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Tsige AW, Kotiso TA, Ayenew KD, Ayele SG. Pharmacist intervention to improve adherence to medication among heart failure patients at North East Ethiopia hospital. Pharmacol Res Perspect 2024; 12:e1199. [PMID: 38686951 PMCID: PMC11059962 DOI: 10.1002/prp2.1199] [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: 02/03/2024] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Heart failure (HF) is a major and growing medical problem and its management is still challenging due to the coexistence of complications, co-morbidity, and medication non-adherence. HF patients who are adherent to their medication have fewer HF exacerbations, improved survival, and lower healthcare expenditure. Adherence to HF medication plays a pivotal role in attaining maximal therapeutic outcomes. The aim was to assess the medication adherence of heart failure patients at Debre Berhan Comprehensive Specialized Hospital (DBCSH). A pre-post interventional study was undertaken from July 1, 2022, to December 31, 2022, at the medical referral clinic of DBCSH. The educational interventions were provided for 6 months. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics and binary logistic regression analysis were performed. The strength of the association between predictor variables and outcome variables was determined using a 95% confidence interval and adjusted odd ratio. In the pre-intervention phase, 54.6% of patients had medium medication adherence, while in the post-intervention phase, 36.4% of patients had high medication adherence and 61.9% of patients had medium medication adherence. Following the intervention, medication cost (120, 50%), inadequate availability of drugs (75, 31%), and forgetfulness (30, 13%) were the main reasons for medication non-adherence. The presence of co-morbidity and the number of co-morbidity (p < .05) were significantly associated with the occurrence of decreased medication adherence in the pre-intervention phase. Interventions by pharmacists to educate HF patients about the nature of their disease and providing brochures to increase awareness of their medications have been shown to improve medication adherence.
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Affiliation(s)
- Abate Wondesen Tsige
- Department of Pharmacy, College of Health SciencesDebre Berhan UniversityDebre BerhanEthiopia
| | | | - Kassahun Dires Ayenew
- Department of Pharmacy, College of Health SciencesDebre Berhan UniversityDebre BerhanEthiopia
| | - Siraye Genzeb Ayele
- Department of Midwifery, School of Nursing and Midwifery, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
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Hatem NAH, Ibrahim MIM, Yousuf SA. Exploring knowledge, attitudes and practice toward medication therapy management services among pharmacists in Yemen. PLoS One 2024; 19:e0301417. [PMID: 38578732 PMCID: PMC10997124 DOI: 10.1371/journal.pone.0301417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/16/2024] [Indexed: 04/07/2024] Open
Abstract
Medication therapy management (MTM) refers to the activities provided by pharmacists that patients recognize as evidence of care being provided. It encompasses the services that patients value and consider valuable. Many developing nations like Yemen have had poor implementation of MTM services. Thus, this research assessed the Knowledge, Attitudes, and Practices (KAP) of Yemen pharmacists regarding MTM. We conducted a cross-sectional study using a self-administered questionnaire among pharmacists in Sana'a, Yemen. They were recruited through convenience sampling. The alpha level of 0.05 was used to determine statistical significance. Four hundred and sixty-one (461) pharmacists completed the questionnaire. About 70% were working in community pharmacies and 57.3% had (1-5) years of experience in pharmacy practice. The younger pharmacists had a higher level of knowledge than pharmacists with older age with median and IQR of 1.2(1.2-1.4) and 1.2(1-1.4) respectively (p < 0.001). Yemen pharmacists have positive attitudes toward MTM indicating a moderated level of attitudes with a median and IQR of 3.8(3.5-4). Hospital pharmacists expressed more positive attitudes toward MTM (P < 0.001) than pharmacists from other areas of practice. Only 11% of sampled pharmacists frequently offered MTM services. The top MTM service reported by Yemen pharmacists was "Performing or obtaining necessary assessments of the patient's health status". However, "Formulating a medication treatment plan" received the least provided MTM service among Yemen pharmacists. Even though MTM services are not commonly utilized in pharmacy practice, Yemeni pharmacists have positive attitudes concerning MTM. Efforts are needed to enhance their MTM knowledge and the value of providing MTM services as well as to develop a culture of continuing pharmacy education about MTM among pharmacists.
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Affiliation(s)
- Najmaddin A. H. Hatem
- Department of Clinical Pharmacy, College of Clinical Pharmacy, Hodeidah University, Al-Hudaydah, Yemen
| | | | - Seena A. Yousuf
- Social Medicine and Public Health Department, Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen
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Hovey SW, Cho HJ, Kain C, Sauer HE, Smith CJ, Thomas CA. Pharmacist-Led Discharge Transitions of Care Interventions for Pediatric Patients: A Narrative Review. J Pediatr Pharmacol Ther 2023; 28:180-191. [PMID: 37303760 PMCID: PMC10249976 DOI: 10.5863/1551-6776-28.3.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
Transitions of care (TOC) before, during, and after hospital discharge are an opportune setting to optimize medication management. The quality standards for pediatric care transitions, however, are lacking, leading to reduced health outcomes in children. This narrative review characterizes the pediatric populations that would benefit from focused, TOC interventions. Different types of medication-focused TOC interventions during hospital discharge are described, including medication reconciliation, education, access, and adherence tools. Various TOC intervention delivery models following hospital discharge are also reviewed. The goal of this narrative review is to help pediatric pharmacists and pharmacy leaders better understand TOC interventions and integrate them into the hospital discharge process for children and their caregivers.
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Affiliation(s)
- Sara W. Hovey
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Hae Jin Cho
- Department of Pharmacotherapy (HJC), College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX
| | - Courtney Kain
- Department of Pharmacy (CK), Nemours Children's Hospital, Wilmington, DE
| | - Hannah E. Sauer
- Department of Pharmacy (HES), Texas Children's Hospital, Houston, TX
| | - Christina J. Smith
- Department of Pharmacy (CJS), Loma Linda University Children's Hospital, Loma Linda, CA
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4
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Aljofan M, Oshibayeva A, Moldaliyev I, Saruarov Y, Maulenkul T, Gaipov A. The rate of medication nonadherence and influencing factors: A systematic Review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lack of adherence to recommended therapy will reduce its effectiveness and can subsequently lead to disease progression, disabilities or even death. A vast number of research studies have emphasized the magnitude of medication nonadherence and its effect on treatment outcomes, patient’s health, healthcare providers and the associated costs; medication nonadherence remains a major concern that is believed to be widely practiced amongst medication taking patients. The current systemic review aims to cohere the available evidence regarding medication nonadherence rate, practices, and potential affecting factors and predictors. A search through different databases was conducted, including PubMed, Medline, and CINHAL for recently published research articles, within five years. The terms used for the search include medication nonadherence, medication nonadherence, factors affecting medication nonadherence and predictors of medication nonadherence. The search was limited to human subjects, English language journal articles and exclusion of review articles, case studies, and data from clinical trials as patient adherence is closely observed.<br />
The search resulted in 667 articles and only 65 articles were included and further screened. However, according to our exclusion criteria, 15 articles only were included in this review. The three most reported practices of medication nonadherence are prescription abandonment, nonconforming, and non-persistence. There are five reported factors that may lead to nonadherence practices such as socioeconomic-related factors, healthcare system-related factors, patient-related factors, disease-related factors, and therapy-related factors. In conclusion, medication nonadherence practice is a multi-dimensional phenomenon that requires a multi-targeted solution.
