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Tran T, Ford J, Hardidge A, Antoine S, Veevers B, Taylor S, Elliott RA. Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study. Int J Clin Pharm 2022; 44:1269-1276. [PMID: 35829822 PMCID: PMC9277971 DOI: 10.1007/s11096-022-01455-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
Background More than 70% of patients continue to use opioid medications 3-weeks following total knee arthroplasty. Post-discharge pharmacist reviews improve medication management, however it’s effect on opioid usage is not known. Aim This study aimed to evaluate the impact of post-discharge pharmacist review on opioid use following a total knee arthroplasty. Method A pilot, cohort pre- and post-intervention study was undertaken on patients who had undergone a total knee arthroplasty and were supplied an opioid upon discharge from hospital. During the intervention, patients were contacted via telephone by a pharmacist approximately five days post-discharge to review analgesic usage, provide education and advice and communicate an opioid management plan to their general practitioner. The primary endpoint was the percentage of patients taking opioids 3-weeks post-discharge. Secondary endpoints included: percentage of patients obtaining an opioid refill; patient satisfaction with opioid supply and the pharmacist review. Results Pre- and post-intervention, 63 and 44 patients were included, respectively. The percentage of patients taking opioids 3-weeks post-discharge declined from 74.6 to 29.6% (p < 0.001) and the percentage requiring an opioid refill from their general practitioner declined from 71.4 to 36.4% (p < 0.001). More patients were satisfied with opioid supply during the intervention period (79.5% cf. 47.6%, p = 0.001). Twenty-eight (63.6%) patients could recall the post-discharge pharmacist review, and all were either satisfied or extremely satisfied with the review. Conclusion Pharmacist-delivered post-discharge analgesia review reduced the percentage of patients taking opioids 3-weeks post-discharge following a total knee arthroplasty. This intervention has the potential to provide a smoother transition of care for patients supplied with opioids at the time of hospital discharge.
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Affiliation(s)
- Tim Tran
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia.
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - James Ford
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Andrew Hardidge
- Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Shari Antoine
- Health Independence Program, Austin Health, Heidelberg, VIC, Australia
| | - Beth Veevers
- Health Independence Program, Austin Health, Heidelberg, VIC, Australia
| | - Simone Taylor
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Rohan A Elliott
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
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Varghese S, Hahn-Goldberg S, Deng Z, Bradley-Ridout G, Guilcher SJT, Jeffs L, Madho C, Okrainec K, Rosenberg-Yunger ZRS, McCarthy LM. Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review. Patient Prefer Adherence 2022; 16:515-560. [PMID: 35241910 PMCID: PMC8887864 DOI: 10.2147/ppa.s348152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings. METHODS Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer. RESULTS A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers). CONCLUSION The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.
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Affiliation(s)
- Shawn Varghese
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Michael G.Degroote School Of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - ZhiDi Deng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glyneva Bradley-Ridout
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sinai Health, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Craig Madho
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Karen Okrainec
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, School of Health Services Management, Ryerson University, Toronto, Ontario, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Correspondence: Lisa M McCarthy, Clinician Scientist, Institute for Better Health, Trillium Health Partners, Tel +1 416-566-2793, Email
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Abbott RA, Moore DA, Rogers M, Bethel A, Stein K, Coon JT. Effectiveness of pharmacist home visits for individuals at risk of medication-related problems: a systematic review and meta-analysis of randomised controlled trials. BMC Health Serv Res 2020; 20:39. [PMID: 31941489 PMCID: PMC6961241 DOI: 10.1186/s12913-019-4728-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting. Review methods To determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data. Results Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge. Conclusion A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.
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Affiliation(s)
- Rebecca A Abbott
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Darren A Moore
- Graduate School of Education, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Alison Bethel
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Ken Stein
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
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Reducing adverse medication events in mental health: Australian National Survey. INT J EVID-BASED HEA 2018; 18:108-115. [PMID: 30239356 DOI: 10.1097/xeb.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia. METHODS The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making. RESULTS The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units. CONCLUSIONS Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.
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Improving communication of medication changes using a pharmacist-prepared discharge medication management summary. Int J Clin Pharm 2017; 39:394-402. [PMID: 28285390 DOI: 10.1007/s11096-017-0435-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
Background Discontinuity of care between hospital and primary care is often due to poor information transfer. Medication information in medical discharge summaries (DS) is often incomplete or incorrect. The effectiveness and feasibility of hospital pharmacists communicating medication information, including changes made in the hospital, is not clearly defined. Objective To explore the impact of a pharmacist-prepared Discharge Medication Management Summary (DMMS) on the accuracy of information about medication changes provided to patients' general practitioners (GPs). Setting Two medical wards at a major metropolitan hospital in Australia. Method An intervention was developed in which ward pharmacists communicated medication change information to GPs using the DMMS. Retrospective audits were conducted at baseline and after implementation of the DMMS to compare the accuracy of information provided by doctors and pharmacists. GPs' satisfaction with the DMMS was assessed through a faxed survey. Main outcome measure Accuracy of medication change information communicated to GPs; GP satisfaction and feasibility of a pharmacist-prepared DMMS. Results At baseline, 263/573 (45.9%) medication changes were documented by doctors in the DS. In the post-intervention audit, more medication changes were documented in the pharmacist-prepared DMMS compared to the doctor-prepared DS (72.8% vs. 31.5%; p < 0.001). Most GPs (73.3%) were satisfied with the information provided and wanted to receive the DMMS in the future. Completing the DMMS took pharmacists an average of 11.7 minutes. Conclusion The accuracy of medication information transferred upon discharge can be improved by expanding the role of hospital pharmacists to include documenting medication changes.
