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Kamusheva M, Aarnio E, Qvarnström M, Hafez G, Mucherino S, Potočnjak I, Trečiokiene I, Mihajlović J, Ekenberg M, van Boven JFM, Leiva-Fernandez F. Pan-European survey on medication adherence management by healthcare professionals. Br J Clin Pharmacol 2024. [PMID: 39073168 DOI: 10.1111/bcp.16183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024] Open
Abstract
AIMS While medication adherence (MA) is a key prerequisite for achieving optimal clinical and economic outcomes, nonadherence is highly prevalent. Assessing how healthcare professionals (HCPs) in Europe manage MA, focusing on measurement, reporting and interventions, is the subject of this study. METHODS A cross-sectional study was conducted among 40 European countries and quantitative analysis was conducted via an online survey. The multi-language online survey was created using Webropol 3.0 survey and reporting tool. Descriptive statistics and chi-squared tests were applied. RESULTS In total, 2875 HCPs (pharmacists: 39.9%; physicians: 36.7%; nurses: 16.4%) from 37 European countries participated. The most used methods for MA assessment were direct communication with patients (86.4%) and referring to personal patient records (56.7%) (P < 0.0001). Physicians (74.9%) and nurses (58.8%) were more aware of problems related to MA in contrast to pharmacists (48.6%) (P < 0.001). Almost all HCPs (92.6%) indicated that MA-enhancing interventions involved mainly direct communication with nonadherent patients (93.3%) and their caregivers (55.7%). Medication review and related optimization of therapy were mainly performed in Western European countries (46.8%). Technological solutions were ranked as one of the less applied approaches (10-15%) (P < 0.001). CONCLUSIONS HCPs in all European regions recognize MA management as an integral element of overall patient-centred care. More efforts are needed to ensure timely, adequate and relevant MA assessment, reporting and improvement and involvement of all HCPs, especially among pharmacists who were generally less aware of MA issues. Promotion and use of digital technological solutions should be the focus of current and future clinical practice to optimize MA management processes.
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Affiliation(s)
- Maria Kamusheva
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Emma Aarnio
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Miriam Qvarnström
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Türkiye
| | - Sara Mucherino
- CIRFF, Department of Pharmacy, University of Naples Federico II, Naples, NA, Italy
| | - Ines Potočnjak
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
- School of Medicine Catholic University of Croatia, Zagreb, Croatia
| | - Indre Trečiokiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- University Medical Center Groningen, Department of Health Sciences, University of Groningen, Groningen, Netherlands
| | - Jovan Mihajlović
- Mihajlović Health Analytics, Novi Sad, Serbia
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Marie Ekenberg
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Udemgba C, Burbank AJ, Gleeson P, Davis CM, Matsui EC, Mosnaim G. Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00632-9. [PMID: 38878860 DOI: 10.1016/j.jaip.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; University Medicine Associates, University Health, San Antonio, Tex.
| | - Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patrick Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Carla M Davis
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Elizabeth C Matsui
- Center for Health & Environment: Education & Research, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Endeavor Health, Glenview, Ill
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Little MA, Reid T, Moncrief M, Cohn W, Wiseman KP, Wood CH, You W, Anderson RT, Krukowski RA. Testing the feasibility of the QuitAid smoking cessation intervention in a randomized factorial design in an independent, rural community pharmacy. Pilot Feasibility Stud 2024; 10:41. [PMID: 38409089 PMCID: PMC10895740 DOI: 10.1186/s40814-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. METHODS Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. RESULTS Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). CONCLUSIONS This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.
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Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA.
| | - Taylor Reid
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Matthew Moncrief
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Wen You
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
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Manfrin A. The relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention. J Eval Clin Pract 2023. [PMID: 37171399 DOI: 10.1111/jep.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aimed to investigate the relationship between the pharmacist's role, patient understanding and satisfaction during the provision of a cost-effective pharmacist-led intervention using structural equation modelling (SEM). SEM is a group of statistical techniques used in different disciplines to model latent variables and evaluate theories. METHODS A validated questionnaire was used to gather patient views on a pharmacist-led intervention. A conceptual model was developed to test the statistical significance of the relationship between patient understanding and satisfaction, the pharmacist's role and patient understanding, the pharmacist's role and patient satisfaction. In addition, the study evaluated the model's in-sample and out-of-sample predictive power. The analysis tested fours hypotheses (H): 1) There was no significant relationship between patient understanding and patient satisfaction; 2) There was no significant relationship between the pharmacist's role and patient understanding; 3) There was no significant relationship between the pharmacist's role and patient satisfaction; 4) The in-sample and out-of-sample predictive power of the model. Data were analysed using Smart-PLS software version 3.2.8. RESULTS Two hundred and forty-six patients returned the questionnaire. Construct reliability, validity (Cronbach's alpha〉0.70, ⍴A>0.70, ⍴C>0.70), average extracted variance (AVE〉0.50) and discriminant validity (HTMT<0.85) were confirmed. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. Path coefficients and effect sizes suggested that the pharmacist's role played a significant part in patient understanding (H2, β=0.650, f2 =0.730, p<0.001), which then influenced patient satisfaction (H1, β=0.474, f2 =0.222, p<0.001). The in-sample and out-of-sample predictive powers were moderate. CONCLUSIONS Patient satisfaction is becoming an integral component in healthcare provision and evaluation of healthcare quality. The results support using structural equation modelling to assess the link between the pharmacist's role and patient understanding and satisfaction when delivering cost-effective pharmacist-led interventions.
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Affiliation(s)
- Andrea Manfrin
- Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
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Deng ZJ, Gui L, Chen J, Peng SS, Ding YF, Wei AH. Clinical, economic and humanistic outcomes of medication therapy management services: A systematic review and meta-analysis. Front Pharmacol 2023; 14:1143444. [PMID: 37089963 PMCID: PMC10113465 DOI: 10.3389/fphar.2023.1143444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Medication therapy management (MTM) services is a method that can effectively improve patients’ conditions, but the efficacy of economic and humanistic outcomes remain unclear. This systematic review and meta-analysis aim to use economic, clinical and humanistic outcomes to evaluate the multi-benefits of MTM services.Method: A systematic review and meta-analysis was conducted by retrieving PubMed, EMBASE, the Cochrane Library and ClinicalTrial.gov from the inception to April 2022. There were two reviewers screening the records, extracting the data, and assessing the quality of studies independently.Results: A total of 81 studies with 60,753 participants were included. MTM services were more effective in clinical outcomes with decreasing the rate of readmission (OR: 0.78; 95% CI: 0.73 to 0.83; I2 = 56%), emergency department visit (OR: 0.88; 95% CI: 0.81 to 0.96; I2 = 32%), adverse drug events (All-cause: OR: 0.68; 95% CI: 0.56 to 0.84; I2 = 61%; SAE: OR: 0.51; 95% CI: 0.33 to 0.79; I2 = 35%) and drug-related problems (MD: −1.37; 95% CI: −2.24 to −0.5; I2 = 95%), reducing the length of stay in hospital (MD: −0.74; 95% CI: −1.37 to −0.13; I2 = 70%), while the economic and humanistic outcomes were less effective.Conclusion: Our systematic review and meta-analysis demonstrated that MTM services had great ability to improve patients’ clinical conditions while the efficacy of economic and humanistic outcomes, with some of the outcomes showing high degree of heterogeneity and possible publication bias, required more future studies to provide stronger evidence.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=349050], identifier [CRD42022349050].
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Affiliation(s)
| | | | | | | | | | - An-Hua Wei
- *Correspondence: Yu-Feng Ding, ; An-Hua Wei,
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Alsayed AR. Illustrating How to Use the Validated Alsayed_v1 Tools to Improve Medical Care: A Particular Reference to the Global Initiative for Asthma 2022 Recommendations. Patient Prefer Adherence 2023; 17:1161-1179. [PMID: 37143905 PMCID: PMC10153448 DOI: 10.2147/ppa.s403239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The current research aimed to illustrate a real case using the validated Alsayed_v1 tools as tutorial training to improve the knowledge and skills of healthcare practitioners in the clinical problem-solving process necessary to implement medical and pharmaceutical care. Patients and Methods The Alsayed_v1 instruments consist of principal components: data collection, assessment of treatments, the medical problem oriented plan (MPOP), as well as a care plan and patient education. Results This study illustrated a real case of asthma patient using the validated Alsayed_v1 tools. These validated and clinically tested tools provide a coding system for the MPOP that permits easy documentation with an open hierarchical structure where higher levels are broad and lower levels are particular, and the possibility to enter free text. The section dedicated to treatment assessments is intended to synthesize patient information to facilitate the identification of the MPOPs. Effective management requires the development of a partnership between the patient with asthma (or the patient's caregivers) and his healthcare professional(s). This partnership aims to allow the patient to control his condition with guidance from the healthcare professional(s), discuss and agree on therapy goals, and develop a personalized, written, self-management asthma care plan. Conclusion By implementing Alsayed_v1 tools, the clinical practitioner can actively give the best practice for optimal patient outcomes.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11937, Jordan
- Correspondence: Ahmad R Alsayed, (PharmD, MSc, PhD in Therapeutics and Precision Medicine), Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan, Tel +962786770778, Email ;
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Fraher EP, Lombardi B, Brandt B, Hawes E. Improving the Health of Rural Communities Through Academic-Community Partnerships and Interprofessional Health Care and Training Models. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1272-1276. [PMID: 35731585 DOI: 10.1097/acm.0000000000004794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Health disparities between rural and urban areas are widening at a time when urban health care systems are increasingly buying rural hospitals to gain market share. New payment models, shifting from fee-for-service to value-based care, are gaining traction, creating incentives for health care systems to manage the social risk factors that increase health care utilization and costs. Health system consolidation and value-based care are increasingly linking the success of urban health care systems to rural communities. Yet, despite the natural ecosystem rural communities provide for interprofessional learning and collaborative practice, many academic health centers (AHCs) have not invested in building team-based models of practice in rural areas. With responsibility for training the future health workforce and major investments in research infrastructure and educational capacity, AHCs are uniquely positioned to develop interprofessional practice and training opportunities in rural areas and evaluate the cost savings and quality outcomes associated with team-based care models. To accomplish this work, AHCs will need to develop academic-community partnerships that include networks of providers and practices, non-AHC educational organizations, and community-based agencies. In this commentary, the authors highlight 3 examples of academic-community partnerships that developed and implemented interprofessional practice and education models and were designed around specific patient populations with measurable outcomes: North Carolina's Asheville Project, the Boise Interprofessional Academic Patient Aligned Care model, and the Interprofessional Care Access Network framework. These innovative models demonstrate the importance of academic-community partnerships to build teams that address social needs, improve health outcomes, and lower costs. They also highlight the need for more rigorous reporting on the components of the academic-community partnerships involved, the different types of health workers deployed, and the design of the interprofessional training and practice models implemented.