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Affiliation(s)
- Mohamad Aljofan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, KAZAKHSTAN
| | - Ainash Oshibayeva
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Ikilas Moldaliyev
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Yerbolat Saruarov
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Tilektes Maulenkul
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, KAZAKHSTAN
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O'Mahony E, Kenny J, Hayde J, Dalton K. Development and evaluation of pharmacist-provided teach-back medication counselling at hospital discharge. Int J Clin Pharm 2023:10.1007/s11096-023-01558-0. [PMID: 37093415 PMCID: PMC10124684 DOI: 10.1007/s11096-023-01558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Pharmacists can use teach-back to improve patients' understanding of medication; however, the evidence of its impact on patient outcomes is inconsistent. From the literature, there is no standardised way to provide pharmacist-delivered medication counselling at hospital discharge, with limited reporting on training. AIM To develop a standardised medication counselling procedure using teach-back at hospital discharge, and to evaluate feedback from patients and pharmacists on this initiative. METHOD A standardised intervention procedure was developed. Participating pharmacists (n = 9) were trained on teach-back via an online education module and watching a demonstration video created by the researchers. Pharmacists provided patients with discharge medication counselling utilising teach-back and a patient-friendly list of medication changes to take home. To obtain feedback, patients were surveyed within seven days of discharge via telephone and pharmacists answered an anonymous survey online. RESULTS Thirty-two patients (mean age: 57 years; range: 19-91) were counselled on a mean 2.94 medications/patient with the mean counselling time as 23.6 min/patient. All patients responded to the survey, whereby 93.7% had increased confidence regarding medication knowledge and were satisfied with the counselling and the information provided. All pharmacist survey respondents (n = 8) agreed they were given adequate training and that teach-back was feasible to apply in practice. CONCLUSION This is the first study to evaluate patients' views on pharmacist-provided teach-back medication counselling. With positive patient outcomes, a standardised procedure, and a comprehensive description of the training, this study can inform the development of discharge medication counselling utilising teach-back going forward.
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Affiliation(s)
- E O'Mahony
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Kenny
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Hayde
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - K Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
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Althomali A, Altowairqi A, Alghamdi A, Alotaibi M, Althubaiti A, Alqurashi A, Harbi AA, Algarni MA, Haseeb A, Elnaem MH, Alsenani F, Elrggal ME. Impact of Clinical Pharmacist Intervention on Clinical Outcomes in the Critical Care Unit, Taif City, Saudi Arabia: A Retrospective Study. PHARMACY 2022; 10:pharmacy10050108. [PMID: 36136841 PMCID: PMC9498917 DOI: 10.3390/pharmacy10050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding ‘indication’ (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis.
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Affiliation(s)
- Abdullah Althomali
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Ahmed Altowairqi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Afnan Alghamdi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Musim Alotaibi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | | | | | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan 53100, Pahang, Malaysia
| | - Faisal Alsenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
- Correspondence: or
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Azhar A, Wasif Gillani S, Jiaan N, Menon V, Abdi S, Rathore HA. Patient satisfaction with inpatient pharmacy services at tertiary care setting—a meta-analysis of recent literature. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
This study aimed to determine patient satisfaction with the following pharmacist-led services for inpatients in tertiary care hospitals.
Methods
Studies were identified from different databases from 2012 to 2020. A total of 1910 articles were identified using the search strategies out of which 1153 were rejected based on the review of titles and abstracts. The search criteria were the roles of inpatient pharmacists and patient satisfaction with inpatient pharmacy services. Multiple keywords were used such as ‘patient satisfaction’/‘inpatient pharmacist’/‘pharmacist hospital services’/‘clinical pharmacist roles’. The quality of each study was measured using the mixed methods appraisal tool, and the same was used to evaluate the risk of bias as well.
Key findings
A total of 11 cross-sectional studies were included in the evidence synthesis of this meta-analysis. Three studies tested the satisfaction of patients with inpatient counselling with a sample size of n = 742. The odd ratio (OR) was 215.33 (141.77 to 327.05) [95% confidence interval (CI)] showed a significant patient satisfaction (P = 0.00001) with the pharmacist’s inpatient counselling (I2 = 0%). Studies showed a statistically significant satisfaction of patients with discharge counselling P < 0.00001 and OR 55.74 (35.93 to 86.49) and heterogeneity I2 = 0%. In a total of five studies, the healthcare professional (HCP) satisfaction with pharmacist services was reported, and satisfied and unsatisfied HCPs were n = 801 and n = 362, respectively. Results showed high satisfaction (P < 0.00001) and OR 4.62 (95% CI, 3.89 to 5.48).
Conclusion
This meta-analysis concluded that clinical pharmacist services in an inpatient setting have a significant impact on increasing patient satisfaction with their treatment. The clinical pharmacist services are not very well implemented and are limited in some hospitals, but patients who have received these services were highly satisfied and expected to receive them more often.
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Affiliation(s)
- Anam Azhar
- College of Pharmacy, Gulf Medical University , Ajman , UAE
| | - Syed Wasif Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University , Ajman , UAE
| | - Nada Jiaan
- College of Pharmacy, Gulf Medical University , Ajman , UAE
| | - Vineetha Menon
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University , Ajman , UAE
| | - Semira Abdi
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University , Ajman , UAE
- Dubai Pharmacy College , Dubai , UAE
| | - Hassaan A Rathore
- College of Pharmacy, QU Health, Qatar University , Doha 2713 , Qatar
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Findlater CK, Gerges S, Litynsky J, Robson K. Implementation of a Meds to Beds Medication Use Program and Parent Experience at the Time of Transition From a Neonatal Intensive Care Unit to Home. J Pediatr Pharmacol Ther 2022; 27:300-305. [DOI: 10.5863/1551-6776-27.4.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
This study aims to describe the overall experience of the neonatal intensive care unit (NICU) parent at time of transition home related to discharge medication use, following implementation of a Meds to Beds program.
METHODS
A descriptive, qualitative study was used to explore parent experiences around medication use during transition home. Eleven parents whose infants required medications at the time of transition home from the NICU participated in a semi-structured telephone interview post-discharge. The data were coded and analyzed for themes.
RESULTS
Major themes nested within the key stages of medication use in preparation for transition home from the NICU were identified: in-hospital preparation (practice early and often, Meds to Beds, and relationship with clinical pharmacist), transition home (schedule and routine, strategies for medication administration) and post-discharge (refills and long-term medication management). Strategies based on parent experiences to improve the process and ameliorate anxiety are presented.
CONCLUSIONS
Parents expressed how effective the Meds to Beds program was on the transition home by increasing parental confidence and knowledge around medications and reducing stress around the acquisition of medications for home. They also reported comfort in having a relationship with the NICU clinical pharmacist, providing a tailored approach to coordinating care both in hospital and during the transition home. Regardless of implementation of a Meds to Beds program, great opportunities remain to refine the transition home. Implementing the suggested improvement strategies could provide significant positive effects with respect to patient care and parental stress during the transition home.
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Affiliation(s)
- Carla K. Findlater
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandra Gerges
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jacklyn Litynsky
- Department of Pharmacy (JL), Windsor Regional Hospital, Windsor, ON, Canada
| | - Kate Robson
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Wondesen A, Berha AB, Woldu M, Mekonnen D, Engidawork E. Impact of medication therapy management interventions on drug therapy problems, medication adherence and treatment satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia: a one-group pre-post quasi-experimental study. BMJ Open 2022; 12:e054913. [PMID: 35414550 PMCID: PMC9006832 DOI: 10.1136/bmjopen-2021-054913] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/04/2022] Open
Abstract
OBJECTIVE To determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients. STUDY DESIGN, SETTING AND PARTICIPANTS A one-group pre-post quasi-experimental study was conducted on 423 ambulatory HF patients at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia. All ambulatory HF patients ≥18 years old attending the adult cardiac clinic of TASH and having a complete medical record and fully met the inclusion criteria were taken as study participants. INTERVENTIONS Educational interventions along with a brochure with information on the nature of HF disease and its treatment were provided to study participants. DTPs encountered were resolved by a team of pharmacists and physicians. RESULTS In the preintervention phase, 288 DTPs were identified with a mean (SD) of 1.3±1.1. A significant reduction of DTPs (0.67±1.1, p<0.001) was observed in the postintervention phase compared with the preintervention phase. At the postintervention phase, 36.4%, 61.9% and 1.7% of HF patients were highly, medium and low adherent to their treatment regimens, respectively. The total composite score for treatment satisfaction of the study participants was 80.35%. CONCLUSIONS The findings of this study demonstrated that by teaming up clinical pharmacists with cardiologists and cardiology fellows, it was possible to reduce the occurrence of DTPs, improve medication adherence and increase treatment satisfaction of HF patients attending at the outpatient cardiac clinic.
