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Manon SM, Phuong JM, Moles RJ, Kelly A, Center JR, Luckie K, White C, Carter SR. The role of community pharmacists in delivering interventions for osteoporosis: A systematic review. J Am Pharm Assoc (2003) 2022; 62:1741-1749.e10. [DOI: 10.1016/j.japh.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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Zeater S, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. A model for the financial assessment of professional services in community pharmacy: A systematic review. J Am Pharm Assoc (2003) 2018; 59:108-116.e1. [PMID: 30661641 DOI: 10.1016/j.japh.2018.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/29/2018] [Accepted: 04/15/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Limited studies have assessed the financial benefit of professional pharmacy services (PPSs) to the community pharmacy as a business. These studies are crucial in developing an insight into the long-term sustainability and broader implementation of services. We reviewed the literature to identify measures and indicators used to assess the financial performance of professional services in community pharmacy. DATA SOURCES The literature search was undertaken in Pubmed and Scopus, and a gray literature search was performed in Google.com. References of the included papers were reviewed for other relevant studies. STUDY SELECTION Articles were reviewed against the following exclusion criteria: 1) literature reviews, 2) studies not reporting quantitative financial data from community pharmacy, 3) studies not assessing a PPS, 4) studies lacking a methodology for the measurement and assessment of financial outcomes, and 5) cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis studies. DATA EXTRACTION A piloted data extraction form was used. A selection of key data collected is as follows: 1) method of data collection and calculation, 2) currency, limitations for cost and revenue and method of data collection and method of calculation, 3) standardized currency value for the results reported, 4) professional services: number assessed, type of service, name of services, nature of services, implementation stage reported, financial result, the frequency of service, costs, sources of revenue, net total cost, net total revenue, break-even point, break-even price, net profit and loss. RESULTS The 21 studies included used different methodologies and indicators to financially assess PPSs. This has led to the development of a model for assessing PPSs composed of the key financial elements identified in this systematic review. CONCLUSION From this review, we propose a model that provides a structured approach for pharmacists to manage the financial performance of services.
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Community osteoporosis screening services for the prevention of osteoporotic fractures in population health. INT J EVID-BASED HEA 2017; 15:43-52. [DOI: 10.1097/xeb.0000000000000104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cost analysis for the implementation of a medication review with follow-up service in Spain. Int J Clin Pharm 2017; 39:750-758. [DOI: 10.1007/s11096-017-0454-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
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Toh LS, Lai PSM, Othman S, Wong KT, Low BY, Anderson C. An analysis of inter-professional collaboration in osteoporosis screening at a primary care level using the D'Amour model. Res Social Adm Pharm 2016; 13:1142-1150. [PMID: 27780658 DOI: 10.1016/j.sapharm.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study describes the perspective of patients, nurses, pharmacists, doctors and policy makers to identify the level of collaboration and the areas for improvement to achieve inter-professional collaboration between doctors, nurses, pharmacists and policy makers in a primary care clinic. METHODS Patients (n = 20), Nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) from a primary care were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis informed by constant comparison. RESULTS Patients, doctors, nurses, pharmacists and policy makers were eager for pharmacists to be more proactive in creating health awareness and conducting osteoporosis screening at the primary care clinic via inter-professional collaboration. These findings were further examined using the D'Amour's structural model of collaboration which encompasses four main themes: shared goals and visions, internalization, formalization and governance. This model supports our data which highlights a lack of understanding of the pharmacists' role among the doctors, nurses, policy makers and pharmacists themselves. There is also a lack of governance and formalization, that fosters consensus, leadership, protocol and information exchange. Nonetheless, the stakeholders trust that pharmacists have sufficient knowledge to contribute to the screening of osteoporosis. Our primary care clinic can be described as developing towards an inter-professional collaboration in managing osteoporosis but is still in its early stages. CONCLUSIONS Inter-professional collaboration in osteoporosis management at the primary care level is beginning to be practised. Efforts extending to awareness and acceptance towards the pharmacists' role will be crucial for a successful change.
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Affiliation(s)
- L S Toh
- Division of Pharmacy, School of Medicine, University of Tasmania, Sandy Bay Campus, Pharmacy Building, Churchill Avenue, 7005, Australia
| | - P S M Lai
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - S Othman
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - K T Wong
- School of Pharmacy, University of Nottingham, Jalan Broga, 43500, Semenyih, Selangor, Malaysia
| | - B Y Low
- School of Pharmacy, University of Nottingham, Jalan Broga, 43500, Semenyih, Selangor, Malaysia
| | - C Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, UK.
