1
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Sweiss H, Hall R, Bhayana S, Patel R, Flores M, Long C. Novel Pharmacy Model: Pharmacy Diabetes Clinic in Abdominal Transplant Recipients. Diabetes Spectr 2023; 37:170-174. [PMID: 38756424 PMCID: PMC11093761 DOI: 10.2337/ds23-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Helen Sweiss
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, TX
- University Health Transplant Institute, University Health System, San Antonio, TX
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
- Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX
| | - Reed Hall
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, TX
- University Health Transplant Institute, University Health System, San Antonio, TX
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
- Pharmacotherapy Division, The University of Texas at Austin, College of Pharmacy, Austin, TX
| | - Suverta Bhayana
- University Health Transplant Institute, University Health System, San Antonio, TX
- Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Rupal Patel
- University Health Transplant Institute, University Health System, San Antonio, TX
- Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Marcus Flores
- The University of Incarnate Word, Feik School of Pharmacy, San Antonio, TX
| | - Christina Long
- Department of Pharmacotherapy & Pharmacy Services, University Health System, San Antonio, TX
- University Health Transplant Institute, University Health System, San Antonio, TX
- Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
- The University of Incarnate Word, Feik School of Pharmacy, San Antonio, TX
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2
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Barton A, Defoe K, Jupp J, Dersch‐Mills D, Ghosh S, Leaker M. A
PHARMacist
led Initiative for the Management of Hydroxyurea Therapy in Pediatric Sickle Cell Anemia patients attending a Multidisciplinary Tertiary Hemoglobinopathy Clinic: A retrospective cohort study (
PHARMIT‐SCA
). JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amanda Barton
- Inpatient Pharmacy Stollery Children's Hospital Edmonton Canada
| | - Kimberly Defoe
- Inpatient Pharmacy Foothills Medical Center Calgary Canada
| | - Jennifer Jupp
- Inpatient Pharmacy Alberta Children's Hospital Calgary Canada
| | | | - Sunita Ghosh
- Department of Medical Oncology Cross Cancer Institute, University of Alberta Edmonton Canada
| | - Michael Leaker
- Department of Pediatric Hematology Alberta Children's Hospital, University of Calgary Calgary Canada
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3
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Jones LK, Tilberry S, Gregor C, Yaeger LH, Hu Y, Sturm AC, Seaton TL, Waltz TJ, Rahm AK, Goldberg A, Brownson RC, Gidding SS, Williams MS, Gionfriddo MR. Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis. Implement Sci 2021; 16:40. [PMID: 33849601 PMCID: PMC8045284 DOI: 10.1186/s13012-021-01108-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Numerous implementation strategies to improve utilization of statins in patients with hypercholesterolemia have been utilized, with varying degrees of success. The aim of this systematic review is to determine the state of evidence of implementation strategies on the uptake of statins. METHODS AND RESULTS This systematic review identified and categorized implementation strategies, according to the Expert Recommendations for Implementing Change (ERIC) compilation, used in studies to improve statin use. We searched Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from inception to October 2018. All included studies were reported in English and had at least one strategy to promote statin uptake that could be categorized using the ERIC compilation. Data extraction was completed independently, in duplicate, and disagreements were resolved by consensus. We extracted LDL-C (concentration and target achievement), statin prescribing, and statin adherence (percentage and target achievement). A total of 258 strategies were used across 86 trials. The median number of strategies used was 3 (SD 2.2, range 1-13). Implementation strategy descriptions often did not include key defining characteristics: temporality was reported in 59%, dose in 52%, affected outcome in 9%, and justification in 6%. Thirty-one trials reported at least 1 of the 3 outcomes of interest: significantly reduced LDL-C (standardized mean difference [SMD] - 0.17, 95% CI - 0.27 to - 0.07, p = 0.0006; odds ratio [OR] 1.33, 95% CI 1.13 to 1.58, p = 0.0008), increased rates of statin prescribing (OR 2.21, 95% CI 1.60 to 3.06, p < 0.0001), and improved statin adherence (SMD 0.13, 95% CI 0.06 to 0.19; p = 0.0002; OR 1.30, 95% CI 1.04 to 1.63, p = 0.023). The number of implementation strategies used per study positively influenced the efficacy outcomes. CONCLUSION Although studies demonstrated improved statin prescribing, statin adherence, and reduced LDL-C, no single strategy or group of strategies consistently improved outcomes. TRIAL REGISTRATION PROSPERO CRD42018114952 .