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Affiliation(s)
- Abate Wondesen
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Woldu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Varghese S, Hahn-Goldberg S, Deng Z, Bradley-Ridout G, Guilcher SJT, Jeffs L, Madho C, Okrainec K, Rosenberg-Yunger ZRS, McCarthy LM. Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review. Patient Prefer Adherence 2022; 16:515-560. [PMID: 35241910 PMCID: PMC8887864 DOI: 10.2147/ppa.s348152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings. METHODS Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer. RESULTS A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers). CONCLUSION The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.
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Affiliation(s)
- Shawn Varghese
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Michael G.Degroote School Of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - ZhiDi Deng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glyneva Bradley-Ridout
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sinai Health, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Craig Madho
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Karen Okrainec
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, School of Health Services Management, Ryerson University, Toronto, Ontario, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Correspondence: Lisa M McCarthy, Clinician Scientist, Institute for Better Health, Trillium Health Partners, Tel +1 416-566-2793, Email
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11
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King PK, Burkhardt C, Rafferty A, Wooster J, Walkerly A, Thurber K, Took R, Masterson J, St. Peter WL, Furuno JP, Williams E, Ferren J, Rascon K. Quality measures of clinical pharmacy services during transitions of care. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Roxane Took
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | - Jon P. Furuno
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Evan Williams
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Janie Ferren
- American College of Clinical Pharmacy Lenexa Kansas USA
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Daud R, Zulkarnain BS, Amu IV. Providing counseling through home pharmacy care (HPC) for hemodialysis patients with hypertension in lowering blood pressure. J Basic Clin Physiol Pharmacol 2021; 32:459-465. [PMID: 34214338 DOI: 10.1515/jbcpp-2020-0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypertension is one of the main factors in increasing the risk of cardiovascular disease with 51% reported cause of death in chronic kidney disease (CKD) patients with end-stage renal disease (ESRD). It is a comorbid that needs to be managed properly and gets special attention from various health disciplines including a pharmacist. METHODS This was a quasi experimental study with pretest-posttest intervention using home pharmacy care (HPC) counseling both on the counseling and the noncounseling group. Initial data collection and informed consent was done at the Hemodialysis Unit Aloei Saboe and Toto Kabila Hospital, Gorontalo. The parameters in the study were patients' compliance to their medication using the Medication Adherence Questionnaire (MAQ) and Pill Count Adherence (PCA) questionnaires and the patient's blood pressure. RESULTS Fifty-eight patients met the inclusion criteria and were divided into two groups (the counseling group and the noncounseling group). Based on MAQ and PCA, the level of patient medication adherence increased significantly in the counseling group compared to the noncounseling group with a significance value of p<0.05. Increasing adherence was correlated with patients' outcome of lowering blood pressure. More patients in the counseling group showed decrease in systolic and diastolic blood pressure compared to the noncounseling group (86.2 vs. 17.2% for systolic BP and 69 vs. 10.3% for diastolic blood pressure (BP). Following adjusted confounding variables, counseling through HPC provided a chance of decreasing systolic blood pressure 32 times (95% CI: 7.198-144.550) and diastolic blood pressure 42 times (95% CI: 6.204-286.677). CONCLUSIONS HPC affects the improvement of patient medication adherence and reduction of blood pressure in hemodialysis patients with hypertension.
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Affiliation(s)
- Rahmiyati Daud
- Faculty of Pharmacy, Airlangga University, Surabaya, Indonesia
| | | | - Ivan Virnanda Amu
- Department of Medicine, Faculty of Medicine, Gorontalo State University, Gorontalo, Indonesia
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Community pharmacists' role in caring for people living with epilepsy: A scoping review. Epilepsy Behav 2021; 117:107850. [PMID: 33631435 DOI: 10.1016/j.yebeh.2021.107850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify and describe studies about pharmacist-provided services for people with epilepsy and their caregivers. METHODS PubMed/MEDLINE and EMBASE were searched for articles that were: (1) written in English, (2) published in 1985 or later, (3) a peer-reviewed empirical study or practice report, and (4) describing an intervention provided by a pharmacist for people with epilepsy and/or their caregivers in an outpatient pharmacy setting. The abstracts and full text, when necessary, were reviewed by two investigators to assess eligibility. Data were extracted from each article by two investigators using a standardized abstraction form based on the Pharmacist Patient Care Services Intervention Reporting (PaCIR) checklist. Data elements of interest included components of service, mode of service delivery, frequency, number and duration of sessions for the service, roles and responsibilities of the community pharmacist, type of community pharmacy, outcomes and measures evaluated along with data sources, and findings and results. Risk of bias was not assessed due to the descriptive nature of the review. RESULTS Twelve articles were included, seven of which reported services conducted in the United States. The most common service reported was medication management (n = 7) followed by education and counseling (n = 4). One article described a care coordination documentation tool that could be used by pharmacists and physicians in epilepsy care. Most interventions were evaluated using observational designs (n = 5) or did not have an evaluation component (n = 4). SIGNIFICANCE This review provides examples of community pharmacists providing care to people living with epilepsy that extend beyond dispensing medications. Findings demonstrate that there is little published evidence on community pharmacists' contributions to epilepsy care and suggest opportunities for further exploration and innovation. This review serves as the first step in a project that seeks to develop a stakeholder-driven community pharmacist integrated population health intervention for people living with epilepsy.
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Medaglio D, Glasgow J, Zhang Z, Elliott D. Noninitiation of Discharge Medications After Revascularization. J Manag Care Spec Pharm 2020; 26:305-310. [PMID: 32105182 PMCID: PMC10390938 DOI: 10.18553/jmcp.2020.26.3.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Timely initiation of medication therapy after a cardiovascular event is vital to achieve optimal patient outcomes, yet there is a lack of insight on the frequency and predictors of discharge medications that are delayed or never initiated. OBJECTIVES To (a) describe how frequently patients do not fill newly prescribed discharge medications within 30 days after revascularization and (b) identify predictors of patients who did not fill their new medications. METHODS A single-center, retrospective analysis was conducted of patients discharged after percutaneous coronary intervention or coronary artery bypass grafting. Discharge prescriptions were linked to pharmacy claims data to identify medications that were not filled within 30 days of discharge. RESULTS 1,206 patients and their 5,253 discharge medications were included for study. More than one third of patients did not fill at least 1 discharge medication within 30 days (466/1,206, 38.6%); nearly 1 in 10 (116/1,206, 9.6%) did not fill any of their discharge prescriptions. Significant predictors of nonadherence included longer length of stay and higher number of prescribed discharge medications (both P values < 0.05). The largest classes of unfilled medications included insulin, factor Xa inhibitors, and narcotic analgesics. CONCLUSIONS Noninitiation is a common issue among patients after cardiac revascularization. These patients may be at a higher risk of not filling their medications if they experience longer lengths of stay or are prescribed a higher number of medications at discharge. DISCLOSURES This work was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod). The sponsor had no connection with Surescripts and no role in the study design, data analysis, interpretation of results, or development of this manuscript. Glasgow reports personal fees from Burroughs Group, outside the submitted work. The other authors have nothing to disclose. Preliminary results from this work were presented as a poster presentation at the 2018 AcademyHealth Annual Research Meeting; June 24-26, 2018; Seattle, WA.
