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Kwakye AO, Kretchy IA, Peprah P, Mensah KB. Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100426. [PMID: 38455671 PMCID: PMC10918559 DOI: 10.1016/j.rcsop.2024.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases. Aim To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes. Methods The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study. Results In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence. Conclusion This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers.
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Affiliation(s)
- Adwoa Oforiwaa Kwakye
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Prince Peprah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Boamah Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Orth LE, Feudtner C, Kempe A, Morris MA, Colborn KL, Gritz RM, Linnebur SA, Begum A, Feinstein JA. A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial. BMC Health Serv Res 2023; 23:414. [PMID: 37120509 PMCID: PMC10148507 DOI: 10.1186/s12913-023-09439-y] [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: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Children with medical complexity (CMC) often rely upon the use of multiple medications to sustain quality of life and control substantial symptom burden. Pediatric polypharmacy (≥ 5 concurrent medications) is prevalent and increases the risk of medication-related problems (MRPs). Although MRPs are associated with pediatric morbidity and healthcare utilization, polypharmacy is infrequently assessed during routine clinical care for CMC. The aim of this randomized controlled trial is to determine if a structured pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention reduces MRP counts, as well as the secondary outcomes of symptom burden and acute healthcare utilization. METHODS This is a hybrid type 2 randomized controlled trial assessing the effectiveness of pMTM compared to usual care in a large, patient-centered medical home for CMC. Eligible patients include all children ages 2-18 years old, with ≥ 1 complex chronic condition, and with ≥ 5 active medications, as well as their English-speaking primary caregivers. Child participants and their primary parental caregivers will be randomized to pMTM or usual care before a non-acute primary care visit and followed for 90 days. Using generalized linear models, the overall effectiveness of the intervention will be evaluated using total MRP counts at 90 days following pMTM intervention or usual care visit. Following attrition, a total of 296 CMC will contribute measurements at 90 days, which provides > 90% power to detect a clinically significant 1.0 reduction in total MRPs with an alpha level of 0.05. Secondary outcomes include Parent-Reported Outcomes of Symptoms (PRO-Sx) symptom burden scores and acute healthcare visit counts. Program replication costs will be assessed using time-driven activity-based scoring. DISCUSSION This pMTM trial aims to test hypotheses that a patient-centered medication optimization intervention delivered by pediatric pharmacists will result in lower MRP counts, stable or improved symptom burdens, and fewer cumulative acute healthcare encounters at 90 days following pMTM compared to usual care. The results of this trial will be used to quantify medication-related outcomes, safety, and value for a high-utilization group of CMC, and outcomes may elucidate the role of integrated pharmacist services as a key component of outpatient complex care programs for this priority pediatric population. TRIAL REGISTRATION This trial was prospectively registered at clinicaltrials.gov (NCT05761847) on Feb 25, 2023.
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Affiliation(s)
- Lucas E Orth
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Chris Feudtner
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Pediatrics and Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison Kempe
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan A Morris
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn L Colborn
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - R Mark Gritz
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunny A Linnebur
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anowara Begum
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
| | - James A Feinstein
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA.
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Alshammari MK, Alotaibi NM, Al Suroor SN, Al Saed RS, Al-Hamoud AA, Alluwaif MA, Alamry MA, Alshehri NM, Alfaidi BE, Alzahrani RA, Almutiri BB, Alosaimi YS, Alosman AS, Alharbi AA, Alenezi AM. Global Advancement in Pharmacy Services for Mental Health: A Review for Evidence-Based Practices. Healthcare (Basel) 2023; 11:healthcare11081082. [PMID: 37107916 PMCID: PMC10137606 DOI: 10.3390/healthcare11081082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
The symptoms of psychiatric infirmities have variability, and selected drug regimens for mental illness are comparatively complex and individualized; therefore, pharmacy services vary with respect to patients, diseases, healthcare settings, community structures, and countries. Clinical pharmacy services for mental health (MH) are continuously being upgraded. A structured search of the literature was performed in the Cochrane, PubMed (Medline), PsycINFO, Google scholar, Scopus, Science Direct, and Springer Links databases. The title and abstract of each retrieved article were evaluated for relevance. To remove uncertainty and ambiguity, the full-text articles were retrieved and examined for relevance. The articles were further assessed on the basis of inclusion and exclusion criteria. Narrative synthesis was performed, creating new categories and relevant subcategories and further subsections. The articles and the results were assessed for quality and bias. Pharmacists have a range of expertise in psychiatric care. The services can be classified as conventional, extended, and advanced pharmacy services. Conventional services include the quality use of medicines in healthcare settings and medication support services in communities that ensure medication adherence. Pharmacists perform extended roles in collaborative medication therapy management, multidisciplinary community mental health teams, collaborative care, patient education, home medication review, hospital-to-home transit, and screening services. In the USA, the role of pharmacists was advanced by prescribing as collaborative and interim prescribers. Australia launched an accredited program for psychiatric first-aid pharmacists. Pharmacists can provide mental care to rural populations using health technology. The role of pharmacists in MH is appreciated either independently or as a team member. Patients and healthcare providers rank the services of pharmacists in MH highly. Still, there is a margin for improvement in the training of pharmacists. Pharmacists cannot provide sufficient time to their patients. Public awareness about the role of pharmacists in MH needs more attention. Moreover, the training of psychiatric pharmacists should be standardized around the world.
