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Vogt CJ, Moecker R, Jacke CO, Haefeli WE, Seidling HM. Exploring the heterogeneity in community pharmacist-led medication review studies - A systematic review. Res Social Adm Pharm 2024; 20:679-688. [PMID: 38811260 DOI: 10.1016/j.sapharm.2024.03.012] [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: 08/31/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Findings on the effectiveness of medication reviews led by community pharmacists (CPs) are often inconclusive. It has been hypothesized that studies are not sufficiently standardized, and thus, it is difficult to draw conclusions. OBJECTIVE(S) To examine differences in the way CP-led medication review studies are set up. This was accomplished by investigating (1) patient selection criteria, (2) components of the medication review interventions, (3) types of outcomes, and (4) measurement instruments used. METHODS A systematic literature search of randomized controlled trials of CP-led medication reviews was carried out in PubMed and Cochrane Library. Information on patient selection, intervention components, and outcome measurements was extracted, and frequencies were analyzed. Where possible, outcomes were mapped to the Core Outcome Set (COS) for medication review studies. Finally, a network analysis was conducted to explore the influence of individual factors on outcome effects. RESULTS In total, 30 articles (26 studies) were included. Most articles had a drug class-specific or disease-specific patient selection criterion (n = 19). Half of the articles included patients aged ≥60 years (n = 15), and in 40% (n = 12/30) patients taking 4 drugs or more. In 24 of 30 articles, a medication review was comprised with additional interventions, such as distribution of educational material and training or follow-up visits. About 40 different outcomes were extracted. Within specific outcomes, the measurement instruments varied, and COS was rarely represented. CONCLUSION The revealed differences in patient selection, intervention delivery, and outcome assessment highlight the need for more standardization in research on CP-led medication reviews. While intervention delivery should be more precisely described to capture potential differences between interventions, outcome assessment should be standardized in terms of outcome selection by application of the COS, and with regard to the selected core outcome measurement instruments to enable comparison of the results.
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Affiliation(s)
- Cathrin J Vogt
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Robert Moecker
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Christian O Jacke
- Scientific Institute of Private Health Insurance (WIP), Gustav-Heinemann-Ufer 74c, 50968, Cologne, Germany.
| | - Walter E Haefeli
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Hanna M Seidling
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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2
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Tilli T, Mathers A, Lin Q, Bhaidani S, Baker J, Wei L, Grootendorst P, Cadarette SM, Dolovich L. The appointment-based model in community pharmacies: Patient demographics and reimbursable clinical services uptake in Ontario. Can Pharm J (Ott) 2024; 157:143-152. [PMID: 38737357 PMCID: PMC11086738 DOI: 10.1177/17151635241241686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 05/14/2024]
Abstract
Background Community pharmacies typically require patients to request medication refills. The appointment-based model (ABM) is a proactive approach that synchronizes refills and schedules patient-pharmacist appointments. These appointments provide opportunities for medication reviews, medication optimization and health promotion services. The primary aim of this study was to describe the types of patients who received an ABM service in a community pharmacy in Ontario in 2017. The secondary aim was to describe reimbursable clinical service uptake. Methods In September 2017, the ABM was implemented across 3 Ontario community pharmacies within a Canadian pharmacy banner. Patients who filled at least 1 chronic oral medication and consented to enrolment were eligible. In December 2018, data were extracted from pharmacies using pharmacy management software. Descriptive statistics and frequencies were generated. Results Analysis of 131 patients (51.1% female; mean ± SD age 70.8 ± 10.5 years) revealed patients were dispensed a mean ± SD of 5.1 ± 2.7 medications, and 73 (55.7%) experienced polypharmacy. Hypertension (87.8%) and dyslipidemia (68.7%) were the most common medical conditions. There were 74 (56.5%) patients who received ≥1 medication review service (MedsCheck). Of 79 unique drug therapy problems (DTPs) identified, the most common categories related to patients needing additional drug therapy and adverse drug reactions. Discussion and conclusion Patients enrolled in the ABM were generally older adults experiencing polypharmacy. The ABM presented opportunities for DTP identification and delivery of reimbursed services. Findings support continued exploration of the ABM to support integration of clinical services within community practice.
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Affiliation(s)
- Tiana Tilli
- Wholehealth Pharmacy Partners, Markham, Ontario
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Qiqi Lin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Jen Baker
- Wholehealth Pharmacy Partners, Markham, Ontario
| | - Louis Wei
- Wholehealth Pharmacy Partners, Markham, Ontario
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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3
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Ho JMW, To E, Sammy R, Stoian M, Tung JMH, Bodkin RJ, Cox L, Antoniou T, Benjamin S. Outcomes of a Medication Optimization Virtual Interdisciplinary Geriatric Specialist (MOVING) Program: A Feasibility Study. Drugs Real World Outcomes 2024; 11:117-124. [PMID: 38007818 DOI: 10.1007/s40801-023-00403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Adverse drug events among older adults result in significant mortality, morbidity and cost. This harm may be mitigated with appropriate prescribing and deprescribing. We sought to understand the prescribing outcomes of an interdisciplinary geriatric virtual consultation service. METHODS We conducted a retrospective, before-and-after feasibility study to measure prescribing outcomes for a medication optimization virtual interdisciplinary geriatric specialist (MOVING) programme comprised of expertise from geriatric clinical pharmacology, pharmacy and psychiatry for older adults (aged ≥ 65 years) between June and December 2018, Ontario, Canada. The primary outcome was the number of distinct prescriptions and the presence of polypharmacy (defined as ≥ 4 medications) before and after the service. Secondary outcomes included the number of as needed and regularly administered prescriptions, number of potentially inappropriate prescriptions as defined by the Beers and STOPP criteria, and number of prescriptions for psychotropics, long-acting opioids and diabetic medications. RESULTS We studied 40 patients with a mean age of 80.6 [standard deviation (SD) 8.8] years who received a MOVING consult. We found no significant change in the mean total number of prescriptions per patient before (12.02, SD 5.83) and after the intervention (11.58, SD 5.28), with a mean difference of -0.45 [95% confidence interval (CI) -0.94 to 0.04; p = 0.07]. We found statistically significant decreases in as needed prescriptions (mean difference - 0.30, 95% CI - 0.45 to - 0.15; p<0.001), and potentially harmful medications as identified by the Beers (mean difference -1.25, 95% CI -2.00 to -0.50; p = 0.002) and STOPP (mean difference -1.65, 95% CI -2.33 to -0.97; p < 0.001) scores. Without including the cost savings from hospital diversion by a MOVING consult, the costs of a MOVING consult were $545.80-$629.80 per person, compared with the costs associated with traditional in-person consults involving similar specialist clinical services ($904.89-$1270.69 per person). CONCLUSION A MOVING model of care is associated with decreases in prescriptions for potentially inappropriate medications in older adults. These findings support further evaluation to ascertain health system impacts.
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Affiliation(s)
- Joanne Man-Wai Ho
- Department of Medicine, McMaster University, Waterloo, ON, Canada.
- Schlegel Research Institute for Aging, Waterloo, ON, Canada.