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Kelling SE, Rondon-Begazo A, DiPietro Mager NA, Murphy BL, Bright DR. Provision of Clinical Preventive Services by Community Pharmacists. Prev Chronic Dis 2016; 13:E149. [PMID: 27788064 PMCID: PMC5084625 DOI: 10.5888/pcd13.160232] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Community pharmacists are highly accessible health care professionals, providing opportunities for partnerships with other health care and public health professionals to expand the population’s access to clinical preventive services. To document examples of the community pharmacist’s role in providing clinical preventive services to the general population, we conducted PubMed searches using the key word “community pharmacy” and key words from the US Preventive Services Task Force recommendations rated A or B. We present 4 descriptive summaries of clinical preventive services that can be offered by community pharmacists. Community pharmacists can provide clinical preventive services such as providing education, conducting screenings, and making referrals to improve population health.
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Affiliation(s)
- Sarah E Kelling
- MPH, Clinical Assistant Professor, Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI 48104.
| | | | | | | | - David R Bright
- Ferris State University College of Pharmacy, Big Rapids, Michigan
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Nik J, Lai PSM, Ng CJ, Emmerton L. A qualitative study of community pharmacists' opinions on the provision of osteoporosis disease state management services in Malaysia. BMC Health Serv Res 2016; 16:448. [PMID: 27577560 PMCID: PMC5006277 DOI: 10.1186/s12913-016-1686-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/17/2016] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Osteoporosis has significant impact on healthcare costs and quality of life. Amongst the models for collaborative disease state management services published internationally, there is sparse evidence regarding the role of community pharmacists in the provision of osteoporosis care. Hence, the aim of our study was to explore community pharmacists' opinions (including the barriers and facilitators) and scope of osteoporosis disease state management services by community pharmacists in Malaysia, informing a vision for developing these services. METHODS Semi-structured individual interviews and focus groups discussions were conducted with community pharmacists from October 2013 to July 2014. Three trained researchers interviewed the participants. Interviews were recorded and transcribed verbatim. Data were analyzed thematically using an interpretative description approach. RESULTS Nineteen community pharmacists with 1-23 years of experience were recruited (in depth interviews: n = 9; focus group discussions: n = 10). These participants reflected on their experience with osteoporosis-related enquiries, which included medication counseling, bone density screening and referral of at-risk patients. Key barriers were the lack of numerous factors: public awareness of osteoporosis, accurate osteoporosis screening tools for community pharmacists, pharmacists' knowledge on osteoporosis disease and medications, time to counsel patients about bone health, collaboration between pharmacists and doctors, and support from the government and professional body. The pharmacists wanted more continuing education on osteoporosis, osteoporosis awareness campaigns, a simple, unbiased osteoporosis education material, and inter-professional collaboration practices with doctors, and pharmacists' reimbursement for osteoporosis care. CONCLUSIONS The involvement of community pharmacists in the provision of osteoporosis disease state management was minimal. Only ad-hoc counseling on osteoporosis prevention was performed by community pharmacists. Development and trial of collaborative osteoporosis disease state management services in community pharmacy could be facilitated by training, support and remuneration.