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Affiliation(s)
| | - Nawaf M Alotaibi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Northern Border University, Rafha 73213, Saudi Arabia
| | | | - Rami Saleh Al Saed
- Department of Pharmacy, Maternity and Children Hospital Dammam, Dammam 63400, Saudi Arabia
| | - Aliaa Ali Al-Hamoud
- Department of Pharmacy, Maternity and Children Hospital Dammam, Dammam 63400, Saudi Arabia
| | - Mawahb Ahmed Alluwaif
- Department of Pharmacy, Maternity and Children Hospital Dammam, Dammam 63400, Saudi Arabia
| | - Mona Awadh Alamry
- Department of Pharmacy, Khamis Mushait General Hospital, Khamis Mushait 62441, Saudi Arabia
| | | | - Bashaier Eed Alfaidi
- Department of Pharmacy, Umluj General Hospital, Ministry of Health, Northern Region, Umluj City 48312, Saudi Arabia
| | | | | | - Yousef Saud Alosaimi
- Department of Pharmacy, Dr. Sulaiman Al Habib Hospital, Riyadh 14926, Saudi Arabia
| | - Amal Saeed Alosman
- Department of Pharmacy, King Khalid University, South Zone, Abha 62541, Saudi Arabia
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Sanchez-Molina AI, Benrimoj SI, Ferri-Garcia R, Martinez-Martinez F, Gastelurrutia MA, Garcia-Cardenas V. Development and validation of a tool to measure collaborative practice between community pharmacists and physicians from the perspective of community pharmacists: the professional collaborative practice tool. BMC Health Serv Res 2022; 22:649. [PMID: 35568892 PMCID: PMC9107731 DOI: 10.1186/s12913-022-08027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaborative practice between community pharmacists and physicians is becoming increasingly common. Although tools and models to explore collaborative practice between both health care professionals have been developed, very few have been validated for their use in clinical practice. The objective of this study was to develop and validate a tool for measuring collaborative practice between community pharmacists and physicians from the perspective of community pharmacists. METHODS The DeVellis method was used to develop and validate the Professional Collaborative Practice Tool. A pool of 40 items with Likert frequency scales was generated based on previous literature and expert opinion. This study was undertaken in Spain. A sample of community pharmacists providing medication reviews with follow-up and a random sample of pharmacists providing usual care were invited to participate. Exploratory and confirmatory factor analysis was used to assess the tool's reliability and content validity. RESULTS Three hundred thirty-six pharmacists were invited with an overall response rate of 84.8%. The initial 40 items selected were reduced to 14 items. Exploratory Factor Analysis provided a 3-factor solution explaining 62% of the variance. Confirmatory Factor Analysis confirmed the three factors "Activation for collaborative professional practice," the "Integration in collaborative professional practice," and the "Professional acceptance in collaborative professional practice." The tool demonstrated an adequate fit (X2/df = 1.657, GFI = 0.889 and RMSEA = 0.069) and good internal consistency (Cronbach's alpha = 0.924). CONCLUSIONS The Professional Collaborative Practice Tool has shown good internal reliability and criterion validity. The tool could be used to measure the perceived level of collaborative practice between community pharmacists and physicians and monitor changes over time. Its applicability and transferability to other settings should be evaluated.
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Affiliation(s)
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Ramon Ferri-Garcia
- Department of Statistics and Operations Research, University of Granada, Granada, Spain
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Lowrie R, Stock K, Lucey S, Knapp M, Williamson A, Montgomery M, Lombard C, Maguire D, Allan R, Blair R, Paudyal V, Mair FS. Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study. Int J Equity Health 2021; 20:19. [PMID: 33413396 PMCID: PMC7789612 DOI: 10.1186/s12939-020-01337-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Homelessness and associated mortality and multimorbidity rates are increasing. Systematic reviews have demonstrated a lack of complex interventions that decrease unscheduled emergency health services utilisation or increase scheduled care. Better evidence is needed to inform policy responses. We examined the feasibility of a complex intervention (PHOENIx: Pharmacist led Homeless Outreach Engagement Nonmedical Independent prescribing (Rx)) to inform a subsequent pilot randomised controlled trial (RCT). METHODS Non-randomised trial with Usual Care (UC) comparator group set in Greater Glasgow and Clyde Health Board, Scotland. Participants were adult inpatients experiencing homelessness in a city centre Glasgow hospital, referred to the PHOENIx team at the point of hospital discharge, from 19th March 2018 until 6th April 2019. The follow up period for each patient started on the day the patient was first seen (Intervention group) or first referred (UC), until 24th August 2019, the censor date for all patients. All patients were offered and agreed to receive serial consultations with the PHOENIx team (NHS Pharmacist prescriber working with Simon Community Scotland (third sector homeless charity worker)). Patients who could not be reached by the PHOENIx team were allocated to the UC group. The PHOENIx intervention included assessment of physical/mental health, addictions, housing, benefits and social activities followed by pharmacist prescribing with referral to other health service specialities as necessary. All participants received primary (including specialist homelessness health service based general practitioner care, mental health and addictions services) and secondary care. Main outcome measures were rates of: recruitment; retention; uptake of the intervention; and completeness of collected data, from recruitment to censor date. RESULTS Twenty four patients were offered and agreed to participate; 12 were reached and received the intervention as planned with a median 7.5 consultations (IQR3.0-14.2) per patient. The pharmacist prescribed a median of 2 new (IQR0.3-3.8) and 2 repeat (1.3-7.0) prescriptions per patient; 10(83%) received support for benefits, housing or advocacy. Twelve patients were not subsequently contactable after leaving hospital, despite agreeing to participate, and were assigned to UC. Two patients in the UC group died of drug/alcohol overdose during follow up; no patients in the Intervention group died. All 24 patients were retained in the intervention or UC group until death or censor date and all patient records were accessible at follow up: 11(92%) visited ED in both groups, with 11(92%) hospitalisations in intervention group, 9(75%) UC. Eight (67%) intervention group patients and 3(25%) UC patients attended scheduled out patient appointments. CONCLUSIONS Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.
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Affiliation(s)
- Richard Lowrie
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK.
