant recipients and living donors. The proposed metrics are based on the Donabedian model and are categorized to coincide with the typical phases of transplant care. The measures focus on key issues that arise in transplant recipients related to medication therapy, including adverse drug events, nonadherence, and clinical outcomes attributable to medication therapy management. This article proposes a comprehensive set of measures, any number of which transplant pharmacists can adopt and measure over time to objectively gauge the value of services they are providing to transplant recipients, the transplant center, and the overall healthcare system.
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Affiliation(s)
- Mary Moss Chandran
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
| | - Elizabeth Cohen
- Department of Transplant, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Lyndsey J Bowman
- Department of Pharmacy, Tampa General Hospital, Tampa, Florida, USA
| | - Tiffany E Kaiser
- Division of Digestive Diseases, Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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3
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Taber DJ, Ward RC, Buchanan CH, Axon RN, Milfred-LaForest S, Rife K, Felkner R, Cooney D, Super N, McClelland S, McKenna D, Santa E, Gebregziabher M. Results of a multicenter cluster-randomized controlled clinical trial testing the effectiveness of a bioinformatics-enabled pharmacist intervention in transplant recipients. Am J Transplant 2023; 23:1939-1948. [PMID: 37562577 DOI: 10.1016/j.ajt.2023.08.004] [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: 04/05/2023] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
An ambulatory medication safety dashboard was developed to identify missing labs, concerning labs, drug interactions, nonadherence, and transitions in care. This system was tested in a 2-year, prospective, cluster-randomized, controlled multicenter study. Pharmacists at 5 intervention sites used the dashboard to address medication safety issues, compared with usual care provided at 5 control sites. A total of 2196 transplant events were included (1300 intervention vs 896 control). During the 2-year study, the intervention arm had a 11.3% (95% confidence interval, 7.1%-15.5%) absolute risk reduction of having ≥1 emergency department (ED) visit (44.2% vs 55.5%, respectively; P < .001, respectively) and a 12.3% (95% confidence interval, 8.2%-16.4%) absolute risk reduction of having ≥1 hospitalization (30.1% vs 42.4%, respectively; P < .001). In those with ≥1 event, the median ED visit rate (2 [interquartile range (IQR) 1, 5] vs 2 [IQR 1, 4]; P = .510) and hospitalization rate (2 [IQR 1, 3] vs 2 [IQR 1, 3]; P = .380) were similar. Treatment effect varied by comorbidity burden, previous ED visits or hospitalizations, and heart or lung recipients. A bioinformatics dashboard-enabled, pharmacist-led intervention reduced the risk of having at least one ED visit or hospitalization, predominantly demonstrated in lower risk patients.
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Affiliation(s)
- David J Taber
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Ralph C Ward
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Casey H Buchanan
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA
| | - Robert Neal Axon
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA
| | - Sherry Milfred-LaForest
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Kelsey Rife
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Rebecca Felkner
- Department of Pharmacy Services, William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin, USA
| | - Danielle Cooney
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Nicholas Super
- Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Samantha McClelland
- Department of Pharmacy Services, Veterans Affairs Great Lakes Health Care System (VISN 12), Westchester, Illinois, USA
| | - Domenica McKenna
- Department of Pharmacy Services, Portland Veterans Affairs Health Care System, Portland, Oregon, USA
| | - Elizabeth Santa
- Department of Pharmacy Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| | - Mulugeta Gebregziabher
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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4
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Cadel L, Guilcher SJT, Kokorelias KM, Sutherland J, Glasby J, Kiran T, Kuluski K. Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ Open 2021; 11:e044291. [PMID: 33574153 PMCID: PMC7880119 DOI: 10.1136/bmjopen-2020-044291] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work. DESIGN Scoping review. METHODS Electronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other. RESULTS Sixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up. CONCLUSIONS This scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.
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Affiliation(s)
- Lauren Cadel
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Quality Division, Ontario Health, Toronto, Ontario, Canada
| | | | - Jason Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jon Glasby
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tara Kiran
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Quality Division, Ontario Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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5
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Lichvar AB, Patel A, Pierce D, Gimbar RP, Tzvetanov I, Benedetti E, Campara M. Factors Influencing Emergency Department Utilization and Hospital Re-Admissions in a Predominantly Obese, Racially Diverse Urban Renal Transplant Population. Prog Transplant 2020; 31:72-79. [PMID: 33353501 DOI: 10.1177/1526924820978596] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Early emergency department and hospital re-admissions are common in renal transplant recipients, but data are lacking in unique populations. Study Aim: The purpose of this study was to identify patient risk factors for multiple acute care utilization events within the first year of renal transplantation. DESIGN This was a single-center, retrospective cohort study of adult renal transplant recipients between 9/2013-9/2016. Patients were compared across number of emergency department visits and by hospital re-admissions. Diagnoses were categorized. Univariate and multivariate logistic regression was used to assess risk for multiple acute care utilization events within the first 12 months post-transplant. RESULTS A total of 216 patients were analyzed and were on average 50.5 (SD 13.9) years old, redominantly Black (49.77%) with an average body mass index of 33.33 (9.8) and were recipients of deceased donor renal transplants (61.11%). A total of 105 (48.6%) patients visited the emergency epartment and 119 (55.1%) patients had a hospital readmission. Patients having a body mass index >35 kg/m2 did not differ across emergency department visit or hospitalization groups. Delayed graft function (OR 2.86, 95% CI 1.07-7.65) and previous renal transplant (OR 2.77, 95% CI 1.04-7.39) were significantly associated with multiple acute care utilizations. DISCUSSION Acute care utilization following renal transplantation was similar to previously reported experiences. Obesity did not impact use of acute care resources or patient outcomes. Strategies addressing potential preventable emergency visits and hospital re-dmissions should be promoted.