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Affiliation(s)
- Jah Nik
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603 Malaysia
| | - Lynne Emmerton
- School of Pharmacy, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
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PACE: Pharmacists use the power of communication in paediatric asthma. Int J Clin Pharm 2014; 36:976-85. [PMID: 25087038 DOI: 10.1007/s11096-014-9984-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paediatric asthma is a public health burden in Australia despite the availability of national asthma guidelines. Community pharmacy interventions focusing on paediatric asthma are scarce. Practitioner Asthma Communication and Education (PACE) is an evidence-based program, developed in the USA for general practice physicians, aimed at addressing the issues of poor clinician-patient communication in the management of paediatric asthma. This program has been shown to improve paediatric asthma management practices of general practitioners in the USA and Australia. The development of a PACE program for community pharmacists will fill a void in the current armamentarium for pharmacist-patient care. OBJECTIVES To adapt the educational program, PACE, to the community pharmacy setting. To test the feasibility of the new program for pharmacy and to explore its potential impact on pharmacists' communication skills and asthma related practices. SETTING Community pharmacies located within the Sydney metropolitan. METHOD The PACE framework was reviewed by the research team and amended in order to ensure its relevance within the pharmacy context, thereby developing PACE for Pharmacy. Forty-four pharmacists were recruited and trained in small groups in the PACE for Pharmacy workshops. Pharmacists' satisfaction and acceptability of the workshops, confidence in using communication strategies pre- and post-workshop and self-reported behaviour change post workshop were evaluated. MAIN OUTCOME MEASURE Pharmacist self-reported changes in communication and teaching behaviours during a paediatric asthma consultation. RESULTS All 44 pharmacists attended both workshops, completed pre- and post-workshop questionnaires and provided feedback on the workshops (100 % retention). The participants reported a high level of satisfaction and valued the interactive nature of the workshops. Following the PACE for Pharmacy program, pharmacists reported significantly higher levels in using the communication strategies, confidence in their application and their helpfulness. Pharmacists checked for written asthma self-management plan possession and inhaler device technique more regularly, and provided verbal instructions more frequently to paediatric asthma patients/carers at the initiation of a new medication. CONCLUSION This study provides preliminary evidence that the PACE program can be translated into community pharmacy. PACE for Pharmacy positively affected self-reported communication and education behaviours of pharmacists. The high response rate shows that pharmacists are eager to expand on their clinical role in primary healthcare.
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Laliberté MC, Perreault S, Damestoy N, Lalonde L. Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada. BMC Public Health 2012; 12:192. [PMID: 22420693 PMCID: PMC3342160 DOI: 10.1186/1471-2458-12-192] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/15/2012] [Indexed: 11/25/2022] Open
Abstract
Background An increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement. Methods Using a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele. Results In all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%). Conclusions Although community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.
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Elias MN, Burden AM, Cadarette SM. The impact of pharmacist interventions on osteoporosis management: a systematic review. Osteoporos Int 2011; 22:2587-96. [PMID: 21720894 PMCID: PMC3169776 DOI: 10.1007/s00198-011-1661-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/25/2011] [Indexed: 01/22/2023]
Abstract
UNLABELLED We completed a systematic review of the literature to examine the impact of pharmacist interventions in improving osteoporosis management. Results from randomized controlled trials suggest that pharmacist interventions may improve bone mineral density testing and calcium intake among patients at high risk for osteoporosis. INTRODUCTION Pharmacists play a key role in many healthcare systems by helping patients manage chronic diseases. We completed a systematic review of the literature to identify randomized controlled trials (RCTs) that have examined the impact of pharmacy interventions in narrowing two gaps in osteoporosis management: identifying at-risk individuals and improving adherence to therapy. METHODS We searched the electronic databases of EMBASE, HealthStar, International Pharmaceutical Abstracts, MEDLINE, and PubMed from database development to April 2010, examined grey literature, and completed manual searches of reference lists to identify English-language research that examined osteoporosis management interventions within pharmacy practice. Results from RCTs were abstracted and assessed for bias. RESULTS We identified 25 studies that examined pharmacist interventions in osteoporosis management: 16 cohort, 5 cross-sectional, 1 historical/ecological control, and 3 RCTs. RCT interventions included osteoporosis educational and counseling programs, screening by pharmacists based on risk factor assessment or bone mineral density testing, and physician contact or recommendations for patients to follow-up with a general practitioner. Results from the three RCTs suggest that pharmacist interventions may improve bone mineral density testing (targeted screening) and calcium intake among patients at high risk for osteoporosis. However, two of the three RCTs had high risk of bias, and no study examined the impact of pharmacist intervention on osteoporosis treatment adherence. CONCLUSIONS Data support the potential role for pharmacists to help reduce gaps in osteoporosis management through improved identification of high-risk patients. More research is needed to examine pharmacist interventions on osteoporosis treatment adherence.
