1
|
Costa S, Biscaia JL, Horta MR, Romano S, Guerreiro J, Heudtlass P, Cary M, Romão M, Teixeira Rodrigues A, Miranda A, Martins AP, Bento AS, Pereira J, Mateus C, Helling DK. Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management between Pharmacies and Primary Care in Portugal: A Multicenter Pragmatic Controlled Trial (USFarmácia ®). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6496. [PMID: 37569036 PMCID: PMC10418740 DOI: 10.3390/ijerph20156496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
There is evidence of the efficacy of collaborative health interventions with pharmacies and primary care providers but little of its real-world effectiveness. We aimed to assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care providers using real-world data exchange between providers and experimental bundled payment. This was a pragmatic, quasi-experimental controlled trial. We collected patient-level data from primary care prescription claims and Electronic Medical Record databases, a pharmacy claims database, and patient telephone surveys at several time points. The primary outcomes were changes in blood pressure and total cholesterol. We used matched controls with difference-in-differences estimators in a Generalized Linear Model (GLM) and controlled interrupted time series (CITS). We collected additional data for economic and qualitative studies. A total of 6 Primary Care Units, 20 pharmacies, and 203 patients entered the study. We were not able to observe significant differences in the effect of intervention vs. control. We experienced challenges that required creative strategies. This real-world trial was not able to show effectiveness, likely due to limitations in the primary care technology which affected the sample size. It offers, however, valuable lessons on methods, strategies, and data sources, paving the way for more real-world effectiveness trials to advance value-based healthcare.
Collapse
Affiliation(s)
- Suzete Costa
- NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Institute for Evidence-Based Health (ISBE), 1649-028 Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - José Luís Biscaia
- USF São Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, 3080-134 Figueira da Foz, Portugal
| | - Maria Rute Horta
- Centre for Medicines Information and Health Interventions (CEDIME), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Sónia Romano
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Peter Heudtlass
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Mariana Romão
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Ana Miranda
- Registo Oncológico Nacional, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
| | - Ana Paula Martins
- Institute for Evidence-Based Health (ISBE), 1649-028 Lisboa, Portugal
- Pharmacy, Pharmacology & Health Technologies, Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal
| | - Ana Sofia Bento
- USF São Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, 3080-134 Figueira da Foz, Portugal
| | - João Pereira
- NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), 1600-560 Lisboa, Portugal
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster LA1 4YX, UK
| | - Dennis K. Helling
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO 80045, USA
| |
Collapse
|
2
|
McKay C, Vest MH, Doligalski C, Summerlin CM, Alexander MD, Deyo ZM, Valgus JM, Waldron KM. Implementation and results of a standardized process for identifying ambulatory pharmacy clinical outcome measures. Am J Health Syst Pharm 2023; 80:860-867. [PMID: 36967551 DOI: 10.1093/ajhp/zxad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023] Open
Abstract
PURPOSE Given the variation in clinical practice, a clinician-centric, standardized process to implement and validate clinical pharmacy outcome measures was developed. SUMMARY Four specialty clinics with embedded clinic-based pharmacists underwent an iterative process to define, refine, and implement the build of electronic health record functionality for outcome measure data collection and reporting. Starting with a list of identified measures, clinic workgroups met to discuss each measure and identify gaps in measure implementation. Information technology experts created electronic documentation forms with discrete data and reports based on criteria specified by the clinic workgroups. Of 32 outcome measures identified as priorities for demonstrating pharmacists' impact in previous research, 29 were implemented for routine monitoring through this project. Implementation strategies included identification through existing reporting, development of discrete documentation tools within the electronic health record, and development of new reporting tools from available discrete data fields. Time to implementation decreased from the first to the last pilot clinic implementation, as demonstrated through a 9-day reduction in electronic documentation form development and 31-day reduction in report development turnaround time. CONCLUSION A standardized and reproducible process was developed for the implementation of clinical pharmacy outcomes measures for 4 specialty clinics. The process was successfully utilized to develop measurable outputs for a variety of oncology and nononcology specialty disease states based upon multidisciplinary stakeholder input.
Collapse
Affiliation(s)
- Connor McKay
- MUSC University Medical Center, Charleston, SC, USA
| | | | | | | | | | | | - John M Valgus
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | |
Collapse
|
3
|
AlAhmad MM, ZainAlAbdin S, AlAhmad K, AlAhmad I, AbuRuz S. Value of the clinical pharmacist interventions in the application of the American College of Cardiology (ACC/AHA) 2018 guideline for cholesterol management. PLoS One 2023; 18:e0283369. [PMID: 36972252 PMCID: PMC10042341 DOI: 10.1371/journal.pone.0283369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES The study aims to examine the extent to which the updated ACC/AHA management of blood cholesterol guideline (2018) is implemented in practice and to assess the value of the clinical pharmacist interventions in improving physicians' adherence the guidelines recommendations. METHODS We utilized in this study an interventional before-after design. The study was conducted on 272 adult patients who visited the study site internal medicine clinics and were candidates for statin therapy based on the 2018 ACC/AHA guidelines for cholesterol management. Adherence to guideline recommendations was measured before and after clinical pharmacists' interventions by calculating the percentage of patients receiving statin therapy as per guideline recommendation, the type and intensity (moderate or high intensity) of statin therapy used, and the need for additional non-statin therapy. RESULTS Adherence with guideline recommendations was significantly improved from 60.3% to 92.6% (X2 = 79.1, p = 0.0001) after clinical pharmacist interventions. Among patients who were on statin therapy, the percentage of those who were on proper statin intensity increased significantly from 47.6% to 94.4% (X2 = 72.5, p = 0.0001). The combination of statins with non-statin therapies such as ezetimibe and PCSK9 inhibitors increased from 8.5% to 30.6% (X2 = 95, p<0.0001) and from 0.0% to 1.6% (X2 = 6, p = 0.014), respectively. The use of other lipid-lowering agents was diminished from 14.6% to 3.2% (X2 = 19.2, p<0.0001). CONCLUSION Collaboration between physicians and clinical pharmacists is a crucial strategy to improve patients' treatment and hence, achieve better health outcomes among patients suffering from dyslipidemia.
Collapse
Affiliation(s)
- Mohammad M AlAhmad
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Sham ZainAlAbdin
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Iqbal AlAhmad
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Salah AbuRuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
| |
Collapse
|
4
|
Alabkal RM, Medlinskiene K, Silcock J, Graham A. Impact of Pharmacist-Led Interventions to Improve Clinical Outcomes for Adults With Type 2 Diabetes at Risk of Developing Cardiovascular Disease: A Systematic Review and Meta-analysis. J Pharm Pract 2022:8971900211064459. [PMID: 35579209 DOI: 10.1177/08971900211064459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis of randomised controlled trials is to evaluate the impact of pharmacist-led interventions on cardiovascular disease (CVD) risk factors among patients with type 2 diabetes. METHOD A literature review was conducted according to PRISMA guidelines using 4 electronic databases: Embase, MEDLINE, CINHAL and the Cochrane Central Register of Controlled Trials. We searched for pharmacist interventions among adults with type 2 diabetes and cardiovascular disease in randomised controlled trials from inception to May 2021 in primary care, diabetes clinics and hospitals. The clinical outcomes measured glycosylated haemoglobin (HbA1c), blood pressure (BP) and lipid profile. The non-clinical outcomes included medication adherence, smoking, health-related quality of life and the cost of the intervention. For the meta-analysis, clinical outcomes were pooled with the random effect model in RevMan 5.3. The Cochrane risk-of-bias tool was used to assess the quality of the included studies. RESULTS We retrieved 223 studies,141 of which were included in the review. Ten published articles met the inclusion criteria and were included in the meta-analysis. The pharmacists delivered the interventions alone or collaboratively with other healthcare professionals in hospitals or similar settings. The overall result showed a significant reduction in HbA1c (n = 10; standard deviation in mean value [SDM]: -.53%, 95% CI: -.84, -.23) and systolic BP (n = 10; [SDM]: -.35 mmHg, 95% CI: -.51, -.20) in pharmacist intervention groups. For the non-clinical outcomes, the review revealed variable results from pharmacist intervention compared with those standard care. CONCLUSION Pharmacy interventions provide evidence for pharmacists' decisive role in diabetes care management and reducing cardiovascular risk factors among adults with type 2 diabetes.
Collapse
Affiliation(s)
- Rahma M Alabkal
- School of Pharmacy, Faculty of Life Sciences, 1905University of Bradford, Bradford, UK
| | - Kristina Medlinskiene
- Pharmacy Doctoral Training Fellow, Faculty of Life Sciences, 1905University of Bradford, Bradford, UK
| | - Jonathan Silcock
- Senior Lecturer in Pharmacy Practice, Faculty of Life Sciences, 1905University of Bradford, Bradford, UK
| | - Anne Graham
- Associate Dean (Research & Knowledge Transfer), Faculty of Life Sciences, 1905University of Bradford, Bradford, UK
| |
Collapse
|
5
|
Khettar S, Jacquin Courtois S, Luaute J, Decullier E, Bin S, Dupuis M, Derex L, Mechtouff L, Nighoghossian N, Dussart C, Rode G, Janoly-Dumenil A. Multiprofessional intervention to improve adherence to medication in stroke patients: a study protocol for a randomised controlled trial (ADMED AVC study). Eur J Hosp Pharm 2022; 29:169-175. [PMID: 32978218 PMCID: PMC9047932 DOI: 10.1136/ejhpharm-2020-002425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Adherence to secondary preventive medications is often suboptimal in patients with stroke, exposing them to an increased risk of recurrent cerebral and/or cardiovascular events. Effective actions in the long term to improve adherence to medication are needed. The study will evaluate the efficacy of a collaborative multiprofessional patient-centred intervention conducted by a pharmacist on adherence to secondary preventive medication in stroke survivors. METHODS AND ANALYSIS This is a multicentre cluster-randomised controlled trial. Two groups of 91 patients (intervention vs standard care) will be recruited. The clinical pharmacist intervention targeting secondary preventive medication will consist of three parts over 1 year: (1) an individual semi-structured interview at hospital discharge; (2) follow-up telephone interviews at 3, 6 and 9 months after discharge; and (3) a final individual semi-structured interview 1 year after discharge. Information on patient follow-up will be shared with the general practitioner and the community pharmacist by sending a report of each interview. The primary outcome is adherence to medication during the 12 months after hospital discharge, assessed using a composite endpoint: the medication possession ratio associated with a self-administered questionnaire. ETHICS AND DISSEMINATION The local ethics committee, the national committee for use of personal data in medical research and the national data protection agency approved the study. The sponsor has no role in study design; collection, analysis and interpretation of data; or report writing. DISCUSSION This pharmacist-led educational programme has the potential to significantly improve adherence to medication in stroke survivors which could lead to a decrease in recurrent cerebral and/or cardiovascular events. TRIAL REGISTRATION NUMBER NCT02611440.
