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Costa S, Guerreiro J, Teixeira I, Helling DK, Pereira J, Mateus C. Cost-effectiveness and cost-utility of hypertension and hyperlipidemia collaborative management between pharmacies and primary care in portugal alongside a trial compared with usual care (USFarmácia®). Front Pharmacol 2022; 13:903270. [PMID: 36160402 PMCID: PMC9493118 DOI: 10.3389/fphar.2022.903270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background: There is little experience in the economic evaluation of pharmacy/primary care collaborative health interventions using interprofessional technology-driven communication under real-world conditions. This study aimed to conduct cost-effectiveness and cost-utility analyses of a collaborative care intervention in hypertension and hyperlipidemia management between pharmacies and primary care versus usual (fragmented) care alongside a trial. Methods: An economic evaluation was conducted alongside a 6-month pragmatic quasi-experimental controlled trial. Data sources included primary care clinical software; pharmacy dispensing software; patient telephone surveys; and published literature. The target population was adult patients on hypertension and/or lipid-lowering medication. The perspective was societal. We collected patient-level data on resource use to estimate trial costs. Effect outcomes included blood pressure (BP) and quality-adjusted life years (QALYs). Bootstrapping was used to estimate uncertainty around the incremental cost-effectiveness and cost-utility ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care as denoted by the levels of uncertainty expressed in wide confidence intervals. The probability of the intervention being cost-effective is 28% at the threshold of €20,000 per QALY gained and 57% at the threshold of €500 per mmHg systolic BP decrease. Conclusion: Considering the limitations of the trial which affected effectiveness and economic outcomes, our results are not generalizable for community pharmacy and primary care in Portugal. This research offers, however, valuable lessons on methods and strategies that can be used in future economic evaluations of collaborative public health interventions with the potential for reimbursement. Clinical trial registration:https://www.isrctn.com/ISRCTN13410498, identifier ISRCTN13410498
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Affiliation(s)
- Suzete Costa
- Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal
- Institute for Evidence-Based Health (ISBE), Lisboa, Portugal
- *Correspondence: Suzete Costa, , orcid.org/0000-0002-4521-5473
| | - José Guerreiro
- Centre for Health Evaluation and Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), Lisboa, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation and Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), Lisboa, Portugal
| | - Dennis K. Helling
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colorado, United States
| | - João Pereira
- Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), and Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Manon SM, Phuong JM, Moles RJ, Kelly A, Center JR, Luckie K, White C, Carter SR. The role of community pharmacists in delivering interventions for osteoporosis: A systematic review. J Am Pharm Assoc (2003) 2022; 62:1741-1749.e10. [DOI: 10.1016/j.japh.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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Miller P, Newby D, Walkom E, Schneider J, Li SC. Depression screening in adults by pharmacists in the community: a systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:428-440. [PMID: 32776433 DOI: 10.1111/ijpp.12661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 11/08/2023]
Abstract
BACKGROUND Improving the identification of depression in adults in primary care can produce clinical and economic benefits. Community Pharmacists may play a role in screening for depression. OBJECTIVE To systematically review and evaluate the evidence for the feasibility, impact and cost-effectiveness of community pharmacists screening adults for depression. METHODS An electronic literature search using the databases EMBASE, PubMed and CINAHL Complete from January 2000 to September 2019 was undertaken to identify studies involving community pharmacists screening for depression. Data relating to sample size, population demographics and medical conditions of adults screened were extracted. Details around the screening model, process-related outcomes, clinical outcomes and economic outcomes were also extracted. RESULTS Ten studies using eight unique depression screening tools were identified. Ease of administration was the most common selection criterion (n = 4) while no reason was given in four studies. Seven studies reported that through screening, pharmacists could identify adults with undiagnosed depression. Pharmacists referred adults screening positive for assessment in seven studies and followed up participants in two studies. No study assessed the impact of screening on depressive symptoms or the cost-effectiveness of pharmacists screening for depression. CONCLUSION Community pharmacists are able to use depression screening tools to identify undiagnosed adults having symptoms of depression. However, there is little evidence around the impact of this screening on clinical and economic outcomes. Larger, well-designed studies that use a highly accurate, easily administered screening tool and include patient referral and follow-up and pharmacist training are warranted to provide evidence on the impact of community pharmacists screening adults for depression.
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Affiliation(s)
- Peter Miller
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - David Newby
- Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Emily Walkom
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Jennifer Schneider
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Shu Chuen Li
- Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev 2019; 12:CD011207. [PMID: 31808563 PMCID: PMC6896091 DOI: 10.1002/14651858.cd011207.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I2 = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I2 = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I2= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation. AUTHORS' CONCLUSIONS Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.
