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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Gillette C, Bodner G, Grant J, Aldrich R, Mospan C, Ip EHS, Daniel S, Crandall S. PAs' attitudes about adolescent suicide screening: The Theory of Planned Behavior. JAAPA 2021; 34:38-45. [PMID: 34608015 DOI: 10.1097/01.jaa.0000794968.09686.b3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Suicide is an increasing public health problem for adolescents and young adults. The purpose of this study was to identify the frequency of physician assistants' (PAs') self-reported adolescent suicide risk assessments and to elicit salient beliefs regarding behavioral attitudes, norm referents, control factors, and intention to conduct suicide risk assessment with adolescents. METHODS A convenience sample of PAs completed an anonymous cross-sectional questionnaire. Relationships were assessed using bivariate analyses and qualitative theme analysis. RESULTS Forty-three PAs completed the questionnaire. Many PAs supported suicide risk assessment screening as a strategy to identify adolescents who are suicidal at an earlier stage of their illness; lack of time during the visit and problematic parental involvement were identified as barriers. CONCLUSIONS PAs recognized that screening adolescents for suicide ideation may help prevent suicides. Their practice behaviors, however, did not correspond to this belief.
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Affiliation(s)
- Chris Gillette
- In the PA program at Wake Forest School of Medicine in Winston-Salem, N.C., Chris Gillette is an associate professor and assistant director of research and scholarship, Gayle Bodner is an assistant professor and director of clinical education, and Jill Grant is an assistant professor and director of the Office of Academic Excellence. Rosalie Aldrich is the John and Corinne Graf Professor in the Department of Communication Studies at Indiana University East in Richmond, Ind. Cortney Mospan is an assistant professor in the School of Pharmacy at Wingate (N.C.) University. Edward Hak-Sing Ip is a professor in the Department of Social Sciences and Health Policy at Wake Forest School of Medicine. Stephanie Daniel is a professor in the Department of Family Medicine at Wake Forest School of Medicine. Sonia Crandall is a professor and director of research and scholarship in the PA program at Wake Forest School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Hernández-Muñoz JJ, Kamdar CR, Zhong L, Alonzo J, Sprenger L. Impact of a pharmaceutical care incentive program on the asthma medication ratio among pediatric patients with persistent asthma enrolled in a Medicaid program. J Manag Care Spec Pharm 2021; 27:714-723. [PMID: 34057388 PMCID: PMC10391139 DOI: 10.18553/jmcp.2021.27.6.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Asthma is one of the leading chronic disease states in pediatric patients in Texas. Pharmacy-led interventions such as targeted asthma education, scheduled consultations, and monitoring have shown success in improving asthma outcomes. However, no studies have evaluated the impact of the pharmaceutical care incentive (PCI) programs on Texas Medicaid pediatric beneficiaries. OBJECTIVES: To (1) describe the prevalence of asthma medication utilization and persistent asthma among Medicaid pediatric patients in Texas Health Service Region 11 (HSR 11) and (2) describe the prevalence and impact of PCI program interventions offered by pharmacists to Medicaid pediatric patients or their caregivers at the point-of-service in their medication utilization and asthma medication ratio (AMR). METHODS: This study used a 2-year longitudinal assessment of Medicaid pharmacy claims for beneficiaries aged between 0 and 18 years, with continuous enrollment, and at least 1 asthma medication claim during 2018 and 2019. The prevalence of asthma medication utilization during the study period was described. Also, the prevalence of PCI interventions among beneficiaries with at least 1 asthma medication was described. The prevalence of PCI interventions was also estimated for beneficiaries with persistent asthma. The AMR for beneficiaries with persistent asthma was calculated and compared for those with and without at least 1 PCI intervention. RESULTS: 22,051 beneficiaries with continuous enrollment between the ages of 0 and 18 years and with at least 1 pharmacy claim for an asthma medication during the study period were included. The overall prevalence of asthma medication utilization was 14.55%. 