- GeriMedRisk, Waterloo, ON, Canada.
| | - Eric To
- Department of Medicine, McMaster University, Waterloo, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
| | - Rebecca Sammy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Matei Stoian
- Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Man-Han Tung
- Department of Pharmacy, Grand River Hospital, Kitchener, ON, Canada
- GeriMedRisk, Waterloo, ON, Canada
| | - Robert Jack Bodkin
- Department of Pharmacy, Grand River Hospital, Kitchener, ON, Canada
- GeriMedRisk, Waterloo, ON, Canada
| | - Lindsay Cox
- Schlegel Research Institute for Aging, Waterloo, ON, Canada
- GeriMedRisk, Waterloo, ON, Canada
| | - Tony Antoniou
- GeriMedRisk, Waterloo, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Sophiya Benjamin
- Department of Pharmacy, Grand River Hospital, Kitchener, ON, Canada
- GeriMedRisk, Waterloo, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Waterloo, ON, Canada
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Hussain R, Babar ZUD. Global landscape of community pharmacy services remuneration: a narrative synthesis of the literature. J Pharm Policy Pract 2023; 16:118. [PMID: 37814349 PMCID: PMC10561514 DOI: 10.1186/s40545-023-00626-0] [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: 07/18/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
Community pharmacists form a vital part of the health system all around the globe. Pharmacy remuneration models are aimed to ensure that pharmacies are sustained, and pharmacists could provide cost-effective services to the patients. This review summarizes the pharmacy services remuneration systems from different parts of the globe. Some countries have well-established reimbursement systems that recognize and compensate community pharmacies for their services, others are in the process of expanding the scope of reimbursable services. It further concludes by highlighting the ongoing efforts to incorporate pharmacist-provided services into reimbursement schemes and the need for standardized and consistent approaches to pharmacy remuneration globally.
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Affiliation(s)
- Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia.
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5
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Houle SKD, Timony P, Waite NM, Gauthier A. Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to administer injections in Ontario. Can Pharm J (Ott) 2022; 155:258-266. [PMID: 36081916 PMCID: PMC9445507 DOI: 10.1177/17151635221115183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Introduction: Pharmacist-administered immunizations have been associated with improved vaccination rates; however, little is known about whether areas with little to no access to this service (“vaccination deserts”) exist. The objective of this work is to determine the geographic availability of pharmacists with authorization to administer injections in the province of Ontario. Methods: Ontario College of Pharmacists registry data were used to identify patient care–providing pharmacists in community pharmacies and their ability to administer injections. Their number of hours worked was converted into full-time equivalents (FTEs), assuming 40 hours per week represents 1 FTE. Practice site(s) were mapped by postal code and presented by Public Health Unit (PHU) area. Communities within PHUs were further categorized as urban or rural and northern or southern, with ratios of FTEs per 1000 population calculated for both injection-trained and non-injection-trained pharmacists. Results: In total, 74.6% of Ontario’s practising community pharmacists are authorized to provide injections. Northern PHUs had slightly better access to pharmacist injectors (0.61 FTEs/1000 overall vs 0.56/1000 in the south), while rural communities had lower availability (0.41 FTEs/1000) than urban communities (0.58 FTEs/1000). PHUs with greater population size and density had greater availability of pharmacist immunizers, while PHUs with greater land area were more likely to not have any immunizing pharmacists present ( p < 0.001 for all). Discussion: As pharmacists increasingly become preferred vaccination providers, awareness of disparities related to access to pharmacy-based immunizations and collaboration with public health and primary care providers to address them (e.g., through mobile vaccination clinics) will be required to ensure equitable access. Can Pharm J (Ott) 2022;155:xx-xx.
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Hussein R, Grindrod KA. Is gamification a good approach to influence pharmacists' behaviour? Can Pharm J (Ott) 2022; 155:82-84. [PMID: 35300024 PMCID: PMC8922226 DOI: 10.1177/17151635221074956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kelly A. Grindrod
- From the School of Pharmacy, University of Waterloo, Waterloo, Ontario. Contact
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7
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Boone CG, Bishop AC, Ivers N, Desveaux L, Tadrous M. Audit and feedback in community pharmacy: An untapped strategy of quality improvement. Can Pharm J (Ott) 2021; 155:79-81. [PMID: 35300026 PMCID: PMC8922220 DOI: 10.1177/17151635211056528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/25/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | - Andrea C. Bishop
- Toronto, Ontario; the Nova Scotia College of Pharmacists, Halifax, Nova Scotia
| | - Noah Ivers
- Women’s College Hospital Research Institute, Toronto, Ontario
| | - Laura Desveaux
- Women’s College Hospital Research Institute, Toronto, Ontario
- Trillium Health Partners, Mississauga, Ontario
| | - Mina Tadrous
- Women’s College Hospital Research Institute, Toronto, Ontario
- University of Toronto, Toronto, Ontario
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8
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Tuula A, Volmer D, Jõhvik L, Rutkovska I, Trečiokienė I, Merks P, Waszyk-Nowaczyk M, Drozd M, Tatarević A, Radovanlija M, Pacadi C, Meštrović A, Viola R, Soós G, Rais C, Táerel AE, Kuzelova M, Zare M, Peymani P, Oona M, Scott M. Factors Facilitating and Hindering Development of a Medication Use Review Service in Eastern Europe and Iran-Cross-Sectional Exploratory Study. Healthcare (Basel) 2021; 9:healthcare9091207. [PMID: 34574981 PMCID: PMC8468572 DOI: 10.3390/healthcare9091207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Polypharmacy is a common issue in patients with chronic diseases. Eastern-European countries and Iran are exploring possibilities for implementing the Medication Use Review (MUR) as a measure for optimizing medication use and ensuring medication safety in polypharmacy patients. The aim of this study was to gain insights into the development of the community pharmacy sector and map facilitators and barriers of MUR in Eastern Europe and Iran. The representatives of the framework countries received a questionnaire on community pharmacy sector indicators, current and future developments of pharmacies, and factors encouraging and hindering MUR. To answer the questionnaire, all representatives performed document analysis, literature review, and qualitative interviews with key stakeholders. The socio-ecological model was used for inductive thematic analysis of the identified factors. Current community pharmacist competencies in framework countries were more related to traditional pharmacy services. Main facilitators of MUR were increase in polypharmacy and pharmaceutical waste, and access to patients’ electronic list of medications by pharmacists. Main barriers included the service being unfamiliar, lack of funding and private consultation areas. Pharmacists in the framework countries are well-placed to provide MUR, however, the service needs more introduction and barriers mostly on organizational and public policy levels must be addressed.
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Affiliation(s)
- Anita Tuula
- Institute of Pharmacy, University of Tartu, 50411 Tartu, Estonia;
- Correspondence: ; Tel.: +372-7375-286
| | - Daisy Volmer
- Institute of Pharmacy, University of Tartu, 50411 Tartu, Estonia;
| | - Liisa Jõhvik
- Hospital Pharmacy, Tartu University Hospital, 50406 Tartu, Estonia;
| | - Ieva Rutkovska
- Faculty of Pharmacy, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Indre Trečiokienė
- Pharmacy Center, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
| | - Magdalena Waszyk-Nowaczyk
- Department of Pharmaceutical Technology, Pharmacy Practice Division, Poznan University of Medical Sciences, 60-780 Poznan, Poland;
| | - Mariola Drozd
- Department of Humanities and Social Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
| | | | | | - Carmen Pacadi
- Mandis Pharm Community Pharmacies, 10000 Zagreb, Croatia;
| | | | - Réka Viola
- Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary; (R.V.); (G.S.)
| | - Gyöngyvér Soós
- Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary; (R.V.); (G.S.)
| | - Cristina Rais
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.R.); (A.-E.T.)
| | - Adriana-Elena Táerel
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (C.R.); (A.-E.T.)
| | - Magdalena Kuzelova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, 83232 Bratislava, Slovakia;
| | - Marziyeh Zare
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran;
| | - Payam Peymani
- Rady Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB R3E 0T5, Canada;
| | - Marje Oona
- Institute of Family Medicine and Public Health, University of Tartu, 50411 Tartu, Estonia;
| | - Michael Scott
- Medicines Optimisation Innovation Centre, Antrim BT41 2RL, UK;
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9
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Necyk C, Johnson JA, Tsuyuki RT, Eurich DT. Exploring the impact of pharmacist comprehensive annual care plans on perceived quality of chronic illness care by patients in Alberta, Canada. Can Pharm J (Ott) 2021; 154:331-341. [PMID: 34484483 PMCID: PMC8408906 DOI: 10.1177/17151635211020340] [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: 07/29/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022]
Abstract
Background: In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients’ perceptions of the care they received through the pharmacist CACP program in Alberta. Methods: We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included. Results: Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients (p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains. Conclusion: Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx.