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Affiliation(s)
- Alicia B Lichvar
- Department of Pharmacy Practice, 15508University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.,Department of Surgery, 14681University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Alisha Patel
- Department of Pharmacy, 14681University of Chicago Medicine, Chicago, IL, USA
| | - Dana Pierce
- Department of Pharmacy Practice, 15508University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Renee Petzel Gimbar
- Department of Pharmacy Practice, 15508University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Ivo Tzvetanov
- Department of Surgery, 14681University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Enrico Benedetti
- Department of Surgery, 14681University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Maya Campara
- Department of Pharmacy Practice, 15508University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.,Department of Surgery, 14681University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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6
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Pilch NA, Park JM, Lichvar A, Kane C, Bowman L, Melaragno JI, Sobhanian M, Perez C, Trofe‐Clark J, Fleming JN. Observations from a systematic review of pharmacist‐led research in solid organ transplantation: An opinion paper of the American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicole A. Pilch
- College of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Jeong M. Park
- College of Pharmacy University of Michigan Ann Arbor Michigan USA
| | - Alicia Lichvar
- Department of Pharmacy Practice and Surgery University of Illinois at Chicago Chicago Illinois USA
| | - Clare Kane
- Department of Pharmacy Northwestern Memorial Hospital Chicago Illinois USA
| | - Lyndsey Bowman
- Department of Pharmacy Tampa General Hospital Tampa Florida USA
| | | | - Minoosh Sobhanian
- Department of Pharmacy Memorial Hermann‐Texas Medical Center Houston Texas USA
| | - Caroline Perez
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Jennifer Trofe‐Clark
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Department of Pharmacy Services Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - James N. Fleming
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
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7
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Maldonado AQ, Hall RC, Pilch NA, Ensor CR, Anders S, Gilarde JA, Tichy EM. ASHP Guidelines on Pharmacy Services in Solid Organ Transplantation. Am J Health Syst Pharm 2019; 77:222-232. [DOI: 10.1093/ajhp/zxz291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Reed C Hall
- University Health System, San Antonio, TX
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | | | | | - Stephanie Anders
- Transplant Pharmacy Services, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Eric M Tichy
- Supply Chain Management, Mayo Clinic, Rochester, MN
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8
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Hall CL, Fominaya CE, Gebregziabher M, Milfred-LaForest SK, Rife KM, Taber DJ. Improving Transplant Medication Safety Through a Technology and Pharmacist Intervention (ISTEP): Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13821. [PMID: 31573933 PMCID: PMC6774238 DOI: 10.2196/13821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 12/31/2022] Open
Abstract
Background Medication errors, adverse drug events, and nonadherence lead to increased health care utilization and increased risk of adverse clinical outcomes, including graft loss, in solid organ transplant recipients. Veterans living with organ transplants represent a population that is at substantial risk for medication safety events and fragmented care coordination issues. To improve medication safety and long-term clinical outcomes in veteran transplant patients, interventions should address interorganizational system failures and provider-level and patient-level factors. Objective This study aims to measure the clinical and economic effectiveness of a pharmacist-led, technology-enabled intervention, compared with usual care, in veteran organ transplant recipients. Methods This is a 24-month prospective, parallel-arm, cluster-randomized, controlled multicenter study. The pharmacist-led intervention uses an innovative dashboard system to improve medication safety and health outcomes, compared with usual posttransplant care. Pharmacists at 10 study sites will be consented into this study before undergoing randomization, and 5 sites will then be randomized to each study arm. Approximately, 1600 veteran transplant patients will be included in the assessment of the primary outcome across the 10 sites. Results This study is ongoing. Institutional review board approval was received in October 2018 and the study opened in March 2019. To date there are no findings from this study, as the delivery of the intervention is scheduled to occur over a 24-month period. The first results are expected to be submitted for publication in August 2021. Conclusions With this report, we describe the study design, methods, and outcome measures that will be used in this ongoing clinical trial. Successful completion of the Improving Transplant Medication Safety through a Technology and Pharmacist Intervention study will provide empirical evidence of the effectiveness of a feasible and scalable technology-enabled intervention on improving medication safety and costs. Clinical Trial ClinicalTrials.gov NCT03860818; https://clinicaltrials.gov/ct2/show/NCT03860818 International Registered Report Identifier (IRRID) PRR1-10.2196/13821
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Affiliation(s)
- Casey L Hall
- Health Equity & Rural Outreach Innovation Center, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Cory E Fominaya
- Department of Pharmacy, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Mulugeta Gebregziabher
- Health Equity & Rural Outreach Innovation Center, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States.,Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | | | - Kelsey M Rife
- Department of Pharmacy, VA Northeast Ohio Healthcare System, Cleveland, OH, United States
| | - David J Taber
- Health Equity & Rural Outreach Innovation Center, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States.,Department of Pharmacy, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States.,Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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9
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Mehrabi A, Golriz M, Khajeh E, Ghamarnejad O, Kulu Y, Wiesel M, Müller T, Majlesara A, Schmitt CP, Tönshoff B. Surgical outcomes after pediatric kidney transplantation at the University of Heidelberg. J Pediatr Urol 2019; 15:221.e1-221.e8. [PMID: 30795985 DOI: 10.1016/j.jpurol.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Kidney transplantation (KTx) is the treatment of choice for children with end-stage renal disease (ESRD). OBJECTIVE An update of 48 years of surgical experience with pediatric KTx (PKTx) is presented, and the results between recipients of organs from deceased donors (DDs) and living donors (LDs) are compared. STUDY DESIGN All patients younger than 18 years who underwent KTx between 1967 and 2015 were evaluated. Data from 540 PKTx operations (409 DD and 131 LD) were obtained from the transplant center database. Peri-operative data and graft and patient survival were analyzed in the DD and LD groups. RESULTS Fewer recipients in the LD group underwent dialysis before PKTx than those in the DD group (50.8% in LD vs. 94.9% in DD, P < 0.001). The mean duration of dialysis (DD: 798 ± 525 days vs. LD: 625 ± 650 days, P = 0.03), time on the waiting list (DD: 472 ± 435 days vs. LD: 120 ± 243 days, P < 0.001), cold ischemia time (CIT) (DD: 1206 ± 368 min vs. LD: 140 ± 63 min, P < 0.001), operation time, and hospital stay were lower in the LD group. Except for arterial stenosis, the rates of postoperative vascular and urological complications were not different between the two groups. The cumulative 25-year graft and patient survival rates were 46.4% and 84.1% in the DD group and 76.5% and 96.1% in the LD group, respectively. DISCUSSION PKTx is the treatment of choice for children with ESRD. Graft quality has a direct impact on KTx outcome and rate of graft failure. Better HLA compatibility and shorter CIT reduce the impairment of graft function after LD PKTx. In addition, Establishment of an interdisciplinary approach using an individualized risk assessment and prevention model can improve PKTx outcomes. CONCLUSION Compared with DD PKTx, LD PKTx has better graft survival associated with a shorter duration of preceding dialysis, waiting time, and CIT and seems to be more beneficial for children.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| | - M Golriz
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - M Wiesel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - T Müller
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - A Majlesara
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - C P Schmitt
- Division of Pediatric Nephrology, Centre for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - B Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
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10
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Weeda ER, Su Z, Taber DJ, Bian J, Morinelli TA, Pilch NA, Mauldin PD, DuBay DA. Hospital admissions and emergency department visits among kidney transplant recipients. Clin Transplant 2019; 33:e13522. [DOI: 10.1111/ctr.13522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/22/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Erin R. Weeda
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy Medical University of South Carolina Charleston South Carolina
| | - Zemin Su
- Division of General Internal Medicine and Geriatrics Medical University of South Carolina Charleston South Carolina
| | - David J. Taber
- Department of Pharmacy Ralph H Johnson VAMC Charleston South Carolina
- Department of Surgery Medical University of South Carolina Charleston South Carolina
| | - John Bian
- Division of General Internal Medicine and Geriatrics Medical University of South Carolina Charleston South Carolina
| | - Thomas A. Morinelli
- Department of Surgery Medical University of South Carolina Charleston South Carolina
| | - Nicole A. Pilch
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy Medical University of South Carolina Charleston South Carolina
| | - Patrick D. Mauldin
- Division of General Internal Medicine and Geriatrics Medical University of South Carolina Charleston South Carolina
| | - Derek A. DuBay
- Department of Surgery Medical University of South Carolina Charleston South Carolina
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11
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Cabral AS, Knihs NDS, Magalhães AP, Alvarez AG, Catarina AA, Martins SR, Ramos SF, Paim SMS. Cultura de segurança no processo de doação de órgãos: revisão de literatura. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Resumo Objetivo Avaliar o desenvolvimento da cultura de segurança no processo de doação de órgãos e transplantes na literatura científica. Métodos Revisão integrativa da literatura a partir das bases de dados CINAHL, LILACS, PubMed, Scopus, Web of Science e na biblioteca eletrônica SciELO, de 2012 a 2016, com sintaxe de palavras-chaves e descritores para cada base, sendo selecionados 14 artigos para análise. Resultados Foram detectados 1.659 estudos, desses, 33 foram lidos na íntegra, sendo definido para coleta dos dados 14 estudos. As informações obtidas foram analisadas criticamentre e agrupadas em duas categorias: Na Categoria 1 – Cultura de segurança no uso de medicamentos no período pós-transplante: destaca-se como fundamental o envolvimento da equipe multidisciplinar na orientação da alta hospitalar no transplante e ainda, os principais fatores de erros no uso dos fármacos. Na Categoria 2 – Cultura de segurança nas unidades transplantadoras: apresenta-se questões relacionadas à segurança dos pacientes submetidos aos transplantes nos períodos pré e intra-operatórios. Conclusão Por meio desse estudo, observou-se que a temática da cultura de segurança no processo de doação e transplante de órgãos está incipiente na literatura sendo necessário desenvolvimento de estudos bem delineados e relacionando à cultura de segurança do paciente em todas as etapas do processo de doação e transplantes.