Collapse
Affiliation(s)
- Sophie Khettar
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
| | - Sophie Jacquin Courtois
- Physical medicine and rehabilitation department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Claude Bernard University Lyon 1, Bron, France
| | - Jacques Luaute
- Physical medicine and rehabilitation department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Claude Bernard University Lyon 1, Bron, France
| | - Evelyne Decullier
- Public Health Center, Research and Clinical Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Sylvie Bin
- Public Health Center, Research and Clinical Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Marine Dupuis
- Public Health Center, Research and Clinical Epidemiology, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- EA 7425 HESPER Health Services and Performance Research, Claude Bernard University Lyon1, Lyon, France
- Stroke center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Laura Mechtouff
- Stroke center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- INSERM U1060, CarMeN laboratory, Claude bernard University Lyon 1, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- INSERM U1044, CNRS UMR 5220, CREATIS, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Claude Dussart
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
| | - Gilles Rode
- Physical medicine and rehabilitation department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Claude Bernard University Lyon 1, Bron, France
| | - Audrey Janoly-Dumenil
- Department of Pharmacy, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- EA 4129 P2S Parcours Santé Systémique, Claude Bernard University Lyon 1, Lyon, France
| |
Collapse
|
6
|
Weiner J, Lui G, Brown M, Páez YD, Fritz S, Sydnor-Campbell T, Allen A, Jabri A, Venkatachalam S, Gavigan K, Nowell WB, Curtis JR, Fraenkel L, Safford M, Navarro-Millán I. Protocol for the pilot randomized trial of the CArdiovascular Risk assEssment for Rheumatoid Arthritis (CARE RA) intervention: a peer coach behavioral intervention. Pilot Feasibility Stud 2022; 8:84. [PMID: 35428359 PMCID: PMC9011938 DOI: 10.1186/s40814-022-01041-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the most common cause of death among people with rheumatoid arthritis (RA), with an estimated increased risk of 50-60% compared to the general population. Lipid-lowering strategies have been shown to lower CVD risk significantly in people with RA and hyperlipidemia. Thus, CVD risk assessment has an important role to play in reducing CVD among people with RA. Yet currently only 37 to 45% of this population are receiving primary lipids screening. This paper describes the CArdiovascular Risk assEssment for RA (CARE RA) intervention, which is designed to address this issue. CARE RA is a peer coach intervention, that is, an intervention in which a person with RA coaches another person with RA, which is designed to educate people with RA about the relation between RA and CVD risk and to help them obtain evidence-based CVD risk assessment and treatment. METHODS This is an open-label pilot study that will test if the participants assigned to complete the CARE RA curriculum with a peer coach will receive a cardiovascular risk assessment more frequently compared to those that complete the CARE RA curriculum by themselves. The CARE RA intervention is guided by Social Cognitive Theory. Participants in the peer coach intervention arm will receive the assistance of a peer coach who will call the participants once a week for 5 weeks to go over the CARE RA curriculum and train them on how to obtain CVD risk assessment. The control arm will complete the CARE RA curriculum without any assistance. Participants will be randomized 1:1 either to the control arm or to the peer coach intervention arm. The primary outcome is a participant's having a CVD risk assessment or initiating a statin, if indicated. Secondary outcomes include patient activation and RA medication adherence. The RE-AIM implementation framework guides the implementation and evaluation of the intervention. DISCUSSION This pilot study will test the feasibility of the peer coach intervention in anticipation of a larger trial. CARE RA pioneers the use of peer coaches to facilitate the implementation of evidence-based treatment guidelines among people with RA. TRIAL REGISTRATION ClinicalTrials.gov NCT04488497 . Registered on July 28, 2020.
Collapse
Affiliation(s)
- Joan Weiner
- Indiana University, Bloomington, IN, USA
- Peer Coach CARE RA, New York, USA
| | - Geyanne Lui
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Mackenzie Brown
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Aberdeen Allen
- Peer Coach CARE RA, New York, USA
- Colgate Palmolive, New York, USA
| | - Assem Jabri
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | - Liana Fraenkel
- Yale University, New Haven, CT, USA
- Berkshire Medical Center, Berkshire, Pittsfield, MA, USA
| | - Monika Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Iris Navarro-Millán
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA.
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
| |
Collapse
|
7
|
Vest MH, Stout S, Waldron K. Implementation of a strategy for identification and monitoring of clinical outcome measures in a department of pharmacy. Am J Health Syst Pharm 2021; 79:e135-e142. [PMID: 34951447 DOI: 10.1093/ajhp/zxab485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To describe a department of pharmacy strategy to identify and monitor outcome measures that represent the impact of clinical pharmacy services on patient outcomes. SUMMARY Our department established the Clinical Impact Committee, with the goal of developing and maintaining an approach to demonstrate the impact of clinical pharmacists on patient care outcomes. We describe the committee's structure, aims, and key stakeholders, inclusive of both departmental leadership and clinical pharmacist representatives across service lines. We also describe the systematic process used by the committee for identifying clinical outcome measures that are both aligned with organizational priorities and representative of pharmacists' impact. This involved assembly of a crosswalk of clinical outcome measures that are prioritized by the organization and attributable to the work of clinical pharmacists. We found it imperative to connect pharmacists' efforts to the priorities of the organization to demonstrate value and continue to justify pharmacy resources. Once the crosswalk of clinical outcome measures was assembled, the Clinical Impact Committee leveraged modified Delphi methodology to build consensus on the measures to prioritize. Once determined, the final outcome measures were developed into outcomes dashboards, to be monitored by the committee and leveraged by frontline pharmacists. CONCLUSION Our organization was successful in developing a structure, the Clinical Impact Committee, to identify, prioritize, and monitor measures that demonstrate pharmacist contributions to patient care outcomes. Further, our approach includes an intentional alignment with organizational priorities, allowing us to understand and communicate the contributions of our teams to meeting-defined organizational quality priorities.
Collapse
Affiliation(s)
- Mary-Haston Vest
- UNC Health, Chapel Hill, NC, and UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | | |
Collapse
|
8
|
Tong V, Krass I, Luckie K, Aslani P. The evolving profile of cognitive pharmaceutical services in Australia. Res Social Adm Pharm 2021; 18:2529-2537. [PMID: 33992586 DOI: 10.1016/j.sapharm.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
Globally, the availability and delivery of cognitive pharmaceutical services (CPS) by pharmacists has expanded over time. Australia has been no exception to this trend, with government funding to support the provision of certain CPS significantly increasing over the last two decades. Whilst medication management services have been consistently funded by the government for more than 15 years, fluctuations in the funding of other CPS have been observed; for example, certain disease state management CPS and introduction of funded MedsChecks. Furthermore, legislative changes have broadened pharmacists' scope of practice and the CPS provided, contributing to an increase in user-pay services. Although the literature to date has highlighted positive impacts associated with CPS on economic, clinical and/or humanistic outcomes, context-specific, real world evidence for the benefits of CPS is much needed to ensure the profession engages in evidence-based practice. The aim of this commentary is to outline the changes in CPS provision and funding within the Australian context, the existing evidence for CPS, and highlight the implications for future research.
Collapse
Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Kate Luckie
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
| |
Collapse
|
9
|
Couzos S, Smith D, Stephens M, Preston R, Hendrie D, Loller H, Tremlett M, Nugent A, Vaughan F, Crowther S, Boyle D, Buettner P, Biros E. Integrating pharmacists into Aboriginal Community Controlled Health Services (IPAC project): Protocol for an interventional, non-randomised study to improve chronic disease outcomes. Res Social Adm Pharm 2020; 16:1431-1441. [DOI: 10.1016/j.sapharm.2019.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/17/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
|
10
|
Real JP, Rossetti CA, Vargas AM, Jimenez‐Kairuz A, Robledo JA. Hypercholesterolaemia screening: proposal for development of a new professional pharmaceutical service. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Juan Pablo Real
- Departamento de Ciencias Farmacéuticas Facultad de Ciencias Químicas Universidad Nacional de Córdoba Ciudad Universitaria Córdoba Argentina
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA) CONICET Córdoba Argentina
- Programa de Servicios En Farmacias Comunitarias (PROSERFARM) de la Facultad de Ciencias Químicas Universidad Nacional de Córdoba Córdoba Argentina
| | - Cristian Alan Rossetti
- Departamento de Ciencias Farmacéuticas Facultad de Ciencias Químicas Universidad Nacional de Córdoba Ciudad Universitaria Córdoba Argentina
| | - Aylen Magali Vargas
- Inter‐Agency Program for Health Prevention and Education (Programa Interinstitucional de Prevención y Educación en Salud, PIPES) Jovita, Córdoba Argentina
| | - Alvaro Jimenez‐Kairuz
- Departamento de Ciencias Farmacéuticas Facultad de Ciencias Químicas Universidad Nacional de Córdoba Ciudad Universitaria Córdoba Argentina
- Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA) CONICET Córdoba Argentina
| | - Jorge Alberto Robledo
- Inter‐Agency Program for Health Prevention and Education (Programa Interinstitucional de Prevención y Educación en Salud, PIPES) Jovita, Córdoba Argentina
| |
Collapse
|
11
|
Effect of pharmacist interventions on reducing low-density lipoprotein cholesterol (LDL-C) levels: A systematic review and meta-analysis. J Clin Lipidol 2020; 14:282-292.e4. [DOI: 10.1016/j.jacl.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
|
12
|
Rong Y, Ward LM, Haines S, Rosenthal M. Pharmacists’ Perceptions of Feasibility and Development of a Weight Management Program for Implementation in Community Pharmacies. J Pharm Pract 2019; 32:629-636. [DOI: 10.1177/0897190018773961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Community pharmacists-directed weight management programs have demonstrated positive impacts. Objective: To explore the feasibility of developing a community pharmacy-based weight management program by examining pharmacists’ perceptions of the implementation of such a program in their practice setting. Methods: This study employed a cross-sectional online survey design. The respondents were registered community pharmacists in the southeastern United States. The survey contained 5 sections including demographics and questions gauging pharmacists interest in the proposed program. Survey findingswere examined using descriptive statistics, and analysis of variance (ANOVA). Results: A total of 426 surveys were completed and returned. Over half (53.3%) of the respondents obtained a BSc in Pharmacy. Several respondents were already providing prescription (44.1%) or over-the-counter (OTC) product (30.4%) recommendations to patients interested in weight management. Approximately 35% of respondents were at least somewhat interested in starting a weight management program. Pharmacists self-identifying as practicing in chain pharmacy or rural settings or as being staff pharmacists were less in favor of implementing a program than the other groups. Conclusions: Community pharmacists’ respondents appeared interested in implementing a weight management program. The information gathered herein will be used to design a weight management program specifically for community pharmacies.