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Affiliation(s)
- Erin P Fraher
- E.P. Fraher is associate professor, Department of Family Medicine, and director, Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brianna Lombardi
- B. Lombardi is assistant professor, Department of Family Medicine, and deputy director, Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barbara Brandt
- B. Brandt is founding director, National Center for Interprofessional Practice and Education, and professor of pharmaceutical care and health systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Emily Hawes
- E. Hawes is associate professor, Department of Family Medicine, University of North Carolina at Chapel Hill, and associate professor of clinical education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-7717-4066
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8
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Ramey OL, Silva Almodóvar A, Nahata MC. Medication adherence in Medicare-enrolled older adults with asthma before and during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2022; 128:561-567.e1. [PMID: 35227901 PMCID: PMC8873040 DOI: 10.1016/j.anai.2022.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/27/2022] [Accepted: 02/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Data regarding medication adherence in older adults with asthma before and during the coronavirus disease 2019 (COVID-19) pandemic are lacking. OBJECTIVE To evaluate medication adherence and determine factors associated with adherence in Medicare-enrolled older adults with asthma before and during the COVID-19 pandemic. METHODS This was a retrospective cohort analysis of Medicare-enrolled patients with asthma. Medication adherence was measured using rates of proportion of days covered for dates January to July 2019 and January to July 2020. Patients less than 65 years of age, with chronic obstructive pulmonary disease, or with cystic fibrosis were excluded. Paired t tests assessed change in adherence between 2019 and 2020. Logistic regression evaluated association of age, sex, depression, moderate or severe asthma, use of a 90-day supply, having 3 or more albuterol fills, number of medications, medication-related problems, prescribers, pharmacies, controller medication classes, and systemic corticosteroid fills with high adherence (proportion of days covered ≥ 80%). RESULTS Mean adherence to asthma controller medications ranged from 75% to 90%, in 2019. Adherence significantly decreased (P < .001) from 51% to 70% for all controller medications, except theophylline in 2020. Similar results were observed among patients with moderate or severe asthma. In 2019 and 2020, number of controller medications, 3 or more albuterol fills, and having a 90-day supply were associated with high adherence (P < .001). CONCLUSION Adherence to asthma controller medications decreased considerably during the COVID-19 pandemic among Medicare-enrolled patients with asthma. Patients with markers for more severe asthma, overuse of albuterol, and a 90-day supply of controller medications were more likely to have high adherence. These findings can be used to identify opportunities to improve adherence and prescribing among adult patients with asthma.
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Affiliation(s)
- Olivia L Ramey
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio; Tabula Rasa HealthCare, Tucson, Arizona
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes (ITIO), College of Pharmacy, The Ohio State University, Columbus, Ohio; College of Medicine, The Ohio State University, Columbus, Ohio.
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Pharmacist Intention to Provide Medication Therapy Management Services in Saudi Arabia: A Study Using the Theory of Planned Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095279. [PMID: 35564673 PMCID: PMC9101803 DOI: 10.3390/ijerph19095279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/10/2022]
Abstract
Medication therapy management (MTM) is provided by pharmacists and other healthcare providers, improves patient health status, and increases the collaboration of MTM providers with others. However, little is known about pharmacists’ intention to provide MTM services in Saudi Arabia. This study aimed to predict the pharmacists’ willingness in this nation to commit to providing MTM services there. This study used a cross-sectional questionnaire based on the theory of planned behaviour (TPB). The survey was distributed to 149 pharmacists working in hospital and community pharmacies. It included items measuring pharmacist attitudes, intentions, subjective norms, perceived behavioural control, knowledge about the provision of MTM services, and other sociodemographic and pharmacy practice-related items. The pharmacists had a positive attitude towards MTM services (mean = 6.15 ± 1.12) and strong intention (mean = 6.09 ± 1.15), highly perceived social pressure to provide those services (mean = 5.42 ± 1.03), strongly perceived control over providing those services (mean = 4.98 ± 1.05), and had good MTM knowledge (mean = 5.03 ± 1.00). Pharmacists who completed a pharmacy residency programme and had good knowledge of MTM services and a positive attitude towards them usually strongly intended to provide MTM services. Thus, encouraging pharmacists to complete pharmacy residency programmes and educating them about the importance and provision of MTM services will enhance their motivation to provide them.
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10
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Harmatz D, Vinker S, Wagner T, Raveh T, Merzon E, Cohen AG. The efficacy of single pharmacist medication review among type II diabetic patients who take six chronic medications or more: a case-control study. Isr J Health Policy Res 2022; 11:15. [PMID: 35241170 PMCID: PMC8896278 DOI: 10.1186/s13584-022-00513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 01/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharmacist medication review has been implemented in many health organizations throughout the world in an attempt to alleviate the underlying risk of polypharmacy in elderly patients. These consultations are often frequent and prolonged, and are thus associated with increased costs. To date, data regarding the most effective way to utilize pharmacist consultations for the improvement of health status is scant. AIM To evaluate the effectiveness of a single pharmacist consultation on changes in chronic medication regimes and on selected outcomes of diabetes 1-year after the consultation. METHODS A case-control study included an intervention group of 740 patients who had pharmacist consultations and a reference group of 1476 matched patients who did not have a pharmacist consultation. 1-year outcome measures were compared including changes in medications, improved safety, and objective variables such as Hba1c, blood pressure, and lipid profile. RESULTS In the pharmacist consultation group, there were significantly more treatment changes ([mean 1.5 vs. 0.7, p < 0.001 medications were stopped], and [mean 1.3 vs. 0.4, p < 0.05 medications were started]). Patient safety improved with a general reduction in opiates and benzodiazepines ([50.0% vs. 31.6%, p < 0.05 opioids were stopped] and [58.8% vs 43.8%, p < 0.001 benzodiazepines were stopped]). Sulfonylurea treatment reduced (10.7% vs. 3.6%, p < 0.05 patients who stopped Sulfonylurea) and Glucagon-like peptide-1 receptor agonists (GLP-1) increased (16.4% vs. 11.2%, p < 0.001 patients who started GLP-1). Additionally, HbA1c levels showed a small decrease in the pharmacist consultation group ([- 0.18 ± 1.11] vs. [- 0.051 ± 0.80], p = 0.0058) but no significant differences were found regarding blood pressure or lipids profile. CONCLUSION A single pharmacist consultation beneficially impacted specific clinical and patient safety outcomes. Pharmacist consultations may thus help resolve polypharmacy complexities in primary care.
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Affiliation(s)
- Danielle Harmatz
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Leumit Health Services, Tel Aviv, Israel
| | | | - Tal Raveh
- Leumit Health Services, Tel Aviv, Israel
| | - Eugene Merzon
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Leumit Health Services, Tel Aviv, Israel
| | - Avivit Golan Cohen
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Leumit Health Services, Tel Aviv, Israel
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11
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Luli AJ, Awdishu L, Hirsch JD, Watanabe JH, Bounthavong M, Morello CM. Transferring Key Success Factors from Ambulatory Care into the Community Pharmacy in the United States. PHARMACY 2021; 9:116. [PMID: 34201476 PMCID: PMC8293369 DOI: 10.3390/pharmacy9030116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022] Open
Abstract
In the United States, pharmacists' scope of practice continues to expand, with increasing opportunities for pharmacists in all practice settings to enhance health in society. In ambulatory care, pharmacists remain integral members on the healthcare team and have demonstrated positive impacts on patient care. Sharing similar characteristics as pharmacists in the community setting, a deeper look into common elements of a successful ambulatory care practice that can be applied in the community pharmacy setting is warranted. Key success factors identified from ambulatory care include (1) maximizing a pharmacist's unique knowledge base and skill set, (2) forming collaborations with physicians and other providers, (3) demonstrating outcomes and value, and (4) maintaining sustainability. Opportunities exist for pharmacists in the community setting to utilize these success factors when developing, implementing, and/or expanding direct patient care services that improve accessibility to quality care and population health.
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Affiliation(s)
- Alex J. Luli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
| | - Linda Awdishu
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
| | - Jan D. Hirsch
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 101 Theory, Suite 100, Irvine, CA 92612, USA; (J.D.H.); (J.H.W.)
| | - Jonathan H. Watanabe
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 101 Theory, Suite 100, Irvine, CA 92612, USA; (J.D.H.); (J.H.W.)
| | - Mark Bounthavong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
| | - Candis M. Morello
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; (L.A.); (M.B.); (C.M.M.)
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12
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Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research. Res Social Adm Pharm 2021; 18:2579-2592. [PMID: 34158263 DOI: 10.1016/j.sapharm.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges. OBJECTIVES This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned. METHODS A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted. RESULTS Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction. CONCLUSIONS This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.
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Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S. PHARMACY 2021; 9:pharmacy9010057. [PMID: 33803293 PMCID: PMC8005938 DOI: 10.3390/pharmacy9010057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022] Open
Abstract
This article describes the history and evolution of pharmacist-physician collaborative practice agreements (CPAs) in the United States with future directions to support pharmacists’ provider status as the profession continues to evolve from product-oriented to patient-centered care and population health. The pharmacy profession has a long history of dispensing and compounding, with the addition of clinical roles in the late 20th century. These clinical roles have continued to expand into diverse arenas such as communicable and non-communicable diseases, antimicrobial stewardship, emergency preparedness and response, public health education and health promotion, and critical and emergency care. Pharmacists continue to serve as integral members of interprofessional and interdisciplinary healthcare teams. In this context, CPAs allow pharmacists to expand their roles in patient care and may be considered as a step towards securing provider status. Moving beyond CPAs to a provider status would enable pharmacists to be reimbursed for cognitive services and promote integrated public health delivery models.
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14
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Nduaguba S, Barner JC, Makhinova T, Roberson K. Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease-A Pilot Study. J Pharm Pract 2021; 35:528-535. [PMID: 33648367 DOI: 10.1177/0897190021997032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists' MTM service provision, results/outcomes of pharmacists' recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD). METHODS This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with "high risk" asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists' interventions, outcomes of pharmacists' recommendations and acceptance rate. RESULTS Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%). CONCLUSION Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.
