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Sandhu RK, Fradette M, Lin M, Youngson E, Lau D, Bungard TJ, Tsuyuki RT, Dolovich L, Healey JS, McAlister FA. Stroke Risk Reduction in Atrial Fibrillation Through Pharmacist Prescribing: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2421993. [PMID: 39046741 PMCID: PMC11270136 DOI: 10.1001/jamanetworkopen.2024.21993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/14/2024] [Indexed: 07/25/2024] Open
Abstract
Importance Major gaps in the delivery of appropriate oral anticoagulation therapy (OAC) exist, leaving a large proportion of persons with atrial fibrillation (AF) unnecessarily at risk for stroke and its sequalae. Objective To investigate whether pharmacist-led OAC prescription can increase the delivery of stroke risk reduction therapy in individuals with AF. Design, Setting, and Participants This prospective, open-label, patient-level randomized clinical trial of early vs delayed pharmacist intervention from January 1, 2019, to December 31, 2022, was performed in 27 community pharmacies in Alberta, Canada. Pharmacists identified patients 65 years or older with 1 additional stroke risk factor and known, untreated AF (OAC nonprescription or OAC suboptimal dosing) or performed screening using a 30-second single-lead electrocardiogram to detect previously unrecognized AF. Patients with undertreated or newly diagnosed AF eligible for OAC therapy were considered to have actionable AF. Data were analyzed from April 3 to November 30, 2023. Interventions In the early intervention group, pharmacists prescribed OAC using guideline-based algorithms with follow-up visits at 1 and 3 months. In the delayed intervention group, which served as the usual care control, the primary care physician (PCP) was sent a notification of actionable AF along with a medication list (both enhancement over usual care). After 3 months, patients without OAC optimization in the control group underwent delayed pharmacist intervention. Main Outcomes and Measures The primary outcome was the difference in the rate of guideline-concordant OAC use in the 2 groups at 3-month follow-up ascertained by a research pharmacist blinded to treatment allocation. Results Eighty patients were enrolled with actionable AF (9 [11.3%] newly diagnosed in 235 individuals screened). The mean (SD) age was 79.7 (7.4) years, and 45 patients (56.3%) were female. The median CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack) score was 2 (IQR, 2-3). Seventy patients completed follow-up. Guideline-concordant OAC use at 3 months occurred in 36 of 39 patients (92.3%) in the early intervention group vs 23 of 41 (56.1%) in the control group (P < .001), with an absolute increase of 34% and number needed to treat of 3. Of the 23 patients who received appropriate OAC prescription in the control group, the PCP called the pharmacist for prescribing advice in 6 patients. Conclusions and Relevance This randomized clinical trial found that pharmacist OAC prescription is a potentially high-yield opportunity to effectively close gaps in the delivery of stroke risk reduction therapy for AF. Scalability and sustainability of pharmacist OAC prescription will require larger trials demonstrating effectiveness and safety. Trial Registration ClinicalTrials.gov Identifier: NCT03126214.
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Affiliation(s)
- Roopinder K. Sandhu
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Division of Cardiology, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miriam Fradette
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Meng Lin
- Alberta Strategy for Patient-Oriented Research, University of Alberta, Edmonton, Canada
| | - Erik Youngson
- Alberta Strategy for Patient-Oriented Research, University of Alberta, Edmonton, Canada
- Alberta Health Services Provincial Research Data Services, Edmonton, Canada
| | - Darren Lau
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | | | - Ross T. Tsuyuki
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Finlay A. McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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Sinclair J, Bottoms L, Dillon S, Allan R, Shadwell G, Butters B. Effects of Montmorency Tart Cherry and Blueberry Juice on Cardiometabolic and Other Health-Related Outcomes: A Three-Arm Placebo Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095317. [PMID: 35564709 PMCID: PMC9103925 DOI: 10.3390/ijerph19095317] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 12/16/2022]
Abstract
The current study aimed to investigate the influence of tart cherry and blueberry juices on cardiometabolic and other health indices following a 20-day supplementation period. Forty-five adults were randomly assigned to receive tart cherry, blueberry, or a placebo, of which they drank 60 mL per day for 20 days. The primary outcome, which was systolic blood pressure, and secondary measures, including anthropometric, energy expenditure, substrate oxidation, hematological, diastolic blood pressure/resting heart rate, psychological wellbeing, and sleep efficacy, were measured before and after the intervention. There were no statistically significant differences (p > 0.05) for systolic blood pressure; however, total and LDL cholesterol were significantly improved with blueberry intake (pre: total cholesterol = 4.36 mmol/L and LDL cholesterol = 2.71 mmol/L; post: total cholesterol = 3.79 mmol/L and LDL cholesterol = 2.23 mmol/L) compared to placebo (pre: total cholesterol = 4.01 mmol/L and LDL cholesterol = 2.45 mmol/L; post: total cholesterol = 4.34 mmol/L and LDL cholesterol = 2.67 mmol/L). Furthermore, psychological wellbeing indices measured using the Beck Depression Inventory, State Trait Anxiety Inventory, and COOP WONCA improved statistically in the blueberry arm compared to placebo. Given the clear association between lipid concentrations and the risk of cardiovascular disease as well as the importance of psychological wellbeing to health-related quality of life, this investigation indicates that it could be an effective approach to assist in managing cardiometabolic disease.