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Affiliation(s)
- M. N. Elias
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - A. M. Burden
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - S. M. Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
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Hall LN, Shrader SP, Ragucci KR. Evaluation of compliance with osteoporosis treatment guidelines after initiation of a pharmacist-run osteoporosis service at a family medicine clinic. Ann Pharmacother 2009; 43:1781-6. [PMID: 19826096 DOI: 10.1345/aph.1m366] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Osteoporosis affects more than 10 million Americans, and fracture complications are devastating to patients and society. Despite the availability of guidelines and performance measures, osteoporosis is not optimally managed. Pharmacists have been pivotal in management of other disease states, and a multidisciplinary approach to osteoporosis management may improve patient outcomes. OBJECTIVE To establish a pharmacist-run osteoporosis service at a family medicine clinic and to evaluate short-term compliance with osteoporosis treatment guidelines before and after initiation of the service. METHODS A pharmacist-run osteoporosis service was established in October 2008. Adults with the diagnosis of osteoporosis before initiation of the service were included in evaluation of short-term compliance with treatment guidelines, including appropriate dual-energy X-ray absorptiometry (DEXA) scan frequency, pharmacotherapy, calcium and vitamin D supplementation, and nonpharmacologic education. Of 42 referred patients, 22 were eligible for inclusion. A retrospective chart review was conducted, and patients served as their own controls, with data from before and after establishment of the service evaluated. RESULTS Of the 22 patients evaluated, 8 (36%) received DEXA scans at the appropriate frequency before the service was established, versus 18 (82%) after the service was initiated. Seven (32%) patients were taking appropriate pharmacotherapy before the service, versus 17 (77%) after the service. Nine (41%) patients were taking calcium and vitamin D before the service, versus 22 (100%) after the service. Three (33%) of these patients were taking the appropriate dose and salt of calcium before the service, versus 20 (91%) after the service. Five (56%) of the 9 patients were taking the appropriate vitamin D dose before the service, versus 21 (95%) after the service. No patient had documented nonpharmacologic education prior to the service, compared with all patients after the service. All differences were significant (p < 0.05). CONCLUSIONS A pharmacist-run osteoporosis service significantly improved short-term compliance with guidelines, including appropriate DEXA scan frequency, pharmacotherapy, calcium and vitamin D supplementation, and nonpharmacologic education.
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Affiliation(s)
- Larissa N Hall
- Department of Pharmacy and Clinical Sciences/Family Medicine, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC, USA
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Mountjoy CR, Shrader SP, Ragucci KR. Compliance with osteoporosis treatment guidelines in postmenopausal women. Ann Pharmacother 2009; 43:242-50. [PMID: 19196838 DOI: 10.1345/aph.1l464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Osteoporosis continues to be poorly managed despite compelling statistics indicating increased morbidity and mortality associated with fractures. Guideline compliance in individual practices must be evaluated to implement improvements in the care of patients with this disease state. OBJECTIVE To evaluate compliance with osteoporosis treatment guidelines by physicians and patients at 2 family medicine clinics affiliated with a large university teaching hospital. METHODS Postmenopausal women 65 years of age or older with the ICD-9 diagnosis code 733.0 for osteoporosis during the study period between July 2006 and July 2007 were identified through the family medicine electronic medical record (EMR). Of 133 patients, 113 were eligible for inclusion. A retrospective chart review was conducted and prospective voluntary telephone surveys were administered. The EMR of each eligible patient was examined for presence of a baseline dual-energy X-ray absorptiometry (DXA) scan as well as appropriate follow-up DXA monitoring, appropriateness of osteoporosis pharmacotherapy, calcium and vitamin D supplementation, and fracture history. The telephone survey was used to assess the patients' calcium use, nonpharmacologic recommendations received, and fracture incidence after diagnosis of osteoporosis. RESULTS Of 113 patients diagnosed with osteoporosis, 68 of 82 (82.9%) had appropriate baseline DXA scans; however, only 9 (13.2%) of these 68 patients had appropriate follow-up scans every 2 years thereafter. Sixty-five (57.5%) patients were on Food and Drug Administration-approved, guideline-endorsed pharmacotherapy for osteoporosis. Thirty-five (70%) of the 50 participants in the telephone survey reported taking calcium regularly, and 41 (82%) patients recalled receiving some nonpharmacologic advice. Thirteen (26%) patients reported a fracture after diagnosis. CONCLUSIONS Osteoporosis care can be measurably improved at these clinics with use of baseline and appropriate follow-up DXA scans, increasing the number of patients who receive pharmacotherapy, and providing ongoing reinforcement of nonpharmacologic measures whereby bone health may be maintained.
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Affiliation(s)
- Cary R Mountjoy
- Medical University of South Carolina/South Carolina College of Pharmacy, Charleston, SC 29425, USA
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