Collapse
Affiliation(s)
- Yiran Rong
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - Lori M. Ward
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| | - Seena Haines
- University of Mississippi School of Pharmacy, 2500 North State Street, Jackson, MS, USA
| | - Meagen Rosenthal
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA
| |
Collapse
|
13
|
Maniara B. NYSCHP Joe Pinto Resident Essay Award Application. J Pharm Pract 2019; 32:701-703. [DOI: 10.1177/0897190019882523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Dähne A, Costa D, Krass I, Ritter CA. General practitioner-pharmacist collaboration in Germany: an explanatory model. Int J Clin Pharm 2019; 41:939-949. [PMID: 31140161 DOI: 10.1007/s11096-019-00851-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor structure of the previously validated Frequency of Inter-professional Collaboration Instrument and the Attitudes Toward Collaboration Instrument in measuring attitudes toward and frequency of collaboration from the general practitioner's perspective in the context of primary care in Germany; to develop an explanatory model which illustrates factors influencing collaboration. Setting The study was conducted in the primary health care sector in Mecklenburg-Western Pomerania, Germany with a cohort of general practitioners. Method The two measures were translated into German and the survey was administered to 1438 practitioners. Exploratory factor analysis was used to assess the structure of the instruments. Structural equation modelling was used to determine how demographic variables and attitudes influence collaborative behaviour. Main outcome measure Outcome measure comprised frequency of and attitudes toward collaboration among German general practitioners and an explanatory model of practitioner-pharmacist collaboration. Results A response rate of 35.9% was achieved. Exploratory factor analysis revealed one factor for the instrument measuring attitudes and two factors for frequency. The factors were interpreted as 'Communication and Collaboration' and 'Pharmacist medication management'. The significant demographic predictors of collaboration were age, population of the surgery's location, distance to the pharmacy, specialty. Conclusion The results provide evidence for the factor structure of both measures in measuring attitudes toward and frequency of collaboration. A model of collaboration in which behaviour and extent of collaboration are directly influenced by individual and context characteristics is supported.
Collapse
Affiliation(s)
- Anna Dähne
- Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany.
| | - Daniel Costa
- Pain Management and Research Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Christoph A Ritter
- Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| |
Collapse
|
15
|
Jones LK, Greskovic G, Grassi DM, Graham J, Sun H, Gionfriddo MR, Murray MF, Manickam K, Nathanson DC, Wright EA, Evans MA. Medication therapy disease management: Geisinger's approach to population health management. Am J Health Syst Pharm 2019; 74:1422-1435. [PMID: 28887344 DOI: 10.2146/ajhp161061] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Pharmacists' involvement in a population health initiative focused on chronic disease management is described. SUMMARY Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. CONCLUSION The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes.
Collapse
Affiliation(s)
- Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | | | - Dante M Grassi
- Enterprise Pharmacy, Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | - Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | - Haiyan Sun
- Biomedical and Translational Informatics, Geisinger, Danville, PA
| | | | | | | | | | - Eric A Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | | |
Collapse
|
16
|
Bates KA, Stafford RA, Teeter BS, Diemer T, Thomas JL, Curran GM. Pharmacist-provided services and community pharmacist integration into a patient-centered medical home: A qualitative study of primary care clinic staff perceptions. J Am Pharm Assoc (2003) 2019; 59:S6-S11.e1. [PMID: 31101441 DOI: 10.1016/j.japh.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/04/2019] [Accepted: 03/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe patient-centered medical home (PCMH) staff members' views toward community pharmacist involvement in patient care within the PCMH and to identify areas in which pharmacist-provided services can improve the quality of care in their clinics. DESIGN Qualitative semistructured interview study. SETTING One primary care clinic. PARTICIPANTS Multidisciplinary clinic staff members. OUTCOME MEASURES Views of staff toward implementing a community pharmacist into their clinic and top pharmacist services to help improve medication management within the clinic. RESULTS A total of 14 staff members of the clinic participated in the study. Participants included physicians, clinical staff members such as registered nurse assistants, licensed practical nurses, and medical assistants, and clinic management. Key themes included the following: the clinic was open to implementing pharmacy services; the providers would be very receptive to pharmacist recommendations; the clinic is willing to try different pharmacist integration models to see what works best within the workflow; the pharmacist must be readily available for consultation; the pharmacist should hold an introductory meeting with the clinic; opinions vary on the best timing of pharmacist appointments with patients; and ideas vary about the best location for pharmacist consultations. The top 5 pharmacist services mentioned by participants included chronic condition management, medication reconciliation training, Beers List education, diabetes education, and adherence counseling. CONCLUSION Primary care clinic staff support the integration of pharmacy services. Further research is needed to apply the results to other clinics and to identify barriers and opportunities in the implementation process.
Collapse
|
17
|
Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? INTEGRATED PHARMACY RESEARCH AND PRACTICE 2019; 8:1-11. [PMID: 30788283 PMCID: PMC6366352 DOI: 10.2147/iprp.s133088] [Citation(s) in RCA: 219] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a leading cause of death globally. This article explores the evidence surrounding community pharmacist interventions to reduce cardiovascular events and related mortality and to improve the management of CVD risk factors. We summarize a range of systematic reviews and leading randomized controlled trials and provide critical appraisal. Major observations are that very few trials directly measure clinical outcomes, potentially owing to a range of challenges in this regard. By contrast, there is an extensive, high-quality evidence to suggest that improvements can be achieved for key CVD risk factors such as hypertension, dyslipidemia, tobacco use, and elevated hemoglobin A1c. The heterogeneity of interventions tested and considerable variation of the context under which implementation occurred suggest that caution is warranted in the interpretation of meta-analyses. It is highly important to generate evidence for pharmacist interventions in developing countries where a majority of the global CVD burden will be experienced in the near future. A growing capacity for clinical registry trials and data linkage might allow future research to collect clinical outcomes data more often.
Collapse
Affiliation(s)
- Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, VIC, Australia,
- Deakin Health Economics, Centre for Population Health, Deakin University, Geelong, VIC, Australia,
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
| | - Hamzah Alzubaidi
- Institute for Medical Research and College of Pharmacy, University of Sharjah, Sharjah, Sharjah, United Arab Emirates
| | - John Keith Jackson
- Centre for Medicine Use & Safety, Faculty of Pharmacy & Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,
| |
Collapse
|
18
|
Shi F, Li J, Yang L, Hou G, Ye M. Hypolipidemic effect and protection ability of liver-kidney functions of melanin from Lachnum YM226 in high-fat diet fed mice. Food Funct 2018; 9:880-889. [PMID: 29299589 DOI: 10.1039/c7fo01294b] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In the present study, we investigated the hypolipidemic properties of melanin from Lachnum YM226 (LM) in high-fat diet induced hyperlipidemic mice. After the hyperlipidemic model was established, mice were randomly divided into six groups, as follows: normal control group (NC), hyperlipidemic control group (HC), positive control group (7 mg kg-1 d-1 simvastatin) (PC) and LM groups (50, 100 and 200 mg kg-1 d-1 denoted as LM-50, LM-100 and LM-200, respectively). Subsequently, the body weight, organ indices, lipid metabolism, antioxidant properties and liver-kidney functions of the mice were examined. Moreover, the activities of lipoprotein metabolism enzymes in serum and liver tissue were examined to study the feasible mechanism. The results imply that LM could effectively reduce body weight, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and atherogenic index (AI), and increase high density lipoprotein cholesterol (HDL-C). Moreover, treatment with LM also increased the antioxidant enzymes activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) and reduced malondialdehyde (MDA) content relative to the HC group. In addition, the liver and kidney damage indices such as alanine aminotransferase (ALT), aspartate aminotransaminase (AST), alkaline phosphatase (ALP), creatinine (CRE), blood urea nitrogen (BUN) and uric acid were lowered. LM administration also significantly corrected disturbances of liver-kidney functions with no fatty deposits in the liver, resulting in a protective effect against renal histological alteration. The hypolipidemic effect occurred partly due to the regulation of hepatic lipase (HL) and lipoprotein lipase (LPL) in serum and liver to markedly decrease TG. This confirms the important role of LM in the prevention of hyperlipidemia.
Collapse
Affiliation(s)
- Fang Shi
- School of Food Science and Engineering, Hefei University of Technology, Hefei 230009, China.
| | | | | | | | | |
Collapse
|
19
|
Rose O, Richling I, Voigt K, Gottschall M, Köberlein-Neu J. Patient selection and general practitioners' perception of collaboration in medication review. Res Social Adm Pharm 2018; 15:521-527. [PMID: 30139537 DOI: 10.1016/j.sapharm.2018.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementation of collaborative Medication Review (MR) into routine care faces several barriers. OBJECTIVE The study aim was to gain information on patient selection for a MR by general practitioners (GPs). GP selection was compared to objective selection criteria on identifying patients, who would benefit from a MR the most. A secondary objective of this study was to get insight into GPs perception on interprofessional collaboration with pharmacists. METHODS GPs were interviewed for a qualitative study on expected outcomes of MR in former study patients. They were asked to select patients, for whom they expected a major benefit from the MR. Results were compared to objective selection criteria, obtained from the WestGem study. Further interviews were done on aspects of patient selection and perception of interprofessional collaboration, results were presented descriptively. RESULTS The study covered 6 GPs with 78 former study patients. GPs would have chosen 45 out of the 78 patients (57.7%) for a MR. According to changes in the Medication Appropriateness Index, 24 of these patients had a greater benefit from the MR. Patient selection by the number of prescribed drugs had reached a higher specificity at a cut-off of 9 drugs, compared to selection by the GP (67% vs. 61.5%). GPs mentioned medication safety, certain diseases, polymedication, multimorbidity as selection criteria. Increasing quality of therapy and better insight into the patient's drug regimen was appreciated by the GPs as perceived personal advantage of the MR. GPs preferred to have a MR initiated by themselves, but appraised concise interprofessional collaboration with pharmacists. CONCLUSIONS Patient selection for MR should take objective parameters into account and combine them with subjective impressions. GPs preferred the initiation of a MR by themselves but expressed a positive attitude towards collaboration with a pharmacist afterwards. Recommendations should be relevant and concise.