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12
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Xu XF, Feng YT, Tian YF, Wang HY. Pharmaceutical Care in Kidney Transplant Recipients: Behavioral and Physiologic Outcomes at 12 Months. Transplant Proc 2018; 50:2451-2456. [PMID: 30316377 DOI: 10.1016/j.transproceed.2018.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/06/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A variety of complex drug regimens are offered to kidney transplant recipients after transplantation. This study aimed to evaluate the behavioral and physiological outcomes of pharmaceutical care in this population. METHODS A cross-sectional prospective study was conducted, which collected and categorized kidney transplant recipients according to pharmaceutical care. In the IR group, patients had received irregular pharmaceutical care after transplantation, and in the RE group, patients had received regular intervention. Intervention included face-to-face interview, checkup for laboratory examinations, discovery of drug-related problems, and pharmaceutical consultation. Baseline knowledge for self-care was tested for patients in both groups. Correct concepts and medication guidance were consistently provided to enable patients to understand the importance of rejection prevention and knowledge for medication and renal care after transplantation. After 12 months, the same test was used to evaluate the outcomes for pharmaceutical care and a satisfaction questionnaire was used to assess for pharmacy service. RESULTS The study results revealed that patients in the RE group possessed better knowledge for self-care (P < .001); however, the differences at 12 months became insignificant (P = .72) after patients in the IR group had also received routine pharmaceutical care. Besides, serum creatinine level of the RE patients was stable without significant variation (P = .93), but it demonstrated a rising trend in IR patients (P < .01). Patients were greatly satisfactory with the intervention. CONCLUSIONS A consistent post-transplantation pharmaceutical care service is effective to substantially improve knowledge of post-transplantation self-care. Pharmaceutical care should be started as early as possible during the pre-transplant period and continue in a long-term follow-up.
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Affiliation(s)
- X F Xu
- Department of Pharmacy, Shanghai Second People's Hospital, Shanghai, China
| | - Y T Feng
- Graduate Institute of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Y F Tian
- Department of General Surgery, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - H Y Wang
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan, ROC; School of Pharmacy, Chia Nan University of Pharmacy & Science, Tainan, Taiwan, ROC.
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13
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Brett KE, Ritchie LJ, Ertel E, Bennett A, Knoll GA. Quality Metrics in Solid Organ Transplantation: A Systematic Review. Transplantation 2018; 102:e308-e330. [PMID: 29557915 PMCID: PMC7228649 DOI: 10.1097/tp.0000000000002149] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/20/2017] [Accepted: 01/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The best approach for determining whether a transplant program is delivering high-quality care is unknown. This review aims to identify and characterize quality metrics in solid organ transplantation. METHODS Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until February 1, 2017. Relevant full text reports and conference abstracts that examined quality metrics in organ transplantation were included. Two reviewers independently extracted study characteristics and quality metrics from 52 full text reports and 24 abstracts. PROSPERO registration: CRD42016035353. RESULTS Three hundred seventeen quality metrics were identified and condensed into 114 unique indicators with sufficient detail to be measured in practice; however, many lacked details on development and selection, were poorly defined, or had inconsistent definitions. The process for selecting quality indicators was described in only 5 publications and patient involvement was noted in only 1. Twenty-four reports used the indicators in clinical care, including 12 quality improvement studies. Only 14 quality metrics were assessed against patient and graft survivals. CONCLUSIONS More than 300 quality metrics have been reported in transplantation but many lacked details on development and selection, were poorly defined, or had inconsistent definitions. Measures have focused on safety and effectiveness with very few addressing other quality domains, such as equity and patient-centeredness. Future research will need to focus on transparent and objective metric development with proper testing, evaluation, and implementation in practice. Patients will need to be involved to ensure that transplantation quality metrics measure what is important to them.
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Affiliation(s)
- Kendra E Brett
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lindsay J Ritchie
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Ertel
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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14
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Cole AJ, Johnson RW, Egede LE, Baliga PK, Taber DJ. Improving Medication Safety and Cardiovascular Risk Factor Control to Mitigate Disparities in African-American Kidney Transplant Recipients: Design and Methods. Contemp Clin Trials Commun 2018. [PMID: 29532038 PMCID: PMC5844505 DOI: 10.1016/j.conctc.2017.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is a lack of data analyzing the influence of cardiovascular disease (CVD) risk factor control on graft survival disparities in African-American kidney transplant recipients. Studies in the general population indicate that CVD risk factor control is poor in African-Americans, leading to higher rates of renal failure and major acute cardiovascular events. However, with the exception of hypertension, there is no data demonstrating similar results within transplant recipients. Recent analyses conducted by our investigator group indicate that CVD risk factors, especially diabetes, are poorly controlled in African-American recipients, which likely impacts graft loss. This study protocol describes a prospective interventional clinical trial with the goal of demonstrating improved medication safety and CVD risk factor control in adult solitary kidney transplant recipients at least one-year post-transplant with a functioning graft. This is a prospective, interventional, 6-month, pharmacist-led and technology enabled study in adult kidney transplant recipients with the goal of improving CVD risk factor outcomes by improving medication safety and patient self-efficacy. This papers describes the issues related to racial disparities in transplant, the details of this intervention and how we expect this intervention to improve CVD risk factor control in kidney transplant recipients, particularly within African-Americans.