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Affiliation(s)
- Laney K Jones
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA.
| | - Stephanie Tilberry
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, MO, USA
| | - Yirui Hu
- Population Health Sciences, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Terry L Seaton
- University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, USA
- Population Health, Mercy Clinic-East Communities, St. Louis, MO, USA
| | | | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Anne Goldberg
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Samuel S Gidding
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
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4
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Barry AR. Development of a Pharmacist REferral Program in a primary cARE clinic (PREPARE): A prospective cross-sectional study. Can Pharm J (Ott) 2017; 150:206-215. [PMID: 28507656 DOI: 10.1177/1715163517702167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing demand for ambulatory health care services has led to the development of primary care multidisciplinary teams that include pharmacists. The objective of this study was to characterize referrals to a pharmacist in a primary care clinic (PCC) based in Chilliwack, British Columbia. METHODS This prospective cross-sectional study included all patients referred to the PCC pharmacist over 12 months (May 2015 to April 2016). Data regarding the source/reason for referral, patient demographics, medical problems/medications and number/category of identified drug therapy concerns (DTCs) were collected. RESULTS A total of 137 referrals were received. Mean age was 60 years and 59% were female. Twenty patients (15%) did not attend their appointment. Fifty-eight percent were new clinic patients identified using a Medication Risk Assessment Questionnaire (MRAQ), 30% were from PCC clinicians and 12% were from community family physicians. The most common reason for referral was for a medication review (82%). Median number of medical problems and medications per patient were 7 (interquartile range [IQR] 5) and 11 (IQR 7.5), respectively. A total of 460 DTCs were identified (median 4 per patient, IQR 3.5), of which 34% were medication without an indication and 28% an untreated indication. DISCUSSION AND CONCLUSION The most common source of referrals to a PCC pharmacist was for medication reviews of new patients using an MRAQ. Most referred patients had multiple medical problems and polypharmacy, and few were referred for disease-specific management. The number of DTCs per patient was variable and, despite polypharmacy being commonplace, almost one-third of patients had an untreated indication.
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Affiliation(s)
- Arden R Barry
- Lower Mainland Pharmacy Services, Chilliwack, and the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
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5
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Semchuk W, Taylor J, Sulz L, Deschamps M, Tsuyuki RT, Duffy P, Wilson T. Pharmacist Intervention in Risk Reduction Study: High-Risk Cardiac Patients. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350714000123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Although there are guidelines for managing patients at high vascular risk, many people remain undertreated. This community-based study was designed to 1) measure the ability of the pharmacist—physician collaboration to affect a broad array of drug-related endpoints and 2) to compare 2 methods of training community pharmacists to collaborate with physicians on cardiac patient care. This paper focuses on the first outcome, and a companion paper will address the second outcome. Methods: We used a before-and-after design to assess pharmacists' ability to affect drug-related endpoints. We identified patients by various methods, one of which was medication profiles. Those providing consent were educated on risk factor modification and encouraged to consult their physicians. Pharmacists subsequently faxed the details of their assessments to the primary care physician, along with suggestions for therapy changes. Our outcome measure was the proportion of patients who achieved a composite of either a dose increase or a new target medication as a result of pharmacist recommendations during the study. Results: A total of 61 pharmacists recruited 217 patients, and of these, follow-up was completed on 216. Of the patients for whom a pharmacist made a suggestion, pharmacologic risk reduction therapy was initiated or enhanced in 53.7%. Conclusion: This community pharmacist—based program improved utilization of the therapies known to decrease vascular risk in patients considered high risk.