| | - Kate Stock
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK
| | | | | | - Andrea Williamson
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Margaret Montgomery
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK
| | - Cian Lombard
- Acute Homeless Liaison Team, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Donogh Maguire
- Emergency Department, Glasgow Royal Infirmary, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Rebecca Blair
- Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK
| | | | - Frances S Mair
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Agarwal S, Griffith ML, Murphy EJ, Greenlee C, Boord J, Gabbay RA. Innovations in Diabetes Care for a Better "New Normal" Beyond COVID-19. J Clin Endocrinol Metab 2021; 106:e377-e381. [PMID: 33205818 PMCID: PMC7665547 DOI: 10.1210/clinem/dgaa704] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 12/13/2022]
Abstract
The coronavirus disease pandemic has created opportunities for innovation in diabetes care that were not possible before. From the lens of this "new normal" state, we have an opportunity to rapidly implement, test, and iterate models of diabetes care to achieve the quadruple aim of improving medical outcomes, patient experience, provider satisfaction, and reducing costs. In this perspective, we discuss several innovative diabetes models of care which promote collaborative care models and improve access to high-quality specialty diabetes care. We discuss ongoing threats to diabetes care innovation, and offer practical solutions to foster evolution and sustain current strides made during the pandemic.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, NY-Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, New York
- Correspondence: Shivani Agarwal MD, MPH, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10461, USA. E-mail:
| | - Michelle L Griffith
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J Murphy
- Division of Endocrinology, Zuckerberg San Francisco General: University of California, San Francisco, California
| | | | | | - Robert A Gabbay
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
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Coe AB, Choe HM, Diez HL, Rockey NG, Ashjian EJ, Dorsch MP, Kim HM, Farris KB. Pharmacists providing care in statewide physician organizations: findings from the Michigan Pharmacists Transforming Care and Quality Collaborative. J Manag Care Spec Pharm 2020; 26:1558-1566. [PMID: 33251995 PMCID: PMC9837743 DOI: 10.18553/jmcp.2020.26.12.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND: Clinical services provided by pharmacists embedded in practices can improve patient outcomes within the primary care setting. Little is known about whether physician organizations (POs) will retain the services of clinical pharmacists after outside funding for a statewide implementation program is ended. OBJECTIVE: To evaluate a statewide program, Michigan Pharmacists Transforming Care and Quality (MPTCQ), that incorporated pharmacists within 17 POs. METHODS: A descriptive study was conducted using data collected from June 2016 to September 2018 from primary care clinical pharmacist encounters in POs participating in MPTCQ. Process outcomes included the number of participating POs, patient encounters, and average visits per patient. Analyses at the encounter level were stratified by 2 encounter types: disease state management (DSM) or comprehensive medication review (CMR). Separately by encounter type, pharmacist effect was described by the number, type, and reasons for medication changes, as well as medication adherence and cost barriers found and addressed. Clinical outcomes included hemoglobin A1c and blood pressure change. Sustainability and patient satisfaction of pharmacists providing clinical services are reported. RESULTS: Across 17 POs, 27 pharmacists participated in the MPTCQ program. Pharmacists completed 24,523 patient encounters for DSM with 5,942 patients, with an average of 5 visits per patient with diabetes and 2 visits for hypertension. Pharmacists made 15,153 therapeutic medication changes during visits for diabetes and hypertension, with approximately 70% related to efficacy. Pharmacists completed 4,203 CMR visits for 3,092 patients. During CMR visits, 1,296 therapeutic medication changes were recommended. Problems with medication cost were identified in 13% of CMR visits. Blood pressure and A1c levels decreased in patients managed by pharmacists. In 157 patients surveyed, 87% rated their pharmacists' care as excellent. Sixteen POs retained their pharmacists at the end of funding. CONCLUSIONS: A statewide provider-payer partnership successfully integrated and retained primary care pharmacists within POs. Pharmacists in the MPTCQ program contributed to improvements in disease control by changing medications to improve patient clinical outcomes. DISCLOSURES: Support for MPTCQ was provided by Blue Cross and Blue Shield of Michigan (BCBSM) as part of the BCBSM Value Partnerships program. Coe was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR002241. Although BCBSM and MPTCQ work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no conflicts of interest to report.
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Affiliation(s)
| | - Hae Mi Choe
- University of Michigan College of Pharmacy and Michigan Medicine, Ann Arbor
| | - Heidi L Diez
- University of Michigan College of Pharmacy and Michigan Medicine, Ann Arbor
| | | | - Emily J Ashjian
- University of Michigan College of Pharmacy and Michigan Medicine, Ann Arbor
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Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Community social determinants and health outcomes drive availability of patient-centered medical homes. Health Place 2020; 67:102439. [PMID: 33212394 DOI: 10.1016/j.healthplace.2020.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/11/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
The collaborative design of America's patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country's medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters were assessed using odds ratios and marginal effects models, producing four different scenarios of resource need and resource availability. All analyses were conducted using county-level data for the contiguous US states. Counties having lower uninsured rates and lower poverty rates were the most consistent indicators of medical home availability. Overall, the analyses indicated that medical homes are more likely to emerge within communities that have more favorable health and socioeconomic conditions to begin with. These findings suggest that intersecting the spatial footprints of medical homes in relation to health and socioeconomic data can provide crucial information for policy makers and payers invested in narrowing the gaps between clinic availability and the communities that experience the brunt of health and social inequalities.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, United States
| | - Rebecca Wilkerson
- Institute for Families in Society, University of South Carolina, United States
| | | | - Ana Lòpez-De Fede
- Institute for Families in Society, University of South Carolina, United States.
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Shin J, Moczygemba LR, Barner JC, Garza A, Linedecker-Smith S, Srinivasa M. Patient experience with clinical pharmacist services in Travis County Federally Qualified Health Centers. Pharm Pract (Granada) 2020; 18:1751. [PMID: 32377276 PMCID: PMC7194041 DOI: 10.18549/pharmpract.2020.2.1751] [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] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/13/2020] [Indexed: 11/14/2022] Open
Abstract
Background Positive patient experiences with care have been linked to improved health outcomes. Patient experience surveys can provide feedback about the level of patient-centered care provided by clinical pharmacists and information about how to improve services. Objectives Study objectives are: 1) To describe patient experience with clinical pharmacist services in a federally qualified health center (FQHC). 2) To determine if demographic or health-related factors were associated with patient experience. Methods This cross-sectional survey included adult patients who were English or Spanish speaking, and completed a clinical pharmacist visit in March or April 2018. Patient experience was evaluated, on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with 10 items using four domains: pharmacist-patient interaction information provision, support for self-care, and involvement in decision making. In addition, one item was used to rate the overall experience. Demographic and health-related variables were also collected. Eligible patients completed the survey after their clinical pharmacist visit. Descriptive and inferential statistics, as well as Cronbach's alpha for scale reliability, were employed. Results Respondents (N=99) were 55.4 (SD=12.1) years and 53.1% were women. Overall, patients rated their experiences very high with the 10-item scale score of 4.8 (SD=0.4) out of 5 points and the overall experience rating of 4.9 (SD=0.4) out of 5 points. With the exception of race, there were no differences between patient experience and demographic and health-related variables. African Americans had significantly (p=0.0466) higher patient experience scores compared to Hispanics. Conclusions Patients receiving care in a FQHC highly rated their experience with clinical pharmacists. This indicates that clinical pharmacists provided a high level of patient-centered care to a diverse group.
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Affiliation(s)
- Jennifer Shin
- PharmD. Clinical Pharmacist Specialist. Memorial Hermann-Texas Medical Center. Houston, TX (United States).
| | - Leticia R Moczygemba
- PharmD, PhD. Associate Professor. Health Outcomes Division, College of Pharmacy, University of Texas. Austin, TX (United States).
| | - Jamie C Barner
- PhD. Professor and Division Head. Health Outcomes Division, College of Pharmacy, University of Texas. Austin, TX (United States).
| | - Aida Garza
- PharmD, CDE, BCACP. Associate Pharmacy Director, Pharmacy Residency Program Director. CommUnityCare Health Centers. Austin, TX (United States).
| | - Sara Linedecker-Smith
- PharmD, BCACP. Clinical Pharmacist. CommUnityCare Health Centers. Austin, TX (United States).
| | - Maaya Srinivasa
- PharmD, BCACP, CDE. Clinical Pharmacist. CommUnityCare Health Centers. Austin, TX (United States).