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Affiliation(s)
- Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Jamie C Barner
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Tatiana Makhinova
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Roberson
- Former Director of Professional Affairs, Texas Pharmacy Association, Austin, TX, USA
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15
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Varas-Doval R, Saéz-Benito L, Gastelurrutia MA, Benrimoj SI, Garcia-Cardenas V, Martinez-Martínez F. Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies. BMC Health Serv Res 2021; 21:156. [PMID: 33596906 PMCID: PMC7890900 DOI: 10.1186/s12913-021-06150-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Implementation of Professional Pharmacy Services (PPSs) requires a demonstration of the service's impact (efficacy) and its effectiveness. Several systematic reviews and randomised controlled trials (RCT) have shown the efficacy of PPSs in patient's outcomes in community pharmacy. There is, however, a need to determine the level of evidence on the effectiveness of PPSs in daily practice by means of pragmatic trials. To identify and analyse pragmatic RCTs that measure the effectiveness of PPSs in clinical, economic and humanistic outcomes in the community pharmacy setting. METHODS A systematic search was undertaken in MEDLINE, EMBASE, the Cochrane Library and SCIELO. The search was performed on January 31, 2020. Papers were assessed against the following inclusion criteria (1) The intervention could be defined as a PPS; (2) Undertaken in a community pharmacy setting; (3) Was an original paper; (4) Reported quantitative measures of at least one health outcome indicator (ECHO model); (5) The design was considered as a pragmatic RCT, that is, it fulfilled 3 predefined attributes. External validity was analyzed with PRECIS- 2 tool. RESULTS The search strategy retrieved 1,587 papers. A total of 12 pragmatic RCTs assessing 5 different types of PPSs were included. Nine out of the 12 papers showed positive statistically significant differences in one or more of the primary outcomes (clinical, economic or humanistic) that could be associated with the following PPS: Smoking cessation, Dispensing/Adherence service, Independent prescribing and MTM. No paper reported on cost-effectiveness outcomes. CONCLUSIONS There is limited available evidence on the effectiveness of community-based PPS. Pragmatic RCTs to evaluate clinical, humanistic and economic outcomes of PPS are needed.
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Affiliation(s)
- R Varas-Doval
- Spanish General Pharmaceutical Council, Villanueva 11, 28001, Madrid, Spain.
| | - L Saéz-Benito
- Faculty of Health Sciences, San Jorge University, Villanueva de Gállego, Zaragoza, Spain.,Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - M A Gastelurrutia
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - S I Benrimoj
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
| | - V Garcia-Cardenas
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain.,Graduate School of Health, Discipline of Pharmacy, University of Technology Sydney, Sydney, NSW, Australia
| | - F Martinez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, Granada University, Granada, Spain
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16
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Khaw SM, Li SC, Mohd Tahir NA. A systematic review of the cost-effectiveness of medicationadherence-enhancing intervention for asthma. J Asthma 2021; 59:697-711. [PMID: 33435775 DOI: 10.1080/02770903.2021.1875483] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: This systematic review aimed to evaluate the cost-effectiveness of medication adherence-improving interventions in patients with asthma.Data source: Search engines including PubMed, Scopus and EBSCOhost were used to locate relevant studies from the inception of the databases to 19 October 2018. Drummond's checklist was used to appraise the quality of the economic evaluation.Study selection: Economic studies evaluating the cost-effectiveness of medication adherence enhancing interventions for asthmatic patients were selected. Relevant information including study characteristics, quality assessment, health outcomes and costs of intervention were narratively summarized. The primary outcome of interest was cost-effectiveness (CE) values and the secondary outcomes were costs, medication adherence and clinical consequences.Results: Twenty studies including 11 randomized controlled trials, 6 comparative studies and 3 modeled studies using Markov models were included in the review. Among these, 15 studies evaluated an educational intervention with 13 showing cost-effectiveness in improving health outcomes. The CE of an internet-based intervention showed similar results between groups, while 3 studies of simplified drug regimens and adding a technology-based training program achieved the desirable cost-effectiveness outcome.Conclusion: Overall, our results would support that all of the identified medication adherence-enhancing interventions were cost-effective considering the increased adherence rate, improved clinical effectiveness and the reduced costs of asthma care. However, it was not possible to identify the most cost-effective intervention. More economic studies with sound methodological conduct will be needed to provide stronger evidence in deciding the best approach to improve medication adherence.
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Affiliation(s)
- Sin Mei Khaw
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Nurul Ain Mohd Tahir
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia
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17
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Peasah SK, Hammonds T, Liu Y, Campbell V, Manolis C, Good CB. Economic assessment of changes to an existing medication therapy management program of a large regional health plan. J Manag Care Spec Pharm 2021; 27:147-156. [PMID: 33506728 PMCID: PMC10391146 DOI: 10.18553/jmcp.2021.27.2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Although medication therapy management (MTM) has specific eligibility criteria and is mandated for specific Medicare Part D enrollees, some health plans have expanded MTM eligibility beyond the minimum criteria to include other Medicare Part D enrollees, Medicaid, and commercial health plan patients. Differences exist in the mode of delivery, location of services, type of personnel involved in managing the service, and the subsequent outcomes. The type and intensity of MTM services delivered have evolved with time to more streamlined and robust interventions, necessitating ongoing evaluation of the effect on clinical and economic outcomes. OBJECTIVE: To assess the effect of changes to an existing MTM program on cost of care, utilization, and medication adherence. METHODS: UPMC Health Plan made changes to an existing MTM program by expanding eligibility (customized by the type of health plan), intervention types, pharmacist involvement, and patient followup contacts. After matching our intervention cohort (identified January 2017-June 2018) with the pre-2016 MTM historical controls (patients identified January 2014-June 2015 who would have been eligible if we used the intervention cohort eligibility criteria), we estimated that the effect of the program changes with a difference-in-difference model (preintervention [2014-2016] and postintervention [2017-2019]). Outcomes of interest included cost (total cost of care including medical, pharmacy, and unplanned care [i.e., unscheduled health care use such as emergency department visits] in 2017 U.S. dollars); utilization; medication adherence (proportion of days covered); and return on investment (ROI). Target population included continuously enrolled patients aged ≥ 21 years in the commercial, Medicare, and Medicaid health plans. RESULTS: Total propensity score-matched members was 10,747, 55% of which were in the historic control group. The average (SD) ages after matching the groups were similar (historical control group: 57.08 years [14.23], intervention group: 56.79 years [14.21]) and the majority was female (57%). Comorbidities identified most for patients included hypertension (77%), dyslipidemia (70%), and diabetes (52%). Forty-one percent were in the commercial, 37% in the Medicaid, and 23% in the Medicare health plans. Proportion of care activities undertaken in the intervention period compared with the control period were significantly different: "sent letter to physician" (67% vs. 87%), "sent letter to member" (15% vs. 0%), "pharmacist phone call to physician" (15% vs. 0.1%), and "pharmacist phone call to member" (13% vs. 7%). There were statistically significant reductions in unplanned care across all health plans especially in the Medicare population, in total cost of care, and increases in medication adherence in 4 therapeutic classes: anticoagulants (OR = 1.25, P = 0.005), cardiac medications (OR = 1.20, P < 0.001), statins (OR = 1.21, P < 0.001), and antidepressants (OR = 1.15, P < 0.001). There was a positive ROI of $18.50 per dollar spent, which equated to a cumulative net savings of $11 million over 24 months. CONCLUSIONS: In a large health plan, expanding MTM eligibility, intensifying patient follow-up contact and pharmacist involvement, and improving provider awareness had favorable clinical and economic benefits. DISCLOSURES: There was no funding for this project except employees' time. All authors are employees of UPMC and have no conflicts of interest to report.
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Affiliation(s)
- Samuel K Peasah
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, Pittsburgh, PA
| | | | - Yushu Liu
- Health Economics, UPMC Health Plan, Pittsburgh, PA
| | | | | | - Chester B Good
- Value-Based Pharmacy Initiatives, Center for High Value HealthCare, UPMC Health Plan, Pittsburgh, PA
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18
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Abrahamsen B, Hansen RN, Rossing C. For which patient subgroups are there positive outcomes from a medication review? A systematic review. Pharm Pract (Granada) 2020; 18:1976. [PMID: 33224322 PMCID: PMC7672485 DOI: 10.18549/pharmpract.2020.4.1976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background: A medication review is a possibility to assess and optimise a
patient’s medicine. A model that includes a medication review and a
follow-up seem to provide the best results. However, it is not known whether
specific subgroups of patients benefit more from a medication review than
others. Objective: This literature review summarises the evidence that is available on which
patient subgroups exist positive outcomes from a medication review carried
out in a primary care setting. Methods: We performed a PICO analysis to identify keywords for setting, medication
review and effect. We then conducted a search using the PubMed database
(2004 to 2019) to identify studies relevant for our investigation. A
screening process was carried out based on either title or abstract, and any
study that matched the aim and inclusion criteria was included. All matching
studies were obtained and read, and were included if they met predefined
criteria such as study design, medication review and primary care. The
studies were divided into subgroups. First, each subgroup was divided
according to the studies’ own definition. Secondly, each subgroup was
allocated as either risk patients if the subgroup described a specific
patient subgroup or risk medication, if the subgroup was defined as using a
specific type of medication. This was done after discussion in the author
group. Results: 28 studies from a total of 935 studies were included. Identified studies were
divided into either risk patients; frail, recently discharged or multimorbid
patients, or risk medication; heart medication, antithrombotic medication,
blood pressure lowering medication, antidiabetic medication, anti-Parkinson
medication or medication increasing the risk of falls. The subgroups
identified from a medication review in primary care were defined as being
frail, recently discharged from hospital or multimorbid (risk patients), or
defined as patients using anticoagulant or blood pressure lowering
medication (risk medication). Most of the medication reviews in the studies
that showed an economic effect included at least one follow-up and were
delivered by a pharmacist. Conclusions: The literature review demonstrates that medication reviews delivered by
pharmacists to specific subgroups of patients are a way of optimising the
economic effect of medication reviews in primary care. This is obtained by
reducing health-related costs or the number of contacts with primary or
secondary health care services.
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Affiliation(s)
- Bjarke Abrahamsen
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Rikke N Hansen
- MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Charlotte Rossing
- PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
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19
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Murphy EM, Rodis JL, Mann HJ. Three ways to advocate for the economic value of the pharmacist in health care. J Am Pharm Assoc (2003) 2020; 60:e116-e124. [PMID: 32863183 DOI: 10.1016/j.japh.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
Numerous studies have demonstrated positive therapeutic and economic outcomes associated with pharmacist-provided care. However, public policy on provider status with subsequent payment for non-dispensing services has been slow to reflect an expanded pharmacist role. It is important for the public to understand the value of a pharmacist outside of the drug distribution system. Pharmacists and other health care and public health practitioners must share this information to further knowledge and affect policies and systems that can most effectively include pharmacists fully in the health care system. The 3 main areas identified in which the pharmacist has economic impact are decreased total health expenditures, decreased unnecessary care, and decreased societal costs. Evidence supports the economic value of the pharmacist; however, public opinion and political movements supporting patients' access to pharmacist-provided care are variable. Strategies to advocate and effect change include advocating to elected leaders for policy change and advocating to other health professionals, patients, and community members to better their understanding of the positive economic value of pharmacist-provided care. Through prioritizing community outreach and legislator education, pharmacist advocates can leverage 3 key areas in which pharmacists have economic value to advance policy and increase patients' access to care.