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Affiliation(s)
- Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (S.D.); (R.A.); (G.S.); (B.B.)
- Correspondence:
| | - Lindsay Bottoms
- Centre for Research in Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK;
| | - Stephanie Dillon
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (S.D.); (R.A.); (G.S.); (B.B.)
| | - Robert Allan
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (S.D.); (R.A.); (G.S.); (B.B.)
| | - Gareth Shadwell
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (S.D.); (R.A.); (G.S.); (B.B.)
| | - Bobbie Butters
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (S.D.); (R.A.); (G.S.); (B.B.)
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Sinclair J, Shadwell G, Dillon S, Allan R, Butters B, Bottoms L. Effects of Montmorency Tart Cherry and Blueberry Juice on Cardiometabolic Outcomes in Healthy Individuals: Protocol for a 3-Arm Placebo Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189759. [PMID: 34574679 PMCID: PMC8466255 DOI: 10.3390/ijerph18189759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Cardiometabolic disease is recognized as the predominant cause of global mortality and healthcare expenditure. Whilst pharmaceutical interventions are effective in the short term, their long-term efficacy remain equivocal and their associated side-effects are concerning. Owing to their high levels of anthocyanins, Montmorency tart cherries and blueberries have been cited as potentially important natural treatment/preventative modalities for cardiometabolic disease. This study proposed a randomized controlled trial, aims to test the effects of consumption of Montmorency tart cherry and blueberry juice on cardiometabolic outcomes compared to placebo. This 20-day, parallel, single-blind, randomized, placebo-controlled trial will recruit 45 individuals, who will be assigned to receive 60 mL per day of either Montmorency tart cherry juice, blueberry juice or a cherry/blueberry flavoured placebo. The primary study outcome is the between-group difference in systolic blood pressure from baseline to post-intervention. Secondary outcome measures will be between-group differences in anthropometric, energy expenditure and substrate oxidation (during rest and physical activity), haematological, blood pressure/resting heart rate, psychological wellbeing and sleep efficacy indices. Statistical analysis will be conducted on an intention-to-treat basis. This study has been granted ethical approval by the University of Central Lancashire, Health Research Ethics Committee (ref: HEALTH 0016) and formally registered as a trial. Dissemination of the study findings from this investigation will be through publication in a leading peer-reviewed journal.
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Affiliation(s)
- Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (G.S.); (S.D.); (R.A.); (B.B.)
- Correspondence:
| | - Gareth Shadwell
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (G.S.); (S.D.); (R.A.); (B.B.)
| | - Stephanie Dillon
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (G.S.); (S.D.); (R.A.); (B.B.)
| | - Robert Allan
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (G.S.); (S.D.); (R.A.); (B.B.)
| | - Bobbie Butters
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK; (G.S.); (S.D.); (R.A.); (B.B.)