374 (1.70%) beneficiaries with at least 1 asthma medication received at least 1 asthma PCI intervention. Among beneficiaries that received at least 1 asthma PCI intervention, 158 (42.25%) were on rescue medication only; 4 (1.07%) were on maintenance medication only; and 212 (56.68%) were on rescue and maintenance medications. The overall prevalence of persistent asthma was 4.86%. 52 (0.76%) persistent asthma cases received at least 1 asthma PCI intervention after the index date. The overall unadjusted mean AMR (SD) for the 6,885 beneficiaries with persistent asthma was 0.50 (0.19). The adjusted AMR (SD) among beneficiaries with persistent asthma was reported at 0.530 (0.026) for beneficiaries who received at least 1 PCI intervention and 0.483 (0.002) for beneficiaries who did not receive a PCI intervention (P = 0.066). Beneficiaries with persistent asthma generated 64.35% of the total asthma pharmacy claims during 2019. CONCLUSIONS: Despite a high utilization of asthma medications among Medicaid pediatric beneficiaries, pharmacists servicing this group are underusing the PCI program interventions. An increase in the AMR among patients with persistent asthma receiving PCI interventions was observed when compared with those without PCI interventions. However, the difference was not statistically significant. Subsequent studies should include larger groups of beneficiaries receiving PCI interventions to establish the effect of PCI interventions on AMR before widespread implementation. DISCLOSURES: This research project was supported by the Global Institute for Hispanic Health (GIHH) through research grant M1803961. The authors have nothing to disclose. A part of this study was presented as a poster at the AMCP 2020 Virtual Annual Meeting and Exposition Meeting, April 21-24, 2020.
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Affiliation(s)
- José J Hernández-Muñoz
- Pharmaceutical Sciences Department, Irma L. Rangel College of Pharmacy, Texas A&M University, College Station
| | - Chandni R Kamdar
- Pharmaceutical Sciences Department and Pharmacy Practice Department, Irma L. Rangel College of Pharmacy, Texas A&M University, College Station
| | - Lixian Zhong
- Pharmaceutical Sciences Department, Irma L. Rangel College of Pharmacy, Texas A&M University, College Station
| | - Joy Alonzo
- Pharmacy Practice Department, Irma L. Rangel College of Pharmacy, Texas A&M University, College Station
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Gillette C, Rockich-Winston N, Shepherd M, Flesher S. Children with asthma and their caregivers help improve written asthma action plans: A pilot mixed-method study. J Asthma 2017; 55:609-614. [PMID: 28759273 DOI: 10.1080/02770903.2017.1355379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objectives of this study were to (a) qualitatively examine caregiver and child feedback about a gold standard written asthma action plan (WAAP), and (b) determine whether having an asthma action plan was associated with child and caregiver self-efficacy in managing an exacerbation. METHODS This was a cross-sectional analysis of structured interviews with 22 children with persistent asthma that collected feedback about the WAAP as well as self-efficacy. An analysis of interviews used the constant comparative method to identify themes of child and caregiver statements. Caregivers completed a questionnaire that measured asthma management self-efficacy, barriers to managing asthma, and belief in the treatment efficacy using validated scales. RESULTS Approximately 36% of the caregivers reported having a WAAP for their child from their child's pediatrician. Most caregivers stated that having pictures would improve the WAAP, while most children stated that the layout needed to be improved by adding more space between the sections. Caregivers who reported knowing what the asthma action plan was had greater self-efficacy than caregivers who did not (z = -1.99, p = 0.047). CONCLUSIONS Re-designing the current WAAP layout and including pictures of inhalers may promote patient understanding. Future research needs to examine if a re-designed WAAP improves asthma management of children with asthma and their caregivers.