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Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development. PHARMACY 2019; 7:pharmacy7040153. [PMID: 31766121 PMCID: PMC6958364 DOI: 10.3390/pharmacy7040153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023] Open
Abstract
Persons experiencing homelessness have a high prevalence of severe mental health problems, alcohol dependence, substance misuse and infectious hepatitis C, and face up to twelve times higher mortality rates compared to the general population. They also face barriers to accessing healthcare. However, clinical pharmacy services are currently not available to homeless populations in England. The aim of this study was to conduct public involvement sessions with persons experiencing homelessness with a view to inform the design of patient-centred clinical pharmacy healthcare services. Qualitative methodology was used, using a focus group with homeless persons from emergency shelters and one to one engagement with those sleeping rough, using a topic guide. A total of nine homeless persons took part—seven males and two females. The participants of the sessions said that patient-centred clinical pharmacy services delivered for homeless persons would address many of their unmet needs around access to medicines, their understanding of prescribed medicines and holistic management of their health. The service would be able to make a positive impact on their health outcomes by screening for health conditions, facilitating better integration across services, referral and liaison with other services, and minimising misuse of prescribed medicines. The findings of this study will be used to inform the development, implementation and evaluation of a patient-centred clinical pharmacy service tailored to meet the specific needs of the homeless population.
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Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services. PHARMACY 2019; 7:pharmacy7030099. [PMID: 31330816 PMCID: PMC6789523 DOI: 10.3390/pharmacy7030099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/13/2019] [Accepted: 07/18/2019] [Indexed: 12/11/2022] Open
Abstract
Value-added pharmacy services encompass traditional and emerging services provided by pharmacists to individual and entire populations of persons increasingly under the auspices of a public health mandate. The success of value-added pharmacy services is enhanced when they are carried out and assessed using appropriate theory-based paradigms. Many of the more important management theories for pharmacy services consider the “servicescape” of these services recognizing the uniqueness of each patient and service encounter that vary based upon health needs and myriad other factors. In addition, implementation science principles help ensure the financial viability and sustainability of these services. This commentary reviews some of the foundational management theories and provides a number of examples of these theories that have been applied successfully resulting in a greater prevalence and scope of value-added services being offered.
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Coe AB, Bostwick JR, Choe HM, Thompson AN. Provider perceptions of pharmacists providing mental health medication support in patient-centered medical homes. J Am Pharm Assoc (2003) 2019; 59:555-559. [PMID: 31010786 DOI: 10.1016/j.japh.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To identify primary care providers' (PCPs') comfort level, potential barriers to management of patients with mental health disorders, and attitudes around clinical pharmacist-provided mental health medication-related support. METHODS A 16-item cross-sectional survey was completed by PCPs in 14 patient-centered medical homes (PCMHs) at 1 academic medical center. Items assessed include PCPs' perceptions of the proportion of patients with a mental health condition, access to psychiatry services, confidence in mental health condition management, clinical pharmacist-provided mental health medication support, and demographics. Checklist, Likert-type-scale agreement statements, and an open-ended question to assess barriers to managing mental health medications were included. Descriptive statistics and qualitative content analysis were used. RESULTS Respondents (n = 85) included attending physicians (67.1%), resident physicians (24.7%), and advanced practice providers (8.2%). The average number of years in practice was 11 (SD 8.6). The majority perceived that 26% to 50% of their patients had a psychiatric illness (57.7%), referred < 10% of their patients (67.1%) to psychiatry services, and disagreed that access to psychiatric services was acceptably timely (87.0%). Participants felt confident diagnosing a patient with depression (97.6%) and starting antidepressants (94.1%) compared with antipsychotics (11.7%) or mood stabilizers (7.1%). Participants agreed that having the clinical pharmacist in clinic to provide support regarding psychiatric medications would increase their comfort level; increase in comfort level by provider type was not different (P = 0.20). Emerging barriers were lack of knowledge or training, low comfort in diagnosing severe psychiatric conditions, and access to psychiatry services. CONCLUSION Outside of the diagnosis and treatment of depression, PCPs indicate a lack of comfort in treating PCMH patients with mental health disorders. Pharmacists can play a key role by providing mental health medication management support to improve access and address PCMH patients' mental health needs.
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Renfro CP, Ferreri S, Barber TG, Foley S. Development of a Communication Strategy to Increase Interprofessional Collaboration in the Outpatient Setting. PHARMACY 2018; 6:E4. [PMID: 29316609 PMCID: PMC5874543 DOI: 10.3390/pharmacy6010004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022] Open
Abstract
Managing patient health is a complex task, requiring the support of an interprofessional healthcare team. Collaboration between neighboring community pharmacies and primary care practices can be an alternate solution for team-based patient care. The purpose of this project was to design and implement a communication strategy for patients with diabetes and hypertension between a community pharmacy and physician practice. An interprofessional team for the practice settings was formed to develop a strategy for collaboration. After agreeing on the common goals and target patient population for the disease states, the team devised a way to communicate via electronic health record (EHR). The communication strategy allowed for more frequent follow-up with the patients which has the potential to result in better clinical outcomes. A communication strategy between a community pharmacy and a physician practice office can be achieved using EHR technology. The greatest outcome of this project was the formation of the collaborative team between the practice settings that continues to work together on additional patient-centered initiatives. Further research is warranted to allow for incorporation of patient perspectives in development of communication strategies.
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Affiliation(s)
- Chelsea Phillips Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA.
| | - Stefanie Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | - Stephanie Foley
- UNC Family Medicine at Hillsborough, Hillsborough, NC 27278, USA.
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Luder HR, Shannon P, Kirby J, Frede SM. Community pharmacist collaboration with a patient-centered medical home: Establishment of a patient-centered medical neighborhood and payment model. J Am Pharm Assoc (2003) 2017; 58:44-50. [PMID: 29153853 DOI: 10.1016/j.japh.2017.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 07/07/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the feasibility of a partnership between a community pharmacy and a patient-centered medical home (PCMH) by measuring the impact on office- and patient-level clinical outcomes. SETTING Kroger Pharmacy and a PCMH practice in Cincinnati, OH. PRACTICE DESCRIPTION The Kroger Co. is a large grocery store chain that operates 102 pharmacies in the Cincinnati-Dayton marketing area. The PCMH practice is an accredited PCMH office serving more than 9000 patients in the Cincinnati area. PRACTICE INNOVATION In a medical neighborhood, a PCMH coordinates care with other local specialty practices or partners. A partnership between the community pharmacy chain and the PCMH was established to create a medical neighborhood. The pharmacist spent 2 half-days per week at the PCMH. The pharmacist provided initial medication therapy management appointments in the PCMH and offered follow-up services in the office, the pharmacy, or both, depending on patient preference. The pharmacy received a capitated payment per patient per month for a predetermined number of 1000 high-risk patients. MAIN OUTCOME MEASURES Office-level changes in clinical outcomes such as A1C, blood pressure, and lipid measures were collected and compared with those of a similar control office. In addition, patient-level outcomes such as change in A1C, blood pressure, lipids, and weight were measured. RESULTS One hundred five patients were seen by the pharmacist during the study period, with 1.5% of the total managed at the office. There was a statistically significant increase in influenza vaccinations received. On a patient level, A1C and systolic blood pressure significantly improved. CONCLUSION This project represents an exciting opportunity for community pharmacists to expand their scope of services through direct partnership with PCMHs and maintain a sustainable reimbursement structure.