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Affiliation(s)
- Liz Steed
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Ratna Sohanpal
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Vichithranie W Madurasinghe
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Elizabeth A Edwards
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Stephanie JC Taylor
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | - RT Walton
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
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5
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Yuan C, Ding Y, Zhou K, Huang Y, Xi X. Clinical outcomes of community pharmacy services: A systematic review and meta-analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e567-e587. [PMID: 31225940 DOI: 10.1111/hsc.12794] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/05/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
Community pharmacy services (CPS) have been shown to be positive in many disease management and patient care programs, but clinical outcomes were followed by process indicators and methodological flaws in previous researches made it difficult to prove the effectiveness of clinical outcomes of CPS. Therefore, this study attempted to review the clinical outcomes of CPS. Interventions included are provision of medication review, patient education, adherence assessment, health/lifestyle advice, physical assessment, monitoring, prescribing, or adjusting and administering therapy from community pharmacists. By searching for key words like community pharmacists, pharmaceutical services, clinical outcomes in MEDLINE and EMBASE and manually searching (up to June 2017), 1910 studies investigating the clinical outcomes of CPS were obtained. After screening the titles, abstracts and full texts for relevancy, 52 researches with controlled groups were included and assessed for methodological quality. Finally, 25 studies were selected for the meta-analysis based on their common endpoints: systolic blood pressure, diastolic blood pressure and glycosylated haemoglobin. The Cochrane tool was used to assess the risk of bias. Chi-square and I-square tests were performed to assess heterogeneity, and the weighted mean differences were estimated using random effect models. Of the 52 articles, 47 studies demonstrated that CPS had positive clinical outcomes, 3 studies showed mixed outcomes and 2 studies revealed no effects. In the meta-analysis, intervention groups displayed greater reductions in systolic BP (95% CI: -8.198-2.356), diastolic BP (95% CI: -3.648-0.645) and HbA1c (95% CI: -0.905-0.224) than usual care groups. CPS have positive clinical outcomes, particularly significant reductions in systolic BP, diastolic BP and HbA1c. It was difficult to find out which intervention(s) of CPS directly led to certain changes and influence of CPS might be underestimated for only three common surrogate endpoints. More researches should be conducted with sufficient data.
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Affiliation(s)
- Cancan Yuan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yiwen Ding
- School of Life Science and Technolog, China Pharmaceutical University, Nanjing, China
| | - Keruo Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yuankai Huang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
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6
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Taing M, Firth N, Ford PJ, Freeman CR. Exploring oral healthcare management across Australian community pharmacies using case vignettes. Community Dent Oral Epidemiol 2019; 47:225-235. [DOI: 10.1111/cdoe.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Meng‐Wong Taing
- School of PharmacyThe University of Queensland Brisbane Queensland Australia
- Centre for Optimising Pharmacy Practice‐based Excellence in ResearchThe University of Queensland Brisbane Queensland Australia
| | - Norman Firth
- School of DentistryThe University of Queensland Brisbane Queensland Australia
| | - Pauline J. Ford
- School of DentistryThe University of Queensland Brisbane Queensland Australia
| | - Christopher R. Freeman
- School of PharmacyThe University of Queensland Brisbane Queensland Australia
- Centre for Optimising Pharmacy Practice‐based Excellence in ResearchThe University of Queensland Brisbane Queensland Australia
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7
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Sabater-Hernández D, Sabater-Galindo M, Fernandez-Llimos F, Rotta I, Hossain LN, Durks D, Franco-Trigo L, Lopes LA, Correr CJ, Benrimoj SI. A Systematic Review of Evidence-Based Community Pharmacy Services Aimed at the Prevention of Cardiovascular Disease. J Manag Care Spec Pharm 2017; 22:699-713. [PMID: 27231797 PMCID: PMC10398089 DOI: 10.18553/jmcp.2016.22.6.699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system. OBJECTIVES To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings. METHODS This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings. RESULTS From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities. CONCLUSIONS This review provides pharmacy service planners and policymakers with a comprehensive list of evidence-based services that have the potential to be adapted to different settings from which they were originally implemented and evaluated in order to reduce the burden of CVD. DISCLOSURES Funding for this review was provided by the University of Technology Sydney Chancellor's Postdoctoral Fellowship awarded to Sabater-Hernández. No other potential conflict of interest was declared. Study concept and design were contributed by Sabater-Hernández, Fernandez-Llimos, Rotta, and Correr. Sabater-Galindo and Sabater-Hernández took the lead in data collection, along with Franco-Trigo and Rotta. Data interpretation was performed by Sabater-Hernández, Durks, and Lopes. The manuscript was written primarily by Sabater-Hernández, along with Hossain, and revised by Fernandez-Llimos, Rotta, and Benrimoj, with assistance from Durks, Sabater-Galindo, Franco-Trigo, and Correr.
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Affiliation(s)
- Daniel Sabater-Hernández
- 1 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia, and Academic Centre in Pharmaceutical Care, University of Granada, Granada, Spain
| | | | - Fernando Fernandez-Llimos
- 3 Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisboa, Lisbon, Portugal
| | - Inajara Rotta
- 4 PostGraduate Program of Pharmaceutical Sciences, Federal University of Parana
| | - Lutfun N Hossain
- 7 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Desire Durks
- 8 Graduate School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Lucia Franco-Trigo
- 9 School of Health (UTS: Pharmacy), University of Technology Sydney, Sydney, Australia
| | - Livia A Lopes
- 5 Post-Graduate Program of Pharmaceutical Sciences, Federal University of Parana
| | - Cassyano J Correr
- 6 Department of Pharmacy, Federal University of Parana, Curitiba, Brazil
| | - Shalom I Benrimoj
- 10 School of Health University of Technology Sydney, Sydney, Australia