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Affiliation(s)
| | - Justin Glasgow
- Hospital Medicine, The University of Alabama at Birmingham
| | - Zugui Zhang
- Value Institute, Christiana Care Health System, Newark, Delaware
| | - Daniel Elliott
- Christiana Care Quality Partners, Christiana Care Health System, Newark, Delaware
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Snyder ME, Krekeler CE, Jaynes HA, Davis HB, Lantaff WM, Shan M, Perkins SM, Zillich AJ. Evaluating the effects of a multidisciplinary transition care management program on hospital readmissions. Am J Health Syst Pharm 2020; 77:931-937. [DOI: 10.1093/ajhp/zxaa091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
To measure the effect of a pharmacist-initiated transitions of care (TOC) program on rates of 30-day all-cause readmissions and primary care follow-up.
Methods
A retrospective cohort study was conducted to evaluate a pharmacist-initiated TOC program for patients discharged from hospitals of a large health system from September 2015 through July 2016. Discharged patients of 13 primary care physicians (the intervention cohort) received TOC program services, and discharged patients seen by 12 other primary care physicians (the control cohort) received usual care. Patients in both cohorts were followed for 90 days. The primary outcome was 30-day all-cause readmissions, and secondary outcomes were 14-day primary care visits, TOC pharmacist identification and resolution of medication therapy problems (MTPs), and transition care management (TCM) billing. Multivariable modeling was performed to test the associations of patient receipt of TOC services with 30-day readmissions and 14-day primary care visits, with controlling for patient demographics and baseline healthcare utilization.
Results
A total of 492 patients received the TOC intervention, and 379 were followed in the usual care cohort. Among intervention patients, 960 MTPs were identified, and 85.7% of identified MTPs were resolved. Moreover, 9% of intervention cohort patients were readmitted within 30 days, compared to 15% of control cohort patients, and this effect was significant in the multivariable model (odds ratio, 1.82; 95% confidence interval, 1.15-2.89; P = 0.0108). Rates of primary care visits did not differ significantly between the groups; 65% of intervention group visits were billed using TCM codes.
Conclusion
A pharmacist-initiated TOC program was effective in reducing 30-day all-cause readmissions.
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Affiliation(s)
| | | | | | | | - Wendy M Lantaff
- Eudaemonia Health, LLC, Indianapolis, IN
- Walmart Pharmacy, Indianapolis, IN
| | - Mu Shan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Susan M Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Alan J Zillich
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN
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McKeirnan KC, Willson MN, Bray BS. Striving for interrater reliability with a patient counseling assessment rubric: Lessons learned. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:603-613. [PMID: 32482261 DOI: 10.1016/j.cptl.2020.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/21/2019] [Accepted: 01/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Providing effective patient counseling is an essential pharmacist skill to ensure patients understand how to take medications, prevent medication-related errors, and meet requirements of federal law. This study sought to develop a new patient counseling assessment rubric to minimize interrater variability, deliver a consistent summative competency assessment, and provide students with formative, actionable feedback. IMPACT A first attempt to achieve statistically significant interrater reliability was not successful due to incorporation of too many variables into study design and the subjective nature of patient counseling. After reducing study variables (number of different medications, number of evaluators, and number of videos) and consulting a statistician, a second attempt was made to analyze interrater reliability for the rubric. However, even with variables minimized, this attempt did not lead to statistically significant agreement. RECOMMENDATIONS The faculty team identified four recommendations (Omnibus Budget Reconciliation Act of 1990): conduct a norming session for graders prior to the assessment (Rantucci, 2006), conduct a post-hoc analysis after grading to reduce interrater variability and increase consistency (Taitel et al., 2012), simplify the rubric to reduce subjectivity and clarify the intent of rubric elements, and (Saranagam et al., 2013) rubrics can be utilized differently in separate courses to target specific learning objectives. DISCUSSION Although the goal of creating a rubric with statistically significant interrater reliability was not achieved, we did learn important lessons about evaluating student pharmacist performance with less subjectivity and more consistency. The authors hope the results and lessons learned will be valuable to our colleagues at other institutions as patient counseling content and rubrics are developed.
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Affiliation(s)
- Kimberly C McKeirnan
- Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 East Spokane Falls Blvd, Spokane, WA 99202-2131, United States.
| | - Megan N Willson
- Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 East Spokane Falls Blvd, Spokane, WA 99202-2131, United States.
| | - Brenda S Bray
- Washington State University Elson S. Floyd College of Medicine, 205 East Spokane Falls Blvd, Spokane, WA 99210-1495, United States.
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Daliri S, Boujarfi S, El Mokaddam A, Scholte Op Reimer WJM, Ter Riet G, den Haan C, Buurman BM, Karapinar-Çarkit F. Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis. BMJ Qual Saf 2020; 30:146-156. [PMID: 32434936 DOI: 10.1136/bmjqs-2020-010927] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related interventions and show conflicting results. However, until now, no review has focused on the effect of intervention components delivered both in hospital and following discharge from hospital to home. OBJECTIVE To examine effects of medication-related interventions on hospital readmissions, medication-related problems (MRPs), medication adherence and mortality. METHODS For this systematic review and meta-analysis, we searched the PubMed, Embase, CINAHL and CENTRAL databases without language restrictions. Citations of included articles were checked through Web of Science and Scopus from inception to 20 June 2019. We included prospective studies that examined effects of medication-related interventions delivered both in hospital and following discharge from hospital to home compared with usual care. Three authors independently extracted data and assessed study quality in pairs. RESULTS Fourteen original studies were included, comprising 8182 patients. Interventions consisted mainly of patient education and medication reconciliation in the hospital, and patient education following discharge. Nine studies were included in the meta-analysis; compared with usual care (n=3376 patients), medication-related interventions (n=1820 patients) reduced hospital readmissions by 3.8 percentage points within 30 days of discharge (number needed to treat=27, risk ratio (RR) 0.79 (95% CI 0.65 to 0.96)). Meta-regression analysis suggested that readmission rates were reduced by 17% per additional intervention component (RR 0.83 (95% Cl 0.75 to 0.91)). Medication adherence and MRPs may be improved. Effects on mortality were unclear. CONCLUSIONS Studied medication-related interventions reduce all-cause hospital readmissions within 30 days. The treatment effect appears to increase with higher intervention intensities. More evidence is needed for recommendations on adherence, mortality and MRPs.
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Affiliation(s)
- Sara Daliri
- Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Samira Boujarfi
- Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Asma El Mokaddam
- Department of Clinical Pharmacy, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, North-Holland, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, North-Holland, The Netherlands
| | - Chantal den Haan
- Department of Research and Education, Medical Library, OLVG, Amsterdam, North-Holland, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location AMC, Amsterdam, North-Holland, The Netherlands
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Medication-Focused Patient Counseling Upon Discharge: A Feasibility Study of Effect on Patient Satisfaction. PHARMACY 2020; 8:pharmacy8010008. [PMID: 31947675 PMCID: PMC7151701 DOI: 10.3390/pharmacy8010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To develop and test a simple medication-focused patient counseling intervention at hospital discharge, with the aim of improving patient satisfaction. METHODS The intervention was developed during a workshop and carried out by pharmaconomists. The final intervention comprised preparing information for the discharge counseling, medication reconciliation, discussion with physician, patient counseling at discharge, medication report to primary care physician, and phone follow-up three days after discharge. The intervention was tested against usual care in a gastrointestinal surgical unit in a feasibility study, using the setup of a randomized controlled trial, with patient satisfaction as the primary outcome. RESULTS A total of 85 patients were invited to participate in the study. Following refusals (n = 11) and exclusions (n = 10), 32 patients were included in each trial arm (median age of 66.5 years; 52% males; median admission length of seven days). Patient satisfaction was high in both groups, with 75% (intervention) and 91% (control) reporting being overall satisfied with the discharge process (p = 0.10). No other differences between the groups were identified. CONCLUSIONS The intervention did not result in improved patient satisfaction. This is likely attributed to the low number of patients included, the high satisfaction at baseline, and the lack of a validated tool to measure patient satisfaction. The developed intervention and study findings can inform future studies.