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Coe AB, Choe HM. Pharmacists supporting population health in patient-centered medical homes. Am J Health Syst Pharm 2017; 74:1461-1466. [DOI: 10.2146/ajhp161052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Antoinette B. Coe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Hae Mi Choe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, and University of Michigan Medical Group, Ann Arbor, MI
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Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services. Res Social Adm Pharm 2017; 13:905-913. [PMID: 28666816 DOI: 10.1016/j.sapharm.2017.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Community pharmacies are an increasingly important health care setting with opportunities for improving quality and safety, yet little is understood about determinants of implementation in this setting. OBJECTIVE This paper presents an implementation framework for pharmacy based on the Consolidated Framework for Implementation Research (CFIR). METHODS This study employed a critical review of 45 articles on professional services provided in community pharmacies, including medication therapy management (MTM), immunizations, and rapid HIV testing. RESULTS The relevant domains and associated constructs for pharmacy services were as follows. Intervention Characteristics ultimately depend on the specific service; of particular note for pharmacy are relative advantage and complexity. The former because implementation of services can pose a cost-benefit challenge where dispensing is the primary role and the latter because of the greater challenge implementing multi-faceted services like MTM compared to a discrete service like immunizations. "In terms of Outer Setting, pharmacies are affected by patient needs and acceptance, and external policies and incentives such as reimbursement and regulations. For Inner Setting, structural characteristics like pharmacy type, size and staff were important as was pharmacists' perception of their role and available resources to provide the service. Key Characteristics of Individuals include training, preparedness, and self-efficacy of the pharmacist for providing a new service. Few studies revealed relevant Process constructs, but if they did it was primarily related to engaging (e.g., champions). CONCLUSIONS As pharmacists' roles in health care are continuing to expand, a framework to inform implementation research in community pharmacy (and other) settings is crucially needed.
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Moczygemba LR, Cox LS, Marks SA, Robinson MA, Goode JVR, Jafari N. Homeless patients' perceptions about using cell phones to manage medications and attend appointments. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:220-230. [PMID: 27896909 DOI: 10.1111/ijpp.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) describe homeless persons' access and use of cell phones and their perceptions about using cell phone alerts to help manage medications and attend health care appointments and (2) identify demographic characteristics, medication use and appointment history and perceptions associated with interest in receiving cell phone alerts to manage medications and appointments. METHODS A cross-sectional survey was conducted in 2013 at a homeless clinic in Virginia. The questionnaire comprised items about cell phone usage, ownership and functions such as text messaging. Participants reported medication use and appointment history, perceptions about cell phone alerts and interest in receiving alerts to manage medications and appointments. Descriptive statistics for all variables are reported. Logistic regression was used to examine predictors of interest in using a cell phone to manage medications and appointments. KEY FINDINGS A total of 290 participants completed the survey; 89% had a cell phone. Seventy-seven percent were interested in appointment reminders, whereas 66%, 60% and 54% were interested in refill reminders, medication taking reminders and medication information messages respectively. Those who believed reminders were helpful were more likely to be interested in medication taking, refill and appointment reminder messages compared to those who did not believe reminders were helpful. A history of running out of medicine and forgetting appointments were predictors of interest in refill and appointment reminders. CONCLUSIONS Mobile technology is a feasible method for communicating medication and appointment information to those experiencing or at risk for homelessness.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, TX, USA
| | - Lauren S Cox
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Samantha A Marks
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Margaret A Robinson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Jean-Venable R Goode
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Nellie Jafari
- Allegheny General Hospital, Health-System Pharmacy Administration Resident, Pittsburgh, PA, USA
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Fisher AM, Herbert MI, Douglas GP. Understanding the dispensary workflow at the Birmingham Free Clinic: a proposed framework for an informatics intervention. BMC Health Serv Res 2016; 16:69. [PMID: 26892780 PMCID: PMC4759722 DOI: 10.1186/s12913-016-1308-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/11/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Birmingham Free Clinic (BFC) in Pittsburgh, Pennsylvania, USA is a free, walk-in clinic that serves medically uninsured populations through the use of volunteer health care providers and an on-site medication dispensary. The introduction of an electronic medical record (EMR) has improved several aspects of clinic workflow. However, pharmacists’ tasks involving medication management and dispensing have become more challenging since EMR implementation due to its inability to support workflows between the medical and pharmaceutical services. To inform the design of a systematic intervention, we conducted a needs assessment study to identify workflow challenges and process inefficiencies in the dispensary. Methods We used contextual inquiry to document the dispensary workflow and facilitate identification of critical aspects of intervention design specific to the user. Pharmacists were observed according to contextual inquiry guidelines. Graphical models were produced to aid data and process visualization. We created a list of themes describing workflow challenges and asked the pharmacists to rank them in order of significance to narrow the scope of intervention design. Results Three pharmacists were observed at the BFC. Observer notes were documented and analyzed to produce 13 themes outlining the primary challenges pharmacists encounter during dispensation at the BFC. The dispensary workflow is labor intensive, redundant, and inefficient when integrated with the clinical service. Observations identified inefficiencies that may benefit from the introduction of informatics interventions including: medication labeling, insufficient process notification, triple documentation, and inventory control. Conclusions We propose a system for Prescription Management and General Inventory Control (RxMAGIC). RxMAGIC is a framework designed to mitigate workflow challenges and improve the processes of medication management and inventory control. While RxMAGIC is described in the context of the BFC dispensary, we believe it will be generalizable to pharmacies in other low-resource settings, both domestically and internationally. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1308-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arielle M Fisher
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Mary I Herbert
- Program for Health Care to Underserved Populations/Birmingham Free Clinic, Pittsburgh, PA, USA
| | - Gerald P Douglas
- Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Coe AB, Moczygemba LR, Gatewood SBS, Osborn RD, Matzke GR, Goode JVR. Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic. Res Social Adm Pharm 2015; 11:e110-20. [PMID: 23218849 PMCID: PMC3733792 DOI: 10.1016/j.sapharm.2012.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/16/2012] [Accepted: 11/16/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. OBJECTIVES To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. METHODS The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008-September 2009. Patients experiencing or at risk of homelessness who were ≥18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient's reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. RESULTS A total of 426 individuals met study criteria. The mean age was 44.7 ± 10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients' medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19-0.87) were less likely to have a medication adherence problem identified during the medication review. CONCLUSIONS The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.