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Affiliation(s)
- Candace Necyk
- School of Public Health, University of Alberta, Edmonton, Alberta
| | - Jeffrey A Johnson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Ross T Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Dean T Eurich
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
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10
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Waltering I, Schwalbe O, Hempel G. Identification of factors for a successful implementation of medication reviews in community pharmacies: Using Positive Deviance in pharmaceutical care. Int J Clin Pharm 2021; 44:79-89. [PMID: 34357475 PMCID: PMC8866257 DOI: 10.1007/s11096-021-01315-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022]
Abstract
Background Pharmacists in community pharmacies worldwide successfully conduct an increasing number of medication reviews (MR). Since June 2012 MR are incorporated in the German ordinance on the operation of pharmacies as pharmaceutical service. In November 2014, a German guideline for MR was established. Different teaching programmes for MR were implemented since. Despite these favorable conditions, only few pharmacies conduct MR regularly. Objective: Identification of factors necessary for a successful implementation of MR in community pharmacies. Setting: Community pharmacies located in the area of the Pharmacists’ Chamber Westphalia-Lippe (Part of Northrhine-Westphalia, Germany). Method: Following a Positive-Deviance approach, telephone interviews were conducted in community pharmacies with pharmacy-owners, MR-trained employed pharmacists, and technicians. Data evaluation was performed using qualitative content analysis. Main outcome results: Successful strategies for implementing MR in community pharmacies. Results: Forty-four interviews were conducted and analysed. Thirty-three success factors were identified. Data analysis revealed two groups of success-factors important for implementation of MR; organisational (n = 25) and individual factors (n = 8). Relevant organisational success-factor were involvement of the entire team with active involvement of technicians, documentation of results in the pharmacy software and training in patient-identification and communication. Restructuring of workflows increased time-periods for MR. Important individual success-factors were: motivation and identification with the service, routine in execution to enhance self-esteem, and specialisation in pharmacotherapy of particular diseases. Pharmacy-owners play a pivotal role as motivators. Professional healthcare attitude, exhibited in daily routine, leads to increased acceptance by patients and practitioners and thus increases implementation-rates considerably. Conclusion: We were able to define strategies for successful implementation of MR in community pharmacies.
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Affiliation(s)
- Isabell Waltering
- Institute of Pharmaceutical and Medicinal Chemistry, Clinical Pharmacy, Westfaelische Wilhelms-University Muenster, Corrensstrasse 48, 48149, Muenster, Germany.
| | - Oliver Schwalbe
- Department of Education and Training, Pharmacists' Chamber of Westphalia-Lippe, Bismarckallee 25, 48151, Muenster, Germany
| | - Georg Hempel
- Institute of Pharmaceutical and Medicinal Chemistry, Clinical Pharmacy, Westfaelische Wilhelms-University Muenster, Corrensstrasse 48, 48149, Muenster, Germany
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Olufemi-Yusuf DT, Kung JY, Guirguis LM. Medication reviews in community pharmacy: a scoping review of policy, practice and research in Canada. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab040] [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 scoping review aims to systematically map the empirical evidence on publicly funded medication reviews provided by community pharmacists in Canada and identify gaps that could inform future research directions.
Methods
We used a scoping review framework and PRISMA guidelines for Scoping Reviews to conduct the study. Three electronic databases were searched for papers published between January 2000 until August 2020. Data was charted on study characteristics, and a thematic synthesis was performed.
Key findings
Of 41 original studies included, most were conducted in Ontario (n = 21). Majority of the studies employed quantitative designs (70%). Five major themes identified were program uptake, patient health outcomes, stakeholder beliefs and attitudes, processes and collaboration and pharmacy workplace culture, which varied considerably. At the individual, organizational and policy levels, many factors were interrelated and influenced the implementation of reimbursed medication reviews by community pharmacists. Gaps in eligibility policy highlighted some patients who may have complex needs are excluded. Variation in clinical outcomes may relate to different types of medication review and pharmacist practice across Canada. Few researchers evaluated eligibility criteria, the impact of policy changes, strategies to engage patients and healthcare professionals, patient–pharmacist communication or compared practice models of medication reviews. About 12% of the research applied a theoretical framework.
Summary
Publicly funded medication reviews in Canadian community pharmacies reduce medication-related problems and potentially improve patient health outcomes. Future research and policies could consider addressing barriers and exploring models for sustainable delivery of high-quality medication reviews internationally.
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Affiliation(s)
- Damilola T Olufemi-Yusuf
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton, Alberta, Canada
| | - Janice Y Kung
- Public Services Librarian, John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Lisa M Guirguis
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton, Alberta, Canada
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12
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Identifying barriers, facilitators and behaviour change techniques to the adoption of the full scope of pharmacy practice among pharmacy professionals: Using the Theoretical Domains Framework. Res Social Adm Pharm 2021; 17:1396-1406. [PMID: 34165083 DOI: 10.1016/j.sapharm.2020.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND As pharmacy evolves, pharmacy professionals continue to struggle to practice to their full scope. A theoretically-informed intervention to change practice can support pharmacy professionals in providing full scope services. The Theoretical Domains Framework (TDF) can inform the design of a behaviour change intervention to improve the uptake of full scope services among pharmacy professionals. OBJECTIVES This study aimed to: (1) identify barriers and facilitators influencing the adoption of full scope services among pharmacy professionals, and (2) identify optimal behaviour change techniques (BCTs) to address the identified barriers and facilitators. METHODS A three-step, mixed method study was conducted. First, a 24-item TDF-based survey was sent via email to users of a national computer-based educational platform (n = 2696). Second, TDF-based interviews were conducted with a convenient sample of survey respondents and analyzed using the framework method. Finally, validated linkages were used to link BCTs with corresponding barriers and facilitators, then interview data were analyzed using a deductive approach to guide the selection of the BCTs. RESULTS A total of 225 participants completed the survey and 24 telephone interviews were conducted (17 pharmacists, 7 pharmacy technicians). A number of key barriers were identified on an individual level (e.g., lack of clear professional identity and limited decision-making skills in ambiguous cases) and on an organizational level (e.g., lack of social support from managers and concerns about making more errors with the current workflow). Mapping the barriers and facilitators to BCTs yielded 18 BCTs to support the adoption of full scope services, including modeling, rehearsal/practice, and social support. CONCLUSIONS This study highlighted several barriers that need to be addressed to facilitate pharmacy professionals working to their full scope, including professional collaboration, professional identity, and adequate training. A comprehensive intervention combining skills training with modeling, social support, and decision-making tools could encourage practice change.
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Cadarette SM, He N, Chaudhry M, Dolovich L. The Ontario Pharmacy Evidence Network Interactive Atlas of Professional Pharmacist Services. Can Pharm J (Ott) 2021; 154:153-159. [PMID: 34104268 PMCID: PMC8165887 DOI: 10.1177/17151635211004969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Nancy He
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Maha Chaudhry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Lin W, Haq S, Sinha S, Fan-Lun C. Impact Analysis of a Pharmacist-Led Home-Medication Review Service Within an interprofessional Outreach Team. Sr Care Pharm 2021; 36:159-170. [PMID: 33662240 DOI: 10.4140/tcp.n.2021.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the demographic and clinical characteristics of frail and homebound communitydwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. DESIGN Retrospective, cross-sectional chart-review study using data from patient records. SETTING Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. PATIENTS 171 patients received a HMR between January 1, 2016, and May 31, 2018. INTERVENTION Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. MAIN OUTCOME MEASURES Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. RESULTS Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. CONCLUSIONS Frail and homebound communitydwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.