Collapse
Affiliation(s)
- Olaf Rose
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA.
| | - Ina Richling
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Mandy Gottschall
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Germany
| |
Collapse
|
20
|
Defining an ‘older’ patient in the context of therapeutic decision making: perspectives of Australian pharmacists and nurses. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0516-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
21
|
Development and psychometrics of a short-form pharmaceutical care-specific measure for quality of life. Int J Clin Pharm 2018; 40:642-649. [PMID: 29744792 DOI: 10.1007/s11096-018-0638-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/19/2018] [Indexed: 10/16/2022]
Abstract
Background The validated patient-reported outcomes measure of pharmaceutical therapy for quality of life (PROMPT-QoL) contains 43-items, and can be too lengthy for some applications. Objectives To develop a brief version called the PROMPT, and test its psychometric properties. Setting Four public hospitals in Bangkok, Thailand. Method Secondary analysis of three databases used to develop and evaluate the original PROMPT-QoL. Items for the short-form PROMPT were selected based on expert and patient evaluations of content and importance, and lack of redundancy. All domains of the original version are represented in the PROMPT. Main outcome measures Psychometric properties (internal consistency and test-retest reliability, criterion, convergent and discriminant validity, and responsiveness), and indicators of practicality (e.g., administration time, missing data). Results Analyses of the PROMPT and its domain subscales demonstrated good internal consistency and fair-to-excellent test-retest reliability. Correlations between the original and short-form, overall and by domain, were high. Expectations for convergent and discriminant validity were met as correlations between the PROMPT and generic health-related quality of life measures (WHOQoL-BREF domains and summary scores of the SF-12v2) were modest (< 0.40). Based on data from a trial of pharmaceutical care, the PROMPT short-form was very responsive to reductions in medication related problems. Administration time for the PROMPT is estimated to be about 5 min, and across all datasets used, no missing data were found amongst the 16 items of the PROMPT. Conclusion The 16-item PROMPT appears to be a practical, reliable, valid, and responsive instrument to identify patient's drug-related needs and to assess the humanistic impact of patient-centered pharmaceutical care.
Collapse
|
22
|
Rosenthal M, Ward LM, Teng J, Haines S. Weight management counselling among community pharmacists: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:475-484. [PMID: 29732639 DOI: 10.1111/ijpp.12453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To complete a scoping review of studies of community pharmacy-delivered weight and obesity management services from January 2010 to March 2017. METHODS A scoping review was conducted to obtain an overview of research related to the study objective. The PubMed, EBSCO and CINAHL databases were searched from January 2010 to March 2017 for articles examining obesity/weight management in community pharmacies. Included studies had to contain an obesity/weight management programme delivered primarily by community pharmacies. All non-interventional studies were excluded. KEY FINDINGS Nine articles were eligible for data extraction. Across the nine included studies, 2141 patients were enrolled. The overwhelming majority of patients enrolled in the studies were female, approximately 50 years of age, had a mean weight of 92.8 kg and mean BMI of 33.8 kg/m2 at baseline. Patients in these various programmes lost a mean of 3.8 kg, however, two studies demonstrated that long-term (>6 months) weight loss maintenance was not achieved. The average dropout rate for each study ranged from 8.3% to 79%. CONCLUSIONS Obesity has a significant impact on the health and wellness of adults globally. Recent research has shown that community pharmacies have the potential to positively impact patient weight loss. However, additional research is needed into the specific interventions that bring the most value to patients and can be sustained and spread across community pharmacy practice.
Collapse
Affiliation(s)
- Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Lori M Ward
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Jason Teng
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Seena Haines
- Department of Pharmacy Practice, School of Pharmacy, University of Mississippi, Mississippi, USA
| |
Collapse
|
23
|
The complexity of implementation factors in professional pharmacy services. Res Social Adm Pharm 2018; 14:498-500. [DOI: 10.1016/j.sapharm.2017.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 11/22/2022]
|
24
|
Erzkamp S, Rose O. Development and evaluation of an algorithm-based tool for Medication Management in nursing homes: the AMBER study protocol. BMJ Open 2018; 8:e019398. [PMID: 29678967 PMCID: PMC5914904 DOI: 10.1136/bmjopen-2017-019398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Residents of nursing homes are susceptible to risks from medication. Medication Reviews (MR) can increase clinical outcomes and the quality of medication therapy. Limited resources and barriers between healthcare practitioners are potential obstructions to performing MR in nursing homes. Focusing on frequent and relevant problems can support pharmacists in the provision of pharmaceutical care services. This study aims to develop and evaluate an algorithm-based tool that facilitates the provision of Medication Management in clinical practice. METHODS AND ANALYSIS This study is subdivided into three phases. In phase I, semistructured interviews with healthcare practitioners and patients will be performed, and a mixed methods approach will be chosen. Qualitative content analysis and the rating of the aspects concerning the frequency and relevance of problems in the medication process in nursing homes will be performed. In phase II, a systematic review of the current literature on problems and interventions will be conducted. The findings will be narratively presented. The results of both phases will be combined to develop an algorithm for MRs. For further refinement of the aspects detected, a Delphi survey will be conducted. In conclusion, a tool for clinical practice will be created. In phase III, the tool will be tested on MRs in nursing homes. In addition, effectiveness, acceptance, feasibility and reproducibility will be assessed. The primary outcome of phase III will be the reduction of drug-related problems (DRPs), which will be detected using the tool. The secondary outcomes will be the proportion of DRPs, the acceptance of pharmaceutical recommendations and the expenditure of time using the tool and inter-rater reliability. ETHICS AND DISSEMINATION This study intervention is approved by the local Ethics Committee. The findings of the study will be presented at national and international scientific conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00010995.
Collapse
Affiliation(s)
| | - Olaf Rose
- Elefanten-Apotheke, gegr. 1575, Steinfurt, Germany
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| |
Collapse
|
25
|
Köberlein-Neu J, Mennemann H, Hamacher S, Waltering I, Jaehde U, Schaffert C, Rose O. Interprofessional Medication Management in Patients With Multiple Morbidities. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:741-748. [PMID: 27890050 DOI: 10.3238/arztebl.2016.0741] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 03/24/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medication reviews and medication management are being used more and more around the world to improve medication safety. Both of these tools were originally conceived as pharmaceutical care activities and have recently been developed into interdisciplinary approaches. We studied the efficacy of interprofessional medication management for multimorbid patients that takes their medical conditions, but also their general living situation into account. METHODS A comprehensive medication management was performed, which involved the collection of information on the drugs each patient took, the way they were stored, the patient's drug intake and handling, and any problems that arose with pharmacotherapy. The interventional approach was evaluated over a period of 15 months in a cluster-randomized controlled trial with a stepped wedge design. The primary endpoint was the quality of pharmacotherapy, as assessed with the Medication Appropriateness Index (MAI). A mixed model was used to analyze efficacy. RESULTS 162 patients were enrolled in the study; 142 were included in the intention-to-treat analysis (53.3% women, mean age 76.8 ± 6.3 years). The mean total MAI score decreased significantly (p ≤ 0.001) from the control phase (29.21, 95% CI [26.09; 32.33]) to the intervention phase (22.27 [19.00; 25.54]), with an effect strength (Cohen's d) of -0.24 [-0.36; -0.13]. The number of drug-related problems declined as well. CONCLUSION In this study, interprofessional collaboration increased medication safety. Working across disciplinary boundaries allowed for a decrease in drugrelated problems and brought up aspects outside the purview of the primary care physician.
Collapse
Affiliation(s)
- Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal; Department of Social Work, M¨nster University of Applied Sciences; Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne; Department of Pharmaceutical and Medicinal Chemistry, University of M¨nster; Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | | | | | | | | | | | | |
Collapse
|
26
|
Omboni S, Caserini M. Effectiveness of pharmacist's intervention in the management of cardiovascular diseases. Open Heart 2018; 5:e000687. [PMID: 29344376 PMCID: PMC5761304 DOI: 10.1136/openhrt-2017-000687] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The pharmacist may play a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes. Systematic reviews of randomised controlled and observational studies have documented an improved control of hypertension, dyslipidaemia or diabetes, smoking cessation and reduced hospitalisation in patients with heart failure, following a pharmacist’s intervention. Limited proof for effectiveness is available for humanistic (patient satisfaction, adherence and knowledge) and economic outcomes. A multidisciplinary approach, including medical input plus a pharmacist, specialist nurse or both, and a greater involvement of community rather than hospital pharmacists, seems to represent the most efficient and modern healthcare delivery model. However, further well-designed research is demanded in order to quantitatively and qualitatively evaluate the impact of pharmacist’s interventions on cardiovascular disease and to identify specific areas of impact of collaborative practice. Such research should particularly focus on the demonstration of a sensitivity to community pharmacist’s intervention. Since pharmacy services are easily accessible and widely distributed in the community setting, a maximum benefit should be expected from interventions provided in this context.
Collapse
Affiliation(s)
- Stefano Omboni
- Department of Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
| | - Marina Caserini
- Department of Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
| |
Collapse
|
27
|
West LM, Vetter-Kerkhoff C, Miljkovic N, Frontini R. Is there a need for a hospital pharmacy common training framework? Review of the literature on the impact of educational interventions on health outcome. Eur J Hosp Pharm 2018; 25:6-9. [PMID: 31156978 PMCID: PMC6452398 DOI: 10.1136/ejhpharm-2016-001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/01/2017] [Accepted: 02/06/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND With the update of the directive 2005/36/EU on the recognition of professional qualifications (2013/55/EU), the European Union (EU) legislation opened also to pharmacists the possibility to define specialisations via a common training framework (CTF). OBJECTIVE The aim of this study was to review, synthesise and present published evidence on the impact of health educational interventions targeting healthcare professionals on patients' health outcomes that support a hospital pharmacy CTF in EU. METHOD The search was carried out in Medline and Cumulative Index to Nursing & Allied Health Literature and was limited to English language full review articles or primary research published since 2000. Data were extracted independently and compared by three of the researchers. RESULTS Ten papers (9 primary research studies and one literature review) were identified. Almost one-third of the studies (30%, n=3) targeted pharmacists in their research. The majority of studies (80%, n=8) have shown that higher education levels among healthcare professionals improved patient outcomes. No study discussed the importance of a CTF. CONCLUSION The review of the literature has demonstrated the need for education and training of health personnel to improve patient outcome. Controlled studies about pharmacist education and training in European countries showed that the benefit of a CTF is lacking.