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Affiliation(s)
- Andrew J Cole
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Reginald W Johnson
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Leonard E Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Prabhakar K Baliga
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - David J Taber
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC.,Department of Pharmacy Services, Ralph H Johnson VAMC, Charleston, SC
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15
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Fleming JN, Treiber F, McGillicuddy J, Gebregziabher M, Taber DJ. Improving Transplant Medication Safety Through a Pharmacist-Empowered, Patient-Centered, mHealth-Based Intervention: TRANSAFE Rx Study Protocol. JMIR Res Protoc 2018; 7:e59. [PMID: 29500161 PMCID: PMC5856926 DOI: 10.2196/resprot.9078] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Medication errors, adverse drug events, and nonadherence are the predominant causes of graft loss in kidney transplant recipients and lead to increased healthcare utilization. Research has demonstrated that clinical pharmacists have the unique education and training to identify these events early and develop strategies to mitigate or prevent downstream sequelae. In addition, studies utilizing mHealth interventions have demonstrated success in improving the control of chronic conditions that lead to kidney transplant deterioration. OBJECTIVE The goal of the prospective, randomized TRANSAFE Rx study is to measure the clinical and economic effectiveness of a pharmacist-led, mHealth-based intervention, as compared to usual care, in kidney transplant recipients. METHODS TRANSAFE Rx is a 12-month, parallel, two-arm, 1:1 randomized controlled clinical trial involving 136 participants (68 in each arm) and measuring the clinical and economic effectiveness of a pharmacist-led intervention which utilizes an innovative mobile health application to improve medication safety and health outcomes, as compared to usual posttransplant care. RESULTS The primary outcome measure of this study will be the incidence and severity of MEs and ADRs, which will be identified, categorized, and compared between the intervention and control cohorts. The exploratory outcome measures of this study are to compare the incidence and severity of acute rejections, infections, graft function, graft loss, and death between research cohorts and measure the association between medication safety issues and these events. Additional data that will be gathered includes sociodemographics, health literacy, depression, and support. CONCLUSIONS With this report we describe the study design, methods, and outcome measures that will be utilized in the ongoing TRANSAFE Rx clinical trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03247322: https://clinicaltrials.gov/ct2/show/NCT03247322 (Archived by WebCite at http://www.webcitation.org/6xcSUnuzW).
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Affiliation(s)
- James N Fleming
- Department of Pharmacy, Medical University of South Carolina, Charleston, SC, United States
| | - Frank Treiber
- Technology Center to Advance Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - John McGillicuddy
- Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, SC, United States.,Department of Pharmacy, Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
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16
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Flamme-Obry F, Belaiche S, Hazzan M, Ramdan N, Noël C, Odou P, Décaudin B. [Clinical pharmacist and medication reconciliation in kidney transplantation]. Nephrol Ther 2018; 14:91-98. [PMID: 29477279 DOI: 10.1016/j.nephro.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Drug related problems (DRP) can lead to severe consequences in kidney recipients. The aim of the study was to assess the impact of the clinical pharmacist interventions on the incidence of DRP. METHOD The number of DRP were evaluated according to 3periods: Without intervention, with medication reconciliation at admission, and with medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge. RESULTS Patients concerned were mainly men, 55years old (median age), stage3 of CKD, transplanted for less than 3months or more than 1year, with cardiovascular risk factors and receiving an average of 9drugs/day. Among the DRP, 20% were avoidable and severe in most cases. In period1, 27.7% patients had at least 1DRP, in period2, 21.3% patients had at least 1DRP, and in period3, 17.4% of patients had at least 1DRP (P=0.03). One hundred and ten patients had medication reconciliation at admission with a mean of 0.6unintentional discrepancies per patient (omission in 81% of cases). The main drugs involved concerned the digestive-metabolic (24.5%), cardiovascular (23%), and nervous (23%) system. Sixty-eight interviews at discharge were realized and revealed self-medication habits. CONCLUSION Our study shows that medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge can help to reduce DRP in kidney recipients. Further studies are needed to confirm our results.
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Affiliation(s)
| | - Stéphanie Belaiche
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France.
| | - Marc Hazzan
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Nassima Ramdan
- EA 2694, santé publique : épidémiologie et qualité des soins, CHRU de Lille, University Lille, 59000 Lille, France
| | - Christian Noël
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
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17
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Collaborative practice agreement in solid organ transplantation. Int J Clin Pharm 2018; 40:474-479. [DOI: 10.1007/s11096-018-0604-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
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18
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Taber DJ, Gebregziabher M, Srinivas T, Egede LE, Baliga PK. Transplant Center Variability in Disparities for African-American Kidney Transplant Recipients. Ann Transplant 2018; 23:119-128. [PMID: 29449524 PMCID: PMC6019128 DOI: 10.12659/aot.907226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Disparities research has traditionally focused on patient-level variables to ascertain predominant risk factors driving differences in outcomes for African-American (AA) kidney transplant recipients. Our objectives were to determine the magnitude and impact of transplant center variability for graft outcome disparities. Material/Methods This was a retrospective cohort study analyzing 25 years of U.S. national transplant registry data at both the patient and center levels using univariate descriptive statistics and multivariable modeling. Results A total of 257,024 recipients from 191 centers were analyzed; AAs represented 31.1% of recipients. After adjusting for baseline characteristics, AAs had 42% higher risk of graft loss (aHR 1.42, 95% CI 1.39 to 1.45; p<0.001). Center variability for graft outcome disparities in AAs was significant (race*center interaction term p<0.05), with the aHRs ranging from 0.5 to 4.9; 46% of centers demonstrated a non-statistically significant disparity (aHR p>0.05) and 25% of centers had a large AA disparity (aHR >1.75). In a more recent transplant time period (2000–14), overall racial disparities decreased but center-level disparities increased in variability. Center-level factors significantly associated with increasing disparity included higher acute rejection rates, fewer transplants per year, longer length of stay, lower use of calcineurin inhibitors (CNI), and lower living donor rates. Conclusions There is evidence of significant center-level variability in graft outcome disparities for AA kidney recipients. Further, there appears to be a number of center-level factors associated with this variability, including acute rejection rates, CNI use, number of transplants per year, and, in recent years, low living donor rates.