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Affiliation(s)
- Wuqi Lin
- 1University of Toronto, Toronto, Ontario, Canada
| | | | - Samir Sinha
- 1University of Toronto, Toronto, Ontario, Canada
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15
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Korenvain C, MacKeigan LD, Dainty KN, Guilcher SJ, McCarthy LM. Exploring deprescribing opportunities for community pharmacists using the Behaviour Change Wheel. Res Social Adm Pharm 2020; 16:1746-1753. [DOI: 10.1016/j.sapharm.2020.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 01/05/2023]
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Gershon AS, McGihon RE, Thiruchelvam D, To T, Wu R, Bell CM, Aaron SD. Medication Discontinuation in Adults With COPD Discharged From the Hospital: A Population-Based Cohort Study. Chest 2020; 159:975-984. [PMID: 33011204 DOI: 10.1016/j.chest.2020.09.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients admitted to the hospital with COPD are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of the long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, health-care transitions sometimes result in unintentional discontinuation. RESEARCH QUESTION What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD? STUDY DESIGN AND METHODS A retrospective cohort study was conducted by using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged ≥ 66 years who had filled prescriptions for a LAMA or LABA-ICS continuously for ≥ 1 year were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort. RESULTS Of the 27,613 hospitalization discharges included in this study, medications were discontinued 1,466 times. Among 78,953 patients with COPD continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios of 1.50 [95% CI, 1.34-1.67; P < .001] and 1.62 [95% CI, 1.39, 1.90; P < .001] for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2% in the hospitalization group and 3.3% in the community group; for people taking LABA-ICS, these rates were 5.5% in the hospitalization group and 3.1% in the community group. INTERPRETATION In an observational study of highly compliant patients with COPD, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These Results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed and quantified in a prospective cohort of patients with COPD and average compliance. Quality improvement efforts should focus on safe transitions and patient medication reconciliation following discharge.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Rachel E McGihon
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Teresa To
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert Wu
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine, University Health Network, Toronto, ON, Canada
| | - Chaim M Bell
- ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health System, Toronto, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, ON, Canada
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Medication review service implementation in community pharmacy settings: Scoping review with focus on implementation studies. Res Social Adm Pharm 2020; 16:875-885. [DOI: 10.1016/j.sapharm.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/21/2019] [Accepted: 10/06/2019] [Indexed: 11/18/2022]
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Hui A, Latif A, Hinsliff-Smith K, Chen T. Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system. Health Policy 2020; 124:298-302. [DOI: 10.1016/j.healthpol.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/12/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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Grindrod K, Morris K, Killeen R. Assessing Performance and Engagement on a Computer-Based Education Platform for Pharmacy Practice. PHARMACY 2020; 8:E26. [PMID: 32102464 PMCID: PMC7151706 DOI: 10.3390/pharmacy8010026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/20/2023] Open
Abstract
A computer-based education platform was developed using a theory-based approach to help Canadian pharmacy professionals adopt their full scope of practice. Data from the platform were used to identify factors that impacted user performance and engagement. A de-identified dataset included response data for 21 unique modules, including quiz responses and self-reflection questions. Outcome measures included user performance (mean quiz score) and engagement (completion rate for attempted modules). Analysis of variance (ANOVA), multivariate regression modelling, and machine learning cluster analysis were used to analyze the data. Of the 5290 users, 68% were pharmacists, 11% were technicians, 13% were pharmacy students, and 8% were pharmacy technician students. Four clusters were identified separately for pharmacists and technicians. Clusters with the higher performance and engagement tended to have more users practicing in community pharmacies while the lower performing clusters tended have more internationally trained users. In the regression modelling, pharmacists performed better than technicians and students while students were more engaged (p < 0.0001). Further, internationally trained pharmacists had slightly lower scores but similar engagement compared to domestically trained pharmacists (p < 0.0001). Users demonstrated higher performance on modules related to scope of practice than on clinical topics, and were most engaged with topics directly impacting daily practice such as influenza vaccinations and new and emerging subjects such as cannabis. The cluster analysis suggests that performance and engagement with a computer-based educational platform in pharmacy may be more related to place of practice than to personal demographic factors such as age or gender.
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Affiliation(s)
- Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, ON N2L 3G1 Canada;
| | - Katherine Morris
- Information and Data Management, Ontario College of Pharmacists, Toronto, ON M5R 2R4, Canada;
| | - Rosemary Killeen
- School of Pharmacy, University of Waterloo, Waterloo, ON N2L 3G1 Canada;
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Impact of the 2016 Policy Change on the Delivery of MedsCheck Services in Ontario: An Interrupted Time-Series Analysis. PHARMACY 2019; 7:pharmacy7030115. [PMID: 31409033 PMCID: PMC6789745 DOI: 10.3390/pharmacy7030115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Abstract
MedsCheck (MC) is an annual medication review service delivered by community pharmacists and funded by the government of Ontario since 2007 for residents taking three or more medications for chronic conditions. In 2010, MC was expanded to include patients with diabetes (MCD), home-bound patients (MCH), and residents of long-term care homes (MCLTC). The Ontario government introduced an abrupt policy change effective 1 October 2016 that added several components to all MC services, especially those completed in the community. We used an interrupted time series design to examine the impact of the policy change (24 months pre- and post-intervention) on the monthly number of MedsCheck services delivered. Immediate declines in all services were identified, especially in the community (47%–64% drop MC, 71%–83% drop MCD, 55% drop MCH, and 9%–14% drop MCLTC). Gradual increases were seen over 24 months post-policy change, yet remained 21%–76% lower than predicted for MedsCheck services delivered in the community, especially for MCD. In contrast, MCLTC services were similar or exceeded predicted values by September 2018 (from 5.1% decrease to 3.5% increase). A more effective implementation of health policy changes is needed to ensure the feasibility and sustainability of professional community pharmacy services.
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Lapointe-Shaw L, Bell CM, Austin PC, Abrahamyan L, Ivers NM, Li P, Pechlivanoglou P, Redelmeier DA, Dolovich L. Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study. BMJ Qual Saf 2019; 29:41-51. [DOI: 10.1136/bmjqs-2019-009545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023]
Abstract
BackgroundIn-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.ObjectiveTo determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.DesignPropensity score-matched cohort study.SettingOntario, CanadaParticipantsPatients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.ExposureMedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.Main outcomeThe primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.ResultsMedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93–0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).Conclusions and relevanceAmong older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.