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van Driel ML, Morledge MD, Ulep R, Shaffer JP, Davies P, Deichmann R. Interventions to improve adherence to lipid-lowering medication. Cochrane Database Syst Rev 2016; 12:CD004371. [PMID: 28000212 PMCID: PMC6464006 DOI: 10.1002/14651858.cd004371.pub4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lipid-lowering drugs are widely underused, despite strong evidence indicating they improve cardiovascular end points. Poor patient adherence to a medication regimen can affect the success of lipid-lowering treatment. OBJECTIVES To assess the effects of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and CINAHL up to 3 February 2016, and clinical trials registers (ANZCTR and ClinicalTrials.gov) up to 27 July 2016. We applied no language restrictions. SELECTION CRITERIA We evaluated randomised controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with a variety of measurable outcomes, such as adherence to treatment and changes to serum lipid levels. Two teams of review authors independently selected the studies. DATA COLLECTION AND ANALYSIS Three review authors extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the quality of the evidence using GRADEPro. MAIN RESULTS For this updated review, we added 24 new studies meeting the eligibility criteria to the 11 studies from prior updates. We have therefore included 35 studies, randomising 925,171 participants. Seven studies including 11,204 individuals compared adherence rates of those in an intensification of a patient care intervention (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) versus usual care over the short term (six months or less), and were pooled in a meta-analysis. Participants in the intervention group had better adherence than those receiving usual care (odds ratio (OR) 1.93, 95% confidence interval (CI) 1.29 to 2.88; 7 studies; 11,204 participants; moderate-quality evidence). A separate analysis also showed improvements in long-term adherence rates (more than six months) using intensification of care (OR 2.87, 95% CI 1.91 to 4.29; 3 studies; 663 participants; high-quality evidence). Analyses of the effect on total cholesterol and LDL-cholesterol levels also showed a positive effect of intensified interventions over both short- and long-term follow-up. Over the short term, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17 to 33.14; 4 studies; 430 participants; low-quality evidence) and LDL-cholesterol decreased by a mean of 19.51 mg/dL (95% CI 8.51 to 30.51; 3 studies; 333 participants; moderate-quality evidence). Over the long term (more than six months) total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95 to 20.19; 2 studies; 127 participants; high-quality evidence). Included studies did not report usable data for health outcome indications, adverse effects or costs/resource use, so we could not pool these outcomes. We assessed each included study for bias using methods described in the Cochrane Handbook for Systematic Reviews of Interventions. In general, the risk of bias assessment revealed a low risk of selection bias, attrition bias, and reporting bias. There was unclear risk of bias relating to blinding for most studies. AUTHORS' CONCLUSIONS The evidence in our review demonstrates that intensification of patient care interventions improves short- and long-term medication adherence, as well as total cholesterol and LDL-cholesterol levels. Healthcare systems which can implement team-based intensification of patient care interventions may be successful in improving patient adherence rates to lipid-lowering medicines.
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Affiliation(s)
- Mieke L van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia, 4029
- Department of Family Medicine and Primary Health Care, Ghent University, 1K3, De Pintelaan 185, Ghent, Belgium, 9000
| | - Michael D Morledge
- Ochsner Clinical School, School of Medicine, The University of Queensland, New Orleans, USA
| | - Robin Ulep
- Ochsner Clinical School, School of Medicine, The University of Queensland, New Orleans, USA
| | - Johnathon P Shaffer
- Ochsner Clinical School, School of Medicine, The University of Queensland, New Orleans, USA
| | - Philippa Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, UK, BS8 2PS
| | - Richard Deichmann
- Department of Internal Medicine, Ochsner Health System, 1514 Jefferson Hwy, New Orleans, USA, 70121
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Perraudin C, Bugnon O, Pelletier-Fleury N. Expanding professional pharmacy services in European community setting: Is it cost-effective? A systematic review for health policy considerations. Health Policy 2016; 120:1350-1362. [DOI: 10.1016/j.healthpol.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 08/02/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022]
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Malet-Larrea A, García-Cárdenas V, Sáez-Benito L, Benrimoj SI, Calvo B, Goyenechea E. Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:747-758. [DOI: 10.1080/14737167.2016.1259071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Malet-Larrea
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - V García-Cárdenas
- Graduate School of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - L Sáez-Benito
- Faculty of Health Sciences, Pharmacy Department, San Jorge University, Villanueva de Gállego, Zaragoza, Spain
| | - SI Benrimoj
- Graduate School of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - B Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - E Goyenechea
- Technical Management Department, Official Pharmacist Association of Guipuzcoa, Donostia-San Sebastian, Spain
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Tsuyuki RT, Sebestyen N, Davis S, Rondos S. Trois points de vue sur les partenariats pour corriger les lacunes en matière de soins de santé. Healthc Manage Forum 2015; 28:S28-S32. [PMID: 26482221 DOI: 10.1177/0840470415595562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Puisqu'ils sont en première ligne auprès des patients, les pharmaciens communautaires jouent un rôle essentiel au sein du système de santé. Le présent article propose trois points de vue sur la manière dont une approche concertée, qui inclut le pharmacien communautaire, peut améliorer les soins aux patients et réduire les coûts pour le système. C'est la réussite de ces modèles de partenariat qui contribue à susciter des changements systémiques. L'article présente les réflexions du docteur Ross Tsuyuki, l'un des chercheurs canadiens de pointe sur le sujet, et quelques découvertes réalisées tout au long de son partenariat avec Merck au Canada depuis 20 ans. La majeure partie des études révisées par des pairs du docteur Tsuyuki sont menées en Alberta, où la portée de la pratique des pharmaciens est élargie.
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Tsuyuki RT, Sebestyen N, Davis S, Rondos S. Three perspectives on partnering to close the care gap. Healthc Manage Forum 2015; 28:S23-7. [PMID: 26487728 DOI: 10.1177/0840470415595567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given their frontline relationship with patients, community pharmacists fill a vital role in our healthcare system. This article offers three perspectives on how a team-based approach, which integrates the community pharmacist, can enhance patient care and reduce system costs. It is the success of these partnership models which have helped drive system-level change. It offers reflections by Dr. Ross T. Tsuyuki, among Canada's leading researchers on the subject, and presents some findings over his 20-year partnership with Merck in Canada. Dr. Tsuyuki's peer-reviewed studies have been largely centred in Alberta, one province in which the scope of practice for pharmacists has been expanded.