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Affiliation(s)
- Antoinette B Coe
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States.
| | - Leticia R Moczygemba
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | - Sharon B S Gatewood
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | | | - Gary R Matzke
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
| | - Jean-Venable R Goode
- School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533, United States
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Patterson BJ, Kaboli PJ, Tubbs T, Alexander B, Lund BC. Rural access to clinical pharmacy services. J Am Pharm Assoc (2003) 2015; 54:518-25. [PMID: 25216881 DOI: 10.1331/japha.2014.13248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine the impact of rural residence and primary care site on use of clinical pharmacy services (CPS) and to describe the use of clinical telepharmacy within the Veterans Health Administration (VHA) health care system. METHODS Using 2011 national VHA data, the frequency of patients with CPS encounters was compared across patient residence (urban or rural) and principal site of primary care (medical center, urban clinic, or rural clinic). The likelihood of CPS utilization was estimated with random effects logistic regression. Individual service types (e.g., anticoagulation clinics) and delivery modes (e.g., telehealth) were also examined. RESULTS Of 3,040,635 patients, 711,348 (23.4%) received CPS. Service use varied by patient residence (urban: 24.9%; rural: 19.7%) and principal site of primary care (medical center: 25.9%; urban clinic: 22.5%; rural clinic: 17.6%). However, in adjusted analyses, urban-rural differences were explained primarily by primary care site and less so by patient residence. Similar findings were observed for individual CPS types. Telehealth encounters were common, accounting for nearly one-half of patients receiving CPS. Video telehealth was infrequent (<0.2%), but more common among patients of rural clinics than those receiving CPS at medical centers (odds ratio [OR] = 9.7; 95% CI 9.0-10.5). CONCLUSION We identified a potential disparity between rural and urban patients' access to CPS, which was largely explained by greater reliance on community clinics for primary care than on medical centers. Future research is needed to determine if this disparity will be alleviated by emerging organizational changes, including expanding telehealth capacity and integrating pharmacists into primary care teams, and whether lessons learned at VHA translate to other settings.
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Snyder ME, Earl TR, Gilchrist S, Greenberg M, Heisler H, Revels M, Matson-Koffman D. Collaborative drug therapy management: case studies of three community-based models of care. Prev Chronic Dis 2015; 12:E39. [PMID: 25811494 PMCID: PMC4375988 DOI: 10.5888/pcd12.140504] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider–pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management.
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Affiliation(s)
| | | | - Siobhan Gilchrist
- Applied Research and Evaluation Branch, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-72, Atlanta, GA 30341. . Siobhan Gilchrist is also affiliated with IHRC, Inc, Atlanta, Georgia. At the time the study was conducted, Ms Gilchrist was affiliated with Columbus Technologies and Services, Inc, Atlanta, Georgia
| | | | - Holly Heisler
- ICF International, Inc, Cambridge, Massachusetts.Ms Heisler was affiliated with ICF International, Inc, Atlanta, Georgia
| | | | - Dyann Matson-Koffman
- Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, Georgia. Dr Matson-Koffman was affiliated with the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Romanelli RJ, Leahy A, Jukes T, Ishisaka DY. Pharmacist-led medication management program within a patient-centered medical home. Am J Health Syst Pharm 2015; 72:453-9. [DOI: 10.2146/ajhp140487] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Robert J. Romanelli
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, and Clinical Outcomes Research, Clinical Integration Department, Sutter Health, Sacramento, CA
| | - Angela Leahy
- Clinical Outcomes Research, Clinical Integration Department, Sutter Health
| | - Trevor Jukes
- Clinical Outcomes Research, Clinical Integration Department, Sutter Health
| | - Denis Y. Ishisaka
- Clinical Outcomes Research, Clinical Integration Department, Sutter Health
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Chan V, Patounas M, Dornbusch D, Tran H, Watson P. Is there a role for pharmacists in multidisciplinary health-care teams at community outreach events for the homeless? Aust J Prim Health 2015; 21:379-83. [PMID: 25719905 DOI: 10.1071/py14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/31/2014] [Indexed: 11/23/2022]
Abstract
Homelessness is a significant public health problem. It is well-documented that people experiencing homelessness exhibit more serious illnesses and have poorer health than the general population. The provision of services and interventions by health-care professionals, including pharmacists, may make a simple yet important contribution to improved health outcomes in those experiencing homelessness, but evidence of roles and interventions is limited and variable. In Australia, the Queensland University of Technology Health Clinic connects with the homeless community by taking part in community outreach events. This paper provides details of one such event, as well as the roles, interventions and experiences of pharmacists. Participation and inclusion of pharmacists in a multidisciplinary health-care team approach at homeless outreach events should be supported and encouraged.
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Patterson BJ, Solimeo SL, Stewart KR, Rosenthal GE, Kaboli PJ, Lund BC. Perceptions of pharmacists' integration into patient-centered medical home teams. Res Social Adm Pharm 2015; 11:85-95. [DOI: 10.1016/j.sapharm.2014.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/17/2022]
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Rubio-Valera M, Chen TF, O'Reilly CL. New roles for pharmacists in community mental health care: a narrative review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10967-90. [PMID: 25337943 PMCID: PMC4211017 DOI: 10.3390/ijerph111010967] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/30/2014] [Accepted: 10/07/2014] [Indexed: 02/05/2023]
Abstract
Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. This narrative review aims to describe the evidence for pharmacist-delivered services in mental health care and address the barriers and facilitators to increasing the uptake of pharmacist services as part of the broader mental health care team. This narrative review is divided into three main sections: (1) the role of the pharmacist in mental health care in multidisciplinary teams and in supporting early detection of mental illness; (2) the pharmacists' role in supporting quality use of medicines in medication review, strategies to improve medication adherence and antipsychotic polypharmacy, and shared decision making; and (3) barriers and facilitators to the implementation of mental health pharmacy services with a focus on organizational culture and mental health stigma. In the first section, the review presents new roles for pharmacists within multidisciplinary teams, such as in case conferencing or collaborative drug therapy management; and new roles that would benefit from increased pharmacist involvement, such as the early detection of mental health conditions, development of care plans and follow up of people with mental health problems. The second section describes the impact of medication review services and other pharmacist-led interventions designed to reduce inappropriate use of psychotropic medicines and improve medication adherence. Other new potential roles discussed include the management of antipsychotic polypharmacy and involvement in patient-centered care. Finally, barriers related to pharmacists' attitudes, stigma and skills in the care of patients with mental health problems and barriers affecting pharmacist-physician collaboration are described, along with strategies to reduce mental health stigma.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Fundació Sant Joan de Déu, Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Barcelona 08830, Spain.