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Affiliation(s)
- David J Taber
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.,Department of Pharmacy Services, Ralph H Johnson Va Medical Center, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Titte Srinivas
- Department of Transplant Nephrology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Prabhakar K Baliga
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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19
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Manias E. Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review. Expert Opin Drug Saf 2018; 17:259-275. [PMID: 29303376 DOI: 10.1080/14740338.2018.1424830] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Medication errors are commonly affected by breakdowns in communication. Interdisciplinary collaboration is an important means of facilitating communication between health professionals in clinical practice. To date, there has been little systematic examination of past research in this area. AREAS COVERED The aims of this integrative review are to examine how interdisciplinary collaboration influences medication errors in hospitals, the araes of interdisciplinary collaboration that have been researched in previous work, and recommendations for future research and practice. An integrative review was undertaken of research papers (N = 30) published from inception to August 2017 using MEDLINE, the Cochrane Library, CINAHL, PsycINFO, and Embase. EXPERT OPINION Five different areas of interdisciplinary collaboration were identified in research involving medication errors. These areas were: communication through tools including guidelines, protocols, and communication logs; participation of pharmacists in interdisciplinary teams; collaborative medication review on admission and at discharge; collaborative workshops and conferences; and complexity of role differentiation and environment. Despite encouraging results demonstrated in past research, medication errors continued to occur. Increased focus is needed on developing tailored, individualized strategies that can be applied in particular contexts to create further reductions in medication errors. Greater understandings are also needed about the changing roles of various disciplines.
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Affiliation(s)
- Elizabeth Manias
- a Faculty of Health, School of Nursing and Midwifery , Deakin University , Burwood , Australia.,b The Royal Melbourne Hospital, Department of Medicine , The University of Melbourne , Parkville , Australia.,c Department of Nursing, School of Health Sciences , The University of Melbourne , Parkville , Australia
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20
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Aziz F, Chu Y, Lehman EB. Lower Extremity Bypass Surgery on Patients Transferred from Other Hospitals is Associated with Increased Morbidity and Mortality. Ann Vasc Surg 2017; 41:205-213.e2. [PMID: 28258020 DOI: 10.1016/j.avsg.2016.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/14/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease (PAD). Patients who are transferred to other hospitals have generally complex medical problems compared to those patients who are directly admitted from home. The purpose of this study is to identify factors associated with an interfacility transfer in patients with PAD and compare the postoperative outcomes of these patients to those who are directly admitted to the hospital. METHODS The 2013 lower extremity revascularization-targeted American College of Surgeons (ACS-National Surgical Quality Improvement Program [NSQIP]) database and generalized 2013 general and vascular surgery ACS-NSQIP Participant Use File were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing lower extremity bypass surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for transfer to another hospital. RESULTS A total of 2,646 patients (65% male, 35% female) were identified in the NSQIP database that underwent lower extremity open revascularization during the year 2013. A total of 287 patients (11%) were transferred from other institutions: acute care hospital inpatient (4%), nursing home/chronic care/intermediate care (3%), outside emergency department (3%), and other (1%). Factors associated with increased risk of interfacility transfer included need for emergency surgery (odds ratio [OR]: 5.51, P < 0.05), infected wounds (OR: 2.77, P < 0.05), and age >85 years (OR: 2.24, P < 0.05). Postoperative outcome associated with transfer was mortality <30 days postop (OR: 1.96) and length of stay >30 days (OR: 2.04; P < 0.05). CONCLUSIONS Multiple factors affect an interfacility transfer of patients including advanced age, need for emergency procedure, contaminated wounds. Patients who are transferred from another institution for a lower extremity bypass surgery are at a substantially higher risk for postoperative morbidity and mortality.
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Affiliation(s)
- Faisal Aziz
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA.
| | - Youngmin Chu
- Office of Medical Education, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA
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21
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Taber DJ, DuBay D, McGillicuddy JW, Nadig S, Bratton CF, Chavin KD, Baliga PK. Impact of the New Kidney Allocation System on Perioperative Outcomes and Costs in Kidney Transplantation. J Am Coll Surg 2017; 224:585-592. [PMID: 28159650 DOI: 10.1016/j.jamcollsurg.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression. RESULTS There were 38,016 kidney transplantation procedures analyzed during the 3.8-year period. Over time, there was a mean increase of 2.7 cases/month (95% CI -0.02 to 5.4; p = 0.059), unaffected by KAS (18.9 case increase; p = 0.5601). Implementation of KAS led to significant changes in patient demographics, including a decrease in age (-2.8 years; p < 0.001), increase in number of African Americans (3.8%; p < 0.001), decrease in number of Caucasians (6.0%; p < 0.001), increase in number of Hispanics (2.9%; p < 0.001), increase in congestive heart failure (1.3%; p < 0.001), and decrease in diabetes with complications (4.0%; p < 0.001). The KAS had no impact on length of stay (0.12 days; 95% CI -0.11 to 0.35), length of stay index (0.01; 95% CI -0.03 to 0.05), ICU cases, ICU length of stay, patient safety indicators, or in-hospital mortality. The KAS led to a significant increase in delayed graft function rates (5.4%; 95% CI 23.3% to 7.4%); total in-hospital costs ($2,429; 95% CI $594 to $4.263); and 7-day (2.2%), 14-day (2.6%), and 30-day (2.7%) readmission rates. CONCLUSIONS Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.
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Affiliation(s)
- David J Taber
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC.
| | - Derek DuBay
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - John W McGillicuddy
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Satish Nadig
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Charles F Bratton
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Kenneth D Chavin
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - Prabhakar K Baliga
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
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22
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Maldonado AQ, Bowman LJ, Szempruch KR. Expanding transplant pharmacist presence in pretransplantation ambulatory care. Am J Health Syst Pharm 2017; 74:22-25. [PMID: 28069678 DOI: 10.2146/ajhp160142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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23
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Staino C, Pilch N, Patel S, Trobaugh K, Fleming J, Meadows H, Taber D, Srinivas TR, Baliga P. Optimizing finite resources: Pharmacist chart reviews in an outpatient kidney transplant clinic. J Am Pharm Assoc (2003) 2016; 55:613-620. [PMID: 26547595 DOI: 10.1331/japha.2015.14241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine if a pharmacist-executed comprehensive chart review could serve as sufficient substitution for direct participation during outpatient clinic visits in the postdischarge follow-up treatment of kidney transplant recipients. DESIGN Retrospective, longitudinal, cross-sectional study. SETTING Acute and chronic transplant clinics at the Medical University of South Carolina, Charleston, SC. PARTICIPANTS 219 individual kidney transplant recipients. MAIN OUTCOME MEASURES Effectiveness of chart review assessments (with written notes) as compared with in-clinic assessments (with verbal communication with transplant providers followed by documentation by pharmacists). An independent transplant provider graded pharmacist recommendations by severity. All recommendations were compared with the provider's plan to determine if the recommendations were incorporated. RESULTS During the 3-month study period, 170 pharmacist chart reviews were written and 175 clinic visits involved direct pharmacist participation. Providers accepted a greater percentage of recommendations that were delivered directly compared with recommendations presented via a note in the patient folder following chart review (92% vs. 28%, respectively; P <0.0001). Directly provided recommendations were also associated with higher severity scores. CONCLUSION The results of this study suggest that comprehensive chart review by pharmacists prior to patient clinic visits may not be as effective as in-person consultation in communicating recommendations to providers. Further research is needed in similar clinic settings.