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Graham A, Bartle W, Madorin P, Teo V, Diamantouros A. Analysis of Real-World Experiences with the Ontario MedsCheck Program. Can J Hosp Pharm 2019; 72:295-300. [PMID: 31452541 PMCID: PMC6699860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Ontario MedsCheck program was introduced in April 2007, with enhancements to strengthen the program made in October 2016. Previous literature has characterized patients who received the service before the enhancements and described the experiences of community pharmacists and physicians, but the experiences of participants in the enhanced MedsCheck program and those of hospital pharmacists and pharmacy technicians have not been explored. OBJECTIVES This study was designed to describe and compare the demographic and clinical characteristics of patients admitted to Sunnybrook Health Sciences Centre (SHSC) who had received a MedsCheck before and after the program enhancements of 2016. The study also aimed to describe the experiences of patients, hospital pharmacists, and pharmacy technicians with the MedsCheck program. METHODS Chart reviews were completed to identify and characterize patients who had received a MedsCheck and were admitted to SHSC between March and May 2016 (retrospective cohort) and between March and May 2017 (prospective cohort). Patients were interviewed and focus groups were conducted with pharmacy staff to explore their experiences with the MedsCheck program. RESULTS MedsChecks had been performed for 321 (14.5%) of 2216 patients in the retrospective cohort and 172 (6.8%) of 2547 patients in the prospective cohort, an absolute decline of 7.7% after the 2016 enhancements. Patient characteristics were similar between the 2 cohorts. Patients' experiences were varied, but because of low enrolment in the interview process (n = 3), it was difficult to identify and summarize common themes. The analysis of focus groups involving pharmacy staff (n = 27 participants) revealed that the benefits of MedsChecks depended on quality and access, and also identified common barriers and opportunities for future enhancements. CONCLUSIONS Patient interviews revealed the features of the program that patients valued. Pharmacy staff identified several benefits and barriers encountered when using MedsChecks. These findings can guide clinicians in optimal application of the current MedsCheck program and can inform subsequent program revisions.
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Affiliation(s)
- Ashley Graham
- , PharmD, ACPR, was, at the time of this study, a pharmacy resident at the Sunnybrook Health Sciences Centre, Toronto, Ontario. She is now with Women's College Hospital, Toronto, Ontario
| | - William Bartle
- , BScPhm, PharmD, FCSHP, is with the Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Patti Madorin
- , BScPhm, ACPR, is with the Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Vincent Teo
- , BScPhm, PharmD, ACPR, is with the Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Artemis Diamantouros
- , BScPhm, MEd, PhD (deceased), was with the Sunnybrook Health Sciences Centre, Toronto, Ontario
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Currie K, Evans C, Mansell K, Perepelkin J, Jorgenson D. Community pharmacists' experiences with the Saskatchewan Medication Assessment Program. Can Pharm J (Ott) 2019; 152:193-203. [PMID: 31156733 DOI: 10.1177/1715163519827980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The Saskatchewan Medication Assessment Program (SMAP) is a publicly funded community pharmacy-based medication assessment service with limited previous evaluation. The purpose of this study was to explore community pharmacists' experiences with the SMAP. Methods Online, self-administered questionnaire that consisted of a combination of 53 Likert scale and free-text questions. All licensed pharmacists who were practising in a community pharmacy setting in Saskatchewan were eligible to participate. Results Response rate was 20.3% (n = 228/1124). Most respondents agreed that the SMAP is achieving all of its intended purposes. For example, 89.7% agreed that the SMAP improved medication safety for patients who receive the service. Most pharmacists enjoyed performing the assessments (84.6%) and were confident in their ability to identify drug-related problems (88.3%). Pharmacists reported lack of time, patients having difficulty coming to the pharmacy and restrictive eligibility criteria as the top barriers to the SMAP. Good teamwork, employer support and personal professional commitment were the top recognized facilitators. Respondents made several suggestions to improve the SMAP in the free-text areas of the questionnaire. Conclusions Community pharmacists in Saskatchewan were positive and confident about performing medication assessments, and most agreed that the SMAP is achieving all of the intended purposes. Respondents also identified several barriers to providing SMAP services, which have resulted in specific recommendations that should be addressed to improve the program.
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Affiliation(s)
- Krysta Currie
- Rosetown Pharmasave (Currie), Rosetown.,College of Pharmacy and Nutrition (Evans, Mansell, Perepelkin, Jorgenson), University of Saskatchewan, Saskatoon, Saskatchewan
| | - Charity Evans
- Rosetown Pharmasave (Currie), Rosetown.,College of Pharmacy and Nutrition (Evans, Mansell, Perepelkin, Jorgenson), University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kerry Mansell
- Rosetown Pharmasave (Currie), Rosetown.,College of Pharmacy and Nutrition (Evans, Mansell, Perepelkin, Jorgenson), University of Saskatchewan, Saskatoon, Saskatchewan
| | - Jason Perepelkin
- Rosetown Pharmasave (Currie), Rosetown.,College of Pharmacy and Nutrition (Evans, Mansell, Perepelkin, Jorgenson), University of Saskatchewan, Saskatoon, Saskatchewan
| | - Derek Jorgenson
- Rosetown Pharmasave (Currie), Rosetown.,College of Pharmacy and Nutrition (Evans, Mansell, Perepelkin, Jorgenson), University of Saskatchewan, Saskatoon, Saskatchewan
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Uptake of Travel Health Services by Community Pharmacies and Patients Following Pharmacist Immunization Scope Expansion in Ontario, Canada. PHARMACY 2019; 7:pharmacy7020035. [PMID: 31013879 PMCID: PMC6630201 DOI: 10.3390/pharmacy7020035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/06/2019] [Accepted: 04/11/2019] [Indexed: 11/17/2022] Open
Abstract
In December 2016, pharmacists in Ontario, Canada with authorization to administer injections saw an expansion in their scope from a restriction to the influenza vaccination only to now including an additional 13 vaccine-preventable diseases, largely those related to travel. It was uncertain whether this change in scope would see sufficient uptake, or translate to a corresponding expansion in other travel health service offerings from community pharmacies. In October/November 2017 a survey was conducted of all licensed community pharmacists in Ontario, followed by semi-structured interviews with 6 survey respondents in June 2018. A web-based survey of members of the public from a single region of the province was also conducted in September 2018 to assess uptake of expanded vaccination services. Broad variability in uptake of these services was noted, ranging from the dispensing of travel-related medications and vaccinations only through to vaccine administration and prescribing under medical directive; however, uptake was generally at the lower end of this spectrum. This was evidenced by 94% of pharmacists reporting administering fewer than 10 travel vaccinations per month, fewer than 10% of patients reporting receiving a travel vaccine administered by a pharmacist, and a maximum of 30 pharmacies (of nearly 6000 in the province) designated to provide yellow fever vaccinations. Fewer than 1 in 3 pharmacists reported performing some form of pre-travel consultation in their practice, often limited to low-risk cases only. Barriers and facilitators reported were similar for these services as they were for other non-dispensing services, including insufficient time to integrate the service into their workload, perceived lack of knowledge and confidence in travel health, and low patient awareness of these new services available to them through community pharmacies.
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Houle SKD, Carter CA, Tsuyuki RT, Grindrod KA. Remunerated patient care services and injections by pharmacists: An international update. Can Pharm J (Ott) 2019; 152:92-108. [PMID: 30886662 DOI: 10.1177/1715163518811065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services. Data sources Systematic searches for relevant articles published from January 2013 to February 2018 across PubMed (MEDLINE), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed. Study selection Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing. Data extraction Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial or regional level, as applicable), payer, service description, patient eligibility criteria and fee structure. Results Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service. Conclusion Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation. Can Pharm J (Ott) 2019;152:xx-xx.