Collapse
Affiliation(s)
- Lorna Marie West
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | | | - Nenad Miljkovic
- Department of Pharmacy, Institute of Orthopaedic Surgery "Banjica", University Hospital of Belgrade, Belgrade, Serbia
| | | |
Collapse
|
28
|
Hayward KL, Martin JH, Cottrell WN, Karmakar A, Horsfall LU, Patel PJ, Smith DD, Irvine KM, Powell EE, Valery PC. Patient-oriented education and medication management intervention for people with decompensated cirrhosis: study protocol for a randomized controlled trial. Trials 2017; 18:339. [PMID: 28728560 PMCID: PMC5520368 DOI: 10.1186/s13063-017-2075-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 07/01/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People with decompensated cirrhosis require complex medical care and are often prescribed an intricate and frequently changing medication and lifestyle regimen. However, many patients mismanage their medications or have poor comprehension of their disease and self-management tasks. This can lead to harm, hospitalization, and death. METHODS/DESIGN A patient-oriented education and medication management intervention has been developed for implementation at a tertiary hospital hepatology outpatient center in Queensland, Australia. Consenting patients with decompensated cirrhosis will be randomly allocated to education intervention or usual care treatment arms when they attend routine follow-up appointments. In the usual care arm, participants will be reviewed by their hepatologist according to the current model of care in the hepatology clinic. In the intervention arm, participants will be reviewed by a clinical pharmacist to receive the education and medication management intervention at baseline in addition to review by their hepatologist. Intervention participants will also receive three further educational contacts from the clinical pharmacist within the following 6-month period, in addition to routine hepatologist review that is scheduled within this time frame. All participants will be surveyed at baseline and follow-up (approximately 6 months post-enrollment). Validated questionnaire tools will be used to determine participant adherence, medication beliefs, illness perceptions, and quality of life. Patients' knowledge of dietary and lifestyle modifications, their current medications, and other clinical data will be obtained from the survey, patient interview, and medical records. Patient outcome data will be collected at 52 weeks. DISCUSSION The intervention described within this protocol is ready to adapt and implement in hepatology ambulatory care centers globally. Investigation of potentially modifiable variables that may impact medication management, in addition to the effect of a clinical pharmacist-driven education and medication management intervention on modifying these variables, will provide valuable information for future management of these patients. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616000780459 . Registered on 15 June 2016.
Collapse
Affiliation(s)
- Kelly L. Hayward
- School of Medicine, The University of Queensland, Brisbane, QLD Australia
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jennifer H. Martin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
| | - W. Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD Australia
| | - Antara Karmakar
- School of Medicine, The University of Queensland, Brisbane, QLD Australia
| | - Leigh U. Horsfall
- The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Brisbane, QLD Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Preya J. Patel
- The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Brisbane, QLD Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - David D. Smith
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia
| | - Katharine M. Irvine
- The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Brisbane, QLD Australia
| | - Elizabeth E. Powell
- The Centre for Liver Disease Research, Translational Research Institute, The University of Queensland, Brisbane, QLD Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Patricia C. Valery
- Cancer and Chronic Disease Research Group, Level 4, Central, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
| |
Collapse
|
29
|
Belaiche S, Mercier E, Cuny D, Kambia N, Wierre P, Bertoux É, Mascaut D, Azar R, Bataille P, Bourdon F, Mac Namara É, Maisonneuve N, Painchart B, Vrigneau L, Noël C, Décaudin B, Glowacki F. [Community pharmacists' interventions to prevent and screen chronic kidney disease patients]. Nephrol Ther 2016; 13:87-92. [PMID: 27810277 DOI: 10.1016/j.nephro.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/20/2016] [Accepted: 06/28/2016] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) is a major concern of public health. The pharmacist is known as a health practitioner involved in prevention and therapeutic education. Our study aimed at defining the impact of community pharmacists' interventions for preventing and screening CKD. In our observational prospective study of 5 months conducted in 109 community pharmacy, we included 2 groups of patients: A (therapeutic optimization): CKD patients and B (CKD screening): population at risk. In group A, we included 354 patients, mainly women (51.2%), in stage 3 of CKD, mean age 73 years old, with hypertension alone (40.6%) or associated with diabetes (44%). About 70% of the patients had a follow up by a nephrologist and 45% of them were good adherent according to the Morisky-Green self-report. However, approximately 20% of patients did not have nephroprotective treatments in their regimen although they were on stage 3 or 4 CKD patients, and about half of them were not aware of medical situations at risk. Concerning group B, 532 patients were included. The pharmaceutical interventions screened 10% of patients with a GFR<60mL/min/1.73m2. The community pharmacists' interventions helped to optimize the therapeutic management of CKD patients and in the early screening of patients at risk. More studies are needed to extrapolate our observations to a larger population.
Collapse
Affiliation(s)
- Stéphanie Belaiche
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marrache, 59000 Lille, France; EA 7365, groupe de recherche sur les formes injectables et les technologies associées (GRITA), université de Lille, 59000 Lille, France.
| | - Edwige Mercier
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marrache, 59000 Lille, France
| | - Damien Cuny
- EA 4483, impact de l'environnement chimique sur la santé humaine (IMPECS), université de Lille, 59000 Lille, France
| | - Nicolas Kambia
- EA 7365, groupe de recherche sur les formes injectables et les technologies associées (GRITA), université de Lille, 59000 Lille, France
| | - Patrick Wierre
- Faculté de pharmacie, université de Lille, 59000 Lille, France
| | | | - Daniel Mascaut
- Faculté de pharmacie, université de Lille, 59000 Lille, France
| | - Raymond Azar
- Service de néphrologie, centre hospitalier de Dunkerque, 59240 Dunkerque, France
| | - Pierre Bataille
- Service de néphrologie, centre hospitalier de Boulogne-sur-Mer, 62200 Boulogne-sur-Mer, France
| | | | - Évelyne Mac Namara
- Service de néphrologie, centre hospitalier de Béthune, 62131 Béthune, France
| | - Nathalie Maisonneuve
- Service de néphrologie-dialyse, centre hospitalier de Valenciennes, 59322 Valenciennes, France
| | - Bernard Painchart
- Service de néphrologie, centre hospitalier de Cambrai, 59400 Cambrai, France
| | - Laurence Vrigneau
- Service de néphrologie-dialyse, centre hospitalier de Valenciennes, 59322 Valenciennes, France
| | - Christian Noël
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Lille inflammation research international center (LIRIC), Inserm U995, université de Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marrache, 59000 Lille, France; EA 7365, groupe de recherche sur les formes injectables et les technologies associées (GRITA), université de Lille, 59000 Lille, France
| | - François Glowacki
- EA 4483, impact de l'environnement chimique sur la santé humaine (IMPECS), université de Lille, 59000 Lille, France; Service de néphrologie, CHRU de Lille, 59000 Lille, France
| | -
- Réseau Néphronor, CHRU de Lille, 59000 Lille, France
| |
Collapse
|
30
|
Tsuyuki RT, Rosenthal M, Pearson GJ. A randomized trial of a community-based approach to dyslipidemia management: Pharmacist prescribing to achieve cholesterol targets (RxACT Study). Can Pharm J (Ott) 2016; 149:283-292. [PMID: 27708674 PMCID: PMC5032933 DOI: 10.1177/1715163516662291] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dyslipidemia is an important risk factor for cardiovascular disease but is suboptimally managed. Pharmacists are accessible primary care professionals and with expanded scopes of practice (including prescribing), could identify and manage patients with dyslipidemia. We sought to evaluate the effect of pharmacist prescribing of dyslipidemia medications on the proportion of participants achieving target LDL-cholesterol (LDL-c) levels. METHODS We conducted a randomized controlled trial in 14 community pharmacies in Alberta, Canada. We enrolled adults with uncontrolled dyslipidemia as defined by the 2009 Canadian Dyslipidemia Guidelines. Intervention was pharmacist-directed dyslipidemia care, including assessment of cardiovascular risk, review of LDL-c, prescribing of medications, health behaviour interventions and follow-up every 6 weeks for 6 months. Usual care patients received their lipid results and a pamphlet on cardiovascular disease and usual care from their physician and pharmacist. Primary outcome was the proportion of participants achieving their target LDL-c (<2 mmol/L or ≥50% reduction) at 6 months between groups. RESULTS We enrolled 99 patients with a mean (SD) age of 63 (13) years, 49% male and baseline LDL-c of 3.37 mmol/L (0.98). Proportion of patients achieving LDL-c target was 43% intervention versus 18% control (p = 0.007). Adjusted odds of achieving target LDL-c were 3.3 times higher for the intervention group (p = 0.031), who also achieved greater reduction in LDL-c (1.12 mmol/L, SE = 0.112) versus control (0.42 mmol/L, SE = 0.109), for an adjusted mean difference of 0.546 mmol/L (SE = 0.157), p < 0.001. CONCLUSION Pharmacist prescribing resulted in >3-fold more patients achieving target LDL-c levels. This could have major public health implications.
Collapse
Affiliation(s)
- Ross T. Tsuyuki
- EPICORE Centre/COMPRIS and the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Meagen Rosenthal
- EPICORE Centre/COMPRIS and the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Glen J. Pearson
- EPICORE Centre/COMPRIS and the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| |
Collapse
|
31
|
Mohammed MA, Moles RJ, Chen TF. Impact of Pharmaceutical Care Interventions on Health-Related Quality-of-Life Outcomes: A Systematic Review and Meta-analysis. Ann Pharmacother 2016; 50:862-81. [PMID: 27363846 DOI: 10.1177/1060028016656016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate the impact of pharmaceutical care (PC) interventions on health-related quality of life (HRQoL) and determine sensitivity of HRQoL measures to PC services. DATA SOURCES MEDLINE, EMBASE, International Pharmaceutical Abstracts, PubMed, Global Health, PsychINFO, CINAHL, and Web of Science (January 2005 to September 2015) were searched. STUDY SELECTION AND DATA EXTRACTION Original English-language articles were included if PC impact on HRQoL was evaluated and reported using validated HRQoL measures. DATA SYNTHESIS A total of 31 randomized controlled trials, 9 nonrandomized studies with comparison groups, and 8 before-after studies were included. PC interventions resulted in significant improvement in 1 domain and ≥3 domains of HRQoL measures in 66.7% and 27.1% of the studies, respectively. There was a significant improvement in at least 1 domain in 18 of 32 studies using generic and 16 of 21 studies using disease-specific measures. When the Short Form 36 Items Health Survey (SF-36) measure was used, PC interventions had a moderate impact on social functioning (standardized mean difference [SMD] = 0.59; 95% CI = 0.14, 1.04), general health (SMD = 0.36; 95% CI = 0.12, 0.59), and physical functioning (SMD = 0.30; 95% CI = 0.11, 0.48). The pooled data on heart failure-specific (SMD = -0.17; 95% CI = -0.43, 0.09), asthma-specific (SMD = 0.17; 95% CI = -0.03, 0.36), and chronic obstructive pulmonary disease-specific (SMD = -0.09; 95% CI = -0.37, 0.19) measures indicated no significant impact of PC on HRQoL. CONCLUSIONS PC interventions can significantly improve at least 1 domain of HRQoL. Existing measures may have minimal to moderate sensitivity to PC interventions, with evidence pointing more toward social functioning, general health, and physical functioning of the SF-36 measure. However, evidence generated from current non-PC-specific HRQoL measures is insufficient to judge the impact of PC interventions on HRQoL. The development of a suitable HRQoL measure for PC interventions may help generate better evidence for the contribution of pharmacist services to improving HRQoL.