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20
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McCree DH, Byrd KK, Johnston M, Gaines M, Weidle PJ. Roles for Pharmacists in the "Ending the HIV Epidemic: A Plan for America" Initiative. Public Health Rep 2020; 135:547-554. [PMID: 32780671 DOI: 10.1177/0033354920941184] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In 2019, President Trump announced a new initiative, Ending the HIV Epidemic: A Plan for America (EHE). EHE will use 3 key strategies-diagnose, treat, and prevent-to reduce new HIV infections at least 90% by 2030, as well as new laboratory methods and epidemiological techniques to respond quickly to potential outbreaks. Partnerships are an important component in the initiative's success. Pharmacists and pharmacies can play important roles in EHE, including dispensing antiretroviral therapy and providing HIV screening, adherence counseling, medication therapy management, preexposure prophylaxis, and nonprescription syringe sales. The objective of this report is to discuss potential roles that pharmacists and pharmacies can play under the key strategies of EHE.
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Affiliation(s)
- Donna Hubbard McCree
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathy K Byrd
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie Johnston
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Malendie Gaines
- 17215 Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Paul J Weidle
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Berenbrok LA, Gabriel N, Coley KC, Hernandez I. Evaluation of Frequency of Encounters With Primary Care Physicians vs Visits to Community Pharmacies Among Medicare Beneficiaries. JAMA Netw Open 2020; 3:e209132. [PMID: 32667653 PMCID: PMC7364370 DOI: 10.1001/jamanetworkopen.2020.9132] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE The shift toward value-based care has placed emphasis on preventive care and chronic disease management services delivered by multidisciplinary health care teams. Community pharmacists are particularly well positioned to deliver these services due to their accessibility. OBJECTIVE To compare the number of patient visits to community pharmacies and the number of encounters with primary care physicians among Medicare beneficiaries who actively access health care services. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed a 5% random sample of 2016 Medicare beneficiaries from January 1, 2016, to December 31, 2016 (N = 2 794 078). Data were analyzed from October 23, 2019, to December 20, 2019. Medicare Part D beneficiaries who were continuously enrolled and had at least 1 pharmacy claim and 1 encounter with a primary care physician were included in the final analysis (n = 681 456). Those excluded from the study were patients who were not continuously enrolled in Part D until death, those with Part B skilled nursing claims, and those with Part D mail-order pharmacy claims. EXPOSURES We conducted analyses for the overall sample and for subgroups defined by demographics, region of residence, and clinical characteristics. MAIN OUTCOMES AND MEASURES Outcomes included the number of visits to community pharmacies and encounters with primary care physicians. Unique visits to the community pharmacy were defined using a 13-day window between individual prescription drug claims. Kruskal-Wallis tests were used to compare the medians for the 2 outcomes. RESULTS A total of 681 456 patients (mean [SD] age, 72.0 [12.5] years; 418 685 [61.4%] women and 262 771 [38.6%] men) were included in the analysis; 82.2% were white, 9.6% were black, 2.4% were Hispanic, and 5.7% were other races/ethnicities. Visits to the community pharmacy outnumbered encounters with primary care physicians (median [interquartile range (IQR)], 13 [9-17] vs 7 [4-14]; P < .001). The number of pharmacy visits was significantly larger than the number of primary care physician encounters for all subgroups evaluated except for those with acute myocardial infarction (median [IQR], 15 [12-19] vs 14 [7-26]; P = .60 using a 13-day window). The difference in the number of pharmacy and primary care physician encounters was larger in rural areas (median [IQR], 14 [10-17] vs 5 [2-11]; P < .001) than in metropolitan areas (median [IQR], 13 [8-17] vs 8 [4-14]; P < .001). In all 50 states and in all but 9 counties, the number of community pharmacy visits was larger than the number of encounters with primary care physicians. CONCLUSIONS AND RELEVANCE This cross-sectional study suggests that community pharmacists are accessible health care professionals with frequent opportunities to interact with community-dwelling patients. Primary care physicians should work collaboratively with community pharmacists, who can assist in the delivery of preventive care and chronic disease management.
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Affiliation(s)
- Lucas A. Berenbrok
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Nico Gabriel
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Kim C. Coley
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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Population Health Management Approach: Integration of Community-Based Pharmacists into Integrated Care Systems: Reflections from the U.S., Achievements in Scotland and Discussions in Germany. Int J Integr Care 2020; 20:13. [PMID: 32607100 PMCID: PMC7319079 DOI: 10.5334/ijic.5431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The annual amount spent on healthcare per capita is higher and expected to grow in the U.S. compared to healthier level 4 countries (e.g., United Kingdom, Canada, Germany, Australia, Japan, Sweden, Netherlands), while health outcomes continue to be suboptimal [123]. Therefore, healthcare is slowly shifting from a fee-for-service to value-based care, which addresses social determinants of health, promotes outcome-based contracting and employs more Population Health Management (PHM) activities. The root cause for this shift has been the increase in patients' out-of-pocket costs and the pervasiveness of poorer outcomes. PHM has been defined by many as a mindset and activities that support the Triple Aim Initiative (i.e., improving population health, experience of care, reducing costs) [4]. This article outlines the value of pharmacists on health outcomes in the U.S., Germany, and Scotland and innovative PHM approaches through pharmacist collaborative networks, polypharmacy management and pharmacists' integration in care models [15].
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Deibl S, Mueller D, Kirchdorfer K, Stemer G, Hoppel M, Weidmann AE. Self-reported clinical pharmacy service provision in Austria: an analysis of both the community and hospital pharmacy sector-a national study. Int J Clin Pharm 2020; 42:1050-1060. [PMID: 32494989 DOI: 10.1007/s11096-020-01066-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/23/2020] [Indexed: 12/28/2022]
Abstract
Background With expansion of more advanced clinical roles for pharmacists we need to be mindful that the extent to which clinical pharmacy services are implemented varies from one country to another. To date no comprehensive assessment of number and types of services provided by either community or hospital pharmacies in Austria exists. Objective To analyse and describe the number and types of clinical pharmacy services provided in both community and hospital pharmacies, as well as the level of clinical pharmacy education of pharmacists across Austria. Setting Austrian community and hospital pharmacies. Method An electronic questionnaire to determine number and types of clinical pharmacy services provided was send to all chief pharmacists at all community (n = 1365) and hospital pharmacies (n = 40) across Austria. Besides current and future services provision, education and training provision were also assessed. Main outcome measure Extent of and attitude towards CPS in Austria. Results Response rates to the surveys were 19.1% (n = 261/1365) in community and 92.5% (n = 37/40) in hospital pharmacies. 59.0% and 89.2% of community and hospital pharmacies, respectively, indicated that the provision of clinical pharmacy services in Austria has increased substantially over the past 10 years. Fifty-one percent of community pharmacies reported to provide a medication review service, while 97.3% of hospitals provide a range of services. Only 18.0% of community pharmacies offer services other than medication review services at dispensing. Binary regressions show that provision of already established medication management is a predictor for the willingness of community pharmacists to extend the range of CPS (p < 0.01), while completed training in the area of clinical pharmacy is not (p > 0.05). More hospital than community pharmacists have postgraduate education in clinical pharmacy (17.4% vs 6.5%). A desire to complete postgraduate education was shown by 28.3% of community and 14.7% of hospital pharmacists. Lack of time, inadequate remuneration, lack of resources and poor relationship between pharmacists and physicians were highlighted as barriers. Conclusion Both community and hospital pharmacists show strong willingness to expand their service provision and will need continued support, such as improved legislative structures, more supportive resources and practice focused training opportunities, to further these services.
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Affiliation(s)
- S Deibl
- Österreichische Apothekerkammer, Spitalgasse 31, Postfach 87, 1091, Vienna, Austria.
| | - D Mueller
- Vienna Pharmacy Department, Hanusch-Hospital, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - K Kirchdorfer
- Vienna Pharmacy Department, Hanusch-Hospital, Heinrich Collin-Straße 30, 1140, Vienna, Austria
| | - G Stemer
- Pharmacy Department, Vienna General Hospital - Medical University Campus, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - M Hoppel
- Österreichische Apothekerkammer, Spitalgasse 31, Postfach 87, 1091, Vienna, Austria
| | - A E Weidmann
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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The effect of community pharmacist-led health coaching on clinical outcomes. J Am Pharm Assoc (2003) 2020; 60:S65-S69. [PMID: 32439280 DOI: 10.1016/j.japh.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact of a community pharmacist-driven health coaching program on clinical outcomes from baseline to 1 year. SETTING Independent community pharmacy in western North Carolina. PRACTICE DESCRIPTION Sona Pharmacy + Clinic is an independent community pharmacy offering enhanced clinical services such as medication synchronization, adherence packaging, and free delivery. Sona Benefits offers pharmacy benefit manager (PBM) services to self-funded plans in western North Carolina. PRACTICE INNOVATION Sona Health Management Program is a disease management program offered to Sona Benefits PBM clients; the services began in October 2016. EVALUATION Change in clinical outcome measures (total number of medications, blood pressure, hemoglobin A1c, weight, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], patient health questionnaire [PHQ-9] scores, and asthma control test [ACT] scores) were assessed for members who participated in the program for a minimum of 12 months for at least 2 of the following conditions: hypertension, hyperlipidemia, diabetes, depression, and asthma. RESULTS Health coaching was provided to 42 members (mean age of 55.9 years and 2.7 qualifying disease states). The mean number of medications per patient significantly decreased from 7.2 to 6.2 (P = 0.02). Systolic and diastolic blood pressures were significantly reduced from 130.8 mm Hg to 125.7 mm Hg (P = 0.04) and 76.9 mm Hg to 73.7 mm Hg (P = 0.04), respectively. Other clinical outcome measures evaluated, such as hemoglobin A1c, weight, LDL-C, HDL-C, TG, and PHQ-9 and ACT scores, were improved but did not reach significance. CONCLUSION These results suggest that community pharmacists can have a positive impact on patients with multiple chronic conditions through health coaching services. This project suggests a potential model of pharmacist health coaching through pharmacist-run PBM services.
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Dean TA, Bamgbade BA, Barner JC, Rush SK, Burdine KM. Impact of a depression counseling intervention on student pharmacists' confidence and comfortability: A pilot study. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:410-417. [PMID: 32334756 DOI: 10.1016/j.cptl.2019.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/07/2019] [Accepted: 12/07/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The objective of this study was to assess the impact of a mental health educational intervention on pharmacy students' confidence and comfortability when engaging in depression counseling. METHODS Third-year pharmacy students completed two 15-item rating scales addressing confidence and comfortability about depression. The intervention was 2.5 hours long and included a depression overview, consumer educator presentation, motivational interviewing, and case studies. Surveys were administered at baseline, immediately after the intervention, and three months post intervention. Data were analyzed using paired t-tests and repeated measures analyses. RESULTS Of the 23 students who participated in the intervention, 12 (52.2%) completed the three-month follow-up. Confidence increased significantly (p < 0.05) from 3.5 ± 0.5 to 4.1 ± 0.4 immediately post intervention and was sustained at three months post (3.9 ± 0.5). Similarly, comfortability increased significantly (p < 0.05) from 3.6 ± 0.4 to 4.1 ± 0.5 immediately post and was sustained at three months post (4.1 ± 0.6). Cronbach's alphas ranged from 0.90 to 0.96. CONCLUSION Pharmacy students' depression counseling confidence and comfortability improved and was sustained after a 2.5-hour intervention with motivational interviewing, consumer education, and case studies.