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Affiliation(s)
- Sherilyn K D Houle
- School of Pharmacy (Houle, Carter, Grindrod), University of Waterloo, Waterloo, Ontario.,Department of Medicine (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Caitlin A Carter
- School of Pharmacy (Houle, Carter, Grindrod), University of Waterloo, Waterloo, Ontario.,Department of Medicine (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Ross T Tsuyuki
- School of Pharmacy (Houle, Carter, Grindrod), University of Waterloo, Waterloo, Ontario.,Department of Medicine (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Kelly A Grindrod
- School of Pharmacy (Houle, Carter, Grindrod), University of Waterloo, Waterloo, Ontario.,Department of Medicine (Tsuyuki), University of Alberta, Edmonton, Alberta
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Silva RDOS, Macêdo LA, Santos GAD, Aguiar PM, de Lyra DP. Pharmacist-participated medication review in different practice settings: Service or intervention? An overview of systematic reviews. PLoS One 2019; 14:e0210312. [PMID: 30629654 PMCID: PMC6328162 DOI: 10.1371/journal.pone.0210312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 12/20/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction Medication review (MR) is a pharmacy practice conducted in different settings that has a positive impact on patient health outcomes. In this context, systematic reviews on MR have restricted the assessment of this practice using criteria such as methodological quality, practice settings, and patient outcomes. Therefore, expanding research on this subject is necessary to facilitate the understanding of the effectiveness of MR and the comparison of its results. Aim To examine the panorama of systematic reviews on pharmacist-participated MR in different practice settings. Methods A literature search was undertaken in Biblioteca Virtual em Saúde (BVS), Embase, PubMed, Scopus, The Cochrane Library, and Web of Science databases through January 2018 using keywords for "medication review", "systematic review", and "pharmacist". Two independents investigators screened titles, abstracts, full texts; assessed methodological quality; and, extracted data from the included reviews. Results Seventeen systematic reviews were included, of which sixteen presented low to moderate methodological quality. Most of reviews were conducted in Europe (n = 7), included controlled primary studies (n = 16), elderly patients (n = 9), and long-term care facilities (n = 8). Seven reviews addressed MR as an intervention and thirteen reviews cited collaboration between physicians and pharmacists in the practice of MR. In addition, thirteen terminologies for MR were used and the main objective was to identify and solve drug-related problems and/or optimize the drug use (n = 11). Conclusion There is considerable heterogeneity in practice settings, population, definitions, terminologies, and approach of MR as well as poor description of patient care process in the systematic reviews. These facts may limit the comparison, summarization and understanding of the results of MR. Furthermore, the methodological quality of most systematic reviews was below ideal. Thus, international agreement on the MR process is necessary to assess, compare and optimize the quality of care provided.
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Affiliation(s)
- Rafaella de Oliveira Santos Silva
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Genival Araújo Dos Santos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Patrícia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
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Dolovich L, Austin Z, Waite N, Chang F, Farrell B, Grindrod K, Houle S, McCarthy L, MacCallum L, Sproule B. Pharmacy in the 21st century: Enhancing the impact of the profession of pharmacy on people's lives in the context of health care trends, evidence and policies. Can Pharm J (Ott) 2018; 152:45-53. [PMID: 30719197 DOI: 10.1177/1715163518815717] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lisa Dolovich
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Nancy Waite
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Feng Chang
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Barbara Farrell
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Kelly Grindrod
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Sherilyn Houle
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy (Dolovich, Austin, McCarthy, MacCallum, Sproule), the Institute for Health Policy, Management and Evaluation (Austin), Department of Family Medicine and Community Medicine (McCarthy) and Banting & Best Diabetes Centre(MacCallum), Faculty of Medicine, University of Toronto, Toronto.,the Department of Family Medicine (Dolovich), McMaster University, Hamilton.,the School of Pharmacy (Dolovich, Waite, Chan, Farrell, Grindrod, Houle), University of Waterloo, Waterloo.,the Department of Family Medicine (Farrell), University of Ottawa and the Bruyère Research Institute (Farrell), Ottawa.,Women's College Research Institute (McCarthy), Women's College Hospital, Toronto.,the Toronto General Hospital Research Institute (MacCallum); and the Centre for Addiction and Mental Health (Sproule), Toronto, Ontario
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28
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Lancaster K, Thabane L, Tarride JE, Agarwal G, Healey JS, Sandhu R, Dolovich L. Descriptive analysis of pharmacy services provided after community pharmacy screening. Int J Clin Pharm 2018; 40:1577-1586. [PMID: 30474769 PMCID: PMC6280862 DOI: 10.1007/s11096-018-0742-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/16/2018] [Indexed: 12/01/2022]
Abstract
Background Community pharmacies are promising locations for opportunistic screening due to pharmacist accessibility and ability to perform various health and medication management services. Little is known as to the provision of pharmacy services following screening initiatives. Objective To describe provision of pharmacy services for participants following a community pharmacy stroke screening initiative. Setting The Program for the Identification of "Actionable Atrial" Fibrillation Pharmacy initiative took place in 30 pharmacies in Alberta and Ontario, Canada. 1149 participants ≥ 65 were screened for atrial fibrillation, type 2 diabetes, and hypertension. Method Retrospective, secondary analysis of data using participant case-report forms, pharmacy data, and pharmacy claims to describe pharmacy services received by participants post-screening. Main Outcome Measure Number and types of remunerated pharmacy services received by participants post-screening. Results A total of 535/1149 (46.6%) participants screened at their regular pharmacy were included in this analysis. Of these, 165 (30.8%) participants received 229 pharmacy services within 3 months post-screening, including 146 medication reviews, 57 influenza vaccinations, and 21 pharmaceutical opinions. A median (interquartile range, IQR) of 6 (2-11) pharmacy services were delivered, and median (IQR) reimbursement was $187.50 ($67.50-$342.50). Conclusions Approximately one-third of participants received a pharmacy service within 3 months post-screening. Relatively large numbers of annual and follow-up medication reviews were delivered despite low eligibility for annual-only reviews and despite many missed opportunities for pharmacy service provision in at-risk patients. In-pharmacy screening may facilitate provision of some services, namely medication reviews, by providing opportunities to identify patients at-risk.
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Affiliation(s)
- Karla Lancaster
- McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada
| | - Lehana Thabane
- McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada
| | - Jean-Eric Tarride
- McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada
| | - Gina Agarwal
- McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada
| | - Jeff S Healey
- Population Health Research Institute, 237 Barton St. E., Hamilton, ON, L8L 2X2, Canada
| | - Roopinder Sandhu
- University of Alberta, 116 St. and 85th Ave., Edmonton, AB, T6G 2R3, Canada
| | - Lisa Dolovich
- McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Room 607, Toronto, ON, M5S 3M2, Canada.
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29
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Farrell B, Archibald D, Pizzola L, Ward N, Cho A, Tsang C. Impact on confidence and practice: How the ADAPT online patient care skills program made a difference for pharmacists. Res Social Adm Pharm 2018; 15:1251-1258. [PMID: 30448031 DOI: 10.1016/j.sapharm.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ADAPT "ADapting pharmacists' skills and Approaches to maximize Patients' drug Therapy effectiveness" online education program was developed to enable pharmacists to overcome a lack of confidence in patient care and collaborative skills, enabling successful adoption of expanded scope of pharmacist practice. OBJECTIVES This study examined responses of ADAPT participants, to determine if acquisition of knowledge, skill, and confidence is retained and translated into adoption of expanded scope of practice and billable services, perceived improvement in quality of patient care, and increased professional satisfaction. METHODS A sequential exploratory mixed methods approach was used for this study. RESULTS Fifty-four surveys were completed and 13 interviews were conducted. Greater than 86% agreed or strongly agreed that their confidence in their ability to perform ADAPT skills had improved. Billing for services varied based on province. Four themes emerged through the interview process: confidence, change, impact and barriers/facilitators. CONCLUSIONS Respondents described confidence in their ability to use ADAPT skills to make changes in personal practice activities, and this appeared to lead to taking on new roles that provided both professional satisfaction and improved patient care and professional relations. However, some barriers remained in providing or billing for certain practice activities.
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Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario, N2G 1C5, Canada.