Collapse
|
32
|
Garcia-Cardenas V, Benrimoj SI, Ocampo CC, Goyenechea E, Martinez-Martinez F, Gastelurrutia MA. Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report. Res Social Adm Pharm 2016; 13:614-627. [PMID: 27423785 DOI: 10.1016/j.sapharm.2016.05.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
Pharmacist-led medication review services are recognized as a key to medicines management. This case study describes the implementation process of a medication review with follow-up service in a community pharmacy setting and evaluates its initial outcomes. An implementation-effectiveness hybrid study was undertaken in a community pharmacy setting. The implementation process was divided into four different phases: Exploration and adoption, program installation, initial implementation, and full operation. A core set of implementation outcomes was measured, including penetration, implementation costs, feasibility, fidelity, acceptability, appropriateness and efficiency. The penetration rate of the service was nearly 62.5%, and the implementation costs were 57,359.67€. There was a high retention-participation rate of patients. For every month of service provision, there was a 1.27 increase in the number of patients requesting the service, compared to the number of patients being offered the service. The time spent on service provision was 171.7 min per patient. Average patient satisfaction with the service was 4.82 (SD: 0.39, scale 1-5), and the acceptance rate of care plans by patients and general medical practitioners were 96.99% and 96.46%, respectively. There were 408 negative outcomes associated with the use of medications were identified during the study (3.09 per patient), of which 96.3% were resolved. The average time per patient spent on service provision significantly decreased along the 18 months of service provision. This case report can assist individual pharmacists and professional organizations interested in implementing evidence-based services by offering an example on how to approach the implementation process in a systematic way.
Collapse
Affiliation(s)
- Victoria Garcia-Cardenas
- Graduate School of Health, University of Technology Sydney, P.O. Box 123 Broadway, New South Wales 2007, Sydney, Australia.
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, P.O. Box 123 Broadway, New South Wales 2007, Sydney, Australia
| | - Carla Castrillon Ocampo
- Pharmaceutical Care Research Group, University of Granada, Facultad de Farmacia, Campus de Cartuja s/n. 18071, Granada, Spain
| | | | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, University of Granada, Facultad de Farmacia, Campus de Cartuja s/n. 18071, Granada, Spain
| | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, University of Granada, Facultad de Farmacia, Campus de Cartuja s/n. 18071, Granada, Spain
| |
Collapse
|
33
|
Rose O, Mennemann H, John C, Lautenschläger M, Mertens-Keller D, Richling K, Waltering I, Hamacher S, Felsch M, Herich L, Czarnecki K, Schaffert C, Jaehde U, Köberlein-Neu J. Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting - Analysis of a Cluster Randomized Controlled Trial (WestGem-Study). PLoS One 2016; 11:e0156304. [PMID: 27253380 PMCID: PMC4890849 DOI: 10.1371/journal.pone.0156304] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy. OBJECTIVE The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians' acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting. METHODS Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician's acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed. RESULTS The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p<0.001) and the duration of the intervention (p = 0.006) could be identified as influential factors for a major benefit from a medication review, whereas morbidity (p>0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation. CONCLUSIONS The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance of medication reviews by physicians supports further implementation into health care systems. TRIAL REGISTRATION ISRCTN ISRCTN41595373.
Collapse
Affiliation(s)
- Olaf Rose
- Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
- Elefanten-Apotheke, Steinfurt, Germany
- * E-mail:
| | - Hugo Mennemann
- Department of Social Sciences, University of Applied Science Muenster, Muenster, Germany
| | | | | | | | | | - Isabel Waltering
- Department of Pharmaceutical and Medicinal Chemistry, Clinical Pharmacy, Westfaelische Wilhelms-University, Muenster, Germany
- Elefanten-Apotheke, Steinfurt, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koeln, Germany
| | - Moritz Felsch
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koeln, Germany
| | - Lena Herich
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koeln, Germany
| | - Kathrin Czarnecki
- Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Corinna Schaffert
- Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Ulrich Jaehde
- Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | - Juliane Köberlein-Neu
- Department of Health Care Management and Public Health, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| |
Collapse
|
34
|
El Hajj MS, Mahfoud ZR, Al Suwaidi J, Alkhiyami D, Alasmar AR. Role of pharmacist in cardiovascular disease-related health promotion and in hypertension and dyslipidemia management: a cross-sectional study in the State of Qatar. J Eval Clin Pract 2016; 22:329-40. [PMID: 26552842 DOI: 10.1111/jep.12477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In Qatar, cardiovascular diseases (CVD) have recently become the leading cause of morbidity and mortality. Prevention, detection and management of CVD risk factors reduce CVD chance. The study objectives were to assess Qatar pharmacists' involvement in CVD health promotion, to identify the activities that they currently provide to patients with CVD risk factors, to describe their attitudes towards their involvement in CVD prevention and to assess their perceived barriers for provision of CVD prevention services METHOD We conducted a cross-sectional survey of community and ambulatory pharmacists in Qatar. Pharmacist characteristics, involvement in CVD-related activities along with their attitudes and perceived barriers were analysed using frequency distributions. Bivariate linear regression models were used to test for associations between CVD health promotion activity score and each variable. Variables with a P-value of 0.20 or less were included in the multivariate model. RESULTS A total of 141 pharmacists completed the survey (response rate 60%). More than 70% responded with rarely or never to 6 out of the 10 CVD health promotion activities. Eighty-four per cent and 68% always or often describe to patients the appropriate time to take antihypertensive medications and the common medication adverse effects, respectively. Yet, 50% rarely or never review the medication refill history or provide adherence interventions. Lack of CVD educational materials was the top perceived barrier (55%) in addition to lack of having private counselling area (44.6%), and lack of time (38.3%). Females and community pharmacists were more involved in CVD health promotion (P = 0.046 and P = 0.017, respectively) than their counterparts. Health promotion practice increased with increasing attitudes score and decreased with increased barriers score (P = 0.012 and P = 0.001). CONCLUSION The scope of pharmacy practice in CVD prevention is limited in Qatar. Efforts need to be exerted to increase pharmacists' involvement in CVD prevention.
Collapse
Affiliation(s)
- Maguy Saffouh El Hajj
- Clinical Pharmacy and Practice Section, College of Pharmacy, Qatar University, Doha, Qatar
| | | | | | | | | |
Collapse
|
35
|
Sabater-Hernández D, Moullin JC, Hossain LN, Durks D, Franco-Trigo L, Fernandez-Llimos F, Martínez-Martínez F, Sáez-Benito L, de la Sierra A, Benrimoj SI. Intervention mapping for developing pharmacy-based services and health programs: A theoretical approach. Am J Health Syst Pharm 2016; 73:156-64. [DOI: 10.2146/ajhp150245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Daniel Sabater-Hernández
- Graduate School of Health, University of Technology Sydney, Sydney, Australia, and Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
| | - Joanna C. Moullin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Lutfun N. Hossain
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Desire Durks
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Lucia Franco-Trigo
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | | | | | | - Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, Spain, and Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
36
|
Lyons I, Barber N, Raynor DK, Wei L. The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of a pharmacist-led telephone based intervention designed to improve medication adherence. BMJ Qual Saf 2016; 25:759-69. [PMID: 26755665 DOI: 10.1136/bmjqs-2015-004670] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/09/2015] [Indexed: 11/03/2022]
Abstract
AIM To test the effectiveness of a tailored, pharmacist-led centralised advice service to improve adherence to patients on established medications. METHODS A parallel group randomised controlled trial was conducted. Patients prescribed at least one oral medication for type 2 diabetes and/or lipid regulation were eligible to participate. 677 patients of a mail-order pharmacy were recruited and randomised (340 intervention, 337 control). The intervention comprised two tailored telephone consultations with a pharmacist, 4-6 weeks apart, plus a written summary of the discussion and a medicines reminder chart. The primary outcome was self-reported adherence to medication at 6-month follow-up, collected via a postal questionnaire, analysed using generalised estimating equations. Secondary outcomes included prescription refill adherence, lipid and glycaemic control and patient satisfaction. RESULTS In intention-to-treat analysis 36/340 (10.6%) of the intervention group were non-adherent (<90% of medication taken in the past 7 days) at 6 months compared with 66/337 (19.6%) in the control group, yielding an unadjusted OR of 1.54 (95% CI 1.11 to 2.15, p=0.01). Analyses of dispensing data also showed that the odds of being classified as adherent (≥90%) were 60% greater for the intervention group compared with the control group (OR 1.60, 95% CI 1.14 to 2.24, p<0.01). In a subsample of patients who provided blood samples, glycaemic and lipid control did not differ significantly between groups (p=0.06 and p=0.24, respectively) but positive trends were observed. Ninety-two per cent of intervention group patients reported that they were satisfied with the service overall. CONCLUSIONS A telephone intervention, led by a pharmacist and tailored to the individuals' needs, can significantly improve medication adherence in patients with long-term conditions, using a mail-order pharmacy. Further work is needed to confirm a trend towards improved clinical outcome. TRIAL REGISTRATION NUMBER NCT01864239.
Collapse
Affiliation(s)
- Imogen Lyons
- UCL Interaction Centre, University College London, London, UK
| | | | | | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| |
Collapse
|
37
|
McNamara KP, O'Reilly SL, George J, Peterson GM, Jackson SL, Duncan G, Howarth H, Dunbar JA. Intervention fidelity for a complex behaviour change intervention in community pharmacy addressing cardiovascular disease risk. HEALTH EDUCATION RESEARCH 2015; 30:897-909. [PMID: 26471920 DOI: 10.1093/her/cyv050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 09/11/2015] [Indexed: 06/05/2023]
Abstract
Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.