| | - Lindsay Bottoms
- Centre for Research in Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK;
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Lokker C, Jezrawi R, Gabizon I, Varughese J, Brown M, Trottier D, Alvarez E, Schwalm JD, McGillion M, Ma J, Bhagirath V. Feasibility of a Web-Based Platform (Trial My App) to Efficiently Conduct Randomized Controlled Trials of mHealth Apps For Patients With Cardiovascular Risk Factors: Protocol For Evaluating an mHealth App for Hypertension. JMIR Res Protoc 2021; 10:e26155. [PMID: 33522978 PMCID: PMC7884212 DOI: 10.2196/26155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background Mobile health (mHealth) interventions can improve health by improving cardiovascular risk factors, but their adoption in care by physicians and patients is untapped. Few mHealth apps have been evaluated in clinical trials, and due to the fast pace of technological development, those previously evaluated are often outdated by the time trial results are available. Given the rapid pace of change in this field, it is not feasible to rigorously evaluate mHealth apps with current methodologies. Objective The overall aim of this pilot study was to test the feasibility of using a web research platform called Trial My App to conduct efficient and rigorous web-based randomized controlled trials (RCTs) of mHealth apps relevant to patients with cardiovascular risk factors by evaluating an app that targets hypertension. Methods For this study, 200 participants with suboptimally controlled hypertension will be recruited through advertisements in newsletters, media, and the internet, as well as through referrals from their health care providers. Screening, consent, randomization, and collection of patient-important health confidence and self-management ability outcomes will be conducted online through the Trial My App research platform. Participants will be randomized into 2 groups: 100 that will use an mHealth app for tracking hypertension and 100 that will be considered as an educational control. All participants will complete questionnaires at 0, 1, 3 and 6 months after enrolment. A substudy to validate the method of blood pressure readings and the consistency of data entered through Trial My App will be conducted with 40 participants. Results The development of the Trial My App web platform has been completed. The creation of survey instruments has been completed in collaboration with our patient partners and advisory board. Recruitment is expected to begin in the first quarter of 2021; data collection and analysis are expected to be completed approximately 1 year after study commencement. Results will be disseminated through conferences and publications. The primary outcomes of this study include the feasibility of conducting an RCT using the Trial My App platform by reporting recruitment, retention, and completion statistics. We will validate app-entered data with a standard 7-day home blood pressure measurement method. Lastly, the pilot, nonblinded RCT will assess the effectiveness of the mHealth app in improving the control of hypertension compared with the control of hypertension in the educational control group. Conclusions This study will determine if it is feasible to use the Trial My App web-based platform to evaluate the effectiveness of mHealth apps for patients with cardiovascular risk factors. As more mHealth apps are evaluated in RCTs, patients will be able to select apps that meet their needs and physicians will be able to make evidence-based recommendations to their patients for apps aimed at improving cardiovascular health. Trial Registration ClinicalTrials.gov NCT04528654; https://clinicaltrials.gov/ct2/show/NCT04528654 International Registered Report Identifier (IRRID) PRR1-10.2196/26155
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Affiliation(s)
- Cynthia Lokker
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rita Jezrawi
- Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Itzhak Gabizon
- Department of Cardiology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Jobin Varughese
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Queen Square Family Health Team, Brampton, ON, Canada
| | - Michael Brown
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dan Trottier
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Jon-David Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael McGillion
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Vinai Bhagirath
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Woit C, Yuksel N, Charrois TL. Pharmacy and medical students' competence and confidence with prescribing: A cross-sectional study. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:1311-1319. [PMID: 32867929 DOI: 10.1016/j.cptl.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Previous research has shown that prescribing competence is weakly correlated with prescribing confidence. This questions whether undergraduate programs adequately prepare students and junior practitioners for safe and rational prescribing. The goal of this project was to investigate whether there are differences in prescribing competence and confidence between fourth year pharmacy and medical students at the University of Alberta. METHODS A cross-sectional design measured prescribing competence using five case scenarios and prescribing confidence with a survey. All fourth-year pharmacy and medical students at the University of Alberta were eligible to participate. Answers to the cases were graded based on therapeutic appropriateness and inclusion of all legal requirements. The confidence survey assessed self-rated confidence of both assessment and prescribing skills. Chi-square tests were used to compare frequencies of prescribing errors and self-rated confidence. The Spearman correlation coefficient was used to explore the correlation between prescribing competence and confidence for both cohorts independently. RESULTS Thirty-one pharmacy students and 16 medical students (response rate 24% and 10%, respectively) completed the assessment between December 2018 and March 2019. Pharmacy students had significantly more appropriate prescriptions and fewer inappropriate prescriptions than medical students. Both rated themselves as confident or very confident with prescribing, however neither group consistently included all the legal requirements of a prescription. There were no significant correlations between competence and confidence. CONCLUSIONS There are differences in prescribing competence and confidence between pharmacy and medical students. This assessment identified deficits in prescribing skills that could be targeted by future educational initiatives.