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Affiliation(s)
- Taylor A Dean
- UPMC Western Psychiatric Hospital, Department of Pharmacy, Pittsburgh, PA, 15213, United States.
| | - Benita A Bamgbade
- Northeastern University Bouvé College of Health Sciences, School of Pharmacy, 360 Huntington Avenue, Boston, MA 02115, United States.
| | - Jamie C Barner
- The University of Texas at Austin, College of Pharmacy, 2409 University Avenue, Austin, TX 78712, United States.
| | - Sharon K Rush
- The University of Texas at Austin, College of Pharmacy, 2409 University Avenue, Austin, TX 78712, United States.
| | - Kimberly M Burdine
- The University of Texas at Dallas, Student Counseling Center, 800 W Campbell Road, SSB45, Richardson, TX 75080-3021, United States.
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Assessment of Knowledge and Attitude among Pharmacists toward Pharmaceutical Care in Eastern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7657625. [PMID: 32149136 PMCID: PMC7049419 DOI: 10.1155/2020/7657625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/10/2019] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
Abstract
Objective To assess knowledge and attitudes toward pharmaceutical care service among hospital and community pharmacists working in Harar and Dire Dawa town, Eastern Ethiopia. Method A descriptive cross-sectional study was conducted among pharmacists working in hospital and community pharmacies, 2018. A total of 43 health settings (6 hospital and 37 community pharmacies) were involved in this study. All pharmacists who met the inclusion criteria were selected using a purposive sampling technique to take part in the study. The pretested structured self-administered questionnaires were used to collect data. The collected data was coded, entered, and analyzed using Statistical Package for Social Sciences (SPSS) version 21.0. The findings were presented by frequencies and percentages, and summary measures were displayed using tables. Chi-Square test and Fisher's exact test were performed to determine the association between sociodemographic characteristics and the level of knowledge and attitude about pharmaceutical care. The study protocol was approved by the Harar Health Sciences College Research Ethics Review Committee. Results A total of seventy-eight pharmacists were included in the study with a response rate of 97.5%. The mean age (±Standard Deviation (SD)) of the study participants was 32.47 ± 7.42 years, and the majority (88.3%) of the respondents were males. 56.4% of the respondents were working in the hospitals while 43.6% were working in community pharmacy. Overall, 85.9% of the respondents had good knowledge of pharmaceutical care. The types of training curriculum of the participants showed an association with the attitude of pharmacists (P value = 0.022). Similarly, pharmacists' knowledge was associated with their practice setting (P value = 0.022). Similarly, pharmacists' knowledge was associated with their practice setting ( Conclusion The majority of pharmacists are knowledgeable about PC. However, nearly half of the pharmacists had an unfavorable attitude toward pharmaceutical care. Harari Regional and Dire Dawa City Health Bureaus should organize and provide in-service training on pharmaceutical care to pharmacists working in community and hospital pharmacies. Furthermore, the bureaus should advocate pharmaceutical care as one area in a continuous professional development program.
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Differences in knowledge about epilepsy and antiepileptic drugs among pharmacy-dispensing workers in Cambodia and in Lao PDR. Epilepsy Behav 2020; 103:106834. [PMID: 31884119 DOI: 10.1016/j.yebeh.2019.106834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
Abstract
UNLABELLED Epilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling. OBJECTIVE The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy. METHOD A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire. RESULTS A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p < 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception. CONCLUSION An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence.
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Gómez-Martinez J, López-Pintor E, Lumbreras B. Effectiveness of a Patient-Centered Weight Management Model in a Community Pharmacy: An Interventional Study. Patient Prefer Adherence 2020; 14:1501-1511. [PMID: 32921990 PMCID: PMC7457851 DOI: 10.2147/ppa.s260404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the provision of a professional pharmaceutical patient-centered model in a weight management program and optimization of the medication in a Spanish community pharmacy. PATIENTS AND METHODS This was a single-group intervention study with a mean follow-up period of 8.2 months (sd 2.3). Patients ≥18 years old seeking to lose weight or improve eating habits were recruited. On the first visit, the pharmacist collected patients' sociodemographic and anthropometric variables, dietary history and lifestyle habits, biochemical measurements and other clinical and therapeutic data. The intervention was based on the Spanish Society of Community Pharmacy recommendations for diet and exercise and for pharmacotherapy management. The follow-up included a two-month visit and a final visit. RESULTS A total of 330 patients were included (80% women; mean age 51.3 years old (sd 15.3)). A statistically significant reduction in anthropometric measurements (weight, BMI, and waist circumference) and a statistically significant increase in the number of patients with normal cholesterol and LDL-cholesterol (p<0.001) were observed at two-month visit compared with first visit (p<0.001). The number of patients with normal triglyceride levels at final visit compared with first visit also increased significantly (p=0.04). A total of 186 (56.4%) patients had drug-related problems at first visit and 31 (9.4%) patients at two-month visit. CONCLUSION The implementation of a patient-centered weight management model had a positive impact on the improvement of anthropometric, clinical and therapeutic parameters.
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Affiliation(s)
| | - Elsa López-Pintor
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technologies, Miguel Hernández University, Alicante03550, Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, CIBER in Epidemiology and Public Health, Alicante03550, Spain
- Correspondence: Blanca Lumbreras Department of Public Health, History of Science and Gynecology, Miguel Hernández University, CIBER in Epidemiology and Public Health, Road Alicante-Valencia km 81, Sant Joan d’Alacant, Alicante03550, SpainTel +34 965919510 Email
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Factors that influence patient acceptance of clinical pharmacy services: A nationwide survey. J Am Pharm Assoc (2003) 2020; 60:1058-1067.e4. [PMID: 32962899 PMCID: PMC9840879 DOI: 10.1016/j.japh.2020.08.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/21/2020] [Accepted: 08/28/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Examine the factors that influence a patient's likelihood of participating in clinical pharmacy services so that pharmacists can use this knowledge to effectively expand clinical services. METHODS An online survey was distributed to U.S. citizens 55 years of age or older through a market research company. The survey assessed pharmacy and medication use, general health, interest in clinical pharmacy services, and general demographics. The specific clinical services examined included medication therapy management (MTM) and a collaborative practice agreement (CPA). Logistic regression and best-worst scaling were used to predict the likelihood of participating and determine the motivating factors to participate in clinical pharmacy services, respectively. RESULTS Two hundred eight (58.45%) respondents reported being likely to participate in MTM services, and 108 (50.6%) reported being likely to participate in the services offered by a pharmacist with a CPA, if offered. The motivations to participate in MTM were driven by pharmacist management of medication interactions and adverse effects (best-worst scores 0.62 and 0.51, respectively). The primary motivator to participate in a CPA was improved physician-pharmacist coordination (best-worst score 0.80). Those with a personal pharmacist were more likely to participate in MTM (odds ratio [OR] 2.43 [95% CI 1.41-4.22], P = 0.002) and a pharmacist CPA (2.08 [1.26-3.44], P = 0.004). Previous experience with MTM increased the likelihood of participating again in MTM (5.98 [95% CI 2.50-14.35], P < 0.001). Patient satisfaction with the pharmacy increased the likelihood of participating in a pharmacist CPA (1.47 [95% CI 1.01-2.13], P = 0.04). CONCLUSION Patients are interested in clinical pharmacy services for the purposes of medication interaction management, adverse effect management, and improved physician-pharmacist coordination. The factors that influenced the likelihood of participating included having a personal pharmacist, previous experience with MTM, and pharmacy satisfaction. These results suggest a potential impact of the patient-pharmacist relationship on patient participation in clinical services.
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Rodis JL, Capesius TR, Rainey JT, Awad MH, Fox CH. Pharmacists in Federally Qualified Health Centers: Models of Care to Improve Chronic Disease. Prev Chronic Dis 2019; 16:E153. [PMID: 31753083 PMCID: PMC6880917 DOI: 10.5888/pcd16.190163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pharmacists are underused in the care of chronic disease. The primary objectives of this project were to 1) describe the factors that influence initiation of and sustainability for pharmacist-provided medication therapy management (MTM) in federally qualified health centers (FQHCs), with secondary objectives to report the number of patients receiving MTM by a pharmacist who achieve 2) hemoglobin A1c (HbA1c) control (≤9%) and 3) blood pressure control (<140/90 mm Hg). METHODS We evaluated MTM provided by pharmacists in 10 FQHCs in Ohio through qualitative thematic analysis of semi-structured interviews with pharmacists and FQHC leadership and aggregate reporting of clinical markers. RESULTS Facilitators of MTM included relationship building with clinicians, staff, and patients; regular verbal or electronic communication with care team members; and alignment with quality goals. Common MTM model elements included MTM provided distinct from dispensing medications, clinician referrals, and electronic health record access. Financial compensation strategies were inadequate and varied; they included 340B revenue, incident-to billing, grants, and shared positions with academic institutions. Of 1,692 enrolled patients, 60% (n = 693 of 1,153) achieved HbA1c ≤9%, and 79% (n = 758 of 959) achieved blood pressure <140/90 mm Hg. CONCLUSION Through this statewide collaborative, access for patients in FQHCs to MTM by pharmacists increased. The factors we identified that facilitate MTM practice models can be used to enhance the models to achieve clinical goals. Collaboration among clinic staff and community partners can improve models of care and improve chronic disease outcomes.