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Lisa Pizzola
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Natalie Ward
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada
| | - Ara Cho
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
| | - Corey Tsang
- Bruyère Research Institute, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada; School of Pharmacy, University of Waterloo, 10A Victoria St S, Kitchener, Ontario, N2G 1C5, Canada
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30
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Waite NM, McCarthy L, Milne E, Hillier C, Houle SK, Dolovich L. Perceived preparedness for full-scope pharmacist services among recent Doctor of Pharmacy graduates from Ontario schools of pharmacy. J Am Pharm Assoc (2003) 2018; 58:630-637. [DOI: 10.1016/j.japh.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
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31
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Houle SKD, Carter CA, Tsuyuki RT, Grindrod KA. Remunerated patient care services and injections by pharmacists: An international update. J Am Pharm Assoc (2003) 2018; 59:89-107. [PMID: 30195440 DOI: 10.1016/j.japh.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services, and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services. DATA SOURCES Systematic searches for relevant articles published from January 2013 to February 2018 across Pubmed (Medline), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus, and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed. STUDY SELECTION Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing. DATA EXTRACTION Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial, or regional level, as applicable), payer, service description, patient eligibility criteria, and fee structure. RESULTS Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations, and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service. CONCLUSION Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility, and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation.
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Abstract
With a growing aging population, the appropriate, effective, and safe use of medicines is a global health policy priority. One concern is patients' non-adherence to medicines, which is estimated to be up to 50%. Policymakers seek to reconfigure medicine management services and consider community pharmacy as especially well-placed to improve medicine use. In England and Wales, a commissioned medication review service called "Medicines Use Reviews (MURs)" was made available in through the National Health Service (NHS) in 2005. This involves a patient-pharmacist consultation to improve patients' knowledge and the use of medicines and to help reduce avoidable waste. However, over a decade since their introduction, questions remain over the extent to which the MUR policy has successfully been embedded in practice and translated into more effective use of medicines. The MUR intervention continues to hold many challenges ranging from poor public awareness and acceptance of MURs, organizational constraints, and issues over interprofessional collaboration. Many of these challenges are not exclusive to the MUR service, or even to the community pharmacy setting. Nevertheless, by identifying and exposing such challenges, an opportunity exists for policymakers and commissioners to seek to improve this service to patients. This narrative review explores the current challenges that face MURs. Damschroder et al's consolidated framework for implementation research is employed to help organize these challenges from patient and professional perspectives across multiple contexts. Over the past decade, MUR policy and practice has continued to evolve, being shaped by research, organizational and professional influences, and policy. Reforms to the service suggest that the MURs are becoming more responsive to patients' need and preferences. It is intended that this review will create impetus and scope for further debate, service reconfiguration, and ultimately service improvement.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, Queen's Medical Centre, The University of Nottingham, Nottingham, UK,
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33
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MacCallum L, Dolovich L. Follow-up in community pharmacy should be routine, not extraordinary. Can Pharm J (Ott) 2018. [PMID: 29531619 DOI: 10.1177/1715163518756586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lori MacCallum
- Banting & Best Diabetes Centre (MacCallum), Faculty of Medicine, and the Leslie Dan Faculty of Pharmacy (MacCallum, Dolovich), University of Toronto, Toronto.,Department of Family Medicine (Dolovich), David Braley Health Sciences Centre, McMaster University, Hamilton.,School of Pharmacy (Dolovich), University of Waterloo, Waterloo, Ontario
| | - Lisa Dolovich
- Banting & Best Diabetes Centre (MacCallum), Faculty of Medicine, and the Leslie Dan Faculty of Pharmacy (MacCallum, Dolovich), University of Toronto, Toronto.,Department of Family Medicine (Dolovich), David Braley Health Sciences Centre, McMaster University, Hamilton.,School of Pharmacy (Dolovich), University of Waterloo, Waterloo, Ontario
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34
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Rosenberg-Yunger ZRS, Verweel L, Gionfriddo MR, MacCallum L, Dolovich L. Community pharmacists' perspectives on shared decision-making in diabetes management. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:414-422. [PMID: 29277945 DOI: 10.1111/ijpp.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Shared decision-making (SDM) is an approach where patients and clinicians share evidence and patients are supported to deliberate options resulting in preference-based informed decisions. The aim of this study was to describe community pharmacists' perceptions and awareness of SDM within their provision of general diabetes management [including Ontario's MedsCheck for Diabetes (MCD) programme], and potential challenges of implementing SDM within community pharmacy. METHODS This qualitative study used semistructured interviews with a convenience sample of community pharmacists. Data were analysed using thematic analysis. KEY FINDINGS We conducted 16 interviews. Six participants were male, and nine were certified diabetes educators. When providing a MCD, participants used aspects of a patient-centred approach focusing on providing education. Variation was evident in participants' description and use of SDM, as well as in their perceived level of training in SDM. Participants also highlighted challenges surrounding implementing a SDM approach in practice. CONCLUSION Pharmacists are well positioned to apply SDM within community settings; however, implementation barriers exist. Pharmacists will require additional training as well as perceived patient and physician barriers should be addressed to encourage uptake.
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Affiliation(s)
- Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, Health Services Management, Ryerson University, Toronto, ON, Canada.,Ontario Pharmacists Association, Toronto, ON, Canada
| | - Lee Verweel
- Ontario Pharmacists Association, Toronto, ON, Canada
| | | | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Departments of Family Medicine, Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, Canada.,School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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35
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Kosar L, Hu N, Lix LM, Shevchuk Y, Teare GF, Champagne A, Blackburn DF. Uptake of the Medication Assessment Program in Saskatchewan: Tracking claims during the first year. Can Pharm J (Ott) 2017; 151:24-28. [PMID: 29317933 DOI: 10.1177/1715163517744228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lynette Kosar
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
| | - Nianping Hu
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
| | - Lisa M Lix
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
| | - Yvonne Shevchuk
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
| | - Gary F Teare
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
| | - Anne Champagne
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
| | - David F Blackburn
- the College of Pharmacy and Nutrition (Kosar, Shevchuk, Blackburn), University of Saskatchewan
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36
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Mansell K, Edmunds K, Guirguis L. Pharmacists' Scope of Practice: Supports for Canadians with Diabetes. Can J Diabetes 2017; 41:558-562. [PMID: 29037573 DOI: 10.1016/j.jcjd.2017.08.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The pharmacists' role in Canada has significantly advanced over the past decade, resulting in increasing access to primary care services. This study aimed to characterize pharmacists' expanded scope of practice as it relates to providing services to Canadians with diabetes. METHODS This environmental scan characterized services that could be useful to Canadians with diabetes in each of the provinces (excluding the territories): immunizations, medication prescribing, ordering and interpreting laboratory tests, and medication reviews. Researchers also collected information on pharmacists' access to health information. Data were collected from regulatory authorities in each province, from pharmacy stakeholders and through a web search. RESULTS Pharmacists' scope of practice varies widely across the Canadian provinces. Three provinces have medication-review programs focused specifically on diabetes, and many people with diabetes can access publicly funded medication reviews. Other than in Quebec, pharmacists can provide influenza (publicly funded) and pneumococcal vaccinations (publicly funded in British Columbia, Alberta and Manitoba). All pharmacists in Canadian provinces can renew prescriptions to ensure continuity of therapy. Pharmacists have varying levels of other prescriptive authority. Pharmacists in all provinces (except Ontario) can access provincial prescription information; in 4 provinces, they can access laboratory results, and in 3 provinces, they can order and interpret laboratory results, such as glycated hemoglobin levels. CONCLUSIONS Canadians with diabetes can expect to receive influenza vaccines and have medications renewed at their pharmacies. Many patients with diabetes qualify for a publicly funded medication review, and some provinces allow pharmacists to order and interpret laboratory results. This expanded scope provides greater opportunities for pharmacists to help support patients with diabetes in conjunction with other health-care team members.