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Affiliation(s)
- Carmelina Staino
- Solid Organ Transplant Pharmacy Resident, Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC.
| | - Nicole Pilch
- Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC
| | - Sweta Patel
- Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC
| | - Kimberly Trobaugh
- Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC
| | - James Fleming
- Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC
| | - Holly Meadows
- Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC
| | - David Taber
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Titte R Srinivas
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
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24
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Griffin SP, Nelson JE. Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients. Prog Transplant 2016; 26:314-321. [PMID: 27628498 DOI: 10.1177/1526924816667950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Tacrolimus requires close therapeutic drug monitoring (TDM) to ensure efficacy and minimize adverse effects. Pharmacists are uniquely positioned on transplant teams to interpret levels and recommend therapy modifications. Their impact in the immediate postoperative setting has not been described previously. OBJECTIVE To evaluate the impact of a clinical solid organ transplant pharmacist on nephrotoxicity, TDM, and revenue generation in adult kidney transplant recipients on tacrolimus. DESIGN, SETTING, AND PATIENTS Retrospective assessment of adult kidney transplant recipients at University of Florida Health Shands Hospital. INTERVENTION A transplant pharmacist rounded 5 days a week and made medication recommendations on transplant recipients-including tacrolimus dose modifications based on levels. Pharmacy services were expanded to include medication reconciliation, medication counseling, and delivery of discharge medications to bedside. MAIN OUTCOME MEASURE Incidence of nephrotoxicity during tacrolimus exposure. RESULTS Of the 70 kidney transplant recipients in the postpharmacist cohort, 18 (25.7%) experienced nephrotoxicity while on tacrolimus, compared to 18 (25%) of the 72 in the prepharmacist cohort ( P = .922). A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function. The rate of appropriately drawn tacrolimus troughs significantly increased from 23.4% to 30.3% in the postpharmacist cohort ( P < .001). The median outpatient pharmacy revenue generated per recipient significantly increased from US$345.49 (interquartile range [IQR]: 0-4727.56) to US$4834.95 per recipient (IQR: 3592.78-6224.60; P < .001). The length of stay (7 days, IQR: 6-9, vs 8 days, IQR: 6-9; P = .107) and the 30-day readmission rate were similar between groups (20.8% vs 21.4%; P = .931).
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Affiliation(s)
- Shawn P Griffin
- 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA
| | - Joelle E Nelson
- 1 Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA.,2 College of Pharmacy, University of Florida, Gainesville, FL, USA, and College of Medicine, University of Florida, Gainesville, FL, USA
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25
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Abstract
Pharmacists may play a key role on the multidisciplinary transplant team. This article describes the development and current status of pharmacists in the management of transplant recipients in the United States. Traditionally, pharmacists played an important support role in transplant medicine. This role has been expanded to include direct patient care for the avoidance, detection, and/or treatment of side effects from the polypharmacy necessary in the management of these complex patients. Pharmacists provide pre- and post-transplant education to transplant recipients to enhance adherence to complicated medical regimens and thereby reduce readmission to hospital and unscheduled, costly visits to urgent care centers and/or hospital emergency departments.
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Affiliation(s)
- Joshua J Wiegel
- Department of Pharmacy Services, Oregon Health and Science University, Portland, OR 97239, USA
| | - Ali J Olyaei
- Department of Pharmacy Services, Oregon Health and Science University, Portland, OR 97239, USA; Department of Pharmacy Services, College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA
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26
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Covert KL, Fleming JN, Staino C, Casale JP, Boyle KM, Pilch NA, Meadows HB, Mardis CR, McGillicuddy JW, Nadig S, Bratton CF, Chavin KD, Baliga PK, Taber DJ. Predicting and preventing readmissions in kidney transplant recipients. Clin Transplant 2016; 30:779-86. [PMID: 27101090 DOI: 10.1111/ctr.12748] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 11/26/2022]
Abstract
A lack of research exploring post-transplant process optimization to reduce readmissions and increasing readmission rates at our center from 2009 to 2013 led to this study, aimed at assessing the effect of patient and process factors on 30-d readmission rates after kidney transplantation. This was a retrospective case-control study in adult kidney transplant recipients. Univariate and multivariate analyses were utilized to assess patient and process determinants of 30-d readmissions. 384 patients were included; 30-d readmissions were significantly associated with graft loss and death (p = 0.001). Diabetes (p = 0.049), pharmacist identification of poor understanding or adherence, and prolonged time on hemodialysis prior to transplant were associated with an increased risk of 30-d readmissions. After controlling for risk factors, readmission rates were only independently predicted by pharmacist identification of patient lack of understanding or adherence regarding post-transplant medications and dialysis exposure for more than three yr (OR 2.3, 95% CI 1.10-4.71, p = 0.026 and OR 2.1, 95% CI 1.22, 3.70, respectively), both of which were significantly modified by history of diabetes. Thirty-d readmissions are attributable to both patient and process-level factors. These data suggest that a lack of post-transplant medication knowledge in high-risk patients drives early hospital readmission.
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Affiliation(s)
- Kelly L Covert
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - James N Fleming
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Carmelina Staino
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Jillian P Casale
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly M Boyle
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Nicole A Pilch
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Holly B Meadows
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin R Mardis
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - John W McGillicuddy
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Satish Nadig
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Charles F Bratton
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth D Chavin
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Prabhakar K Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.,Department of Pharmacy, Ralph H. Johnson VAMC, Charleston, SC, USA
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Jones EL, Lees N, Martin G, Dixon-Woods M. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review. Jt Comm J Qual Patient Saf 2016; 42:196-206. [PMID: 27066922 PMCID: PMC4964906 DOI: 10.1016/s1553-7250(16)42025-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. METHODS Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) check list, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e. g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. RESULTS The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). CONCLUSIONS The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved.
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Affiliation(s)
- Emma L Jones
- University of Leicester, University Hospitals of Leicester NHS Trust, Leicester, USA
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28
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McGregor T, Bjazevic J, Patel P, Koulack J. Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community. Can Urol Assoc J 2016; 10:E7-E11. [PMID: 26858788 PMCID: PMC4729576 DOI: 10.5489/cuaj.3256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. METHODS A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. RESULTS There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. CONCLUSIONS The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients.