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Bethishou L, Herzik K, Fang N, Abdo C, Tomaszewski DM. The impact of the pharmacist on continuity of care during transitions of care: A systematic review. J Am Pharm Assoc (2003) 2020; 60:163-177.e2. [DOI: 10.1016/j.japh.2019.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/31/2019] [Accepted: 06/26/2019] [Indexed: 12/01/2022]
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Patel A, Dodd MA, D'Angio R, Hellinga R, Ahmed A, Vanderwoude M, Sarangarm P. Impact of discharge medication bedside delivery service on hospital reutilization. Am J Health Syst Pharm 2019; 76:1951-1957. [PMID: 31724038 DOI: 10.1093/ajhp/zxz197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. METHODS A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. RESULTS A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45-1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. CONCLUSION There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.
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Affiliation(s)
- Avni Patel
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Melanie A Dodd
- Department of Pharmacy Practice and Administrative Sciences, The University of New Mexico College of Pharmacy Albuquerque, NM
| | - Richard D'Angio
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Robert Hellinga
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Ali Ahmed
- Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
| | - Michael Vanderwoude
- Ambulatory Care Services, Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM
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A Study to Identify Medication-Related Problems and Associated Cost Avoidance by Community Pharmacists during a Comprehensive Medication Review in Patients One Week Post Hospitalization. PHARMACY 2019; 7:pharmacy7020051. [PMID: 31146447 PMCID: PMC6630417 DOI: 10.3390/pharmacy7020051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community pharmacists provided CMRs to covered employees and dependents of a self-insured regional grocery store chain who were discharged from the hospital. Data was collected prospectively over 4 months. Discrepancies were identified among patients’ medication regimens by comparing the hospital discharge record, the pharmacy profile, and what the patient reported taking. MRPs were categorized into ten categories, as defined by the OutcomesMTM® Encounter Worksheet. Interventions were categorized using the severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were analyzed using descriptive statistics and bivariate correlations. Results: Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most common type of MRP was underuse of medication (70.6%). Significant positive correlations were found between the number of scheduled prescription medications and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r = 0.697). Most commonly, the severity levels associated with the MRPs involved the prevention of physician office visits or addition of new prescription medications (n = 10 each); however, four emergency room visits and three hospitalizations were also avoided. The total estimated cost avoidance was $92,143, or $4850 per patient. Extrapolated annual cost savings related to this service would be $276,428. Conclusions: This transitions of care service was successful in identifying and addressing MRPs and discrepancies for this patient population. By providing this service, community pharmacists were able to prevent outcomes of various severities and to avoid patient care costs.
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Vawter-Lee M, Lutley A, Lake SW, Fledderjohn S, King A, Horn PS, Wesselkamper KR. Pediatric Epilepsy Readmissions: The Who, When, and Why. Pediatr Neurol 2019; 93:11-16. [PMID: 30704869 DOI: 10.1016/j.pediatrneurol.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies have demonstrated a pediatric epilepsy readmission rate of 6% to 10% but have not described details of the readmitted patients. We report the characteristics of pediatric patients admitted for epilepsy who were readmitted to the hospital within 30 days of discharge. METHODS An interdisciplinary team was established to individually review and characterize the 30-day readmissions of patients admitted for epilepsy from May 2014 to October 2016. The team contained both inpatient and outpatient neuroscience nurses, care managers, a quality outcomes manager, and child neurology physicians. RESULTS Over a 30-month period we had an all-cause 30-day readmission rate of 8.0%, which was 219 pediatric epilepsy readmissions from 169 patients. We found that 21.5% of readmissions were scheduled, 37% were for progression of chronic epilepsy, 9.6% were for recently diagnosed epilepsy, and 14.6% were for unrelated diagnoses. We classified 21.5% of readmissions as preventable and 64.9% as not preventable. Thirty-five percent of readmissions occurred within seven days of the initial discharge, including 29 of 47 (61.7%) preventable readmissions. The most common reasons for preventable readmissions were problems with the discharge care plan or medication management. CONCLUSIONS We demonstrate that 21.5% of pediatric epilepsy readmissions were scheduled and 21.5% were judged to be preventable. The majority of preventable readmissions occurred within seven days of index discharge. Characterizing epilepsy readmissions is the first step in being able to reduce readmissions.
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Affiliation(s)
- Marissa Vawter-Lee
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Alexandria Lutley
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sharon W Lake
- Cincinnati Children's Hospital Medical Center, Neuroscience Trauma Unit, Cincinnati, Ohio
| | - Shirley Fledderjohn
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anna King
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Horn
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kristen R Wesselkamper
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Lee R, Malfair S, Schneider J, Sidhu S, Lang C, Bredenkamp N, Liang SFS, Hou A, Virani A. Evaluation of Pharmacist Intervention on Discharge Medication Reconciliation. Can J Hosp Pharm 2019; 72:111-118. [PMID: 31036971 PMCID: PMC6476574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Discharge medication reconciliation (Discharge MedRec) was implemented on one unit at a large urban teaching hospital, and was to be expanded across the rest of the hospital and the health authority's various sites by the end of 2018. Clinical pharmacists on the Acute Care for the Elderly unit carried out discharge planning and led Discharge MedRec during a pilot period, to inform the future implementation. OBJECTIVES The primary objective was to examine the number and type of medication discrepancies before and after implementation of Discharge MedRec. The secondary objectives were to compare documented medication changes, pharmacist recommendations, discharge counselling, communication with community pharmacists, polypharmacy, and 30-day readmission rates. METHODS Patients seen in December 2015 constituted the control (pre-implementation) group, who received usual care. Patients seen from January to April 2016 constituted the intervention group, for whom pharmacists performed Discharge MedRec and other discharge activities as per the hospital-to-home checklist of the Institute for Safe Medication Practices Canada. RESULTS There were 66 patients in the control group and 306 in the intervention group. Median discrepancies per patient decreased from 6.5 to 3 (p = 0.007), median number of documented changes without rationale increased from 2 to 3 (p = 0.01), and median number of documented changes with rationale increased from 1 to 2 (p < 0.001). Pharmacists made a per-patient median of 1 progress note recommendation in the control group and 2 progress note recommendations in the intervention group (p = 0.007), and a per-patient median of 2 orders in both the control and intervention groups (p = 0.62). Median recommendation acceptance was 100% for both groups, but twice as many recommendations were made per patient for the intervention group. Discharge counselling increased from 22.7% to 65%. Communication with community pharmacists increased from 10.6% to 60.8%. CONCLUSIONS Clinical pharmacist involvement improved Discharge MedRec planning and documentation. Decreases in medication discrepancies, combined with an increase in discharge counselling, should improve continuity of care across the health care team and increase patient adherence with medication therapy. This study further demonstrates the leadership role that pharmacists play in the assessment and clear documentation of medication changes at all transitions of care.