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Affiliation(s)
- Kerry Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Kirsten Edmunds
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
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37
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Hann M, Schafheutle EI, Bradley F, Elvey R, Wagner A, Halsall D, Hassell K, Jacobs S. Organisational and extraorganisational determinants of volume of service delivery by English community pharmacies: a cross-sectional survey and secondary data analysis. BMJ Open 2017; 7:e017843. [PMID: 29018074 PMCID: PMC5652532 DOI: 10.1136/bmjopen-2017-017843] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to identify the organisational and extraorganisational factors associated with existing variation in the volume of services delivered by community pharmacies. DESIGN AND SETTING Linear and ordered logistic regression of linked national data from secondary sources-community pharmacy activity, socioeconomic and health need datasets-and primary data from a questionnaire survey of community pharmacies in nine diverse geographical areas in England. OUTCOME MEASURES Annual dispensing volume; annual volume of medicines use reviews (MURs). RESULTS National dataset (n=10 454 pharmacies): greater dispensing volume was significantly associated with pharmacy ownership type (large chains>independents>supermarkets), greater deprivation, higher local prevalence of cardiovascular disease and depression, older people (aged >75 years) and infants (aged 0-4 years) but lower prevalence of mental health conditions. Greater volume of MURs was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, and lower disease prevalence.Survey dataset (n=285 pharmacies; response=34.6%): greater dispensing volume was significantly associated with staffing, skill-mix, organisational culture, years open and greater deprivation. Greater MUR volume was significantly associated with pharmacy ownership type (large chains/supermarkets>>independents), greater dispensing volume, weekly opening hours and lower asthma prevalence. CONCLUSIONS Organisational and extraorganisational factors were found to impact differently on dispensing volume and MUR activity, the latter being driven more by corporate ownership than population need. While levels of staffing and skill-mix were associated with dispensing volume, they did not influence MUR activity. Despite recent changes to the contractual framework, the existing fee-for-service reimbursement may therefore not be the most appropriate for the delivery of cognitive (rather than supply) services, still appearing to incentivise quantity over the quality (in terms of appropriate targeting) of services delivered. Future research should focus on the development of quality measures that could be incorporated into community pharmacy reimbursement mechanisms.
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Affiliation(s)
- Mark Hann
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Ellen I Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Fay Bradley
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Rebecca Elvey
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Collaboration for Leadership in Applied Health Research and Care Greater Manchester, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Andrew Wagner
- Division 5, NIHR Comprehensive Research Network – Eastern, Norwich, UK
| | - Devina Halsall
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Controlled Drugs Team, NHS England (North Region) Cheshire and Merseyside, Liverpool, UK
| | - Karen Hassell
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- College of Pharmacy, California Northstate University, Elk Grove, California, USA
| | - Sally Jacobs
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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MacKeigan LD, Ijaz N, Bojarski EA, Dolovich L. Implementation of a reimbursed medication review program: Corporate and pharmacy level strategies. Res Social Adm Pharm 2017; 13:947-958. [DOI: 10.1016/j.sapharm.2017.03.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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Doggrell SA. Pilot study, in a rental retirement village, of an "AdherenceCheck" on the management of medicines by the older-aged. Int J Clin Pharm 2017; 39:443-449. [PMID: 28238101 DOI: 10.1007/s11096-017-0423-9] [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: 04/18/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
Background The older-aged living in a low socioeconomic, rental, retirement village have a low adherence to medicines and a poor understanding of their illnesses. MedsChecks are commonly used in Australian pharmacies in an attempt to improve the management of medicines. There is no published evidence that MedsChecks, or similar brief/single, interventions improve the management of medicines in the older-aged. Objective The objective of our study was to determine the effect of an AdherenceCheck, which is similar to a MedsCheck, but is performed in the home of the older-aged, had on the ongoing management of medicines by the older-aged living independently. Both a MedsCheck and an AdherenceCheck involves forming an individual Action Plan. Setting Rental retirement village. Method After interviewing the older-aged in the village about their management of medicines, they were given an AdherenceCheck and an Action Plan. Six months later their management of medicines and the Action Plan were (re-)evaluated. Main outcome measure Present and ongoing adherence to medicines. Results Only 15 of the original 23 participants completed the study. The AdherenceCheck with Action Plan did not significantly change the adherence to medicines of these older-aged living in the rental retirement village. Pre- to post-AdherenceCheck, there was a reduction in the percentage of participants with a good knowledge of their illnesses, and thus a corresponding significant increase in the percentage with no knowledge of their illnesses, and this may have been age related. Only 11 of the 15 participants remembered receiving an Action Plan, as part of the AdherenceCheck, and 7 of these considered that the Action Plan helped them manage their medicines. Conclusion An AdherenceCheck may not improve the management of medicines by the older-aged living in a rental retirement village. As there are no peer-reviewed publications as to whether the commonly used MedsChecks, which have some similarities to the AdherenceCheck, improve the management of medicines, it is suggested that these MedsChecks should also be formally evaluated.
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Affiliation(s)
- Sheila A Doggrell
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, GPO 2434, Brisbane, QLD, 4002, Australia.
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Pechlivanoglou P, Abrahamyan L, MacKeigan L, Consiglio GP, Dolovich L, Li P, Cadarette SM, Rac VE, Shin J, Krahn M. Factors affecting the delivery of community pharmacist-led medication reviews: evidence from the MedsCheck annual service in Ontario. BMC Health Serv Res 2016; 16:666. [PMID: 27871324 PMCID: PMC5117572 DOI: 10.1186/s12913-016-1888-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/28/2016] [Indexed: 02/07/2023] Open
Abstract
Background Medication reviews have become part of pharmacy practice across developed countries. This study aimed to identify factors affecting the likelihood of eligible Ontario seniors receiving a pharmacy-led medication review called MedsCheck annual (MCA). Methods We designed a cohort study using a random sample of pharmacy claims for MCA-eligible Ontario seniors using linked administrative data from April 2012 to March 2013. Guided by a conceptual framework, we constructed a generalized-estimating-equations model to estimate the effect of patient, pharmacy and community factors on the likelihood of receiving MCA. Results Of the 2,878,958 eligible claim-dates, 65,605 included an MCA. Compared to eligible individuals who did not receive an MCA, recipients were more likely to have a prior MCA (OR = 3.03), receive a new medication on the claim-date (OR = 1.78), be hypertensive (OR = 1.18) or have a recent hospitalization (OR = 1.07). MCA recipients had fewer medications (e.g., OR = 0.44 for ≥12 medications versus 0–4 medications), and were less likely to receive an MCA in a rural (OR = 0.74) or high-volume pharmacy (OR = 0.65). Conclusions The most important determinant of receiving an MCA was having had a prior MCA. Overall, MCA recipients were healthier, younger, urban-dwelling, and taking fewer medications than non-recipients. Policies regarding current and future medication review programs may need to evolve to ensure that those at greatest need receive timely and comprehensive medication reviews.
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Affiliation(s)
- Petros Pechlivanoglou
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada. .,The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay st, Toronto, M5G0A4, ON, Canada. .,The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
| | - Lusine Abrahamyan
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.,The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Linda MacKeigan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Giulia P Consiglio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences , Toronto, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Department of Family Medicine, McMaster Innovation Park University, Hamilton, ON, Canada
| | - Ping Li
- Institute for Clinical Evaluative Sciences , Toronto, ON, Canada
| | - Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences , Toronto, ON, Canada
| | - Valeria E Rac
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.,The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jonghyun Shin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.,The Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto General Hospital, Toronto, ON, Canada
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Dolovich L, Tsuyuki RT. Pharmacy practice research produces findings that inform how pharmacists contribute to optimal drug therapy outcomes for Canadians. Can Pharm J (Ott) 2016; 149:261-263. [PMID: 27708670 DOI: 10.1177/1715163516663693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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