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Affiliation(s)
- Tom McGregor
- University of Manitoba, Section of Urology, Winnipeg, MB, Canada
| | | | - Premal Patel
- University of Manitoba, Section of Urology, Winnipeg, MB, Canada
| | - Joshua Koulack
- University of Manitoba, Section of Vascular Surgery, Winnipeg, MB, Canada
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29
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Taber DJ, Pilch NA, Trofe-Clark J, Kaiser TE. A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs. Am J Transplant 2015; 15:2683-90. [PMID: 25988533 DOI: 10.1111/ajt.13323] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/08/2015] [Accepted: 03/20/2015] [Indexed: 01/25/2023]
Abstract
Integration of pharmacists into multidisciplinary transplant patient care has advanced in recent years, with limited data available to evaluate the current status of the profession. This was a national survey developed as an AST Pharmacy COP initiative. Responses were solicited from pharmacists practicing at U.S. transplant programs based on UNOS listing; 176 participants from 113 centers (41%) responded, with 79% practicing ≤10 years. There is a median of 1.4 pharmacist full-time equivalents (FTEs) (range 0.1-7.1) for every 100 transplants. The predominant activities performed by pharmacists during the transplant phase include medication review (95%), lab review (92%), allergy review (88%), medication therapy management (92%), bedside rounds (87%), medication education (79%), documentation (71%), and coordinating discharge medications (58%). Similar activities were reported during the other phases, but participation was less common. The involvement of dedicated transplant pharmacists within multidisciplinary care has become standard at a large number of centers, although expansion is still needed to ensure core pharmaceutical care components are provided to all transplant recipients across all centers. These results inform on the typical responsibilities of pharmacists practicing within the field of transplantation and illustrate that the level of pharmacist involvement significantly varies across transplant centers and the phases of transplantation.
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Affiliation(s)
- D J Taber
- Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC.,Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - N A Pilch
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC
| | - J Trofe-Clark
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA.,Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - T E Kaiser
- College of Medicine, University of Cincinnati, Cincinnati, OH
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30
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Inclusion of dynamic clinical data improves the predictive performance of a 30-day readmission risk model in kidney transplantation. Transplantation 2015; 99:324-30. [PMID: 25594549 DOI: 10.1097/tp.0000000000000565] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thirty-day readmissions (30DRA) are a highly scrutinized measure of healthcare quality and relatively frequent among kidney transplants (KTX). Development of predictive risk models is critical to reducing 30DRA and improving outcomes. Current approaches rely on fixed variables derived from administrative data. These models may not capture clinical evolution that is critical to predicting outcomes. METHODS We directed a retrospective analysis toward: (1) developing parsimonious risk models for 30DRA and (2) comparing efficiency of models based on the use of immutable versus dynamic data. Baseline and in-hospital clinical and outcomes data were collected from adult KTX recipients between 2005 and 2012. Risk models were developed using backward logistic regression and compared for predictive efficacy using receiver operating characteristic curves. RESULTS Of 1147 KTX patients, 123 had 30DRA. Risk factors for 30DRA included recipient comorbidities, transplant factors, and index hospitalization patient level clinical data. The initial fixed variable model included 9 risk factors and was modestly predictive (area under the curve, 0.64; 95% confidence interval [95% CI], 0.58-0.69). The model was parsimoniously reduced to 6 risks, which remained modestly predictive (area under the curve, 0.63; 95% CI, 0.58-0.69). The initial predictive model using 13 fixed and dynamic variables was significantly predictive (AUC, 0.73; 95% CI, 0.67-0.80), with parsimonious reduction to 9 variables maintaining predictive efficacy (AUC, 0.73; 95% CI, 0.67-0.79). The final model using dynamically evolving clinical data outperformed the model using static variables (P=0.009). Internal validation demonstrated that the final model was stable with minimal bias. CONCLUSIONS We demonstrate that modeling dynamic clinical data outperformed models using immutable data in predicting 30DRA.
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Maldonado AQ, Tichy EM, Rogers CC, Campara M, Ensor C, Doligalski CT, Gabardi S, Descourouez JL, Doyle IC, Trofe-Clark J. Assessing pharmacologic and nonpharmacologic risks in candidates for kidney transplantation. Am J Health Syst Pharm 2015; 72:781-93. [DOI: 10.2146/ajhp140476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Eric M. Tichy
- Department of Pharmacy, Yale–New Haven Hospital, New Haven, CT
| | - Christin C. Rogers
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA
| | - Maya Campara
- Department of Pharmacy, University of Illinois at Chicago
| | | | | | - Steven Gabardi
- Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women’s Hospital, Boston, MA
| | | | - Ian C. Doyle
- School of Pharmacy, Pacific University, Hillsboro, OR
| | - Jennifer Trofe-Clark
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania
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Value of solid organ transplant-trained pharmacists in transplant infectious diseases. Curr Infect Dis Rep 2015; 17:475. [PMID: 25870143 DOI: 10.1007/s11908-015-0475-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in organ transplantation have led to improved graft and patient survival. Transplant pharmacist's education and training uniquely position them to contribute knowledge and skills to the management of these highly complex patients. In 2004, the United Network for Organ Sharing bylaws added requirements that all transplant programs identify one or more pharmacists with experience in transplant pharmacotherapy to be responsible for providing pharmaceutical care to solid organ transplant recipients. These bylaws also delineated the transplant pharmacist's roles and responsibilities. To further support these efforts, in 2007 the Centers for Medicare and Medicaid Services accreditation standards for transplant centers also mandated that a center have a designated, qualified expert in transplant pharmacology as a multidisciplinary team member. The transplant pharmacist is a consistent member of the transplant team that can add value to the multidisciplinary approach of prevention and treatment of transplant infectious diseases through all phases of transplant care.
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Tichy EM, Pilch NA, Smith LD, Maldonado AQ, Taber DJ. Building a business plan to support a transplantation pharmacy practice model. Am J Health Syst Pharm 2014; 71:751-7. [PMID: 24733139 DOI: 10.2146/ajhp130555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eric M Tichy
- Eric M. Tichy, Pharm.D., BCPS, is Senior Clinical Pharmacy Specialist, Solid Organ Transplant, and Director, Postgraduate Year 2 Pharmacy Residency-Transplant, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Nicole A. Pilch, Pharm.D., M.S.C.R., BCPS, is Clinical Specialist, Solid Organ Transplantation, and Clinical Assistant Professor, Department of Pharmacy and Clinical Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston. Lonnie D. Smith, Pharm.D., is Manager, Department of Solid Organ Transplant, and Director, Postgraduate Year 2 Pharmacy Residency-Transplant, University of Utah Hospitals and Clinics, Salt Lake City. Angela Q. Maldonado, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Transplant Services, Vidant Medical Center, Greenville, NC. David J. Taber, Pharm.D., BCPS, is Director, Clinical Research, and Assistant Professor of Surgery, Medical University of South Carolina
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Pinelli NR, Clark LM, Carrington AC, Carrington JL, Malinzak L, Patel A. Pharmacist managed diabetes and cardiovascular risk reduction clinic in kidney transplant recipients: bridging the gap in care transition. Diabetes Res Clin Pract 2014; 106:e64-7. [PMID: 25451909 DOI: 10.1016/j.diabres.2014.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/17/2022]
Abstract
The purpose was to assess the feasibility of a care transition intervention for kidney transplant recipients (KTRs) with diabetes. Results document improved quality indicators and reduced resource utilization. These findings imply that a care transition intervention for KTRs with diabetes is feasible and associated with improved patient outcomes.