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Affiliation(s)
- Jennifer L Rodis
- The Ohio State University College of Pharmacy, 500 West 12th Ave, Columbus, OH 43210.
| | | | | | - Magdi H Awad
- AxessPointe Community Health Center/NEOMED, Akron, Ohio
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Barnes B, Hincapie AL, Luder H, Kirby J, Frede S, Heaton PC. Appointment-based models: A comparison of three model designs in a large chain community pharmacy setting. J Am Pharm Assoc (2003) 2019; 58:156-162.e1. [PMID: 29506660 DOI: 10.1016/j.japh.2018.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/17/2017] [Accepted: 01/18/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare the effects of 3 different appointment-based model (ABM) designs on medication adherence and medication use outcomes controlling for patient and pharmacy characteristics. METHODS This study was a retrospective cohort analysis in a large grocery store chain from January 1, 2012, to October 31, 2015. A total of 500 comparison and 613 intervention patients in 3 different model designs were analyzed. The outcome measures were proportion of days covered for selected medication classes, number of fills, administered vaccinations, number of trips, statin use in persons with diabetes, use of high-risk medications in older adults, and medication therapy for persons with asthma. RESULTS After adjusting for relevant covariates, the authors found that all of the ABM designs significantly increased the number of fills after enrollment. Model designs 1 and 3 also significantly reduced the number of trips after enrollment: 4.5 fewer trips (95% CI -5.3 to -3.8; P < 0.05) for model 1 and 1.9 fewer trips (95% CI -3 to -0.9; P < 0.05) for model 3. Models 1 and 3 increased the percentage of patients considered to be adherent for diabetes medications and increased the number of vaccinations patients received. Models 1 and 2 significantly increased the percentage of patients considered to be adherent for statins. No model design was significantly associated with statin use in diabetes, high-risk medication use in older adults, nor percentage of patients considered to be adherent for the hypertension measure. CONCLUSION All of the ABM designs were effective at increasing the number of fills after enrollment. This paralleled an increase in percentage of patients considered to be adherent to diabetes and statin therapies after enrollment. Models that included face-to-face delivery of the appointment and telephonic synchronization, or face-to-face delivery for all components, increased the number of vaccinations that patients received after enrollment and significantly reduced the number of trips a patient made to the pharmacy.
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Nuffer W, Trujillo T, Griend JV. Estimated Potential Financial Impact of Pharmacist-Delivered Disease Management Services Across a Network of Pharmacies in Rural Colorado. J Manag Care Spec Pharm 2019; 25:984-988. [PMID: 31456492 PMCID: PMC6859940 DOI: 10.18553/jmcp.2019.25.9.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study summarizes the potential financial impact of a 3-year collaboration focused on delivering disease management services through pharmacies in 12 rural Colorado communities. OBJECTIVES To (a) identify components within the disease management program that would be billable and generate revenue to each pharmacy and (b) estimate the revenue amount that could be generated based on these services across the 3-year project. METHODS Reimbursable services included diabetes self-management education; medication therapy management services, including the comprehensive medication review; and improvements in Medicare star ratings through pharmacy interventions. RESULTS An estimated total of $117,800 could have been generated by services provided to patients across the 12 pharmacy sites. After subtracting the estimated cost of labor for a pharmacist to provide these services, an estimated net profit of $60,023 resulted over 3 years. Star rating impacts were discussed but were not able to be included as specific revenue based on the complex contracting between pharmacies and third-party insurers. CONCLUSIONS Based on these estimates, delivery of chronic disease management could represent a financially feasible option for community pharmacists. Some credentialing and changes to the mode of delivery would be required to meet billing requirements. Further research is needed to better estimate the cost savings resulting from these services to possibly expand pharmacists' reimbursement opportunities. DISCLOSURES This publication was supported by Cooperative Agreement Number DP004796-05, funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. None of the authors have any conflicts of interest to disclose regarding this work.
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Affiliation(s)
- Wesley Nuffer
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora
| | - Tara Trujillo
- Colorado Department of Public Health and Environment, Denver
| | - Joseph Vande Griend
- University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora
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Bailey JE, Surbhi S, Wan JY, Munshi KD, Waters TM, Binkley BL, Ugwueke MO, Graetz I. Effect of Intensive Interdisciplinary Transitional Care for High-Need, High-Cost Patients on Quality, Outcomes, and Costs: a Quasi-Experimental Study. J Gen Intern Med 2019; 34:1815-1824. [PMID: 31270786 PMCID: PMC6712187 DOI: 10.1007/s11606-019-05082-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/19/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many health systems have implemented team-based programs to improve transitions from hospital to home for high-need, high-cost patients. While preliminary outcomes are promising, there is limited evidence regarding the most effective strategies. OBJECTIVE To determine the effect of an intensive interdisciplinary transitional care program emphasizing medication adherence and rapid primary care follow-up for high-need, high-cost Medicaid and Medicare patients on quality, outcomes, and costs. DESIGN Quasi-experimental study. PATIENTS Among 2235 high-need, high-cost Medicare and Medicaid patients identified during an index inpatient hospitalization in a non-profit health care system in a medically underserved area with complete administrative claims data, 285 participants were enrolled in the SafeMed care transition intervention, and 1950 served as concurrent controls. INTERVENTIONS The SafeMed team conducted hospital-based real-time screening, patient engagement, enrollment, enhanced discharge care coordination, and intensive home visits and telephone follow-up for at least 45 days. MAIN MEASURES Primary difference-in-differences analyses examined changes in quality (primary care visits, and medication adherence), outcomes (preventable emergency visits and hospitalizations, overall emergency visits, hospitalizations, 30-day readmissions, and hospital days), and medical expenditures. KEY RESULTS Adjusted difference-in-differences analyses demonstrated that SafeMed participation was associated with 7% fewer hospitalizations (- 0.40; 95% confidence interval (CI), - 0.73 to - 0.06), 31% fewer 30-day readmissions (- 0.34; 95% CI, - 0.61 to - 0.07), and reduced medical expenditures ($- 8690; 95% CI, $- 14,441 to $- 2939) over 6 months. Improvements were limited to Medicaid patients, who experienced large, statistically significant decreases of 39% in emergency department visits, 25% in hospitalizations, and 79% in 30-day readmissions. Medication adherence was unchanged (+ 2.6%; 95% CI, - 39.1% to 72.9%). CONCLUSIONS Care transition models emphasizing strong interdisciplinary patient engagement and rapid primary care follow-up can enable health systems to improve quality and outcomes while reducing costs among high-need, high-cost Medicaid patients.
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Affiliation(s)
- James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA. .,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. .,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satya Surbhi
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jim Y Wan
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Teresa M Waters
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Bonnie L Binkley
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Ilana Graetz
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Mubarak N, Hatah E, Khan TM, Zin CS. A systematic review and meta-analysis of the impact of collaborative practice between community pharmacist and general practitioner on asthma management. J Asthma Allergy 2019; 12:109-153. [PMID: 31213852 PMCID: PMC6538034 DOI: 10.2147/jaa.s202183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/28/2019] [Indexed: 01/10/2023] Open
Abstract
Objective: This systematic review aims to investigate the impact of collaborative practice between community pharmacist (CP) and general practitioner (GP) in asthma management. Methods: A systematic search was performed across 10 databases (PubMed, Medline/Ovid, CINAHL, Scopus, Web of Science, Cochrane central register of controlled trials, PsycARTICLES®, Science Direct, Education Resource Information Centre, PRO-Quest), and grey literature using selected MeSH and key words, such as "community pharmacist", "general practitioner", and "medicine use review". The risk of bias of the included studies was assessed by Cochrane risk of bias tool. All studies reporting any of the clinical, humanistic, and economical outcomes using collaborative practice between CPs and GPs in management of asthma, such as CPs conducting medications reviews, patient referrals or providing education and counseling, were included. Results: A total of 23 studies (six RCTs, four C-RCT, three controlled interventions, seven pre-post, and three case control) were included. In total, 11/14 outcomes were concluded in favor of CP-GP collaborative interventions with different magnitude of effect size. Outcomes, such as asthma severity, asthma control, asthma symptoms, PEFR, SABA usage, hospital visit, adherence, and quality of life (QoL) (Asthma Quality-of-Life Questionnaire [AQLQ]; Living with Asthma Questionnaire [LWAQ]) demonstrated a small effect size (d≥0.2), while inhalation technique, ED visit, and asthma knowledge witnessed medium effect sizes (ES) (d≥0.5). In addition to that, inhalation technique yielded large ES (d≥0.8) in RCTs subgroup analysis. However, three outcomes, FEV, corticosteroids usage, and preventer-to-reliever ratio, did not hold significant ES (d<0.2) and, thus, remain inconclusive. The collaboration was shown to be value for money in the economic studies in narrative synthesis, however, the limited number of studies hinder pooling of data in meta-analysis. Conclusion: The findings from this review established a comprehensive evidence base in support of the positive impact of collaborative practice between CP and GP in the management of asthma.
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Affiliation(s)
- Naeem Mubarak
- Kulliyyah of Pharmacy, Department of Pharmacy Practice, International Islamic University, Kuantan, Malaysia.,Lahore Pharmacy College, Lahore Medical & Dental College, University of Health Sciences, Lahore, Pakistan
| | - Ernieda Hatah
- Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Che Suraya Zin
- Kulliyyah of Pharmacy, Department of Pharmacy Practice, International Islamic University, Kuantan, Malaysia
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Dombrowski SK, Bacci JL, Klatt PM, Osborne M, Castelli G, Burns A, Somma McGivney MA. Key factors for sustainable integration of pharmacists in team-based primary care physician practices. J Am Pharm Assoc (2003) 2019; 59:439-448.e1. [DOI: 10.1016/j.japh.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
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Ndefo UA, Davis PN, Henry A. Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma. J Am Pharm Assoc (2003) 2019; 59:521-526. [PMID: 31036527 DOI: 10.1016/j.japh.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers' knowledge of asthma is described. DESIGN This study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients' homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SETTING A local Medicaid managed care organization. PARTICIPANTS Pediatric African American patients (4-17 years old) with uncontrolled asthma. MAIN OUTCOME MEASURES Outcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. RESULTS Overall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. CONCLUSION Rates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.
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Tran T, Miller H, Ivy D. Evaluation of Pharmacist Involvement in Medicare Wellness Visits. J Pharm Pract 2019; 33:745-748. [PMID: 30808266 DOI: 10.1177/0897190019827126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the difference in the number of drug therapy interventions between patients seen by pharmacists and patients seen by nonpharmacist providers during Medicare Annual Wellness Visits (AWVs). METHODS Pharmacists completed the medication history portion of AWVs at a primary care, interdisciplinary clinic in Central Texas. Drug therapy problems were collected and compared to those identified by physicians conducting AWVs. Drug therapy problems were grouped into 4 categories: indication, effectiveness, safety, and adherence. Each category was divided into subcategories to further specify the problem. RESULTS Fifty patients received an AWV in each group. Pharmacists identified more drug therapy problems in all 4 categories as compared to physicians (100 vs 20 interventions, respectively) and significant differences were detected in most subcategories: indication without medication (P = .005), suboptimal regimen (P = .0034), drug-drug interaction (P = .0267), warning/precaution requiring additional monitoring (P = .0267), nonadherence (P = .0058), and patient lack of understanding medication therapy (P = .005). CONCLUSION Pharmacist involvement in AWVs helped identify drug therapy problems.