Collapse
Affiliation(s)
- K P McNamara
- Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Deakin University campus, Princes Hwy, Warrnambool, VIC 3280, Australia, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia,
| | - S L O'Reilly
- Centre for Physical Activity and Nutrition Research, Faculty of Health, Deakin University, Victoria, Australia
| | - J George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia
| | - G M Peterson
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Australia
| | - S L Jackson
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Australia
| | - G Duncan
- Faculty of Medicine, Nursing and Health Sciences, Monash University, and
| | - H Howarth
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Australia
| | - J A Dunbar
- Deakin University Population Health Strategic Research Centre, Melbourne, Australia
| |
Collapse
|
38
|
Henrichsmann M, Hempel G. Impact of medication therapy management in patients with Parkinson's disease. Int J Clin Pharm 2015; 38:54-60. [PMID: 26590989 DOI: 10.1007/s11096-015-0206-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 09/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since the new German Apothekenbetriebsordnung was released, medication therapy management (MTM) has increased in importance. MTM is intended to improve the quality of life of patients. OBJECTIVES The aim of this study was to improve the quality of life of patients with Parkinson's disease through an MTM by a community pharmacist. SETTING The patients were recruited in cooperation with the Deutsche Parkinson Vereinigung e.V. (dPV) in Germany. Methods All patients were evaluated at baseline (t0) and after a follow-up of 4 months (t1). During the intervention period, the pharmacists implemented an MTM with standardized pharmaceutical care. Main outcome measure The effects of the interventions were measured by the Unified Parkinson Disease Rating Scale (UPDRS) and the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS). RESULTS In this study, 90 patients with Parkinson's disease were included. The most common intervention was to find a therapy for untreated comorbidities. The UPDRS or MDS-UPDRS improved significantly after the intervention period by a median change rate of 1 (p < 0.05) or rather 2 (p < 0.05) compared to the baseline. CONCLUSION The study shows that the quality of life in Parkinson's disease patients improved significantly through MTM.
Collapse
Affiliation(s)
- Martina Henrichsmann
- Institute of Pharmaceutical and Medical Chemistry, Westfälische Wilhelms-University Münster, Corrensstraße 48, 48149, Münster, Germany.
| | - Georg Hempel
- Institute of Pharmaceutical and Medical Chemistry, Westfälische Wilhelms-University Münster, Corrensstraße 48, 48149, Münster, Germany
| |
Collapse
|
39
|
Pelicano‐Romano J, Neves MR, Amado A, Cavaco AM. Do community pharmacists actively engage elderly patients in the dialogue? Results from pharmaceutical care consultations. Health Expect 2015; 18:1721-34. [PMID: 24341397 PMCID: PMC5060884 DOI: 10.1111/hex.12165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about community pharmacist-patient interaction within a consultation room, particularly in terms of patient activation and engagement. OBJECTIVE To explore pharmacists' communication and attitudes while providing advanced medication-related services. METHODS A cross-sectional descriptive study, using the Roter Interaction Analysis System (RIAS) framework, to analyse a sample of audio-recorded pharmaceutical care consultations with elderly patients. RESULTS Around 15.0 per cent of pharmacists' utterances and 3.6 per cent of patients' were related to engagement with the latter during the exchange. To improve health outcomes, such as adherence to a therapeutic regime, pharmacists should augment patients' participation in the dialogue, facilitating concerns and disclosure of doubts, thus improving correct medication use behaviour.
Collapse
Affiliation(s)
- João Pelicano‐Romano
- Department of Pharmacoepidemiology and Social PharmacyResearch Institute for Medicines and Pharmaceutical Sciences (iMed.UL)Faculty of PharmacyUniversity of LisbonLisboaPortugal
| | - Mariana R. Neves
- Department of Pharmacoepidemiology and Social PharmacyResearch Institute for Medicines and Pharmaceutical Sciences (iMed.UL)Faculty of PharmacyUniversity of LisbonLisboaPortugal
| | - Ana Amado
- Faculty of PharmacyUniversity of LisbonLisboaPortugal
| | - Afonso M. Cavaco
- Department of Pharmacoepidemiology and Social PharmacyResearch Institute for Medicines and Pharmaceutical Sciences (iMed.UL)Faculty of PharmacyUniversity of LisbonLisboaPortugal
| |
Collapse
|
40
|
Ifeanyi Chiazor E, Evans M, van Woerden H, Oparah AC. A Systematic Review of Community Pharmacists’ Interventions in Reducing Major Risk Factors for Cardiovascular Disease. Value Health Reg Issues 2015; 7:9-21. [DOI: 10.1016/j.vhri.2015.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 01/08/2023]
|
41
|
Lee JK, Alshehri S, Kutbi HI, Martin JR. Optimizing pharmacotherapy in elderly patients: the role of pharmacists. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:101-111. [PMID: 29354524 PMCID: PMC5741014 DOI: 10.2147/iprp.s70404] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
As the world's population ages, global health care systems will face the burden of chronic diseases and polypharmacy use among older adults. The traditional tasks of medication dispensing and provision of basic education by pharmacists have evolved to active engagement in direct patient care and collaborative team-based care. The care of older patients is an especially fitting mission for pharmacists, since the key to geriatric care often lies with management of chronic diseases and polypharmacy use, and preventing harmful consequences of both. Because most chronic conditions are treated with medications, pharmacists, with their extensive training in pharmacotherapy and pharmacokinetics, are in a unique and critical position in the management of them. Pharmacists have the expertise to detect, resolve, and prevent medication errors and drug-related problems, such as overtreatment, undertreatment, adverse drug events, and nonadherence. Pharmacists are also competent in critically reviewing and applying clinical guidelines to the care of individual patients, and in some instances confront the lack of data (common in older adults) to provide the best possible patient-centered care. The current review aimed to depict the evidence of geriatric pharmacy care, demonstrate current impact of pharmacists' interventions on older patients, survey the tools used by pharmacists to provide effective care, and explore their role in pharmacotherapy optimization in elders. The findings of the current review strongly support previous studies that showed positive impact of pharmacists' interventions on older patients' health-related outcomes. There is a clear role for pharmacists working directly or collaboratively to improve medication use and management in older populations. Therefore, in global health care systems, teams caring for elders should involve pharmacists to optimize pharmacotherapy.
Collapse
Affiliation(s)
- Jeannie K Lee
- Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Samah Alshehri
- Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, USA.,Department of Clinical Pharmacy, King Abdulaziz University College of Pharmacy, Jeddah, Saudi Arabia
| | - Hussam I Kutbi
- Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, USA.,Department of Clinical Pharmacy, King Abdulaziz University College of Pharmacy, Jeddah, Saudi Arabia
| | - Jennifer R Martin
- Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, USA.,Arizona Health Sciences Library, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
42
|
Mekdad SS, AlSayed AD. Towards safety of oral anti-cancer agents, the need to educate our pharmacists. Saudi Pharm J 2015; 25:136-140. [PMID: 28223874 PMCID: PMC5310136 DOI: 10.1016/j.jsps.2015.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/16/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction: The global prevalence of cancer is rising. Use of oral anticancer medications has expanded exponentially. Knowledge about these medications as well as safe handling guidelines has not kept abreast with the rapidity these medications are applied in clinical practice. They pose serious hazards on all personal involved in handling these medications as well as on patients and their caregivers. We addressed the gaps in knowledge and safe handling of oral anticancer agents among pharmacists in institutional based cancer care. Materials and Methods: We used a 41 item questionnaire to explore three domains, pharmacists' knowledge, safe handling practice and confidence and self-improving strategies towards these agents among pharmacists in multicentre specialized cancer care. Results: Participants included 120 pharmacists dedicated to handle and dispense oral anticancer agents. About 20% of Pharmacists have adequate knowledge about oral anticancer agents. Less than 50% apply safe handling principles adequately. Only a quarter are confident in educating cancer patients and their caregivers about Oral Anti-Cancer Agents. Conclusions: Pharmacists' knowledge about Oral Anticancer agents needs to be improved. Safe handling and dispensing practice of these medications should be optimized. Pharmacists' confidence towards educating patients and their caregiver needs to be addressed. Enhancing safety of oral anticancer agents should be a priority. Involving all key players, research and quality improving projects are needed to improve all aspects of the safety of oral anticancer agents.
Collapse
Affiliation(s)
- Sanaa Saeed Mekdad
- Senior and Clinical Pharmacist, Department of Pharmacy, King Fahad Medical City, AlDhabab Street, Riyadh 11525, Saudi Arabia
| | - Adher Dhaya AlSayed
- King Faisal Hospital and Research Center, Oncology Center, Riyadh 11211, Saudi Arabia
| |
Collapse
|
43
|
Ocampo CC, Garcia-Cardenas V, Martinez-Martinez F, Benrimoj SI, Amariles P, Gastelurrutia MA. Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes. Int J Clin Pharm 2015; 37:931-40. [PMID: 26040837 DOI: 10.1007/s11096-015-0145-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/27/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite many research studies demonstrating the benefit in clinical, economic, and humanistic outcomes of professional pharmacy services, there is a paucity of evidence when these services become incorporated into the usual practice of a community pharmacy. OBJECTIVE The objective of the present study was to evaluate the clinical, economic, and humanistic impact of a pharmacist-conducted medication review with follow-up following 18 months implementation. SETTING Community pharmacies in Spain. METHOD The study used an effectiveness-implementation hybrid design. During the follow-up, patients attended the pharmacy on a monthly basis and received the medication review with follow-up service. MAIN OUTCOME MEASURE Economic, clinical, and humanistic measures were used to assess the impact of the service. RESULTS 132 patients received the service. During the 18 months of follow-up, 408 negative outcomes related to medicines (which are uncontrolled health problems) were identified, of which 393 were resolved. The average number of medicines used by patients significantly decreased from 6.1 (SD: 2.9) to 3.3 (SD: 2.2). A significant decrease was also observed in hospitalizations [OR = 0.31 (IC 95% = 0.10-0.99)] and in emergency department visits [OR = 0.16 (IC 95% = 0.05-0.55); p = 0.001]. A general trend to increase all quality of life domains was observed over time. The higher increase was observed in the construct health transition [mean increase: 30.7 (SD: 25.4)], followed by bodily pain [mean increase: 22.3 (SD: 25.4)], and general health [mean increase: 20.7 (SD: 23.7)]. Medication knowledge significantly increased in terms of aggregated domains of dose, frequency, drug indication [from 8.9 (SD: 17.5) to 87.9 (SD: 25.0)], and dose and frequency [from 9.3 (SD: 17.9) to 92.5 (22.1)]. Although a slight improvement was observed in terms of drug indication, this increase was not statistically significant. 68 out of 132 patients (51.5%) were non-adherent to their treatment. This number decreased to 1 (0.8%) after the follow-up [OR = 0.007 (IC 95%: 0.001-0.053) p < 0.001]. CONCLUSION A community pharmacy based medication review with follow-up service delivered by a trained pharmacist, has positive effects across clinical, economic, and humanistic outcomes. These results are consistent with previous studies. Incorporating community pharmacists into the multidisciplinary team is a reliable solution to improve health care.