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6
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Graham MR, Landgraf CG, Lindsey CC. A Comparison of Orlistat Use in a Veteran Population: A Pharmacist-Managed Pharmacotherapy Weight-Loss Clinic versus Standard Medical Care. J Pharm Technol 2016. [DOI: 10.1177/875512250301900601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: To determine whether a pharmacist-managed pharmacotherapy weight-loss clinic using orlistat is beneficial in promoting weight loss and reducing cardiovascular risk. Methods: A retrospective review of the records of all veterans receiving orlistat was conducted. Patients were assigned to 1 of 2 treatment groups: those enrolled in the pharmacist-managed pharmacotherapy weight-loss clinic (intervention) or those receiving standard medical care (control). Changes in weight and body mass index (BMI) at 6 months were compared with baseline measures. Treatment success, defined as a weight loss of ≥5% of initial body weight, was determined. The impact of weight loss on cardiovascular risk factor reduction was compared within each group. The prevalence of adverse drug reactions was also assessed and compared. Results: Forty-seven patients were included in the analysis: 18 and 29 in the intervention and control groups, respectively. Intervention patients lost a mean ± SD of 5.0 ± 6.0 kg by 6 months compared with 2.2 ± 4.7 kg for the controls (p = 0.109). BMI significantly decreased for all patients independent of group assignment (intervention, p = 0.006; control, p = 0.026), yet a between-group comparison revealed no difference (p = 0.140). Five patients (28%) in the intervention group were considered treatment successes versus 4 (14%) in the control group; however, this was not a significant difference (p = 0.274). Total cholesterol and glycosylated hemoglobin were significantly decreased in intervention patients, while control patients demonstrated significant improvement only in total cholesterol. There was no difference in adverse reaction occurrence between groups (p = 0.995). Conclusions: Patients enrolled in the pharmacist-managed pharmacotherapy weight-loss clinic lost twice as much weight, and twice as many were considered treatment successes compared with control patients. Intervention patients demonstrated improvement in several cardiovascular risk factors.
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Affiliation(s)
- Maqual R Graham
- MAQUAL R GRAHAM PharmD, Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO; Department of Pharmacy Services, Veterans Affairs Medical Center, Kansas City
| | - Chelsea G Landgraf
- CHELSEA G LANDGRAF PharmD, at time of writing, Pharmacy Practice Resident, Veterans Affairs Medical Center, Kansas City, now, Clinical Pharmacist, Phelps County Regional Medical Center, Rolla, MO
| | - Cameron C Lindsey
- CAMERON C LINDSEY PharmD, Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City; Department of Pharmacy Services, Veterans Affairs Medical Center, Kansas City
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7
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Abstract
Dyslipidemia is one of a number of independent risk factors for cardiovascular disease. Numerous large-scale, randomized clinical trials demonstrate the benefit of aggressive lipid-modifying therapy in reducing the mortality and morbidity associated with cardiovascular disease. Despite these data and the wide dissemination of clinical practice guidelines outlining management strategies for patients with dyslipidemia, particularly those at the greatest cardiovascular risk, studies indicate that a significant proportion of patients are not screened, initiated on appropriate therapy, or treated to target lipid levels. Pharmacists, as part of the multidisciplinary team, can play a vital role in assisting in the management of patients with dyslipidemias. This article reviews published studies that have evaluated the pharmacist's role in lipid management, reviews the process for managing a patient with dyslipidemia, and provides suggestions on how pharmacists can become more involved in lipid management.
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Affiliation(s)
- Kari L. Olson
- School of Pharmacy, University of Colorado at Denver and Health Sciences Center; 16601 East Centretech Parkway, Aurora, CO 80011
| | - Lisa A. Potts
- Ambulatory Care, Department of Pharmacy, Harper University Hospital, Detroit, Michigan
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8
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Schafer JJ, Gill TK, Sherman EM, McNicholl IR. ASHP Guidelines on Pharmacist Involvement in HIV Care. Am J Health Syst Pharm 2016; 73:468-94. [PMID: 26892679 DOI: 10.2146/ajhp150623] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor K Gill
- Internal Medicine, Via Christi Hospitals Wichita, Wichita, KS
| | - Elizabeth M Sherman
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, and South Broward Community Health Services, Memorial Healthcare System, Hollywood, FL
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9
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Moss JM, Bryan WE, Wilkerson LM, Jackson GL, Owenby RK, Van Houtven C, Stevens MB, Powers JS, Vaughan CP, Hung WW, Hwang U, Markland AD, McGwin G, Hastings SN. Impact of Clinical Pharmacy Specialists on the Design and Implementation of a Quality Improvement Initiative to Decrease Inappropriate Medications in a Veterans Affairs Emergency Department. J Manag Care Spec Pharm 2016; 22:74-80. [PMID: 27015054 PMCID: PMC10397930 DOI: 10.18553/jmcp.2016.22.1.74] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND As the proportion of older adult patients who interface with the health care system grows, clinical pharmacy specialists (CPS) have a pivotal role in reducing potentially inappropriate medication (PIM) use in this population. OBJECTIVES To (a) describe CPS involvement in the design and implementation of a quality improvement (QI) initiative to decrease PIM