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Affiliation(s)
- Robin Lee
- , BScPharm, BSc, is a Pharmacist with the Surrey Memorial Hospital and the Jim Pattison Outpatient Care and Surgery Centre, Surrey, British Columbia
| | - Suzanne Malfair
- , BSc(Pharm), ACPR, PharmD, FCSHP, BCPS, is Coordinator, Clinical Pharmacy Services, with Lions Gate Hospital and The University of British Columbia, North Vancouver, British Columbia
| | - Jordan Schneider
- , PharmD, MS, BCPS, is a Clinical Pharmacist with the Jim Pattison Outpatient Care and Surgery Centre, Surrey Memorial Hospital, Surrey, British Columbia
| | - Sukjinder Sidhu
- , BSc(Pharm), ACPR, is a Clinical Pharmacist with Surrey Memorial Hospital, Surrey, British Columbia
| | - Caitlin Lang
- , BSc(Pharm), ACPR, is a Clinical Pharmacist with Surrey Memorial Hospital, Surrey, British Columbia
| | - Nina Bredenkamp
- , BSc(Pharm), ACPR, is a Clinical Pharmacist with Surrey Memorial Hospital, Surrey, British Columbia
| | - Shu Fei Sophie Liang
- , BSc(Pharm), is a Pharmacist with Surrey Memorial Hospital, Surrey, British Columbia
| | - Alice Hou
- , BSc(Pharm), ACPR, is a Clinical Pharmacist with Surrey Memorial Hospital, Surrey, British Columbia
| | - Adil Virani
- , BSc(Pharm), PharmD, is the Manager of Pharmacy Services, Lower Mainland Pharmacy Services, and Associate Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
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Fanizza FA, Ruisinger JF, Prohaska ES, Melton BL. Integrating a health information exchange into a community pharmacy transitions of care service. J Am Pharm Assoc (2003) 2018; 58:442-449. [DOI: 10.1016/j.japh.2018.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
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Ruiz-Millo O, Climente-Martí M, Navarro-Sanz JR. Patient and health professional satisfaction with an interdisciplinary patient safety program. Int J Clin Pharm 2018; 40:635-641. [PMID: 29594676 DOI: 10.1007/s11096-018-0627-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
Abstract
Background Measuring humanistic outcomes is an important component of valuating healthcare services. There is a paucity of data on satisfaction with pharmacist implemented clinical services in long-term care settings. Objective To evaluate patient and health professional (HP) satisfaction with an interdisciplinary patient safety program performed in elderly patients with polypharmacy admitted to a long-term care hospital (LTCH). Method An interventional, longitudinal, prospective study was conducted in a Spanish LTCH. Pharmacist conducted the pharmacotherapy follow-up (reconciliation, pharmacotherapeutic optimization and educational interviews). Two satisfaction surveys were designed on a 10-point Likert-type scale. The patient survey was administered at discharge. The HP survey included the following dimensions: knowledge and program importance, pharmacist skills and pharmacist contributions to the interdisciplinary team. A reliability analysis was performed. Results 123 surveys were completed and returned; 74 patient surveys (response rate 97.4%) and 49 HP surveys (response rate 98.0%). The overall mean score of the patient survey was 9.46 ± 0.87, resulting in 82.4% very satisfied and 17.6% satisfied. The overall mean score of the HP survey was 8.85 ± 1.42, resulting in 65.3% very satisfied and 30.6% satisfied. Conclusion Elderly patients with polypharmacy and HPs reported high levels of satisfaction with the interdisciplinary patient safety program implemented in an LTCH. This positive response supports the value of pharmacists for managing older high-risk populations.
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Affiliation(s)
- Oreto Ruiz-Millo
- Pharmacy Department, Doctor Peset University Hospital, Gaspar Aguilar, 90, 46017, Valencia, Spain. .,Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Doctor Peset University Hospital, Valencia, Spain.
| | - Mónica Climente-Martí
- Pharmacy Department, Doctor Peset University Hospital, Gaspar Aguilar, 90, 46017, Valencia, Spain
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Comer D, Goldsack J, Flaherty J, Van Velzen K, Caplan R, Britt K, Viohl H, Heitz K, Corbo T. Impact of a discharge prescription program on hospital readmissions and patient satisfaction. J Am Pharm Assoc (2003) 2017; 57:498-502.e1. [DOI: 10.1016/j.japh.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/08/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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Emergency Department Asthma Medication Delivery Program: An Initiative to Provide Discharge Prescriptions and Education. Pediatr Qual Saf 2017; 2:e033. [PMID: 29202118 PMCID: PMC5690291 DOI: 10.1097/pq9.0000000000000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/16/2017] [Indexed: 11/01/2022] Open
Abstract
Background Prescription fill rates for children being discharged from the emergency department (ED) after asthma exacerbations are low, placing the child at risk for additional ED visits or admissions for asthma. This article describes the implementation of an ED asthma prescription delivery service designed to improve pharmacy prescription capture and decrease ED revisit rates. Methods A core group developed a service to provide asthma prescriptions and education to patients in their ED room before discharge. The project assessed the percent of ED asthma patients who filled ED asthma prescriptions at the hospital outpatient pharmacy, 7-, 14-, and 30-day ED revisit rates, and patient satisfaction. Intervention Patients/families who chose to participate in the service received asthma prescriptions and education at the ED bedside. Within 1-3 days, ED outreach nurses obtained patient satisfaction survey responses via telephone. Results There was a statistically significant increase in the number of patients who filled ED asthma prescriptions at the hospital outpatient pharmacy (22.2% versus 33.8%; P < 0.0001). The decrease in 7-, 14-, or 30-day ED revisit rates for patients who received the medication delivery service compared with standard of care was not statistically significant. Patients were satisfied to very satisfied with the service. Conclusion Postimplementation of a medication delivery program within the ED, there was an increase in the percentage of patients who filled ED asthma medication prescriptions at the hospital outpatient pharmacy. There was no difference in ED revisit rates for patients who enrolled in the prescription delivery service versus standard of care.
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Leathers LA, Brittain KL, Crowley K. Effect of a Pediatric Prescription Medication Discharge Program on Reducing Hospital Readmission Rates. J Pediatr Pharmacol Ther 2017; 22:94-101. [PMID: 28469533 DOI: 10.5863/1551-6776-22.2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the pediatric prescription medication discharge delivery and counseling program, implemented at an 186-bed children's hospital integrated within a larger academic medical center, and its effectiveness on reducing hospital readmissions. METHODS This study was a retrospective chart review of existing data in the electronic medical record from patients <21 years of age who were discharged from our institution between September 1, 2014, and November 30, 2014. Patients who participated in the pediatric discharge program were compared to non-participants. The primary objective was to determine if the patient was readmitted within 30 days. Secondary objectives included time until readmission, diagnosis at discharge, and hospital unit at discharge. RESULTS In total, 1804 patients were assessed. After exclusions, 932 subjects were included in the analysis. In total, 393 (42.2%) patients participated in the pediatric medication discharge and counseling program, and 539 did not participate. Of the patients who participated in the program, 52 were readmitted within 30 days (13.2%), compared with 67 patients (12.4%) who did not participate in the discharge program, p = 0.717. Patients with the diagnoses of malignancy and kidney injury were more likely to be readmitted within this time frame, and those with the diagnoses of heart defects or cardiology disorders and malignancy were more likely to participate in the pediatric prescription medication discharge program. CONCLUSION Participation in the pediatric discharge medication delivery and counseling program did not reduce hospital readmission rate within 30 days.
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Paravattil B, Kheir N, Yousif A. Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar. Int J Clin Pharm 2017. [PMID: 28466396 DOI: 10.1007/s11096‐017‐0469‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient's medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.
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Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar. Int J Clin Pharm 2017; 39:759-768. [PMID: 28466396 DOI: 10.1007/s11096-017-0469-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t = 6.177; p < 0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f = 3.261; p = 0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient's medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.
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Bissonnette S, Goeres LM, Lee DSH. Pharmacy density in rural and urban communities in the state of Oregon and the association with hospital readmission rates. J Am Pharm Assoc (2003) 2016; 56:533-7. [PMID: 27492860 DOI: 10.1016/j.japh.2016.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/17/2016] [Accepted: 05/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterize the pharmacy density in rural and urban communities with hospitals and to examine its association with readmission rates. DESIGN Ecologic study. SETTING Forty-eight rural and urban primary care service areas (PCSAs) in the state of Oregon. PARTICIPANTS All hospitals in the state of Oregon. INTERVENTION Pharmacy data were obtained from the Oregon Board of Pharmacy based on active licensure. Pharmacy density was calculated by determining the cumulative number of outpatient pharmacy hours in a PCSA. MAIN OUTCOME MEASURES Oregon hospital 30-day all-cause readmission rates were obtained from the Centers for Medicare and Medicaid Services and were determined with the use of claims data of patients 65 years of age or older who were readmitted to the hospital within 30 days from July 2012 to June 2013. RESULTS Readmission rates for Oregon hospitals ranged from 13.5% to 16.5%. The cumulative number of pharmacy hours in PCSAs containing a hospital ranged from 54 to 3821 hours. As pharmacy density increased, the readmission rates decreased, asymptotically approaching a predicted 14.7% readmission rate for areas with high pharmacy density. CONCLUSION Urban hospitals were in communities likely to have more pharmacy access compared with rural hospitals. Future research should determine if increasing pharmacy access affects readmission rates, especially in rural communities.