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Affiliation(s)
- Cassandra Woit
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Nese Yuksel
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Theresa L Charrois
- University of Alberta, Faculty of Pharmacy and Pharmaceutical Sciences, 3-227 Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
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Stallings AM, Dixon C, Carter A, Ali A, Herring C. Evaluation of a Pharmacist-Managed Hypertension Clinic in a Rural Primary Care Setting. J Pharm Pract 2020; 34:844-849. [PMID: 32452264 DOI: 10.1177/0897190020926841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe clinical pharmacy services provided in a rural North Carolina primary care clinic and assess the impact of these services on systolic and diastolic blood pressures in patients with uncontrolled hypertension. METHODS This single-center, retrospective study evaluated change in systolic and diastolic blood pressures from baseline, percentage of patients with blood pressure reductions, percentage at The Eight Joint National Committee (JNC 8) goal blood pressure, percentage at care gap closure defined as obtaining a blood pressure <140/90 mm Hg, and time to reach care gap closure. RESULTS The mean change in systolic blood pressure was -20.1 mm Hg (14.716-25.418, P < .0001) and the mean change in diastolic blood pressure was -8.8 mm Hg (5.449-12.117, P < .0001). Eighty percent of patients experienced blood pressure reductions from baseline, 51% met their respective JNC 8 goal blood pressure, and 48% met care gap closure. The average time to reach care gap closure was 23 weeks. CONCLUSION When embedded within a primary care clinic in a rural setting, a pharmacist-managed hypertension clinic significantly improved both systolic and diastolic blood pressures of patients with uncontrolled hypertension.
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Affiliation(s)
- Ashley M Stallings
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Candace Dixon
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Amanda Carter
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Asima Ali
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Charles Herring
- Department of Pharmacy, Campbell College of Pharmacy and Health Sciences, Buies Creek, NC, USA
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de Barra M, Scott C, Johnston M, De Bruin M, Scott N, Matheson C, Bond C, Watson M. Do pharmacy intervention reports adequately describe their interventions? A template for intervention description and replication analysis of reports included in a systematic review. BMJ Open 2019; 9:e025511. [PMID: 31862736 PMCID: PMC6937059 DOI: 10.1136/bmjopen-2018-025511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 05/28/2019] [Accepted: 06/25/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Scientific progress and translation of evidence into practice is impeded by poorly described interventions. The Template for Intervention Description and Replication (TIDieR) was developed to specify the minimal intervention elements that should be reported. OBJECTIVES (1) To assess the extent to which outpatient pharmacy interventions were adequately reported. (2) To examine the dimension(s) across which reporting quality varies. (3) To examine trial characteristics that predict better reporting. METHODS The sample comprised 86 randomised controlled trials identified in a Cochrane review of the effectiveness of pharmacist interventions on patient health outcomes. Duplicate, independent application of a modified 15-item TIDieR checklist was undertaken to assess the intervention reporting. The reporting/non-reporting of TIDieR items was analysed with principal component analysis to evaluate the dimensionality of reporting quality and regression analyses to assess predictors of reporting quality RESULTS: In total, 422 (40%) TIDieR items were fully reported, 395 (38%) were partially reported and 231 (22%) were not reported. A further 242 items were deemed not applicable to the specific trials. Reporting quality loaded on one component which accounted for 26% of the variance in TIDieR scores. More recent trials reported a slightly greater number of TIDieR items (0.07 (95% CI 0.02 to 0.13) additional TIDieR items per year of publication). Trials reported an 0.09 (95% CI 0.04 to 0.14) additional TIDieR items per unit increase in impact factor (IF) of the journal in which the main report was published. CONCLUSIONS Most trials lacked adequate intervention reporting. This diminished the applied and scientific value of their research. The standard of intervention reporting is, however, gradually increasing and appears somewhat better in journals with higher IFs. The use of the TIDieR checklist to improve reporting could enhance the utility and replicability of trials, and reduce research waste.