prescribing in a Veterans Affairs (VA) emergency department (ED) and (b) report on changes in PIM prescribing before and after the initiative. METHODS Enhancing Quality of Prescribing Practices for Veterans Discharged from the Emergency Department (EQUiPPED) is an ongoing multisite QI project that aims to decrease ED PIM prescribing. We used a mixed-method approach that applied qualitative and quantitative measures in describing the CPS role and evaluating PIM rates. PIMs were defined using the 2012 Beers Criteria. We reported monthly PIM rates in patients aged 65 years and older who were discharged from the ED from January 2012 to November 2014. A piecewise, nonlinear regression model evaluated the pattern in PIM prescriptions over time. RESULTS At the Durham, North Carolina, VA Medical Center, a total of 4 CPS were involved with tailoring the design and implementation of the EQUiPPED intervention for local use. CPS input led to 3 key innovations: academic detailing performed by a physician-CPS pair, medication alert messages identifying medications as PIMs in the computerized patient record system, and automated reports describing the frequency and type of PIMs prescribed by each ED provider. Between February 2013 and November 2014, 73 ED providers received the academic detailing. The ED facility experienced a relative reduction of 47.5% in the rate of PIM prescribing over the observation period. CONCLUSIONS This QI project resulted in a meaningful decrease in PIM prescribing in older ED adults. CPS contributions to QI can extend beyond pharmacotherapy and provider education to also include information technology tools using formulary management expertise.
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10
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Garcia BH, Giverhaug T, Høgli JU, Skjold F, Småbrekke L. A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway - a randomized controlled trial. Pharm Pract (Granada) 2015; 13:575. [PMID: 26131047 PMCID: PMC4482847 DOI: 10.18549/pharmpract.2015.02.575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/07/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives: The aim of the study was twofold; 1) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease (CHD) discharged from the University Hospital of North Norway, and 2) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors. Methods: A total of 102 patients aged 18-82 years were enrolled in a non-blinded randomized controlled trial with an intervention group and a control group. The intervention comprised medication reconciliation, medication review and patient education during three meetings; at discharge, after three months and after twelve months. The control group received standard care from their general practitioner. Primary outcomes were adherence to clinical guideline recommendations concerning prescription, therapy goal achievement and lifestyle education defined in the medication assessment tool for secondary prevention of CHD (MAT-CHDSP). Secondary outcomes included changes in the biomedical risk factors cholesterol, blood pressure and blood glucose. Results: Ninety-four patients completed the trial, 48 intervention group patients and 46 controls. Appropriate prescribing was high, but therapy goal achievement was low in both groups. Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end, 78.4% vs. 62.0%, p<0.001. The difference was statistically significant for the documented lifestyle advices in intervention group patients. No significant improvements in biomedical risk factors were observed in favor of the intervention group. Conclusions: The study showed an increased guideline adherence in both study groups. This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task. A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention. Amendments to the follow-up program are suggested before implementation in standard patient care can be recommended.
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Affiliation(s)
- Beate H Garcia
- Hospital Pharmacy of North Norway; & Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
| | - Trude Giverhaug
- Regional Drug Information Center of North Norway & University Hospital of North-Norway. Tromsø ( Norway ).
| | - June U Høgli
- Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
| | - Frode Skjold
- Department of Pharmacy, University of Tromsø , Tromsø ( Norway ).
| | - Lars Småbrekke
- Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
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11
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Pharmacist-managed clinics for patient education and counseling in Japan: current status and future perspectives. J Pharm Health Care Sci 2015; 1:2. [PMID: 26819713 PMCID: PMC4676320 DOI: 10.1186/s40780-014-0001-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
To improve the adherence to and knowledge about pharmacotherapy in outpatients and to maximize the efficacy and minimize the adverse drug events, the first pharmacist-managed clinic (PMC) in Japan was established for anticoagulation therapy at Nagoya University Hospital in 2000. Since then, various PMCs such as for asthma/chronic obstructive pulmonary disease, Alzheimer's disease, hypercholesterolemia, chronic hepatitis C, cancer chemotherapy, palliative care, chronic kidney disease, and continuous ambulatory peritoneal dialysis have been established and expanded to many hospitals in Japan. Accumulating evidences suggest that PMCs have some beneficial effects on patients' adherence to and knowledge about their pharmacotherapy as well as the clinical outcome, besides being cost-effective. Notably, PMCs for cancer chemotherapy have been approved as a new medical service in hospitals in 2014, which is covered by the universal health coverage in Japan. In this review article, the current status of PMCs for patient education and counseling in Japan and their impact on pharmaceutical care and management are critically reviewed. Furthermore, future perspectives on PMCs are discussed.