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Affiliation(s)
- Ross T Tsuyuki
- Epicore Centre, University of Alberta, Edmonton, Alberta, Canada
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Finkelstein EA, Khavjou OA, Will JC, Farris RP, Prabhu M. Assessing the ability of cardiovascular disease risk calculators to evaluate effectiveness of trials and interventions. Expert Rev Pharmacoecon Outcomes Res 2014; 6:417-24. [DOI: 10.1586/14737167.6.4.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists' practice: implications for physicians. CMAJ 2013; 185:1228-32. [PMID: 23959280 DOI: 10.1503/cmaj.121990] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Johnson JA, Al Sayah F, Wozniak L, Rees S, Soprovich A, Chik CL, Chue P, Florence P, Jacquier J, Lysak P, Opgenorth A, Katon WJ, Majumdar SR. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: rationale and design for a comprehensive evaluation. BMC Health Serv Res 2012; 12:258. [PMID: 22897901 PMCID: PMC3445824 DOI: 10.1186/1472-6963-12-258] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/03/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND When depression accompanies diabetes, it complicates treatment, portends worse outcomes and increases health care costs. A collaborative care case-management model, previously tested in an urban managed care organization in the US, achieved significant reduction of depressive symptoms, improved diabetes disease control and patient-reported outcomes, and saved money. While impressive, these findings need to be replicated and extended to other healthcare settings. Our objective is to comprehensively evaluate a collaborative care model for comorbid depression and type 2 diabetes within a Canadian primary care setting. METHODS/DESIGN We initiated the TeamCare model in four Primary Care Networks in Northern Alberta. The intervention involves a nurse care manager guiding patient-centered care with family physicians and consultant physician specialists to monitor progress and develop tailored care plans. Patients eligible for the intervention will be identified using the Patient Health Questionnaire-9 as a screen for depressive symptoms. Care managers will then guide patients through three phases: 1) improving depressive symptoms, 2) improving blood glucose, blood pressure and cholesterol, and 3) improving lifestyle behaviors. We will employ the RE-AIM framework for a comprehensive and mixed-methods approach to our evaluation. Effectiveness will be assessed using a controlled "on-off" trial design, whereby eligible patients would be alternately enrolled in the TeamCare intervention or usual care on a monthly basis. All patients will be assessed at baseline, 6 and 12 months. Our primary analyses will be based on changes in two outcomes: depressive symptoms, and a multivariable, scaled marginal model for the combined outcome of global disease control (i.e., A1c, systolic blood pressure, LDL cholesterol). Our planned enrolment of 168 patients will provide greater than 80% power to observe clinically important improvements in all measured outcomes. Direct costing of all intervention components and measurement of all health care utilization using linked administrative databases will be used to determine the cost-effectiveness of the intervention relative to usual care. DISCUSSION Our comprehensive evaluation will generate evidence to reliability, effectiveness and sustainability of this collaborative care model for patients with chronic diseases and depression. TRIALS REGISTRATION Clinicaltrials.gov Identifier: NCT01328639.
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Affiliation(s)
- Jeffrey A Johnson
- Department of Public Health Sciences, University of Alberta, Edmonton, Canada
- ACHORD, University of Alberta, Edmonton, Canada
| | - Fatima Al Sayah
- Department of Public Health Sciences, University of Alberta, Edmonton, Canada
- ACHORD, University of Alberta, Edmonton, Canada
| | | | - Sandra Rees
- ACHORD, University of Alberta, Edmonton, Canada
| | | | | | - Pierre Chue
- Alberta Health Services, Edmonton, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | | | - Pauline Lysak
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sumit R Majumdar
- ACHORD, University of Alberta, Edmonton, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
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Brown D, Portlock J, Rutter P. Review of services provided by pharmacies that promote healthy living. Int J Clin Pharm 2012; 34:399-409. [PMID: 22527479 DOI: 10.1007/s11096-012-9634-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The recognition that community pharmacies have the potential to make a greater contribution to promoting public health has led to a new concept, called the Healthy Living Pharmacy (HLP). These are designed to meet public health needs through a tiered commissioning framework delivering health and well being services through community pharmacy, tailored to local requirements for tackling health inequalities. AIM To search the literature for quality evidence to support the inclusion of services in the HLP portfolio and suggest areas where more evidence is required. METHOD A systematic review of the research literature covering the period January 1990-August 2011 inclusive, using MEDLINE, EMBASE, Pharmline, NHS Evidence and the Cochrane databases. On-line searching of the grey literature (e.g. conference proceedings) was also carried out. Standard methods of assessing quality were employed. RESULTS A total of 377 papers were included. Over time, there was a marked increase in frequency of publications reflecting a growing pharmacy interest in the public healthcare agenda; over a third (35 %) of papers appeared in the last three-year study period. The body of research had a wide geographical basis; contributions were as follows: UK (51.5 %), US (20.4 %), Australia/New Zealand (9.8 %), Europe (7.7 %) and Canada (7.2 %). The topics of contraception, cardiovascular disease prevention, diabetes and smoking cessation accounted for 40 % of included papers. The literature supports the introduction of specific community pharmacy services, targeted at customer groups, both with and without pre-existing diseases. Good evidence exists for smoking cessation, cardiovascular disease prevention, hypertension and diabetes. Some good evidence exists for interventions on asthma and heart failure. The evidence supporting weight management, sexual health, osteoporosis detection, substance abuse and chronic obstructive pulmonary disease is weak and needs development. CONCLUSION There is strong evidence for the role of community pharmacy in a range of services, not only aimed at improving general health, but also maintaining the health of those with existing disease. In other areas, the evidence is less strong and further research is required to justify their inclusion in a HLP portfolio.