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Affiliation(s)
- Tram Tran
- Baylor Scott & White Health-Temple, TX, USA.,15494Texas A&M College of Pharmacy, Kingsville, TX, USA
| | - Heather Miller
- Baylor Scott & White Health-Temple, TX, USA.,15494Texas A&M College of Pharmacy, Kingsville, TX, USA
| | - Delaney Ivy
- Baylor Scott & White Health-Temple, TX, USA.,15494Texas A&M College of Pharmacy, Kingsville, TX, USA
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Al-Tameemi NK, Sarriff A. Knowledge, attitude and practice of pharmacists on medication therapy management: a survey in Hospital Pulau Pinang, Penang, Malaysia. J Pharm Health Care Sci 2019; 5:1. [PMID: 30652009 PMCID: PMC6327512 DOI: 10.1186/s40780-019-0131-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/02/2019] [Indexed: 02/04/2023] Open
Abstract
Background Medication therapy management (MTM) service provides set of clinical activities to optimize therapeutic outcomes for patients. It requires the collaboration between patient, pharmacist and other healthcare providers to ensure safe and effective use of medicines. The objective of the current study was to assess Hospital Pulau Pinang pharmacists’ knowledge, attitude and practice on MTM service. Methods A self-administrated validated survey was carried out among all pharmacists working at Hospital Pulau Pinang. Results A total of 93 pharmacists out of 130 (71.5%) were included in the study (61.3% between the age of 20–30 years old, 74.2% female, 68.8% Chinese, 88.2% holding bachelor’s degree and 48.4% working in medication therapy adherence clinic and outpatient pharmacy). Majority of pharmacists had a high level of knowledge and positive attitudes regarding MTM service. All pharmacists agreed that MTM service could improve the quality of health services and most pharmacists were interested in providing MTM service (92.5%). Moreover, 95.7% were interested in acquiring more information about MTM service. About the barriers that might affect MTM service implementation, the most common barriers identified by pharmacists were lack of training (88.2%), need of high budget to implement MTM service (51.6%) and lack of time (46.2%). Conclusions Overall, the research findings provide some insights about the Hospital Pulau Pinang pharmacists’ knowledge, attitude and practice regarding MTM service. Majority of pharmacists agreed and showed their interest towards the implementation of MTM service.
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Affiliation(s)
- Noor Kifah Al-Tameemi
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang, Malaysia
| | - Azmi Sarriff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang, Malaysia
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Alshehri AM, Barner JC, Rush S. The impact of a required course on third year pharmacy students' perceived abilities and intentions in providing medication therapy management. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:94-105. [PMID: 30527882 DOI: 10.1016/j.cptl.2018.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 07/10/2018] [Accepted: 09/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE To examine the impact of a Medication Therapy Management (MTM) course on third-year pharmacy students' (P3s) perceived abilities and intentions to provide MTM services before and after the course. EDUCATIONAL ACTIVITY AND SETTING An anonymous 48-item self-administered survey was administered to P3s before and after the MTM course. Forty-six items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) measured abilities in MTM provision using the following seven subdomains: general MTM ability (GA), medication therapy review (MTR), medication-related problems identification/recommendations (MRPIR), disease measurement/monitoring (DM), communication (CO), follow-up/referral (FR), and billing/documentation (BD). Two items assessed intent to provide MTM in practice. Descriptive statistics, Cronbach's alphas, and paired t-tests were used. FINDINGS All enrolled P3s (n = 110) completed both surveys. Subdomain Cronbach's alphas ranged from 0.70-0.97. Paired t-test showed no significant difference in intention to provide MTM before and after the course; however, the results revealed a significant increase in perceived abilities (before vs. after, respectively) regarding MTR (3.2 ± 0.6;4.2 ± 0.4; p < 0.0001), MRPIR (3.3 ± 0.6;4.2 ± 0.4; p < 0.0001), DM (4.2 ± 0.6;4.5 ± 0.5; p = 0.0004), CO (3.9 ± 0.5; 4.3 ± 0.4; p < 0.0001), FR (3.7±0.8;4.2±0.6; p = 0.0002), and BD (2.4±0.9;3.9±0.8; p < 0.0001). DISCUSSION AND SUMMARY A required MTM course with both didactic and experiential components were instrumental in improving P3s' perceived abilities to provide MTM services. Additional research is needed to understand why students' intention to provide MTM did not change pre- to post-course completion.
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Affiliation(s)
- Ahmed M Alshehri
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX, United States; Prince Sattam bin Abdulaziz University, College of Pharmacy, Clinical Pharmacy Department, Al-Kharj, Riyadh, Saudi Arabia.
| | - Jamie C Barner
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX 78712-1120, United States.
| | - Sharon Rush
- University of Texas at Austin, College of Pharmacy, Health Outcomes and Pharmacy Practice, 2409 University Avenue, Stop A1930, Austin, TX 78712-1120, United States.
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Zairina E, Nugraheni G, Achmad GN, Sulistyarini A, Nita Y, Bakhtiar A, Amin M. Efficacy of an Education Session by Pharmacists for Patients With Asthma: Protocol and Design of a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10210. [PMID: 30563816 PMCID: PMC6315257 DOI: 10.2196/10210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Asthma is a chronic disease that requires indefinite long-term therapy. Many approaches have been developed to enable people with asthma to live as normally as possible. In medication therapy management, pharmacists could play important roles in supporting the everyday life of asthmatic patients, such as by providing education therapy management to ensure that patients achieve optimal therapeutic outcomes. A good collaboration between health care practitioners and patients will produce a better system in terms of therapeutic management, which will lead to health care cost savings related to emergency visits. Although the Government has made various efforts to manage asthma in Indonesia, without commitment and support from both patients and health care professionals, the expected outcomes cannot be achieved. Objective This study aims to evaluate the effectiveness of an educational intervention provided by pharmacists compared with that of usual care. Methods A randomized controlled trial comparing usual care with an education session by pharmacists is underway. The intervention comprises a one-on-one education session of 60 minutes with a pharmacist comprising information regarding (1) asthma medication that has been used; (2) how to use asthma medication devices correctly; (3) asthma symptoms and how to prevent exacerbation of asthma; and (4) how to manage asthma triggers and environmental control measures. The primary outcome measure is change in asthma control, as measured using the Asthma Control Questionnaire. Secondary outcomes include changes in Asthma Quality of Life Questionnaire score, lung function, asthma-related health visits, days off from work or study, and oral corticosteroid use. Research assistants who are masked to the group allocation will collect outcome data at the baseline and every month for a 3-month period. Informed consent will be sought at enrollment and intention-to-treat analysis will be performed. Results This study was funded in January 2017 and ethical approval was obtained in June 2017. The enrollment was started in August 2017, and about 72 participants have been enrolled. First results are expected to be submitted for publication in 2019. Conclusions This is the first study to evaluate the effectiveness of a pharmacist-guided asthma education session compared with that of usual care in Indonesia. If it is proven effective, this intervention program could improve asthma self-management by patients, which may reduce risks of poorly controlled asthma. This intervention could also be implemented in addition to the current usual care for patients with asthma. Trial Registration Thai Clinical Trials Registry TCTR20171219001; http://www.clinicaltrials.in.th/index.php? tp =regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3068 (Archived by WebCite at http://www.webcitation.org/73Ci5eKtv) International Registered Report Identifier (IRRID) DERR1-10.2196/10210
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Affiliation(s)
- Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Gesnita Nugraheni
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Gusti Nv Achmad
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Arie Sulistyarini
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Yunita Nita
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Arief Bakhtiar
- Faculty of Medicine, Department of Pulmonology and Respiratory Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology, Dr Soetomo Hospital, Surabaya, Indonesia.,Department of Pulmonology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Muhammad Amin
- Faculty of Medicine, Department of Pulmonology and Respiratory Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology, Dr Soetomo Hospital, Surabaya, Indonesia.,Department of Pulmonology, Universitas Airlangga Hospital, Surabaya, Indonesia
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Abraham TG, Huggins C, Diaz-Fuentes G, Roglieri J. Combining pharmacy expertise with asthma educator certification: assessing the impact on inner-city asthma patients. J Asthma 2018; 56:891-896. [PMID: 30015531 DOI: 10.1080/02770903.2018.1501697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Asthma is one of the major causes of hospital readmissions in the South Bronx. The goal of this study was to assess the impact of asthma education provided by registered pharmacists with asthma educator certification (AE-C), on medication adherence and hospitalizations/Emergency Department (ED) visits. Methods: This was a retrospective chart review of patients seen in the pulmonary clinic from October 2014 to August 2015 for asthma education by AE-C pharmacists. Medical records were reviewed over an 18-month period - 9 months before and after the initial asthma education session. Data obtained included adherence to asthma controller inhalers based on pharmacy refill claims, asthma control using asthma control test (ACT) scores and asthma-related hospitalizations or ED visits within 30 days of asthma education. Pre-education data served as the pre-intervention group data and post-education data served as the post-intervention group data, allowing each patient to serve as their own control. Results: We found a statistically significant improvement in average medication adherence, i.e. asthma controller inhaler fills at pharmacy (46.3% vs 67.9%, p-value <0.001) and asthma control (15.71% vs 56.38%, p-value <0.001) between the pre-intervention and the post-intervention groups. Additionally, a lower hospitalization/ED utilization rate (31.2% vs 6.38%, p-value <0.001) was observed in the post-intervention group within 30 days of education. Conclusions: Asthma education provided by AE-C pharmacists had a positive impact on asthma care in our inner-city community. Improving medication adherence and asthma control as well as decreasing hospital utilization could potentially decrease health care costs in addition to improving quality of life.
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Affiliation(s)
| | | | | | - John Roglieri
- d Department of Pharmacy, JFK medical Center , Edison , NJ , USA
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Tinelli M, White J, Manfrin A. Novel pharmacist-led intervention secures the minimally important difference (MID) in Asthma Control Test (ACT) score: better outcomes for patients and the healthcare provider. BMJ Open Respir Res 2018; 5:e000322. [PMID: 30397484 PMCID: PMC6203066 DOI: 10.1136/bmjresp-2018-000322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/20/2018] [Accepted: 08/06/2018] [Indexed: 11/27/2022] Open
Abstract
Introduction A key priority in asthma management is achieving control. The Asthma Control Test (ACT) is a validated tool showing a numerical indicator which has the potential to provide a target to drive management. A novel pharmacist-led intervention recently evaluated and introduced in the Italian setting with a cluster randomised controlled trial (C-RCT) showed effectiveness and cost-effectiveness. This paper evaluates whether the intervention is successful in securing the minimally important difference (MID) in the ACT score and provides better health outcomes and economic savings. Methods Clinical data were sourced from 816 adult patients with asthma participating in the C-RCT. The success of the intervention was measured looking at the proportion of patients reaching MID in the ACT score. Different levels of asthma control were grouped according to international guidelines and graded using the traffic light rating system. Asthma control levels were linked to economic (National Health Service (NHS) costs) and quality-adjusted life years outcomes using published data. Results The median ACT score was 19 (partially controlled) at baseline, and 20 and 21 (controlled) at 3-month and 6-month-follow up, respectively (p<0.01). The percentage of patients reaching MID at 3 and 6 months was 15.8% (129) and 19.9% (162), respectively. The overall annual NHS cost savings per 1000 patients attached to the shift towards the MID target were equal to €346 012 at 3 months and increased to €425 483 at 6 months. Health utility gains were equal to 35.42 and 45.12 years in full health gained, respectively. Discussion The pharmacist-led intervention secured the MID in the ACT score and provided better outcomes for both patients and providers.