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12
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Manigault KR, Lewis KA. Pharmacists role in cholesterol management: addressing challenges and barriers. J Pharm Pract 2014; 28:35-43. [PMID: 25500555 DOI: 10.1177/0897190014562384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cholesterol management is an important factor in the modification of primary and secondary cardiovascular events. Guidelines emphasize incorporation of appropriate medication therapy and lifestyle adjustments to reduce low-density lipoprotein cholesterol (LDL-C) for cardiovascular disease (CVD) risk reduction. Of note, studies and nation-wide statistics indicate many patients do not achieve their LDL-C goals. Eliminating barriers and challenges associated with cholesterol management will allow patients to reach prespecified goals for CVD risk reduction. As the nation transitions to covering more individuals, the need for additional health care providers is evident. Pharmacists are accessible and knowledgeable health care contributors who can assist in optimizing patient outcomes. This article discusses the pharmacist's role in addressing challenges and barriers in cholesterol management.
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13
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Thumar R, Zaiken K. Impact of live medication therapy management on cholesterol values in patients with cardiovascular disease. J Am Pharm Assoc (2003) 2014; 54:526-9. [DOI: 10.1331/japha.2014.13205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Yakiwchuk EM, Jorgenson D, Mansell K, Laubscher T, Lebras M, Blackburn DF. Collaborative Cardiovascular Risk Reduction in Primary Care II (CCARP II): Implementation of a systematic case-finding process for patients with uncontrolled risk factors. Can Pharm J (Ott) 2013; 146:284-92. [PMID: 24093040 PMCID: PMC3785192 DOI: 10.1177/1715163513499303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors. METHODS This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors. RESULTS Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed. DISCUSSION Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention. CONCLUSION Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting.
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Affiliation(s)
- Erin M Yakiwchuk
- College of Pharmacy & Nutrition (Yakiwchuk, LeBras, Jorgenson, Mansell, Blackburn), University of Saskatchewan, Saskatoon, Saskatchewan
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15
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Hough A, Vartan CM, Groppi JA, Reyes S, Beckey NP. Evaluation of clinical pharmacy interventions in a Veterans Affairs medical center primary care clinic. Am J Health Syst Pharm 2013; 70:1168-72. [PMID: 23784165 DOI: 10.2146/ajhp120514] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Augustus Hough
- Department of Veterans Affairs Medical Center, West Palm Beach, FL
| | - Christine M. Vartan
- West Palm Beach; at the time of writing she was Postgraduate Year 1 Pharmacy Resident, Department of Veterans Affairs Medical Center, West Palm Beach
| | | | - Sonia Reyes
- Department of Veterans Affairs Medical Center, West Palm Beach
| | - Nick P. Beckey
- Department of Veterans Affairs Medical Center, West Palm Beach
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16
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Milfred-LaForest SK, Chow SL, DiDomenico RJ, Dracup K, Ensor CR, Gattis-Stough W, Heywood JT, Lindenfeld J, Page RL, Patterson JH, Vardeny O, Massie BM. Clinical Pharmacy Services in Heart Failure: An Opinion Paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. Pharmacotherapy 2013; 33:529-48. [DOI: 10.1002/phar.1295] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Sheryl L. Chow
- College of Pharmacy; Western University of Health Sciences; Pomona California
| | | | - Kathleen Dracup
- School of Nursing; University of California; San Francisco California
| | | | - Wendy Gattis-Stough
- College of Pharmacy and Health Sciences; Department of Clinical Research; Campbell University; Buies Creek North Carolina
| | | | - JoAnn Lindenfeld
- Heart Transplantation Program; Division of Cardiology; Department of Medicine; University of Colorado Denver; Aurora Colorado
| | - Robert L. Page
- Schools of Pharmacy and Medicine; University of Colorado Denver; Aurora Colorado
| | - J. Herbert Patterson
- Eshelman School of Pharmacy; University of North Carolina; Chapel Hill North Carolina
| | - Orly Vardeny
- Schools of Pharmacy and Medicine; University of Wisconsin; Madison Wisconsin
| | - Barry M. Massie
- School of Medicine; University of California, and San Francisco VA Medical Center; San Francisco California
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17