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Affiliation(s)
- Mícheál de Barra
- Life Sciences, Brunel University London, Middlesex, UK
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Claire Scott
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Dental Clinical Effectiveness, NHS Education for Scotland, Dundee, UK
| | - Marie Johnston
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - M De Bruin
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Radboud University Medical Center, Radboud Institute for Health Sciences, Radboud, The Netherlands
| | - Neil Scott
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Christine Bond
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Margaret Watson
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
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Sandhu RK, Guirguis LM, Bungard TJ, Youngson E, Dolovich L, Brehaut JC, Healey JS, McAlister FA. Evaluating the potential for pharmacists to prescribe oral anticoagulants for atrial fibrillation. Can Pharm J (Ott) 2017; 151:51-61. [PMID: 29317937 DOI: 10.1177/1715163517743269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Oral anticoagulant therapy (OAC) to prevent atrial fibrillation (AF)-related strokes remains poorly used. Alternate strategies, such as community pharmacist prescribing of OAC, should be explored. Methods Approximately 400 pharmacists, half with additional prescribing authority (APA), randomly selected from the Alberta College of Pharmacists, were invited to participate in an online survey over a 6-week period. The survey consisted of demographics, case scenarios assessing appropriateness of OAC (based on the 2014 Canadian Cardiovascular Society AF guidelines) and perceived barriers to prescribing. Regression analysis was performed to determine predictors of knowledge. Results A total of 35% (139/397) of pharmacists responded to the survey, and 57% of these had APA. Depending on the case scenario, 55% to 92% of pharmacists correctly identified patients eligible for stroke prevention therapy, but only about a half selected the appropriate antithrombotic agent; there was no difference in the knowledge according to APA status. In multivariable analysis, predictors significantly associated with guideline-concordant prescribing were having the pharmacist interact as part of an interprofessional team (p = 0.04) and direct OAC (DOAC) self-efficacy (confidence in ability to extend, adapt, initiate or alter prescriptions; p = 0.02). Barriers to prescribing OAC for APA pharmacists included a lack of AF and DOAC knowledge and preference for consulting the physician first, but these same pharmacists also identified difficulty in contacting the physician as a major barrier. Interpretation and Conclusion Community pharmacists can identify patients who would benefit from stroke prevention therapy in AF. However, physician collaboration and further training on AF and guidelines for prescribing OAC are needed.
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Affiliation(s)
- Roopinder K Sandhu
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Lisa M Guirguis
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Tammy J Bungard
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Erik Youngson
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Lisa Dolovich
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Jamie C Brehaut
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Jeff S Healey
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
| | - Finlay A McAlister
- Division of Cardiology (Sandhu, Bungard), Faculty of Pharmacy and Pharmaceutical Sciences (Guirguis), Strategy for Patient-Oriented Research (Youngson) and Division of General Internal Medicine (McAlister), University of Alberta, Edmonton, Alberta
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Houle SK, Charrois TL, Faruquee CF, Tsuyuki RT, Rosenthal MM. A randomized controlled study of practice facilitation to improve the provision of medication management services in Alberta community pharmacies. Res Social Adm Pharm 2017; 13:339-348. [DOI: 10.1016/j.sapharm.2016.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
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Rosenthal MM, Desai N, Houle SKD. Pharmacists' perceptions of pay for performance versus fee-for-service remuneration for the management of hypertension through pharmacist prescribing. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 25:388-393. [PMID: 28097711 DOI: 10.1111/ijpp.12330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES As pharmacists expand their roles as patient care providers, remuneration must be offered for patient care activities apart from dispensing. Most jurisdictions paying for such services utilize the fee-for-service (FFS) model, while little is known about the role of pay for performance (P4P) within the pharmacy profession. This study aimed to elicit the experience of pharmacists practicing under both models within the Alberta Clinical Trial in Optimizing Hypertension (RxACTION) study in Alberta, Canada. METHODS Pharmacist participants in RxACTION caring for at least one patient under FFS and under P4P were interviewed about their experiences until data saturation was reached. Interviews were conducted in June-July 2015, with responses audio recorded, transcribed and coded to identify key themes. KEY FINDINGS Eight pharmacists were interviewed, with three key themes identified: a perceived comfort with the existing FFS model particularly due to its ease related to business planning, the transformative effect of the study on their practices and a preference for future models to consider a blend of both service count- and performance-driven metrics. The degree of influence pharmacists feel they can have on outcomes achieved by patients, the perceptions of patients and other healthcare professionals on outcome-based payment, and concerns with the impact of variable remuneration on the pharmacy business model are concerns raised with P4P in pharmacy practice. CONCLUSIONS This study reveals a hesitation to radically transform payment for pharmacists' patient care services towards a P4P model. Efforts to implement P4P should therefore be gradual and accompanied with a robust evaluation plan.