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Affiliation(s)
- Michela Tinelli
- Personal Social Services Research Unit (PSSRU), The London School of Economics and Political Science, London, UK
| | - John White
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Andrea Manfrin
- Sussex Pharmacy, School of Life Sciences, University of Sussex, Brighton, UK
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Consistency and replicability of a pharmacist-led intervention for asthma patients: Italian Medicines Use Review (I-MUR). Prim Health Care Res Dev 2018; 20:e10. [PMID: 30208976 PMCID: PMC6476346 DOI: 10.1017/s1463423618000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AimThis study aimed to assess the consistency and replicability of these process measures during provision of the Italian Medicines Use Review (I-MUR). BACKGROUND Medication review is a common intervention provided by community pharmacists in many countries, but with little evidence of consistency and replicability. The I-MUR utilised a standardised question template in two separate large-scale studies. The template facilitated pharmacists in recording medicines and problems reported by patients, the pharmaceutical care issues (PCIs) they found and actions they took to improve medicines use. METHODS Community pharmacists from four cities and across 15 regions were involved in the two studies. Patients included were adults with asthma. Medicines use, adherence, asthma problems, PCIs and actions taken by pharmacists were compared across studies to assess consistency and replicability of I-MUR.FindingsThe total number of pharmacists and patients completing the studies was 275 and 1711, respectively. No statistically significant differences were found between the studies in the following domains: patients' demographic, patients' perceived problems, adherence, asthma medicines used and healthy living advice provided by pharmacists. The proportion of patients in which pharmacists identified PCIs was similar across both studies. There were differences only in the incidence of non-steroidal anti-inflammatory drug use, the frequency of potential drug-disease interactions and in the types of advice given to patients and GPs. CONCLUSIONS The use of a standardised template for the I-MUR may have contributed to a degree of consistency in the issues found, which suggests this intervention could have good replicability.
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Guglielmo BJ, Sullivan SD. Pharmacists as health care providers: Lessons from California and Washington. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- B. Joseph Guglielmo
- School of Pharmacy; University of California; San Francisco San Francisco, California
| | - Sean D. Sullivan
- School of Pharmacy; University of Washington; Seattle Washington
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Hawes EM, Lambert E, Reid A, Tong G, Gwynne M. Implementation and evaluation of a pharmacist-led electronic visit program for diabetes and anticoagulation care in a patient-centered medical home. Am J Health Syst Pharm 2018; 75:901-910. [DOI: 10.2146/ajhp170174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Emily M. Hawes
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC
- UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Erika Lambert
- UNC Medical Center, Chapel Hill, NC
- UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Alfred Reid
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC
| | - Gretchen Tong
- UNC Family Medicine Center, Chapel Hill, NC
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC
| | - Mark Gwynne
- UNC Health Alliance, Chapel Hill, NC
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, NC
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Murray ME, Barner JC, Pope ND, Comfort MD. Impact and Feasibility of Implementing a Systematic Approach for Medication Therapy Management in the Community Pharmacy Setting: A Pilot Study. J Pharm Pract 2018; 32:664-670. [PMID: 29865973 DOI: 10.1177/0897190018779847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine how implementing a systematic medication therapy management (MTM) process impacted MTM completion rates. Methods: This process improvement pilot included 4 grocery store-based community pharmacy sites. Site staff were trained on a systematic process to integrate OutcomesMTM opportunities into pharmacy workflow. Technicians prepared MTM paperwork, including a standardized comprehensive medication review (CMR) worksheet, which pharmacists used to deliver the service at the counsel window. The primary outcome was the change in CMR completion rate from pre- to post implementation, with each site serving as its own control. Secondary outcomes were change in targeted intervention program (TIP) completion rate and survey results assessing barriers and feasibility. Results: The mean CMR completion rate improved from 2.7% ± 5.4% to 23.2% ± 7.7% ( P < .10). The mean TIP completion rate improved from 3.4% ± 4.2% to 24.9% ± 19.2% ( P < 0.10) pre- to post-implementation. Survey results indicated that pharmacists were satisfied with this; the most significant barriers were time spent contacting prescribers, documentation, and claim submission. Conclusion: Implementing this systematic approach to providing MTM into the pharmacy workflow may lead to an improvement in CMR completion rate. However, the sample size is small, and the results and process may not be generalizable to other sites.
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Affiliation(s)
- Marie E. Murray
- PGY-1 Community Pharmacy Resident, H-E-B Pharmacy/The University of Texas at Austin College of Pharmacy PGY-1 Community Residency Program, Austin, TX, USA
| | - Jamie C. Barner
- Division of Health Outcomes and Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Nathan D. Pope
- PGY-1 Community Pharmacy Resident, H-E-B Pharmacy/The University of Texas at Austin College of Pharmacy PGY-1 Community Residency Program, Austin, TX, USA
- Division of Health Outcomes and Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Mark D. Comfort
- Division of Health Outcomes and Pharmacy Practice, The University of Texas at Austin College of Pharmacy, Austin, TX, USA
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Crossman‐Barnes C, Peel A, Fong‐Soe‐Khioe R, Sach T, Wilson A, Barton G. Economic evidence for nonpharmacological asthma management interventions: A systematic review. Allergy 2018; 73:1182-1195. [PMID: 29105788 PMCID: PMC6033175 DOI: 10.1111/all.13337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Abstract
Asthma management, education and environmental interventions have been reported as cost‐effective in a previous review (Pharm Pract (Granada), 2014;12:493), but methods used to estimate costs and outcomes were not discussed in detail. This review updates the previous review by providing economic evidence on the cost‐effectiveness of studies identified after 2012, and a detailed assessment of the methods used in all identified studies. Twelve databases were searched from 1990 to January 2016, and studies included economic evaluations, asthma subjects and nonpharmacological interventions written in English. Sixty‐four studies were included. Of these, 15 were found in addition to the earlier review; 53% were rated fair in quality and 47% high. Education and self‐management interventions were the most cost‐effective, in line with the earlier review. Self‐reporting was the most common method used to gather resource‐use data, accompanied by bottom‐up approaches to estimate costs. Main outcome measures were asthma‐related hospitalizations (69%), quality of life (41%) and utility (38%), with AQLQ and the EQ‐5D being the most common questionnaires measured prospectively at fixed time points. More rigorous costing methods are needed with a more common quality of life tool to aid greater replicability and comparability amongst asthma studies.
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Affiliation(s)
| | - A. Peel
- Norwich Medical School University of East Anglia Norwich UK
| | | | - T. Sach
- Norwich Medical School University of East Anglia Norwich UK
| | - A. Wilson
- Norwich Medical School University of East Anglia Norwich UK
| | - G. Barton
- Norwich Medical School University of East Anglia Norwich UK
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Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management. J Clin Rheumatol 2018; 23:317-323. [PMID: 28816767 DOI: 10.1097/rhu.0000000000000561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes. OBJECTIVES The aim of this study was to examine associations of patient and provider factors with optimal gout management. METHODS Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement. RESULTS A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20-2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50-3.68) and dose escalation (OR, 2.48; 95% CI, 2.48-4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02-1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12-0.37). CONCLUSIONS Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.
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Lampkin SJ, Gildon B, Benavides S, Walls K, Briars L. Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients. J Pediatr Pharmacol Ther 2018; 23:4-17. [PMID: 29491747 PMCID: PMC5823491 DOI: 10.5863/1551-6776-23.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/11/2022]
Abstract
Pediatric clinical pharmacists are an integral part of the health care team. By practicing in an ambulatory care clinic, they can reduce the risk of medication errors, improve health outcomes, and enhance patient care. Unfortunately, because of limited data, misconceptions surrounding the role of pharmacists, and reimbursement challenges, there may be difficulty in establishing or expanding pediatric clinical pharmacy services to an ambulatory care setting. The purpose of this paper is to provide an overview of considerations for establishing or expanding pharmacy services in a pediatric ambulatory care clinic. The primer will discuss general and pediatric-specific pharmacy practice information, as well as potential barriers, and recommendations for identifying a practice site, creating a business plan, and integrating these services into a clinic setting.
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Malet-Larrea A, Goyenechea E, Gastelurrutia MA, Calvo B, García-Cárdenas V, Cabases JM, Noain A, Martínez-Martínez F, Sabater-Hernández D, Benrimoj SI. Cost analysis and cost-benefit analysis of a medication review with follow-up service in aged polypharmacy patients. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:1069-1078. [PMID: 27913940 DOI: 10.1007/s10198-016-0853-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Drug related problems have a significant clinical and economic burden on patients and the healthcare system. Medication review with follow-up (MRF) is a professional pharmacy service aimed at improving patient's health outcomes through an optimization of the medication. OBJECTIVE To ascertain the economic impact of the MRF service provided in community pharmacies to aged polypharmacy patients comparing MRF with usual care, by undertaking a cost analysis and a cost-benefit analysis. METHODS The economic evaluation was based on a cluster randomized controlled trial. Patients in the intervention group (IG) received the MRF service and the comparison group (CG) received usual care. The analysis was conducted from the national health system (NHS) perspective over 6 months. Direct medical costs were included and expressed in euros at 2014 prices. Health benefits were estimated by assigning a monetary value to the quality-adjusted life years. One-way deterministic sensitivity analysis was undertaken in order to analyse the uncertainty. RESULTS The analysis included 1403 patients (IG: n = 688 vs CG: n = 715). The cost analysis showed that the MRF saved 97 € per patient in 6 months. Extrapolating data to 1 year and assuming a fee for service of 22 € per patient-month, the estimated savings were 273 € per patient-year. The cost-benefit ratio revealed that for every 1 € invested in MRF, a benefit of 3.3 € to 6.2 € was obtained. CONCLUSION The MRF provided health benefits to patients and substantial cost savings to the NHS. Investment in this service would represent an efficient use of healthcare resources.
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Affiliation(s)
- Amaia Malet-Larrea
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain.
| | - Estíbaliz Goyenechea
- Official Pharmacist Association of Guipúzcoa, Prim 2, 20006, San Sebastián, Spain
| | - Miguel A Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, P. Universidad 7, 01006, Vitoria, Spain
| | - Victoria García-Cárdenas
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Juan M Cabases
- Department of Economics, Public University of Navarra, Campus Arrosadía, 31006, Pamplona, Spain
| | - Aránzazu Noain
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Daniel Sabater-Hernández
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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