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Nazar H, Nazar Z, Portlock J, Todd A, Slight SP. A systematic review of the role of community pharmacies in improving the transition from secondary to primary care. Br J Clin Pharmacol 2015; 80:936-48. [PMID: 26149372 PMCID: PMC4631167 DOI: 10.1111/bcp.12718] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 11/26/2022] Open
Abstract
AIM We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings. METHOD We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes. RESULTS We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered. CONCLUSIONS There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.
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Affiliation(s)
- Hamde Nazar
- School of Medicine, Pharmacy and Health, Durham UniversityQueen's Campus, Stockton, TS17 6BH
| | - Zachariah Nazar
- School of Pharmacy and Biomedical Sciences, University of PortsmouthWhite Swan Road, Portsmouth, PO1 2DT
| | - Jane Portlock
- School of Pharmacy and Biomedical Sciences, University of PortsmouthWhite Swan Road, Portsmouth, PO1 2DT, UK
| | - Adam Todd
- School of Medicine, Pharmacy and Health, Durham UniversityQueen's Campus, Stockton, TS17 6BH
| | - Sarah P Slight
- School of Medicine, Pharmacy and Health, Durham UniversityQueen's Campus, Stockton, TS17 6BH
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Deeks LS, Cooper GM, Draper B, Kurrle S, Gibson DM. Dementia, medication and transitions of care. Res Social Adm Pharm 2015; 12:450-60. [PMID: 26265028 DOI: 10.1016/j.sapharm.2015.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/04/2015] [Accepted: 07/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses. OBJECTIVES To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice. METHOD Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer's Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion. RESULTS Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training. CONCLUSIONS Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.
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Affiliation(s)
- Louise S Deeks
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia.
| | - Gabrielle M Cooper
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | - Susan Kurrle
- Faculty of Medicine, University of Sydney, Sydney, Australia; Rehabilitation and Aged Care Service, Hornsby Hospital, Sydney, Australia
| | - Diane M Gibson
- Faculty of Health, University of Canberra, ACT 2601, Australia
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Marriott JL, Bessell TL. Pharmacist's Role in the Hospital Discharge Process. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2008.tb00815.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Tracey L Bessell
- Monash University; Pharmaceutical Benefits Division, Department of Health and Ageing; Canberra Australian Capital Territory
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Kumar N, Knowler CB, Strumpman D, Bajorek BV. Facilitating Medication Misadventure Risk Assessment in the Emergency Medical Unit. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00675.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Beata V Bajorek
- The University of Sydney; Department of Pharmacy and Clinical Pharmacology, Royal North Shore Hospital; St Leonards New South Wales
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10
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Elliott RA, C. Booth J. Problems with medicine use in older Australians: a review of recent literature. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/jppr.1041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Rohan A. Elliott
- Pharmacy Department; Austin Health; Heidelberg Victoria Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria Australia
| | - Jane C. Booth
- Pharmacy Department; Austin Health; Heidelberg Victoria Australia
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Walter C, Mellor JD, Rice C, Kirsa S, Ball D, Duffy M, Herschtal A, Mileshkin L. Impact of a specialist clinical cancer pharmacist at a multidisciplinary lung cancer clinic. Asia Pac J Clin Oncol 2014; 12:e367-74. [DOI: 10.1111/ajco.12267] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Clare Walter
- Pharmacy Department; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - James D Mellor
- Pharmacy Department; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - Carol Rice
- Pharmacy Department; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - Sue Kirsa
- Pharmacy Department; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - David Ball
- Division of Radiation Oncology; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - Mary Duffy
- Division of Cancer Allied Health, Nursing and Support; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
| | - Linda Mileshkin
- Division of Cancer Medicine; Peter MacCallum Cancer Centre, St Andrew's Place; East Melbourne Victoria Australia
- University of Melbourne; Parkville Victoria Australia
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Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review. Int J Clin Pharm 2014; 36:882-91. [PMID: 25052621 DOI: 10.1007/s11096-014-9982-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
Background Pharmacists' counseling has improved health-related outcomes in many acute and chronic conditions. Several studies have shown how pharmacists have been contributing to reduce morbidity and mortality related to drug-therapy (MMRDT). However, there still is a lack of reviews that assemble evidence-based clinical pharmacists' counseling. Equally, there is also a need to understand structure characteristics, processes and technical contents of these clinical services. Aim of the review To review the structure, processes and technical contents of pharmacist counseling or education reported in randomized controlled trials (RCT) that had positive health-related outcomes. Methods We performed a systematic search in specialized databases to identify RCT published between 1990 and 2013 that have evaluated pharmacists' counseling or educational interventions to patients. Methodological quality of the trials was assessed using the Jadad scale. Pharmacists' interventions with positive clinical outcomes (p < 0.05) were evaluated according to patients' characteristics, setting and timing of intervention, reported written and verbal counseling. Results 753 studies were found and 101 RCT matched inclusion criteria. Most of the included RCTs showed a Jadad score between two (37 studies) and three (32 studies). Pharmacists were more likely to provide counseling at ambulatories (60 %) and hospital discharge (25 %); on the other hand pharmacists intervention were less likely to happen when dispensing a medication. Teaching back and explanations about the drug therapy purposes and precautions related to its use were often reported in RCT, whereas few studies used reminder charts, diaries, group or electronic counseling. Most of studies reported the provision of a printed material (letter, leaflet or medication record card), regarding accessible contents and cultural-concerned informations about drug therapy and disease. Conclusion Pharmacist counseling is an intervention directed to patients' health-related needs that improve inter-professional and inter-institutional communication, by collaborating to integrate health services. In spite of reducing MMRDT, we found that pharmacists' counseling reported in RCT should be better explored and described in details, hence collaborating to improve medication-counseling practice among other countries and settings.