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
| | - Claire L O'Reilly
- Faculty of Pharmacy, The University of Sydney, Sydney 2006, Australia.
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Kelly MS, Moczygemba LR, Gatewood SS. Concordance of Pharmacist Assessment of Medication Nonadherence With a Self-Report Medication Adherence Scale. J Pharm Pract 2014; 29:194-8. [PMID: 25312260 DOI: 10.1177/0897190014550003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the concordance of the Modified Morisky Scale (MMS) with a pharmacist assessment of medication adherence during a medication review. METHODS This retrospective study examined the electronic medical records (EMRs) of patients ≥18 years who received a medication review by a pharmacist from October 2008 to September 2009 at a homeless behavioral health clinic. In addition to the 6-item MMS, adherence was assessed using the first 4 items of the MMS, which comprise the original Morisky Scale. A final pharmacist assessment of adherence based upon the medication review was documented in the EMR. The McNemar test was used to assess the agreement between the MMS (6 and 4 items) and the pharmacist assessment of medication adherence. RESULTS A total of 288 patients were eligible for the study, which included 449 medication reviews. Nonadherence was identified in 61.7% and 49.7% of medication reviews using the 6 and 4 items of the MMS. The pharmacist assessment determined nonadherence in 23.8% of medication reviews. There were significant differences between the pharmacist adherence assessment and the 6 (P < .0001) and 4 (P < .0001) items of the MMS. CONCLUSION A combination of methods including self-report and pharmacist assessment may provide the greatest insight into adherence.
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Affiliation(s)
- Michael S Kelly
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Leticia R Moczygemba
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Sharon S Gatewood
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
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Maxwell L, Odukoya OK, Stone JA, Chui MA. Using a conflict conceptual framework to describe challenges to coordinated patient care from the physicians' and pharmacists' perspective. Res Social Adm Pharm 2013; 10:824-836. [PMID: 24440119 DOI: 10.1016/j.sapharm.2013.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND In an effort to increase cost-effectiveness of health care and reduce overall costs, patient-centered medical homes have been proposed to spur fundamental changes in the way primary care is delivered. One of the chief principles that describe a patient-centered medical home is that care is organized across all elements of the broader health care system, including community pharmacies. OBJECTIVES To identify and describe challenges derived from a conflict management framework to a physician-pharmacist approach to coordinating patient care. METHODS A descriptive, exploratory, non-experimental study was conducted in Wisconsin (U.S. State) from June to December, 2011. Data were collected through two rounds of face-to-face interviews with physicians and community pharmacists. The first round involved one-on-one interviews with pharmacists and physicians. The second round brought pharmacist-physician dyads together in an open-ended interview exploring issues raised in the first round. Content analysis was guided by a conflict management conceptual framework using NVivo 10 qualitative software. RESULTS A total of four major themes emerged from the conflict analysis of interviews that illustrate challenges to coordinated patient care: Scarce resources, technology design and usability, insurance constraints, and laws and policy governing patient care. The study findings indicate that both groups of health care professionals work within an environment of conflict and have to negotiate the challenges and strains that exist in the current health care system. Their need to work together, or interdependence, is primarily challenged by scarce resources and external interference. CONCLUSIONS Efforts to coordinate patient care through teams of inter-professional health care providers will be more successful if they acknowledge the inherent conflict that exists. Efforts should be made to provide an infrastructure for interdependence and to support interpersonal communication.
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Affiliation(s)
- Leigh Maxwell
- Department of Communication Studies, Edgewood College, Madison, WI 53711, USA
| | - Olufunmilola K Odukoya
- Department of Pharmacy and Therapeutics, University of Pittsburgh, School of Pharmacy, Pittsburgh, PA 15261, USA
| | - Jamie A Stone
- Social & Administrative Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
| | - Michelle A Chui
- Social & Administrative Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA.
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Congdon HB, Dowling TC, Cheng I, Truong HA. Impact of Medication Therapy Management on Underserved, Primarily Hispanic Patients with Diabetes. Ann Pharmacother 2013; 47:665-70. [DOI: 10.1345/aph.1r648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Diabetes-related complications are more pronounced in Hispanic patients versus patients of other ethnicities. It is documented that medication therapy management (MTM) can improve diabetes outcomes; however, data regarding Hispanic patients are limited. OBJECTIVE To evaluate the impact of MTM on hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in underserved, primarily Hispanic patients who use a safety-net clinic as their medical home. METHODS A retrospective, observational study of uninsured, primarily Hispanic patients with diabetes who received MTM from October 2009 through March 2011. Patients were stratified into 2 cohorts: A1C less than 9% and A1C greater than or equal to 9%. Patients were also stratified by frequency of MTM visits and insulin use, regardless of A1C. A chart review was conducted to evaluate diabetes-related outcomes pre- and postimplementation of MTM. The primary study outcome was reduction of A1C. Secondary outcomes included reduction of BP and LDL-C and reduction of A1C based on MTM visit frequency or insulin use. RESULTS Sixty-four patients with at least 1 MTM visit and pre- and postimplementation A1C data were included. In the cohort with A1C greater than or equal to 9%, mean (SD) A1C values decreased from 10.9% (1.4%) to 8.8% (1.5%) versus the cohort with A1C less than 9%, whose A1C changed minimally, from 7.2% (0.9%) to 7.4% (1.4%). Regardless of their A1C, patients who were using insulin at baseline had a change in A1C of −0.8% (1.5%) versus −0.1% (1.6%) in those who were not using insulin at baseline (p = 0.04); patients who participated in multiple MTM visits had a significant reduction in A1C, from 9% to 8.3% (95% CI −1.26 to −0.03; p = 0.02) compared with patients participating in only 1 MTM visit. CONCLUSIONS Pharmacist-provided MTM can significantly improve diabetes control in uninsured, primarily Hispanic patients with poorly controlled diabetes and in those who are using insulin. Multiple MTM visits also yielded significant A1C reductions.