Collapse
Affiliation(s)
- Carla Castrillon Ocampo
- Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Victoria Garcia-Cardenas
- Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain.
- Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Fernando Martinez-Martinez
- Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Pedro Amariles
- Grupo Promoción y Prevención Farmacéutica, Departamento de Farmacia, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia
| | - Miguel Angel Gastelurrutia
- Grupo de Investigacion en Atencion Farmaceutica, Facultad de Farmacia, Universidad de Granada, Campus de Cartuja s/n, 18071, Granada, Spain
| |
Collapse
|
44
|
Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000–2010). Int J Clin Pharm 2015; 37:687-97. [DOI: 10.1007/s11096-015-0137-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 05/12/2015] [Indexed: 01/08/2023]
|
45
|
Rosenthal M, Hall KW, Bussières JF, Tsuyuki RT. Professional Culture and Personality Traits of Hospital Pharmacists across Canada: A Fundamental First Step in Developing Effective Knowledge Translation Strategies. Can J Hosp Pharm 2015; 68:127-35. [PMID: 25964684 DOI: 10.4212/cjhp.v68i2.1438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence for the value of pharmacists' interventions in the care of patients is strong and continues to grow, but the rate at which these new practice opportunities are being integrated into daily practice has not kept pace. The knowledge translation literature suggests that before effective change strategies can be implemented, a better understanding of the current environment must be obtained. Two important factors within the practice environment are the professional culture and personality traits of group members. OBJECTIVE To gain insight, at a national level, into the culture of hospital pharmacy, using the Organizational Culture Profile, and into hospital pharmacists' personality traits, using the Big Five Inventory. METHODS A cross-sectional survey of hospital pharmacists from across Canada was conducted intermittently over the period August 2012 to September 2013. The online survey contained questions about demographic characteristics and practice setting, as well as questions from the Organizational Culture Profile and Big Five Inventory. The survey link was distributed directly to hospital pharmacists or made available through provincial monthly newsletters. All data were analyzed descriptively and inferentially. RESULTS In total, 401 surveys were returned. Descriptive analyses from the Organizational Culture Profile revealed that most respondents perceived value in the factors of supportiveness, competitiveness, and stability. Descriptive analyses from the Big Five Inventory revealed that respondents may have been more likely to exhibit behaviours in line with the trait of conscientiousness. Several significant subgroup differences were noted in relation to levels of education, regions of practice within Canada, years in practice, and proportion of time spent conducting clinical duties. CONCLUSIONS The results from this survey provide preliminary insight into the professional culture and personality traits of Canadian hospital pharmacists. It will be important to explore these findings in more depth to maximize the success of any future practice change initiatives.
Collapse
Affiliation(s)
- Meagen Rosenthal
- PhD, is Assistant Professor in the Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, Mississippi
| | - Kevin W Hall
- BScPharm, PharmD, FCSHP, is Clinical Associate Professor in the Faculty of Pharmacy, University of Alberta, Edmonton, Alberta
| | - Jean-François Bussières
- BPharm, MSc, MBA, FCSHP, is Head of the Department of Pharmacy and the Pharmacy Practice Research Unit, Centre hospitalier universitaire Sainte-Justine, and Clinical Professor in the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
| | - Ross T Tsuyuki
- BSc(Pharm), PharmD, MSc, FCSHP, FACC, is a Professor of Medicine (Cardiology) and Director, EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| |
Collapse
|
46
|
Sakthong P, Suksanga P, Sakulbumrungsil R, Winit-Watjana W. Development of Patient-reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL): A novel instrument for medication management. Res Social Adm Pharm 2015; 11:315-38. [DOI: 10.1016/j.sapharm.2014.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
|
47
|
Rosenthal MM, Tsuyuki RT, Houle SK. A cluster-randomized controlled knowledge translation feasibility study in Alberta community pharmacies using the PARiHS framework: study protocol. Pilot Feasibility Stud 2015; 1:2. [PMID: 27965782 PMCID: PMC5066522 DOI: 10.1186/2055-5784-1-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/29/2014] [Indexed: 12/03/2022] Open
Abstract
Background Despite evidence of benefit for pharmacist involvement in chronic disease management, the provision of these services in community pharmacy has been suboptimal. The Promoting Action on Research Implementation in Health Services (PARiHS) framework suggests that for knowledge translation to be effective, there must be evidence of benefit, a context conducive to implementation, and facilitation to support uptake. We hypothesize that while the evidence and context components of this framework are satisfied, that uptake into practice has been insufficient because of a lack of facilitation. This protocol describes the rationale and methods of a feasibility study to test a facilitated pharmacy practice intervention based on the PARiHS framework, to assist community pharmacists in increasing the number of formal and documented medication management services completed for patients with diabetes, dyslipidemia, and hypertension. Methods A cluster-randomized before-after design will compare ten pharmacies from within a single organization, with the unit of randomization being the pharmacy. Pharmacies will be randomized to facilitated intervention based on the PARiHS framework or usual practice. The Alberta Context Tool will be used to establish the context of practice in each pharmacy. Pharmacies randomized to the intervention will receive task-focused facilitation from an external facilitator, with the goal of developing alternative team processes to allow the greater provision of medication management services for patients with diabetes, hypertension, and dyslipidemia. The primary outcome will be a process evaluation of the needs of community pharmacies to provide more clinical services, the acceptability and uptake of modifications made, and the willingness of pharmacies to participate. Secondary outcomes will include the change in the number of formal and documented medication management services in the aforementioned chronic conditions provided 6 months before, versus after, the intervention between the two groups, and identification of feasible quantitative outcomes for evaluating the effect of the intervention on patient care outcomes. Results To date, the study has identified and enrolled the ten pharmacies required and initiated the intervention process. Conclusion This study will be the first to examine the role of facilitation in pharmacy practice, with the goal of scalable and sustainable practice change. Trial registration Clinicaltrials.gov identifier NCT02191111.
Collapse
Affiliation(s)
- Meagen M Rosenthal
- Department of Pharmacy Administration, University of Mississippi, 223 Faser Hall, Post Office Box 1848, Mississippi, MS 38677-1848 USA
| | - Ross T Tsuyuki
- University of Alberta, 3rd Floor, Brain and Aging Research Building, Edmonton, Alberta T6G 2M8 Canada
| | - Sherilyn Kd Houle
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| |
Collapse
|
48
|
Puspitasari HP, Aslani P, Krass I. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists. PLoS One 2014; 9:e113337. [PMID: 25409194 PMCID: PMC4237444 DOI: 10.1371/journal.pone.0113337] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background As primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD) as a case study, we explored factors that influence community pharmacists’ everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD. Methods In-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a “grounded-theory” approach. Results Our model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the “people” factors, including their own attitudes and beliefs as well as those of clients and doctors; the “environment” within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists’ contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration. Conclusion Tackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society.
Collapse
Affiliation(s)
- Hanni P. Puspitasari
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
- Fakultas Farmasi, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | - Parisa Aslani
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| |
Collapse
|
49
|
Caractéristiques des revues systématiques présentant les interventions de pharmaciens. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:429-39. [DOI: 10.1016/j.pharma.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/24/2022]
|
50
|
Lalonde L, Leroux-Lapointe V, Choinière M, Martin E, Lussier D, Berbiche D, Lamarre D, Thiffault R, Jouini G, Perreault S. Knowledge, attitudes and beliefs about chronic noncancer pain in primary care: a Canadian survey of physicians and pharmacists. Pain Res Manag 2014; 19:241-50. [PMID: 25299473 PMCID: PMC4197751 DOI: 10.1155/2014/760145] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary care providers' knowledge, attitudes and beliefs (KAB) regarding chronic noncancer pain (CNCP) are a barrier to optimal management. OBJECTIVES To evaluate and identify the determinants of the KAB of primary care physicians and pharmacists, and to document clinician preferences regarding the content and format of a continuing education program (CEP). METHOD Physicians and pharmacists of 486 CNCP patients participated. Physicians completed the original version of the KnowPain-50 questionnaire. Pharmacists completed a modified version. A multivariate linear regression model was developed to identify the determinants of their KAB. RESULTS A total of 137 of 387 (35.4%) physicians and 110 of 278 (39.5%) pharmacists completed the survey. Compared with the physicians, the pharmacists surveyed included more women (64% versus 38%) and had less clinical experience (15 years versus 26 years). The mean KnowPain-50 score was 69.3% (95% CI 68.0% to 70.5%) for physicians and 63.8% (95% CI 62.5% to 65.1%) for pharmacists. Low scores were observed on all aspects of pain management: initial assessment (physicians, 68.3%; pharmacists, 65.4%); definition of treatment goals and expectations (76.1%; 61.6%); development of a treatment plan (66.4%; 59.0%); and reassessment and management of longitudinal care (64.3%; 53.1%). Ten hours of reported CEP sessions increased the KAB score by 0.3 points. All clinicians considered a CEP for CNCP to be essential. Physicians preferred an interactive format, while pharmacists had no clear preferences. CONCLUSION A CEP to improve primary care providers' knowledge and competency in managing CNCP, and to reduce false beliefs and inappropriate attitudes regarding CNCP is relevant and perceived as necessary by clinicians.
Collapse
Affiliation(s)
- Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal
- Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval
| | - Vincent Leroux-Lapointe
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval
- Department of Medicine
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal
- Department of Anesthesiology, Faculty of Medicine
| | - Elisabeth Martin
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval
| | - David Lussier
- Institut universitaire de gériatrie de Montréal, Department of Medicine, Université de Montréal
- Division of Geriatric Medicine, McGill University Health Centre, Department of Medicine, McGill University
| | - Djamal Berbiche
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval
| | - Diane Lamarre
- Faculty of Pharmacy, Université de Montréal, Montreal
- Ordre des pharmaciens du Québec, Montreal
| | | | - Ghaya Jouini
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal
- Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, Quebec
| |
Collapse
|