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Affiliation(s)
- Nicole R Pinelli
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, United States; Transplant Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, United States.
| | - Lindsey M Clark
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, United States; Transplant Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, United States
| | - Anne C Carrington
- UNC Eshelman School of Pharmacy, 300 Pharmacy Lane, Chapel Hill, NC 27599, United States
| | - Julia L Carrington
- UNC Eshelman School of Pharmacy, 300 Pharmacy Lane, Chapel Hill, NC 27599, United States
| | - Lauren Malinzak
- Transplant Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, United States
| | - Anita Patel
- Transplant Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, United States
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Siracuse JJ, Gill HL, Jones DW, Schneider DB, Connolly PH, Parrack I, Huang ZS, Meltzer AJ. Risk factors for protracted postoperative length of stay after lower extremity bypass for critical limb ischemia. Ann Vasc Surg 2014; 28:1432-8. [PMID: 24517986 DOI: 10.1016/j.avsg.2013.12.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/27/2013] [Accepted: 12/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared with other common chronic conditions, admissions for management of peripheral arterial disease (PAD) are associated with prolonged hospitalizations. Length of stay (LOS) is one of many metrics receiving increased attention in the current focus on efficient healthcare delivery. Our objective was to characterize LOS among patients with severe PAD, those undergoing surgical bypass for critical limb ischemia (CLI), and identify risk factors for protracted postoperative LOS. METHODS Patient data from the 2007 to 2009 American College of Surgeons National Surgical Quality Improvement Program were used to develop a database consisting of patients undergoing bypass surgery for CLI (n = 4,894). Protracted postoperative LOS was defined as the top quartile of days hospitalized from surgery to discharge. Preoperative risk factors with significant association (Pearson chi-squared test; P < 0.05) were used to develop a logistic regression model for protracted postoperative LOS. RESULTS Average postoperative LOS was 7.5 days (median 6 days). The top quartile of postoperative LOS, >8 days, was used to define protracted LOS. Independent preoperative risk factors for protracted postoperative LOS included demographic characteristics (advanced age and non-Caucasian race), comorbidities, and medical history (e.g., obesity, dialysis dependence, severe cardiac and pulmonary disease, and bleeding disorders). Indicators of PAD severity (e.g., distal target sites, open wounds or gangrene, and prior arterial surgery) were also independent predictors of protracted LOS after surgery. The greatest predictors of extended postoperative LOS were prolonged preoperative hospitalization (OR 2.2 [95% CI: 1.8-2.6], P < 0.001) and preoperative dependent functional status (OR 2.0 [95% CI: 1.7-2.3], P < 0.001 for partial dependence; OR 2.8 [95% CI: 1.8-4.3], P < 0.001 for totally dependent status), where OR and CI stand for odds ratio and confidence interval. CONCLUSIONS Here, we identify preoperative risk factors for protracted postoperative LOS after infrainguinal bypass for CLI. These findings provide an important evidence basis for ongoing efforts to reduce healthcare spending and facilitate provision of efficient health care. Future efforts will include prospective identification of patients at high risk for protracted postoperative LOS and targeted multidisciplinary efforts to reduce associated costs without sacrificing healthcare quality.
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Affiliation(s)
- Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
| | - Heather L Gill
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Darren B Schneider
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Peter H Connolly
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Inkyong Parrack
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Zhen S Huang
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | - Andrew J Meltzer
- Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
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The concept of a composite perioperative quality index in kidney transplantation. J Am Coll Surg 2013; 218:588-97. [PMID: 24491243 DOI: 10.1016/j.jamcollsurg.2013.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Public reporting of patient and graft outcomes in a national registry and close Centers for Medicare and Medicaid Services oversight has resulted in transplantation being a highly regulated surgical discipline. Despite this, transplantation surgery lacks comprehensive tracking and reporting of perioperative quality measures. Therefore, the aim of this study was to determine the association between a kidney transplantation centers' perioperative quality benchmarking and graft and patient outcomes. STUDY DESIGN This was an analysis of 2011 aggregate data compiled from 2 national datasets that track outcomes from member hospitals and transplantation centers. The transplantation centers included in this study were composed of accredited US kidney transplantation centers that report data through the national registry and are associate members of the University HealthSystem Consortium. RESULTS A total of 16,811 kidney transplantations were performed at 236 centers in the United States in 2011, of which 10,241 (61%) from 93 centers were included in the analysis. Of the 6 perioperative quality indicators, 3 benchmarked metrics were significantly associated with a kidney transplantation center's underperformance: mean ICU length of stay (C-statistic 0.731; p = 0.002), 30-day readmissions (C-statistic 0.697; p = 0.012) and in-hospital complications (C-statistic 0.785; p = 0.001). The composite quality index strongly correlated with inadequate center performance (C-statistic 0.854; p < 0.001, R(2) = 0.349). The centers in the lowest quartile of the quality index performed 2,400 kidney transplantations in 2011, which led to 2,640 more hospital days, 4,560 more ICU days, 120 more postoperative complications, and 144 more patients with 30-day readmissions, when compared with centers in the 3 higher-quality quartiles. CONCLUSIONS An objective index of a transplantation center's quality of perioperative care is significantly associated with patient and graft survival.
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Self-administration education and polypharmacy in mechanical circulatory support patients. J Heart Lung Transplant 2013; 32:1141-2. [DOI: 10.1016/j.healun.2013.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/18/2022] Open
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Riley K. Enhanced medication management services in the community: A win-win proposal from an economic, clinical and humanistic perspective. Can Pharm J (Ott) 2013; 146:162-8. [PMID: 23795201 DOI: 10.1177/1715163513481315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pharmacists are now receiving reimbursement by the Ontario government to do medication reviews for patients on 3 or more medications. However, they are often too busy in the community setting to thoroughly review medications with patients. Having a designated pharmacist to provide medication reviews could increase the number of reviews performed. METHODS Step 1 involved developing a business plan to determine the number of medication reviews that needed to be done to pay a pharmacist a full-time salary. Step 2 involved establishing the core elements of medication therapy management that included medication review, a medication-related action plan, documentation and follow-up. In step 3, eligible patients were called and invited to attend an appointment to review their medications with the pharmacist. Upon completion of the medication reviews, a random group of patients were requested to complete a satisfaction survey after the medication review. RESULTS Three hundred thirty-six patients received billable medication reviews from April 4 to July 27, 2012. Twenty-seven additional visits were performed as follow-up visits. Eighty pharmaceutical opinions met the eligibility criteria for billing. Fifteen patients received counselling for smoking cessation. Medication reviews were completed for 19 patients from 8 other pharmacies. Extra revenue was generated through the sales of replacements of expired products. An average of 2.08 drug-related problems per patients was identified. One hundred percent of the patients were very satisfied with the service. CONCLUSION A full-time pharmacist position providing enhanced medication management services generated enough income to pay for a full-time pharmacist's salary. The benefits to the patients were an increase in identification and resolution of drug-related problems, as well as an opportunity to receive disease state education and experience an improvement in disease states. Patients were extremely satisfied with the medication review process and the service provided to them. Can Pharm J 2013;146:162-168.
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