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Affiliation(s)
- Chris Gillette
- a School of Pharmacy , Wingate University , Wingate , NC , USA
| | - Nicole Rockich-Winston
- a School of Pharmacy , Wingate University , Wingate , NC , USA.,c School of Pharmacy , Marshall University , Huntington , WV , USA
| | - Meagan Shepherd
- b Joan C. Edwards School of Medicine , Marshall University , Huntington , WV , USA
| | - Susan Flesher
- b Joan C. Edwards School of Medicine , Marshall University , Huntington , WV , USA
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Evaluation of a pharmacist-managed asthma clinic in an Indian Health Service clinic. J Am Pharm Assoc (2003) 2017; 56:237-41. [PMID: 27156940 DOI: 10.1016/j.japh.2015.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To observe whether American Indian and Alaskan Native (AI/AN) patients at the Yakama Indian Health Service seen at the pharmacist-managed asthma clinic improved asthma outcomes. DESIGN Retrospective chart review, single group, preintervention and postintervention. SETTING Pharmacist-managed asthma clinic at an Indian Health Service ambulatory care clinic. PATIENTS Sixty-one AI/AN patients who were seen at least once in the asthma clinic from 2010 to 2014. INTERVENTION Pharmacist-provided asthma education and medication management. MAIN OUTCOME MEASURES Asthma-related hospitalizations and emergency department or urgent care (ED) visits. RESULTS The total number of asthma-related hospitalizations and ED visits between the 12-month periods preceding and following the initial asthma clinic visit were 11 versus 2 hospitalizations (P = 0.02) and 43 versus 25 ED visits (P = 0.02), respectively. Over the same period, asthma-related oral corticosteroid use showed a nonsignificant decrease in the number of prescriptions filled (n = 59, P = 0.08). In contrast, inhaled corticosteroid prescription fills significantly increased (n = 42, P = 0.01). CONCLUSION A reduction of asthma-related hospitalizations and ED visits were observed during the course of the intervention. Increased access to formal asthma education and appropriate asthma care benefit the Yakama AI/AN people. A controlled trial is needed to confirm that the intervention causes the intended effect.
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Abraham O, Brothers A, Alexander DS, Carpenter DM. Pediatric medication use experiences and patient counseling in community pharmacies: Perspectives of children and parents. J Am Pharm Assoc (2003) 2017; 57:38-46.e2. [DOI: 10.1016/j.japh.2016.08.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
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Guo M, Gao G, Guo J, Wen L, Zeng L. Burden among caregivers for children with asthma: A mixed-method study in Guangzhou, China. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Klok T, Kaptein AA, Brand PLP. Non-adherence in children with asthma reviewed: The need for improvement of asthma care and medical education. Pediatr Allergy Immunol 2015; 26:197-205. [PMID: 25704083 DOI: 10.1111/pai.12362] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 12/31/2022]
Abstract
Adherence to daily inhaled corticosteroid therapy is a key determinant of asthma control. Therefore, improving adherence to inhaled corticosteroids is the most effective method through which healthcare providers can help children with uncontrolled asthma. However, identifying non-adherent patients is difficult, and electronic monitoring is the only reliable method to assess adherence. (Non-)adherence is a complex behavioural process influenced by many interacting factors. Intentional barriers to adherence are common; driven by illness perceptions and medication beliefs, patients and parents deliberately choose not to follow the doctor's recommendations. Common non-intentional barriers are related to family routines, child-raising issues, and to social issues such as poverty. Effective interventions improving adherence are complex, because they take intentional and non-intentional barriers to adherence into account. There is evidence that comprehensive, guideline-based asthma self-management programmes can be successful, with excellent adherence and good asthma control. Patient-centred care focused on healthcare provider-patient/parent collaboration is the key factor determining the success of guided self-management programmes. Such care should focus on shared decision-making as this has been shown to improve adherence and healthcare outcomes. Current asthma care falls short because many physicians fail to adhere to asthma guidelines in their diagnostic approach and therapeutic prescriptions, and because of the lack of application of patient-centred health care. Increased awareness of the importance of patient-centred communication and increased training in patient-centred communication skills of undergraduates and experienced attending physicians are needed to improve adherence to daily controller therapy and asthma control in children with asthma.
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Affiliation(s)
- Ted Klok
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.,Princess Amalia Children's Center, Isala Hospital, Zwolle, the Netherlands
| | - Adrian A Kaptein
- Unit of Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, the Netherlands.,UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, Groningen, the Netherlands
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