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Affiliation(s)
- David Brown
- University of Portsmouth, Portsmouth, Hampshire, UK.
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Nkansah N, Mostovetsky O, Yu C, Chheng T, Beney J, Bond CM, Bero L. Effect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev 2010; 2010:CD000336. [PMID: 20614422 PMCID: PMC7087444 DOI: 10.1002/14651858.cd000336.pub2] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The roles of pharmacists in patient care have expanded from the traditional tasks of dispensing medications and providing basic medication counseling to working with other health professionals and the public. Multiple reviews have evaluated the impact of pharmacist-provided patient care on health-related outcomes. Prior reviews have primarily focused on in-patient settings. This systematic review focuses on services provided by outpatient pharmacists in community or ambulatory care settings. This is an update of the Cochrane review published in 2000. OBJECTIVES To examine the effect of outpatient pharmacists' non-dispensing roles on patient and health professional outcomes. SEARCH STRATEGY This review has been split into two phases. For Phase I, we searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (January 1966 through March 2007). For Phase II, we searched MEDLINE/EMBASE (January 1966 through March 2008). The Phase I results are reported in this review; Phase II will be summarized in the next update. SELECTION CRITERIA Randomized controlled trials comparing 1. Pharmacist services targeted at patients versus services delivered by other health professionals; 2. Pharmacist services targeted at patients versus the delivery of no comparable service; 3. Pharmacist services targeted at health professionals versus services delivered by other health professionals; 4. Pharmacist services targeted at health professionals versus the delivery of no comparable service. DATA COLLECTION AND ANALYSIS Two authors independently reviewed studies for inclusion, extracted data, and assessed risk of bias of included studies. MAIN RESULTS Forty-three studies were included; 36 studies were pharmacist interventions targeting patients and seven studies were pharmacist interventions targeting health professionals. For comparison 1, the only included study showed a significant improvement in systolic blood pressure for patients receiving medication management from a pharmacist compared to usual care from a physician. For comparison 2, in the five studies evaluating process of care outcomes, pharmacist services reduced the incidence of therapeutic duplication and decreased the total number of medications prescribed. Twenty-nine of 36 studies reported clinical and humanistic outcomes. Pharmacist interventions resulted in improvement in most clinical outcomes, although these improvements were not always statistically significant. Eight studies reported patient quality of life outcomes; three studies showed improvement in at least three subdomains. For comparison 3, no studies were identified meeting the inclusion criteria. For comparison 4, two of seven studies demonstrated a clear statistically significant improvement in prescribing patterns. AUTHORS' CONCLUSIONS Only one included study compared pharmacist services with other health professional services, hence we are unable to draw conclusions regarding comparisons 1 and 3. Most included studies supported the role of pharmacists in medication/therapeutic management, patient counseling, and providing health professional education with the goal of improving patient process of care and clinical outcomes, and of educational outreach visits on physician prescribing patterns. There was great heterogeneity in the types of outcomes measured across all studies. Therefore a standardized approach to measure and report clinical, humanistic, and process outcomes for future randomized controlled studies evaluating the impact of outpatient pharmacists is needed. Heterogeneity in study comparison groups, outcomes, and measures makes it challenging to make generalised statements regarding the impact of pharmacists in specific settings, disease states, and patient populations.
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Affiliation(s)
- Nancy Nkansah
- University of California, San FranciscoClinical Pharmacy155 North Fresno Street, Suite 224FresnoCaliforniaUSA93701
| | - Olga Mostovetsky
- University of California, San FranciscoClinical PharmacySuite 420, Box 06133333 California StreetSan FranciscoCaliforniaUSA94118
| | - Christine Yu
- University of California, San FranciscoClinical PharmacySuite 420, Box 06133333 California StreetSan FranciscoCaliforniaUSA94118
| | - Tami Chheng
- University of California, San FranciscoClinical PharmacySuite 420, Box 06133333 California StreetSan FranciscoCaliforniaUSA94118
| | - Johnny Beney
- Institut Central des Hopitaux ValaisansPharmacyGrand Champsec 86CP 736SionSwitzerland1951
| | - Christine M Bond
- University of AberdeenDepartment of General Practice and Primary CareForesterhill Health CentreWestburn RoadAberdeenUKAB25 2AY
| | - Lisa Bero
- University of California San FranciscoProfessor of Clinical Pharmacy & Health PolicySuite 420, Box 06133333 California StreetSan FranciscoCaliforniaUSA94143‐0613
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Abstract
BACKGROUND Lipid lowering drugs are still widely underused, despite compelling evidence about their effectiveness in the treatment and prevention of cardiovascular disease. Poor patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidaemia. In this updated review we focus on interventions which encourage patients at risk of heart disease or stroke to take lipid lowering medication regularly. OBJECTIVES To assess the effects of interventions aimed at improved adherence to lipid lowering drugs, focusing on measures of adherence and clinical outcomes. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, PsycINFO and CINAHL (March 2008). No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials of adherence-enhancing interventions for lipid lowering medication in adults for both primary and secondary prevention of cardiovascular disease in an ambulatory setting looking at adherence, serum lipid levels, adverse effects and health outcomes. Studies were selected independently by two review authors. DATA COLLECTION AND ANALYSIS Data were extracted and assessed by two review authors following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Three additional studies were found in the update and, in total, 11 studies were included in this review. The studies included interventions that caused a change in adherence ranging from -3% to 25% (decrease in adherence by 3% to increase in adherence by 25%). Patient re-enforcement and reminding was the most promising category of interventions, investigated in six trials of which four showed improved adherent behaviour of statistical significance (absolute increase: 24%, 9%, 8% and 6%). Other interventions associated with increased adherence were simplification of the drug regimen (absolute increase 11%) and patient information and education (absolute increase 13%). The methodological and analytical quality of some studies was low and results have to be considered with caution. AUTHORS' CONCLUSIONS At this stage, reminding patients seems the most promising intervention to increase adherence to lipid lowering drugs. The lack of a gold standard method of measuring adherence is one major barrier in adherence research. More reliable data might be achieved by newer methods of measurement, more consistency in adherence assessment and longer duration of follow up. More recent studies have started using more reliable methods for data collection but follow-up periods remain too short. Increased patient-centredness with emphasis on the patient's perspective and shared decision-making might lead to more conclusive answers when searching for tools to encourage patients to take lipid lowering medication.