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Affiliation(s)
- Heather B Congdon
- Heather B Congdon PharmD BCPS CDE, Assistant Dean and Assistant Professor of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Shady Grove Campus, Rockville
| | - Thomas C Dowling
- Thomas C Dowling PharmD PhD FCCP, Associate Professor and Vice Chair of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore
| | - Iliana Cheng
- Iliana Cheng PharmD MPH, at time of study, PharmD Student, School of Pharmacy, University of Maryland, Baltimore; now, Pharmacist, MedImmune, Gaithersburg, MD
| | - Hoai-An Truong
- Hoai-An Truong PharmD MPH AE-C, at time of study, Assistant Director, Experiential Learning Program and Assistant Professor of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore; now, Assistant Dean for Professional Affairs and Associate Professor of Pharmacy Practice and Administration, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Princess Anne
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Moczygemba LR, Barner JC, Gabrillo ER. Outcomes of a Medicare Part D telephone medication therapy management program. J Am Pharm Assoc (2003) 2012; 52:e144-52. [DOI: 10.1331/japha.2012.11258] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Marks SA, Moczygemba LR, Gatewood SB, Osborn RD, Wallace N, Lakhani S, Matzke GR, Goode JVR. The relationship between medication-related problems and behavioural health condition among patients served by a health care for the homeless centre. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2012. [DOI: 10.1111/j.1759-8893.2012.00091.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
To evaluate the association between behavioural health conditions and the presence of a medication-related problem (MRP) and the association between the type of MRP and the presence of a dual diagnosis.
Methods
We used an existing database from a behavioural health clinic for homeless persons. Logistic regression was used to assess the relationship between the type of behavioural health condition and MRP presence, and whether the type of MRP varied with the presence of a dual diagnosis.
Key findings
A total of 426 patients were eligible. The majority were black (61%) and women (53%). Patients were 44.7 ± 10.2 years old, taking 3.4 ± 2.4 medications and had 2.3 ± 0.9 behavioural health conditions. The majority (53%) had a dual diagnosis, 44% had depression, 30% had a bipolar disorder, 26% had a personality disorder and 12% had an anxiety disorder. Bipolar [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.8–8.9] and anxiety disorders (OR 3.1, CI 1.0–9.2) and a dual diagnosis (OR 2.1, CI 1.2–3.8) were independently associated with the presence of an MRP. Patients with a dual diagnosis were more likely to have ineffective drug therapy (OR 1.7, CI 1.1–2.8) and less likely to have an adverse effect (OR 0.5, CI 0.3–0.9).
Conclusions
Patients with bipolar or anxiety disorders and/or a dual diagnosis may benefit from a pharmacist intervention to address MRPs. Pharmacists can make recommendations to improve the effectiveness of patients' medication therapy and help to resolve adverse effects.
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Affiliation(s)
| | - Leticia R. Moczygemba
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University
| | - Sharon B.S. Gatewood
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University
| | | | | | | | - Gary R. Matzke
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University
| | - Jean-Venable R. Goode
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University
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Dolovich L. Ontario Pharmacists Practicing in Family Health Teams and the Patient-Centered Medical Home. Ann Pharmacother 2012; 46:S33-9. [DOI: 10.1345/aph.1q804] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The patient-centered medical home (PCMH) approach continues to gather momentum in the United States and Canada as a broad approach to reform the delivery of the complete primary care system. The family health team (FHT) model implemented in Ontario, Canada, best mirrors the PCMH approach of the United States. The integration of pharmacists as key members of the health care team providing on-site, in-office coordinated care to FHT patients was included from the start of planning the FHT model and represents a substantial opportunity for pharmacists to realize their professional vision. Several research projects in Canada and elsewhere have contributed to providing evidence to support the integration of pharmacists into primary care practice sites. Two major research programs, the Seniors Medication Assessment Research Trial (SMART) cluster randomized controlled trial and the Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) multipronged demonstration project made substantial contributions to evidence-informed policy decisions supporting the integration of pharmacists into FHTs. These projects can provide useful information to support the integration of pharmacists into the PCMH and to encourage further research to better measure the effect of the pharmacist from the holistic patient-centered perspective.
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Affiliation(s)
- Lisa Dolovich
- McMaster University, Department of Family Medicine, 175 Longwood Road S., Suite 201 A, Hamilton, Ontario, Canada, L8P 0A1
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Haga SB, Kawamoto K, Agans R, Ginsburg GS. Consideration of patient preferences and challenges in storage and access of pharmacogenetic test results. Genet Med 2011; 13:887-90. [PMID: 21673581 PMCID: PMC3731746 DOI: 10.1097/gim.0b013e31822077a5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Pharmacogenetic testing is one of the primary drivers of personalized medicine. The use of pharmacogenetic testing may provide a lifetime of benefits through tailoring drug dosing and selection of multiple medications to improve therapeutic outcomes and reduce adverse responses. We aimed to assess public interest and concerns regarding sharing and storage of pharmacogenetic test results that would facilitate the reuse of pharmacogenetic data across a lifetime of care. METHODS We conducted a random-digit-dial phone survey of a sample of the US public. RESULTS We achieved an overall response rate of 42% (n = 1139). Most respondents indicated that they were extremely or somewhat comfortable allowing their pharmacogenetic test results to be shared with other doctors involved in their care management (90% ± 2.18%); significantly fewer respondents (74% ± 3.27%) indicated that they were extremely or somewhat comfortable sharing results with their pharmacist (P < 0.0001). CONCLUSION Patients, pharmacists, and physicians will all be critical players in the pharmacotherapy process. Patients are supportive of sharing pharmacogenetic test results with physicians and pharmacists and personally maintaining their test results. However, further study is needed to understand which options are needed for sharing, appropriate storage, and patient education about the relevance of pharmacogenetic test results to promote consideration of this information by other prescribing practitioners.
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Affiliation(s)
- Susanne B Haga
- Institute for Genome Sciences & Policy and Sanford School of Public Policy, Duke University, Durham, NC 27708, USA.
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Mehta BH, Snyder ME, Nikitas A. Developing collaborative relationships between pharmacists and other health professionals. J Am Pharm Assoc (2003) 2011; 51:332-8. [DOI: 10.1331/japha.2011.11518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Douglas Ried L. Home sweet medical home. J Am Pharm Assoc (2003) 2011; 51:152. [DOI: 10.1331/japha.2011.11515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gatewood SBS, Moczygemba LR, Alexander AJ, Osborn RD, Reynolds-Cane DL, Matzke GR, Goode JVR. Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons. Innov Pharm 2011; 2:1-7. [PMID: 22259752 PMCID: PMC3258539 DOI: 10.24926/iip.v2i1.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need. Pharmacist services are provided in the mental health and medical clinics. A satisfaction survey showed that the providers and staff (n = 13) in the clinic were very satisfied with the integration of pharmacist services. The quality and safety of medication use has improved as a result of the academic-community collaborative. Education and research initiatives have also resulted from the collaborative. This manuscript describes the implementation, outcomes and benefits of the partnership for both the HCH clinic and the school of pharmacy.
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Affiliation(s)
- Sharon B S Gatewood
- Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University
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