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Statile AM, Schondelmeyer AC, Thomson JE, Brower LH, Davis B, Redel J, Hausfeld J, Tucker K, White DL, White CM. Improving Discharge Efficiency in Medically Complex Pediatric Patients. Pediatrics 2016; 138:peds.2015-3832. [PMID: 27412640 DOI: 10.1542/peds.2015-3832] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. METHODS We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ(2) tests, respectively. RESULTS The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention-postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8-7.0] vs 2.9 days [interquartile range, 1.7-6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51). CONCLUSIONS Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met.
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Affiliation(s)
- Angela M Statile
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
| | - Joanna E Thomson
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
| | - Laura H Brower
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blair Davis
- James M. Anderson Center for Health Systems Excellence
| | | | - Julie Hausfeld
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Karen Tucker
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Denise L White
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
| | - Christine M White
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
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Shcherbakova N, Tereso G. Clinical pharmacist home visits and 30-day readmissions in Medicare Advantage beneficiaries. J Eval Clin Pract 2016; 22:363-8. [PMID: 26695700 DOI: 10.1111/jep.12495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS & OBJECTIVES A variety of transition of care interventions has been evaluated to date to reduce readmissions. No studies evaluated effectiveness of clinical pharmacist's home-visits to recently discharged Medicare Advantage patients with the goal of preventing subsequent readmissions and urgent care use. The objective of this study was to evaluate the effectiveness of in-home clinical pharmacist's transition of care program on 30-day all-cause readmissions, emergency department (ED) visits, outpatient visits, as well as to assess patient satisfaction with the program. METHODS The study used retrospective cohort design. RESULTS A total of 245 patients were included in the study (mean (SD) age 77.8 (8.7); mean Charlson's Comorbidity Index 5.0 (2.5); 53.5% male). Forty-seven patients (19.0%) experienced at least one ED visit and twenty-two patients (9.0%) were readmitted within 30 days. The two groups did not differ on available demographic and clinical characteristics (p > 0.05). There was no difference in 30-day readmission rates, percent of patients with ≥1 ED visit, ≥1 outpatient physician office visit between the groups (p > 0.05). A total of 78 program participants responded to a satisfaction survey with 95% agreeing the program helped to stay healthy at home. CONCLUSION Multiple medication-related problems were identified by in-home pharmacists and the program appeared to be well-accepted by participants. In this study we did not find that the program had an impact on reduction of inpatient or urgent healthcare use. Further research using a different study design and a larger sample to estimate the program effectiveness is warranted.
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Affiliation(s)
| | - Gary Tereso
- Health New England, Inc, Springfield, MA, USA
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Owen-Smith A, Stewart C, Green C, Ahmedani BK, Waitzfelder BE, Rossom R, Copeland LA, Simon GE. Adherence to common cardiovascular medications in patients with schizophrenia vs. patients without psychiatric illness. Gen Hosp Psychiatry 2016; 38:9-14. [PMID: 26423559 PMCID: PMC4698196 DOI: 10.1016/j.genhosppsych.2015.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study was to examine whether individuals with diagnoses of schizophrenia were differentially adherent to their statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) medications compared to individuals without psychiatric illness. METHOD Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of schizophrenia or schizoaffective disorder receiving two or more medication dispensings of a statin or an ACEI/ARB in 2011 (N=710) were identified and matched on age, sex and Medicare status to controls with no documented mental illness and two or more medication dispensings of a statin in 2011 (N=710). Medication adherence, and sociodemographic and clinical characteristics of the study population were assessed. RESULTS Multivariable models indicated that having a schizophrenia diagnosis was associated with increased odds of statin medication adherence; the odds ratio suggested a small effect. After adjustment for medication regimen, schizophrenia no longer showed an association with statin adherence. Having a schizophrenia diagnosis was not associated with ACEI/ARB medication adherence. CONCLUSIONS Compared to patients without any psychiatric illness, individuals with schizophrenia were marginally more likely to be adherent to their statin medications. Given that patterns of adherence to cardioprotective medications may be different from patterns of adherence to antipsychotic medications, improving adherence to the former may require unique intervention strategies.
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Haga SB, Mills R. Nurses' communication of pharmacogenetic test results as part of discharge care. Pharmacogenomics 2015; 16:251-6. [PMID: 25712188 DOI: 10.2217/pgs.14.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
As pharmacogenetic (PGx) testing is becoming integrated into routine clinical procedures for admitted hospital patients, consideration is needed as to when test results will be communicated to patients and by whom. Given the implications of PGx test results for current and future care, we propose that if results are not promptly discussed with patients when testing is completed, results should be discussed with patients during discharge care when possible, included in the printed or electronic discharge summary and a copy of the results sent to their primary provider. Nurses play an important role in discharge planning and care by providing patients with the necessary information and support to transfer from the hospital setting to an outpatient setting or to return to home and work. To promote nurses' ability to fulfill the role of communicating PGx test results, revised curricula and interprofessional and clinical decision support are needed.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
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Leguelinel-Blache G, Dubois F, Bouvet S, Roux-Marson C, Arnaud F, Castelli C, Ray V, Kinowski JM, Sotto A. Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling. Medicine (Baltimore) 2015; 94:e1805. [PMID: 26469927 PMCID: PMC4616785 DOI: 10.1097/md.0000000000001805] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge.This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge.We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89).This study highlights that discharge counseling sessions are essential to improve outpatients' primary medication adherence. We identified predictive factors of primary nonadherence in order to target the most eligible patients for discharge counseling sessions. Moreover, implementation of discharge counseling could be facilitated by using Health Information Technology to adapt human resources and select patients at risk of nonadherence.
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Affiliation(s)
- Géraldine Leguelinel-Blache
- From the Department of Pharmacy, Nîmes University Hospital, Nîmes, France (GLB, FD, CRM, FA, JMK); Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France (GLB, CRM, CC, JMK); Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France (SB, CC); Department of General Medicine, Nîmes University Hospital, Nîmes, France (VR); and Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France (AS)
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Delgado O, Kernan WP, Knoer SJ. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health Syst Pharm 2015; 71:1871-6. [PMID: 25320137 DOI: 10.2146/ajhp130624] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The implementation, benefits, and outcomes of a layered learner model (LLM) using pharmacy students as pharmacist extenders are described. SUMMARY In 2011, Cleveland Clinic Florida (CCF) implemented a pharmacy practice model change with the goal of providing all inpatients quality pharmaceutical care while still providing key specialty clinical pharmacy services. An LLM was initiated in which pharmacists supervise pharmacy residents and students in a team format in which students are used as pharmacist extenders. CCF partnered with local and regional colleges of pharmacy to increase the number of advanced pharmacy practice experience student rotations at CCF. Students are given accountability for a specific number of patient beds based on their rotation. They are required to perform medication histories, education on drug indication and adverse effects, discharge counseling, targeted disease counseling, and profile review for drug-related problems for their patients. After the implementation of this model, improvements were observed in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores (58% versus 70%, respectively), pharmacy interventions per patient per day (0.9 versus 1.4, respectively), and bedside medication delivery capture rate (48% versus 65%, respectively). CONCLUSION The implementation of an LLM and partnering with local colleges of pharmacy have improved pharmacy practice at CCF by allowing pharmacy students to work as pharmacist extenders in providing comprehensive pharmacy services to many patients who would not otherwise be reached. This approach has improved HCAHPS scores within the "communication of medication" domain, increased overall patient interventions, and allowed expansion of CCF's discharge prescription program.