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Affiliation(s)
- Angela Schedlbauer
- Division of Primary Care, School of Community Health Studies, University of Nottingham, Nottingham, UK, NG7 2RD
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White EV, Latif DA. Reengineering pharmacotherapy delivery to maximize the role of the pharmacist and improve patient outcomes. Res Social Adm Pharm 2007; 3:223-35. [PMID: 17561221 DOI: 10.1016/j.sapharm.2006.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 06/29/2006] [Accepted: 06/29/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Eugene V White
- Department of Pharmaceutical and Administrative Sciences, University of Charleston School of pharmacy, Charleston, WV 25304, USA
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Farley JF, Devine JW, Hadsall RS. Professional implications of the expansion of pharmacy-based medical clinics. J Am Pharm Assoc (2003) 2007; 47:410-4. [PMID: 17510039 DOI: 10.1331/japha.2007.06093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe challenges and opportunities to the profession of pharmacy associated with the emergence of pharmacy-based medical clinics. SUMMARY Pharmacy-based medical clinics have emerged as a convenient, low-cost treatment option for many patients. These clinics, which are staffed by physicians' assistants or nurse practitioners, often are located directly within community pharmacies and offer rapid diagnosis and treatment for a limited number of health problems. With plans for significant expansion of these clinics, the profession of pharmacy faces a number of challenges. Allocating space in community pharmacies for medical clinics could place pharmacists at a disadvantage to other providers as they pursue ancillary health care activities. However, these clinics also represent an opportunity for pharmacists to position themselves as legitimized health care providers who are reimbursed for the consultative services they perform. Because most conditions diagnosed at pharmacy-based medical clinics have well-established treatment protocols, pharmacists would be well positioned to provide these services under collaborative practice agreements. This could ultimately provide the resources and payment structure necessary for pharmacists to provide other types of patient care services, including medication therapy management (MTM). CONCLUSION As pharmacy-based clinics continue to proliferate, pharmacists should carefully consider surrendering space in community pharmacies to other health care practitioners. These clinics present pharmacists with an opportunity to provide many of the additional health care services for which we have so vigorously argued. Failure to respond to the acute care needs of patients today may present pharmacists with a significant barrier as they continue to expand into direct patient care activities.
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Affiliation(s)
- Joel F Farley
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, USA.
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Affiliation(s)
- Leigh M Howell
- Department of Clinical and Administrative Pharmacy College of Pharmacy, University of Georgia, Athens, GA, USA.
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Kent K, McDonough RP, Dinges B, Doucette WR. Retrospective Financial Analysis of Wellness Center from an Independent Community Pharmacy Perspective. J Am Pharm Assoc (2003) 2006; 46:447-52. [PMID: 16913387 DOI: 10.1331/154434506778073646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the net financial gain or loss from health screening services provided to patients at an independent community pharmacy-based wellness center. DESIGN Retrospective review of pharmacy wellness center records over a 24-month period. SETTING A wellness center at one independent community pharmacy. PARTICIPANTS Patients receiving one or more of nine different services (blood pressure [BP], blood glucose, body fat [BF], glycosylated hemoglobin [A1C], bone density [BD], total cholesterol/blood glucose, total lipid panel [TLP], total cholesterol/high-density lipoprotein, alanine aminotransferase) during a 2-year period. INTERVENTIONS The services were performed and results recorded by a resident or staff pharmacist. MAIN OUTCOME MEASURES Using a pharmacy perspective, net financial gains or losses were calculated for each of the individual services, for all of the services performed using the Cholestech LDX Analyzer, and for the wellness center as a whole. Sensitivity analyses were based upon a pharmacist, a pharmacy resident, or both a pharmacist and pharmacy resident each providing half of the total number of services over the 2-year period. RESULTS A total of 1,181 pharmacy records for the selected services were reviewed for the specified time period. A net financial gain for the wellness center was achieved when the services were performed by a pharmacist, a pharmacy resident, or a pharmacist/pharmacy resident combination, respectively. Three of the individual services (BG, BF and TLP) and assays performed using the Cholestech LDX Analyzer had a net financial gain for each sensitivity analysis. Two of the services (BP and AIC) had a net financial gain only when a resident provided the service. One of the services (BD) had a net financial loss for all of analyses. CONCLUSION Revenues for these services exceeded their costs from the wellness center perspective when they were performed by a pharmacist, a pharmacy resident, or a pharmacist/pharmacy resident combination.
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Affiliation(s)
- Kelly Kent
- Liberty Pharmacy, North Liberty, Iowa, USA
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Doucette WR, Kreling DH, Schommer JC, Gaither CA, Mott DA, Pedersen CA. Evaluation of Community Pharmacy Service Mix: Evidence from the 2004 National Pharmacist Workforce Study. J Am Pharm Assoc (2003) 2006; 46:348-55. [PMID: 16739756 DOI: 10.1331/154434506777069471] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN Cross-sectional study. SETTING Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.