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Affiliation(s)
| | - Nimisha Desai
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada
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Houle SKD, Charrois TL, McAlister FA, Kolber MR, Rosenthal MM, Lewanczuk R, Campbell NRC, Tsuyuki RT. Pay-for-performance remuneration for pharmacist prescribers' management of hypertension: A substudy of the RxACTION trial. Can Pharm J (Ott) 2016; 149:345-351. [PMID: 27829858 DOI: 10.1177/1715163516671745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To be sustainable, pharmacists providing direct patient care must receive appropriate payment for these services. This prespecified substudy of the RxACTION trial (a randomized trial of pharmacist prescribing vs usual care in patients with above-target blood pressure [BP]) aimed to determine if BP reduction achieved differed between patients whose pharmacist was paid by pay-for-performance (P4P) vs fee-for-service (FFS). METHODS Within RxACTION, patients with elevated BP assigned to the pharmacist prescribing group were further randomized to P4P or FFS payment for the pharmacist. In FFS, pharmacists received $150 for the initial visit and $75 for follow-up visits. P4P included FFS payments plus incentives of $125 and $250 for each patient who reached 50% and 100% of the BP target, respectively. The primary outcome was difference in change in systolic BP between P4P and FFS groups. RESULTS A total of 89 patients were randomized to P4P and 92 to the FFS group. Patients' average (SD) age was 63.0 (13.2) years, 49% were male and 76% were on antihypertensive drug therapy at baseline, taking a median of 2 (interquartile range = 1) medications. Mean systolic BP reductions in the P4P and FFS groups were 19.7 (SD = 18.4) vs 17.0 (SD = 16.4) mmHg, respectively (p = 0.47 for the comparison of deltas and p = 0.29 after multivariate adjustment). CONCLUSIONS This trial of pharmacist prescribing found substantial reductions in systolic BP among poorly controlled hypertensive individuals but with no appreciable difference when pharmacists were paid by P4P vs FFS.
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Affiliation(s)
- Sherilyn K D Houle
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Theresa L Charrois
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Finlay A McAlister
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Michael R Kolber
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Meagen M Rosenthal
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Richard Lewanczuk
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Norman R C Campbell
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
| | - Ross T Tsuyuki
- School of Pharmacy (Houle, Tsuyuki), University of Waterloo, Kitchener, Ontario; the Faculty of Pharmacy and Pharmaceutical Sciences (Charrois), the EPICORE Centre/COMPRIS (Charrois, McAlister, Kolber, Tsuyuki), the Department of Medicine (McAlister, Lewanczuk, Tsuyuki) and the Department of Family Medicine (Kolber), University of Alberta, Edmonton; the Cumming School of Medicine (Campbell), University of Calgary, Calgary, Alberta; and the School of Pharmacy (Rosenthal), University of Mississippi, Oxford, Mississippi, USA
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Res R, Hoti K, Charrois TL. Pharmacists’ Perceptions Regarding Optimization of Antibiotic Prescribing in the Community. J Pharm Pract 2016; 30:146-153. [DOI: 10.1177/0897190015623883] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objective: The overuse of antibiotics in the community is a primary cause of antibiotic resistance. Community pharmacists are the most accessible health professionals and so they are in an ideal position to implement interventions to ensure the appropriate use of antibiotics. This study aimed to explore the role of community pharmacists in the optimization of antibiotic prescribing and utilization. Method: Four focus groups were conducted with community pharmacists in Perth, Western Australia. Audio-recorded data were compared with field notes, transcribed, and thematically analyzed. Results: There were twenty-four participants in four focus group sessions. Four main themes were identified: patient perceptions and behaviors, prescribing behaviors, pharmacists’ roles and responsibilities, and health care system interventions in relation to antibiotic utilization. A number of interventions that could be implemented by community pharmacists were identified. In addition to interventions that are currently in place in Australia, forward dispensing, improved interprofessional collaboration, an expansion of current prescribing role, and vaccination capabilities were also suggested. Conclusions: This study indicated that current scope of pharmacists’ roles has room for more intervention strategies aimed at improving antibiotic prescribing and utilization in the community.
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Affiliation(s)
- Rebecca Res
- Faculty of Health Sciences, School of Pharmacy, Curtin University, Bentley, Australia
| | - Kreshnik Hoti
- Faculty of Health Sciences, School of Pharmacy, Curtin University, Bentley, Australia
- Department of Pharmacy, Medical Faculty, University of Prishtina, Prishtina, Kosovo
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Faruquee CF, Guirguis LM. A scoping review of research on the prescribing practice of Canadian pharmacists. Can Pharm J (Ott) 2015; 148:325-48. [PMID: 26600824 PMCID: PMC4637852 DOI: 10.1177/1715163515608399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pharmacists in Canada have been prescribing since 2007. This review aims to explore the volume, array and nature of research activity on Canadian pharmacist prescribing and to identify gaps in the existing literature. METHODS We conducted a scoping review to examine the literature on prescribing by pharmacists in Canada according to methodological trends, research areas and key findings. We searched for peer-reviewed research articles and abstracts in the Ovid MEDLINE, Ovid EMBASE and International Pharmaceutical Abstracts databases without any date limitations. A standardized form was used to extract information. RESULTS We identified 156 articles; of these, 26 articles and 12 abstracts met inclusion criteria. One-half of the research studies (20) used quantitative methods, including surveys, trials and experimental designs; 11 studies used qualitative methods and 7 used other methods. Research on pharmacist prescribing demonstrated an improvement in patient outcomes (13 studies), varied stakeholder perceptions (10 studies) and factors that influence this practice change (11 studies). Pharmacist prescribing was adopted when pharmacists practised patient-centred care. Stakeholders held contrasting perceptions of pharmacist prescribing. DISCUSSION Canadian research has demonstrated the benefit of pharmacist prescribing on patient outcomes, which is not present in the international literature. Future research may consider a meta-analysis addressing the impact on patient health. Gaps in research include comparisons between provinces, effects on physicians' services, overall patient safety and access to health care systems and economic implications for society. CONCLUSION A growing body of research on pharmacist prescribing has captured the early impact of prescribing on patient outcomes, perceptions of practice and practice change. Opportunities exist for pan-Canadian research that examines the system impact.