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13
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Spinewine A, Claeys C, Foulon V, Chevalier P. Approaches for improving continuity of care in medication management: a systematic review. Int J Qual Health Care 2013; 25:403-17. [DOI: 10.1093/intqhc/mzt032] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Eichenberger PM, Haschke M, Lampert ML, Hersberger KE. Drug-related problems in diabetes and transplant patients: an observational study with home visits. Int J Clin Pharm 2011; 33:815-23. [DOI: 10.1007/s11096-011-9542-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 07/11/2011] [Indexed: 11/30/2022]
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15
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Lehnbom EC, Brien JAE. Challenges in chronic illness management: a qualitative study of Australian pharmacists' perspectives. ACTA ACUST UNITED AC 2010; 32:631-6. [PMID: 20628817 DOI: 10.1007/s11096-010-9414-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore pharmacists' views on managing patients with chronic illness; to understand the incentives and barriers they perceive and the solutions they propose to overcome these barriers. SETTING Hospital pharmacists, with experience in managing people with chronic illnesses, working in western Sydney, Australia, were interviewed during June and July 2008. METHOD A qualitative study involving group and individual interviews using a semi-structured interview guide. RESULTS Hospital pharmacists identified lack of communication between different healthcare providers and with patients as a contributing factor to lack of continuity of care and this was perceived as a major barrier in managing patients with chronic illnesses. Pharmacists were also concerned about the effects of medication costs, and poor patient knowledge regarding their disease and medications, and the effects on adherence. Suggested solutions included taking a teamwork approach in the management of chronic illness and providing more information to patients to improve adherence. CONCLUSION The identified incentives and barriers have provided valuable information on what pharmacists face in managing patients with chronic illness. Most of the solutions suggested by them have been tested and proven unsuccessful. Develop successful health policy to address the identified barriers remains a challenge.
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Affiliation(s)
- Elin C Lehnbom
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia.
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Grimes T, Duggan C, Gallagher P, Strawbridge J. Care of the stroke patient-communication between the community pharmacist and prescribers in the Republic of Ireland. ACTA ACUST UNITED AC 2009; 31:648-55. [PMID: 19757142 DOI: 10.1007/s11096-009-9322-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 06/28/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study sought to examine the perceptions that community pharmacists have of communication with prescribers in both primary and secondary care in Ireland, with respect to care of stroke patients. SETTING Community pharmacies across Ireland, stratified into the four representative administrative regions. METHOD Survey using a structured postal questionnaire. MAIN OUTCOME MEASURE Perceptions of communication with prescribers based in primary and secondary care; pharmacy and pharmacy premises demographics. RESULTS A response rate of 52% (n = 314) was achieved. Community pharmacists' perceptions of information provision from secondary care were low, the majority (83%) never received any information from the hospital, although they would welcome it. Communication with hospital based prescribers was considered by most (93%) to be poor. The majority (greater than 75%) of respondents expressed a desire for greater information provision concerning a stroke patient's medication and diagnostic information. Pharmacists' perceptions of interaction with general practitioners were generally regarded as good (63%) although information provision in both directions between pharmacist and general practitioner could be improved. CONCLUSION The findings of this study indicated that community pharmacists perceive that there is room for improvement in the communication between themselves and prescribers in the primary and secondary care settings, concerning the care of the stroke patient. This highlights the need for the development of formal communication channels between community pharmacists and other members of the healthcare team involved in the care of the stroke patient. However, the challenges of communicating patient information across healthcare sectors are recognized.
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Affiliation(s)
- Tamasine Grimes
- Adelaide and Meath Hospital, incorporating the National Children's Hospital, Dublin 24, Ireland.
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