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Cross LB, Franks AS. Clinical Outcomes Associated with Pharmacist Involvement in Patients with Dyslipidemia. ACTA ACUST UNITED AC 2005. [DOI: 10.2165/00115677-200513010-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
BACKGROUND Lipid lowering drugs are still widely underused, despite compelling evidence about their effectiveness in the treatment and prevention of cardiovascular disease. Poor patient adherence to medication regimen is a major factor in the lack of success in treating hyperlipidaemia. In this review we focus on interventions, which encourage patients at risk of heart disease or stroke to take lipid lowering medication regularly. OBJECTIVES To assess the effect of interventions aiming at improved adherence to lipid lowering drugs, focusing on measures of adherence and clinical outcomes. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycInfo and CINAHL. Date of most recent search was in February 2003. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials of adherence-enhancing interventions to lipid lowering medication in adults for both primary and secondary prevention of cardiovascular disease in an ambulatory setting. DATA COLLECTION AND ANALYSIS Two reviewers extracted data independently and assessed studies according to criteria outlined by the Cochrane Reviewers' Handbook. MAIN RESULTS The eight studies found contained data on 5943 patients. Interventions could be stratified into four categories : 1. simplification of drug regimen, 2. patient information/education, 3. intensified patient care such as reminding and 4. complex behavioural interventions such as group sessions. Change in adherence ranged from -3% to 25% (decrease in adherence by 3% to increase in adherence by 25%). Three studies reported significantly improved adherence through simplification of drug regimen (category 1), improved patient information/education (category 2) and reminding (category 3). The fact that the successful interventions were evenly spread across the categories, does not suggest any advantage of one particular type of intervention. The methodological and analytical quality was generally low and results have to be considered with caution. Combining data was not appropriate due to the substantial heterogeneity between included randomised controlled trials (RCTs). REVIEWERS' CONCLUSIONS At this stage, no specific intervention aimed at improving adherence to lipid lowering drugs can be recommended. The lack of a gold standard method of measuring adherence is one major barrier in adherence research. More reliable data might be achieved by newer methods of measurement, more consistency in adherence assessment and longer duration of follow-up. Increased patient-centredness with emphasis on the patient's perspective and shared-decision-making might lead to more conclusive answers when searching for tools to encourage patients to take lipid lowering medication.
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Affiliation(s)
- A Schedlbauer
- Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol, UK, BS6 6JL.
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Calis KA, Hutchison LC, Elliott ME, Ives TJ, Zillich AJ, Poirier T, Townsend KA, Woodall B, Feldman S, Raebel MA. Healthy People 2010: Challenges, Opportunities, and a Call to Action for America’s Pharmacists. Pharmacotherapy 2004; 24:1241-94. [PMID: 15460187 DOI: 10.1592/phco.24.13.1241.38082] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Simpson SH, Johnson JA, Biggs RS, Tsuyuki RT. Greater effect of enhanced pharmacist care on cholesterol management in patients with diabetes mellitus: a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Pharmacotherapy 2004; 24:389-94. [PMID: 15040652 DOI: 10.1592/phco.24.4.389.33169] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine the effect of enhanced pharmacist care on cholesterol management in patients with and without diabetes mellitus. METHODS We conducted a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP), a 54-center randomized trial of pharmacist intervention compared with usual care in patients at high risk for cardiovascular events. The patients involved had atherosclerotic disease or diabetes. We compared the effect of pharmacist intervention in patients with and without diabetes. The primary end point was a composite of performing a fasting cholesterol profile, or adding or increasing the dosage of a cholesterol-lowering drug. Secondary end points were individual components of the primary end point and change in 10-year risk for cardiovascular events, using the Framingham risk equation. RESULTS Of the 675 patients enrolled in the SCRIP study, 294 (44%) had diabetes. Enhanced pharmacist care had a more beneficial effect on cholesterol management in those with diabetes (odds ratio [OR] 4.8) than without diabetes (OR 2.1), p=0.01. Secondary end points showed similar trends, and reduction in Framingham risk was greater in patients with diabetes than without. CONCLUSION Pharmacist intervention for dyslipidemia appears to have a greater impact in patients with diabetes. Results of this substudy suggest that pharmacists should target this patient group for interventions in cholesterol risk management.
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Affiliation(s)
- Scot H Simpson
- Institute of Health Economics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Snella KA, Trewyn RR, Hansen LB, Bradberry JC. Pharmacist Compensation for Cognitive Services: Focus on the Physician Office and Community Pharmacy. Pharmacotherapy 2004; 24:372-88. [PMID: 15040651 DOI: 10.1592/phco.24.4.372.33179] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We provide a stepwise approach for the clinical pharmacy practitioner in the physician clinic or community pharmacy setting to secure compensation for cognitive services. How to establish compensation for pharmacist services is explored, including evaluating the payer mix, developing a relationship with the first- or third-party payer, becoming credentialed with a third-party payer, and creating a fee structure. We detail the physical process of billing, which involves completing appropriate billing forms, appropriately using billing codes, documenting cognitive services in the patient record, and obtaining the proper waivers and/or approvals to provide specific services such as laboratory services and immunizations. This comprehensive review of compensation for cognitive services available in the community pharmacy and physician office environment is designed to be a template for pharmacists to further develop specific strategies, implement fee structures, and obtain compensation in their pharmacy environment and payer mix. Exploration into these innovative markets will enable pharmacists to increase revenue as they enhance and expand their cognitive services for patients.