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Clinical Pharmacy Services in Heart Failure: An Opinion Paper From the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network. J Card Fail 2013; 19:354-69. [DOI: 10.1016/j.cardfail.2013.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 11/20/2022]
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18
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Harrison JJ, Wang J, Cervenko J, Jackson L, Munyal D, Hamandi B, Chernenko S, Dorosz J, Chaparro C, Singer LG. Pilot study of a pharmaceutical care intervention in an outpatient lung transplant clinic. Clin Transplant 2012; 26:E149-57. [PMID: 22507355 DOI: 10.1111/j.1399-0012.2012.01623.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lung transplant recipients have complex drug regimens. Study objectives were to assess drug therapy problems (DTPs), pharmacist recommendations, and patient satisfaction with pharmacist services. METHODS Using a pharmaceutical care assessment process, pharmacists identified DTPs and made therapeutic recommendations. Number of DTPs identified per pharmacist visit was calculated and compared to standard care visits through retrospective chart review. Potential clinical impact of recommendations was evaluated by blinded clinicians. Patient satisfaction was assessed via survey. RESULTS Fifty-five DTPs were identified in 43 patients over 50 pharmacist visits (1.05 ± 1.34 DTPs per visit). In these same patients, rate of DTP identification was 0.51 ± 0.64 DTPs per standard visit in the preceding two-wk period (p = 0.018 vs. pharmacist visit). The most common DTPs identified by the pharmacist were adverse drug effect (27%) and untreated indication (25%). Overall, 62% of pharmacist recommendations were rated very significant or significant. Survey return rate was 58% and satisfaction scores ranged from 3 to 5 out of 5. Review of medications and teaching regarding the use of medications received the most "very satisfied" and "highly important" scores. CONCLUSIONS Pharmacists can make valuable contributions in a lung transplant clinic setting by identifying DTPs and making recommendations with a positive impact on patient outcomes and satisfaction.
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Affiliation(s)
- Jennifer J Harrison
- Department of Pharmacy Services, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
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Gonzalvo JD, Papineau EC, Ramsey DC, Vincent AH, Walton AM, Weber ZA, Wilhoite JE. Patient Perceptions of Pharmacist-Managed Clinics: A Qualitative Analysis. J Pharm Technol 2012. [DOI: 10.1177/875512251202800103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pharmacist-managed clinics have consistently demonstrated improvement in patient outcomes. Quantitative research offers the benefit of objective outcomes to track progress toward therapeutic goals at pharmacist-managed clinics. While quantitative studies are readily available in the literature, there is a paucity of qualitative studies to capture the patients' perspectives of pharmacy services. Objective: To assess through the use of qualitative research methods patient perceptions of pharmacist-managed services within ambulatory care clinics that operate under a collaborative practice agreement. Methods: A semi-structured interview questionnaire was developed, pilot tested, and revised using a focus group of clinical pharmacists. The questionnaire was used to conduct face-to-face patient interviews at 6 pharmacist-managed clinics in central Indiana. English-speaking patients with a minimum of 2 visits with the clinical pharmacist were included in this study. Pharmacist-managed clinics without established collaborative practice agreements were excluded. Patient interviews were conducted by a trained research assistant, audio-recorded, and transcribed verbatim. The interview transcripts were analyzed to identify cross-cutting themes without predetermined definitions via inductive qualitative analysis. Four study investigators independently identified themes using a sample of the transcripts. Additional themes were identified and defined in a series of independent reviews and investigator meetings using the remaining transcripts until theme saturation. All themes were assigned to segments of the interview transcripts according to the consensus definitions. Results: A total of 30 interviews were conducted across the clinics. Ten themes from the interview transcripts emerged, including disease state management expertise, patient alliance, practice novelty, accessibility, increased sense of patient well-being, and compassion. Conclusions: Patient perceptions from qualitative interviews revealed that pharmacists are viewed as medication experts who provide patient-centered care. This study highlights unique in-depth perspectives from the patient that further support maintenance and expansion of pharmacist-managed services.