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Affiliation(s)
- Chowdhury Farhana Faruquee
- Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta
| | - Lisa M. Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta
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Tsuyuki RT, Houle SKD, Charrois TL, Kolber MR, Rosenthal MM, Lewanczuk R, Campbell NRC, Cooney D, McAlister FA. Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community: The Alberta Clinical Trial in Optimizing Hypertension (RxACTION). Circulation 2015; 132:93-100. [PMID: 26063762 DOI: 10.1161/circulationaha.115.015464] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving, and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. METHODS AND RESULTS We designed a patient-level, randomized, controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines) through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age, 64 years; 49% male) were enrolled. Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg. The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group, an adjusted difference of 6.6±1.9 mm Hg (P=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% confidence interval, 1.17-4.15 in favor of the intervention). CONCLUSIONS Pharmacist prescribing for patients with hypertension resulted in a clinically important and statistically significant reduction in BP. Policy makers should consider an expanded role for pharmacists, including prescribing, to address the burden of hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00878566.
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Affiliation(s)
- Ross T Tsuyuki
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.).
| | - Sherilyn K D Houle
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Theresa L Charrois
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Michael R Kolber
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Meagen M Rosenthal
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Richard Lewanczuk
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Norm R C Campbell
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Dale Cooney
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
| | - Finlay A McAlister
- From EPICORE Centre/COMPRIS, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., T.L.C., M.R.K., M.M.R., F.A.M.), Department of Medicine, Faculty of Medicine and Dentistry (R.T.T., S.K.D.H., M.M.R., R.L., F.A.M.), Mazankowski Alberta Heart Institute (R.T.T., S.K.D.H., R.L., F.A.M.), Faculty of Pharmacy and Pharmaceutical Sciences (T.L.C.), and Department of Family Medicine, Faculty of Medicine and Dentistry (M.R.K.), University of Alberta, Edmonton, Canada; School of Pharmacy, University of Waterloo, Kitchener, ON, Canada (R.T.T., S.K.D.H.); Department of Medicine, Faculty of Medicine, University of Calgary, AB, Canada (N.R.C.C.); and Alberta College of Pharmacists, Edmonton, Canada (D.C.)
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Abstract
PURPOSE OF REVIEW Studies on collaborative and multidisciplinary approaches to the management of hypertension published in the past 2 years are summarized. Expanding scopes of practice for nonphysician health professionals, a need to build capacity in the healthcare system, and a movement toward multidisciplinary care warrant an examination of the evidence in this area. RECENT FINDINGS Multidisciplinary care for hypertension management, across the majority of studies identified, resulted in improved blood pressure (BP) outcomes and the timeliness of achieving treatment targets. Interventions involving therapeutic decision-making by nonphysician health professionals consistently resulted in significant BP improvements compared with usual care, whereas more passive approaches, such as education and lifestyle monitoring programs, were unable to significantly benefit participants' BP. SUMMARY Our findings support recent efforts to integrate collaborative care approaches into chronic disease management, with the strongest evidence for pharmacist care. Expanding scopes of practice and clinical decision-making protocols for nurses, pharmacists, dietitians, and physiotherapists have the potential to further improve hypertension care.