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Affiliation(s)
- Kathleen A Snella
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Amarillo, Texas 79106, USA
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Abstract
Many barriers exist to the delivery of preventive services by cardiologists and other physicians. Appropriate training and the development of supportive infrastructures can effectively overcome these barriers. In addition, institutional priorities must change to encourage such efforts. Cardiologists must continue to recognize the importance of risk-factor modification, and training programs in cardiology should teach appropriate counseling techniques, the use of risk-factor-lowering pharmacologic agents, and the manner in which cardiologists should interface with dietitians and other ancillary personnel [77]. In addition, it is important to recognize and teach, both didactically and by example, that counseling patients and carrying out long-term preventive interventions can be as gratifying and interesting as performing dramatic procedures that, although valuable and rewarding, take place at a very late point in the patient's clinical course, a point that might have been averted by greater attention to risk-factor modification. Increasingly, the public and governmental agencies are becoming involved in encouraging such an approach [66], and health care provider groups [78] and organizations [67] are also facilitating the development of a more comprehensive approach to the delivery of preventive intervention [79].
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Affiliation(s)
- David E Chiriboga
- Preventive Medicine Program, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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McDonough RP, Doucette WR. Drug therapy management: an empirical report of drug therapy problems, pharmacists' interventions, and results of pharmacists' actions. J Am Pharm Assoc (2003) 2003; 43:511-8. [PMID: 12952316 DOI: 10.1331/154434503322226266] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the number and types of drug therapy problems identified by pharmacists at six community pharmacies, identify the interventions made by these pharmacists in their attempts to resolve drug therapy problems, and determine the results of the pharmacists' actions taken to resolve drug therapy problems. DESIGN Retrospective review of patient records from pharmacies. SETTING Six community pharmacies that had participated in Project ImPACT: Hyperlipidemia. PATIENTS One hundred sixteen patients from Project ImPACT: Hyperlipidemia. INTERVENTION Drug therapy problems, pharmacists' interventions, and results of pharmacists' actions were identified and categorized. Drug therapy problems were classified into seven categories, pharmacists' interventions into six categories, and results were categorized into eight types. Frequencies and descriptive statistics were calculated for the measures. RESULTS A total of 512 initial drug therapy problems were reported for 116 patients in the 6 pharmacies. In addition to the initial interventions, pharmacists documented another 545 times in which they intervened on the original problems. There were 354 (69.1%) drug therapy problems associated with hyperlipidemia and 158 (30.9%) with other conditions. Overall, most common types of drug therapy problems were needs additional therapy (39.8%) and nonadherence to therapy (31.1%). The most common discretionary pharmacist interventions were patient education and physician communication, which occurred on average 4.63 and 3.30 times during the project period. The most common consequence of a pharmacist intervention was an increase in patient adherence, which was reported for almost half of the patients. CONCLUSION Drug therapy management (DTM) for patients with dyslipidemias identified frequent drug therapy problems associated with both hyperlipidemia and other conditions. Pharmacists used interventions that included laboratory testing, patient monitoring, patient education, and physician communication to influence patient adherence and optimize drug therapy. Although further research is needed, the findings of this analysis are promising for the more widespread adoption of a DTM role by community pharmacists.
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Rybacki JJ. Improving cardiovascular health in postmenopausal women by addressing medication adherence issues. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2002; 42:63-71; quiz 72-3. [PMID: 11833520 DOI: 10.1331/108658002763538099] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review medication adherence issues that relate to managing cardiovascular health in postmenopausal women and to explore strategies pharmacists can use to improve outcomes by identifying and resolving adherence problems. DATA SOURCES Published articles identified through MEDLINE using the search terms adherence, compliance, cardiovascular, and menopause. Additional articles and data were identified from the bibliographies of the retrieved articles and from Web sites and reports from the National Council on Patient Information and Education, North American Menopause Society, American College of Obstetricians and Gynecologists, and American Heart Association. DATA SYNTHESIS Cardiovascular disease is the leading killer of women, a fact many women do not recognize. Although effective pharmacologic treatments for managing risk factors for cardiovascular disease have been developed, these therapies are underprescribed, and patient adherence to them is often poor. Efforts to increase postmenopausal women's awareness of cardiovascular disease and the efficacy of therapeutic regimens can help improve such patients' adherence to these lifesaving treatments. CONCLUSION As one of the most accessible health care professionals, pharmacists are well positioned to provide counseling about the importance of medication adherence, help measure and optimize outcomes from medication use, and help patients find objective and authoritative sources of information about their conditions. By working with postmenopausal women to enhance their adherence, pharmacists can help them improve their cardiovascular health.
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Simpson SH, Johnson JA, Biggs C, Biggs RS, Kuntz A, Semchuk W, Taylor JG, Farris KB, Tsuyuki RT. Practice-based research: lessons from community pharmacist participants. Pharmacotherapy 2001; 21:731-9. [PMID: 11401185 DOI: 10.1592/phco.21.7.731.34570] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We designed this project to determine community pharmacists' opinions regarding the challenges and motivations of their recent participation in a pharmacy practice-based research study At the conclusion of a randomized, multicenter study, 87 community pharmacist-investigators were sent a questionnaire that explored four areas: motivating factors to participate, barriers to participation, communication tools used by study coordinators, and design issues for future studies. Fifty-eight (67%) completed questionnaires were returned. Key factors motivating participation in the study were desire to improve the profession and opportunity to learn. Time was the greatest barrier to participation. Pharmacy practice-based research has two distinct advantages. First, it translates clinical knowledge into direct application in the community. Second, it provides needed data to demonstrate the value of enhanced pharmacy practice. Thorough understanding of pharmacists' opinions is necessary to optimize the design of future studies.
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Affiliation(s)
- S H Simpson
- EPICORE Center, Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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