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Affiliation(s)
- Osmel Delgado
- Osmel Delgado, Pharm. D., M.B.A., BCPS, FASHP, is Chief Operating Officer; and William P. Kernan, Pharm.D., BCPS, is Assistant Director of Pharmacy, Cleveland Clinic Florida, Weston, FL. Scott J. Knoer, Pharm.D., M.S., FASHP, is Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH.
| | - William P Kernan
- Osmel Delgado, Pharm. D., M.B.A., BCPS, FASHP, is Chief Operating Officer; and William P. Kernan, Pharm.D., BCPS, is Assistant Director of Pharmacy, Cleveland Clinic Florida, Weston, FL. Scott J. Knoer, Pharm.D., M.S., FASHP, is Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH
| | - Scott J Knoer
- Osmel Delgado, Pharm. D., M.B.A., BCPS, FASHP, is Chief Operating Officer; and William P. Kernan, Pharm.D., BCPS, is Assistant Director of Pharmacy, Cleveland Clinic Florida, Weston, FL. Scott J. Knoer, Pharm.D., M.S., FASHP, is Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH
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Truong JT, Backes AC. The impact of a Continuum of Care Resident Pharmacist on heart failure readmissions and discharge instructions at a community hospital. SAGE Open Med 2015; 3:2050312115577986. [PMID: 26770775 PMCID: PMC4679237 DOI: 10.1177/2050312115577986] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 02/22/2015] [Indexed: 12/21/2022] Open
Abstract
Purpose: To examine the impact of a Continuum of Care Resident Pharmacist on (1) heart failure 30-day hospital readmissions and (2) compliance with Joint Commission Heart Failure core measure 1 at a community hospital. Methods: The Continuum of Care Network led by a Continuum of Care Resident Pharmacist was established in August 2011. The Continuum of Care Resident Pharmacist followed Continuum of Care Network patients and retrospectively collected data from August 2011 to December 2012. Thirty-day readmission rates for Continuum of Care Network heart failure patients versus non-Continuum of Care Network heart failure patients were compared and analyzed. Joint Commission Heart Failure core measure 1 compliance rates were retrospectively collected from January 2011 and compared to data after establishment of the Continuum of Care Network. Results: In all, 162 Continuum of Care Network patients and 470 non-Continuum of Care Network patients were discharged with a diagnosis of heart failure from August 2011 to December 2012. Continuum of Care Network heart failure patients had a lower 30-day all-cause readmission rate compared to non-Continuum of Care Network heart failure patients (12% versus 24%, respectively; p = 0.005). In addition, Heart Failure core measure 1 compliance rates improved from the 80th percentile to the 90th percentile after implementation of the Continuum of Care Network (p = 0.004). The top three interventions performed by the Continuum of Care Resident Pharmacist were discharge counseling (74.1%), providing a MedActionPlan™ (68.5%), and resolving medication reconciliation discrepancies (64.8%). Conclusion: The study findings suggest that a Continuum of Care Resident Pharmacist contributed to lowered heart failure readmission rates and improved Heart Failure core measure 1 compliance rates. Future randomized, controlled trials are needed to confirm these findings.
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Affiliation(s)
- Julie T Truong
- Keck Graduate Institute School of Pharmacy, Claremont, CA, USA
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Kuhmmer R, Lima KM, Ribeiro RA, Hammes LS, Bastos GAN, Cotta de Souza MCS, Polanczyk CA, Soares Rollin GAF, Caon S, Guterres CM, Araújo Leite LE, Delabary TS, Falavigna M. Effectiveness of pharmaceutical care at discharge in the emergency department: study protocol of a randomized controlled trial. Trials 2015; 16:60. [PMID: 25888343 PMCID: PMC4355358 DOI: 10.1186/s13063-015-0579-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient education on pharmacological therapy may increase medication adherence and decrease hospitalizations. Our aim is to evaluate the effectiveness of pharmaceutical care at emergency department discharge in patients with hypertension and/or diabetes. METHODS/DESIGN This is a randomized controlled trial. Participants will be recruited from a public emergency department at Restinga district in Porto Alegre, southern Brazil. A total of 380 patients will be randomly assigned into 2 groups at the moment of emergency department discharge after receiving medical orientations: an intervention group, consisting of a structured individual counseling session by a pharmacist in addition to written orientations, or a control group, consisting only of written information about the disease. Outcomes will be assessed in an ambulatory visit 2 months after the randomization. The primary outcome is the proportion of patients with high medication adherence assessed using the Morisky-Green Test and the Brief Medication Questionnaire. The secondary outcomes are reduction of blood pressure, glycated hemoglobin, fasting plasma glucose, quality of life and number of visits to the emergency department. DISCUSSION Pharmaceutical care interventions have shown to be feasible and effective in increasing medication adherence in both hospital outpatient and community pharmacy settings. However, there have been no previous assessments of the effectiveness of pharmacy care interventions initiated in patients discharged from emergency departments. Our hypothesis is that pharmaceutical counseling is also effective in this population. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT01978925 (11 November 2013) and Brazilian Registry of Clinical Trials U1111-1149-8922 (5 November 2013).
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Affiliation(s)
- Regina Kuhmmer
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Graduate Program in Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Karine Margarites Lima
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Rodrigo Antonini Ribeiro
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Luciano Serpa Hammes
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
| | - Gisele Alsina Nader Bastos
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Department of Public Health, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
| | - Maria Claudia Schardosim Cotta de Souza
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Carisi Anne Polanczyk
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Graduate Program in Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | - Suhelen Caon
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
| | - Cátia Moreira Guterres
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
| | - Leni Everson Araújo Leite
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
| | - Tássia Scholante Delabary
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento, Rua Ramiro Barcellos 910, Bloco D, Porto Alegre, RS, 90035-001, Brazil.
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Volino LR, Das RP, Mansukhani RP, Cosler LE. Evaluating the Potential Impact of Pharmacist Counseling on Medication Adherence Using a Simulation Activity. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2014; 78:169. [PMID: 26056407 PMCID: PMC4453085 DOI: 10.5688/ajpe789169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/21/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To evaluate the impact of counseling in a simulated medication adherence activity. DESIGN Students were randomized into 2 groups: patient medication monograph only (PMMO) and patient medication monograph with counseling (PMMC). Both groups received a fictitious medication and monograph. Additionally, the PMMC group received brief counseling. A multiple-choice, paper-based survey instrument was used to evaluate simulated food-drug interactions, adherence, and perceptions regarding the activity's value and impact on understanding adherence challenges. ASSESSMENT Ninety-two students participated (PMMC, n=45; and PMMO, n=47). Overall, a significantly higher incidence of simulated food-drug interactions occurred in the PMMO group (30%) vs the PMMC group (22%) (p=0.02). Doses taken without simulated food-drug interactions were comparable: 46.2% (PMCC) vs 41.9% (PMMO) (p=0.19). The average number of missed doses were 3.2 (PMMC) vs 2.8 (PMMO) (p=0.55). Approximately 70% of the students found the activity to be valuable and 89% believed it helped them better understand adherence challenges. CONCLUSION This activity demonstrated the challenges and important role of counseling in medication adherence.
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Affiliation(s)
- Lucio R. Volino
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Rolee Pathak Das
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Rupal Patel Mansukhani
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Leon E. Cosler
- Albany College of Pharmacy and Health Sciences, Albany, New York
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Abstract
Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e)-prescribing.
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Affiliation(s)
- Aurel O Iuga
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; Johns Hopkins University, Baltimore, MD, USA
| | - Maura J McGuire
- Johns Hopkins Community Physicians, Baltimore, MD, USA ; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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