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Lyster RL, Houle SKD. Abnormal vaginal bleeding following pharmacist prescribing of metformin leads to the detection of complex endometrial hyperplasia. Ann Pharmacother 2013; 47:1581-3. [PMID: 24285770 DOI: 10.1177/1060028013504385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe a case where pharmacist prescribing of metformin therapy resulted in unexplained vaginal bleeding in a patient later diagnosed with complex endometrial hyperplasia. CASE SUMMARY A 57-year-old woman with diagnoses of hypertension and dyslipidemia was assessed by a pharmacist with prescribing authorization for hypertension management. Cardiovascular risk assessment performed by the pharmacist resulted in the detection of metabolic syndrome confirmed by the patient's physician. The pharmacist prescribed metformin 500 mg twice daily for prediabetes and metabolic syndrome, resulting in vaginal bleeding 1 week following initiation of therapy. Bleeding stopped following discontinuation of metformin, and recurred on retrial. The symptoms were dose dependent as bleeding did not occur at a dose of 500 mg once daily, but recurred at a total dose of 1000 mg/d. The patient was referred for physical examination and endometrial ultrasound and sampling, and was found to have complex endometrial hyperplasia. DISCUSSION Metformin is widely used for the treatment of polycystic ovary syndrome as it improves ovulation and menstrual cycle regularity. In this case, the patient was not known to have polycystic ovary syndrome but was instead provided metformin for metabolic syndrome and hyperinsulinemia. It is believed that metformin's endocrine effects resulted in the sloughing of this hyperplastic tissue, prompting the pharmacist to refer the patient for medical assessment. This case is unique as it is the first of our knowledge to report a scenario where pharmacist prescribing resulted in facilitated detection of a previously undetected disease, highlighting that an expanded scope of practice for pharmacists can facilitate disease diagnosis when collaboration occurs among health professionals. CONCLUSIONS Female patients initiated on metformin therapy should be aware that any changes to their menstrual cycle following metformin may indicate endometrial disease. Additionally, pharmacist prescribing for chronic disease management, when practiced collaboratively with the patient and their physician, can facilitate disease detection through effective referral and follow-up.
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Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists' practice: implications for physicians. CMAJ 2013; 185:1228-32. [PMID: 23959280 DOI: 10.1503/cmaj.121990] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Tejani AM, Siu JTP, Wright JM, Bassett K, Musini V, Mintzes B, Perry T. Another hypertension visit. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:829-30. [PMID: 22893330 PMCID: PMC3418977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Houle SKD, Chuck AW, McAlister FA, Tsuyuki RT. Effect of a pharmacist-managed hypertension program on health system costs: an evaluation of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN). Pharmacotherapy 2012; 32:527-37. [PMID: 22552863 DOI: 10.1002/j.1875-9114.2012.01097.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE To quantify the potential cost savings of a community pharmacy-based hypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN) study in terms of avoided cardiovascular events-myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings with the cost of the pharmacist intervention program. DESIGN An economic model was developed to estimate the potential cost avoidance in direct health care resources from reduced cardiovascular events over a 1-year period. MEASUREMENTS AND MAIN RESULTS The SCRIP-HTN study found that patients with diabetes mellitus and hypertension who were receiving the pharmacist intervention had a greater mean reduction in systolic blood pressure of 5.6 mm Hg than patients receiving usual care. For our model, published meta-analysis data were used to compute cardiovascular event absolute risk reductions associated with a 5.6-mm Hg reduction in systolic blood pressure over 6 months. Costs/event were obtained from administrative data, and probabilistic sensitivity analyses were performed to assess the robustness of the results. Two program scenarios were evaluated-one with monthly follow-up for a total of 1 year with sustained blood pressure reduction, and the other in which pharmacist care ended after the 6-month program but the effects on systolic blood pressure diminished over time. The cost saving results from the economic model were then compared with the costs of the program. Annual estimated cost savings (in 2011 Canadian dollars) from avoided cardiovascular events were $265/patient (95% confidence interval [CI] $63-467) if the program lasted 1 year or $221/patient (95%CI $72-371) if pharmacist care ceased after 6 months with an assumed loss of effect afterward. Estimated pharmacist costs were $90/patient for 6 months or $150/patient for 1 year, suggesting that pharmacist-managed programs are cost saving, with the annual net total cost savings/patient estimated to be $131 for a program lasting 6 months or $115 for a program lasting 1 year. CONCLUSION Our model found that community pharmacist interventions capable of reducing systolic blood pressure by 5.6 mm Hg within 6 months are cost saving and result in improved patient outcomes. Wider adoption of pharmacist-managed hypertension care for patients with diabetes and hypertension is encouraged.
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Affiliation(s)
- Sherilyn K D Houle
- Epidemiology Coordinating and Research Centre/Centre for Community Pharmacy Research and Interdisciplinary Strategies, University of Alberta, 8215-112 Street NW, Edmonton, Alberta, Canada
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