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Affiliation(s)
- Jasmine D Gonzalvo
- JASMINE D GONZALVO PharmD, Clinical Assistant Professor, College of Pharmacy, Purdue University, West Lafayette, IN; Clinical Pharmacy Specialist, Ambulatory Care, Wishard Health Services, Indianapolis, IN
| | - Emily C Papineau
- EMILY C PAPINEAU PharmD, Assistant Professor of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis; Clinical Pharmacy Specialist, Ambulatory Care, Community Family Medicine Center, Indianapolis
| | - Darin C Ramsey
- DARIN C RAMSEY PharmD, Assistant Professor of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University; Clinical Pharmacy Specialist, Primary Care, RL Roudebush VA Medical Center, Indianapolis
| | - Ashley H Vincent
- ASHLEY H VINCENT PharmD, Clinical Assistant Professor, College of Pharmacy, Purdue University; Clinical Pharmacy Specialist, Ambulatory Care, IU Health Methodist Hospital, Indianapolis
| | - Alison M Walton
- ALISON M WALTON PharmD BCPS, Assistant Professor of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University; Clinical Pharmacy Specialist, Ambulatory Care, St. Vincent Health, Indianapolis
| | - Zachary A Weber
- ZACHARY A WEBER PharmD BCPS, Clinical Assistant Professor of Pharmacy Practice, College of Pharmacy, Purdue University; Clinical Pharmacy Specialist, Primary Care, Wishard Health Services
| | - Jessica E Wilhoite
- JESSICA E WILHOITE PharmD, Assistant Professor of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University; Clinical Pharmacy Specialist, Primary Care, St. Vincent Health
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Evans CD, Eurich DT, Taylor JG, Blackburn DF. The Collaborative Cardiovascular Risk Reduction in Primary Care (CCARP) Study. Pharmacotherapy 2010; 30:766-75. [DOI: 10.1592/phco.30.8.766] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Villeneuve J, Genest J, Blais L, Vanier MC, Lamarre D, Fredette M, Lussier MT, Perreault S, Hudon E, Berbiche D, Lalonde L. A cluster randomized controlled Trial to Evaluate an Ambulatory primary care Management program for patients with dyslipidemia: the TEAM study. CMAJ 2010; 182:447-55. [PMID: 20212029 DOI: 10.1503/cmaj.090533] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have reported the efficacy of collaborative care involving family physicians and community pharmacists for patients with dyslipidemia. METHODS We randomly assigned clusters consisting of at least two physicians and at least four pharmacists to provide collaborative care or usual care. Under the collaborative care model, pharmacists counselled patients about their medications, requested laboratory tests, monitored the effectiveness and safety of medications and patients' adherence to therapy, and adjusted medication dosages. After 12 months of follow-up, we assessed changes in low-density lipoprotein (LDL) cholesterol (the primary outcome), the proportion of patients reaching their target lipid levels and changes in other risk factors. RESULTS Fifteen clusters representing a total of 77 physicians and 108 pharmacists were initially recruited, and a total of 51 physicians and 49 pharmacists were included in the final analyses. The collaborative care teams followed a total of 108 patients, and the usual care teams followed a total of 117 patients. At baseline, mean LDL cholesterol level was higher in the collaborative care group (3.5 v. 3.2 mmol/L, p = 0.05). During the study, patients in the collaborative care group were less likely to receive high-potency statins (11% v. 40%), had more visits with health care professionals and more laboratory tests, were more likely to have their lipid-lowering treatment changed and were more likely to report lifestyle changes. At 12 months, the crude incremental mean reduction in LDL cholesterol in the collaborative care group was -0.2 mmol/L (95% confidence interval [CI] -0.3 to -0.1), and the adjusted reduction was -0.05 (95% CI -0.3 to 0.2). The crude relative risk of achieving lipid targets for patients in the collaborative care group was 1.10 (95% CI 0.95 to 1.26), and the adjusted relative risk was 1.16 (95% CI 1.01 to 1.34). INTERPRETATION Collaborative care involving physicians and pharmacists had no significant clinical impact on lipid control in patients with dyslipidemia. International Standard Randomized Controlled Trial register no. ISRCTN66345533.
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Gerrald KR, Dixon DL, Barnette DJ, Williams VG. Evaluation of a pharmacist-managed lipid clinic that uses point-of-care lipid testing. J Clin Lipidol 2010; 4:120-5. [DOI: 10.1016/j.jacl.2010.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/01/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Hargraves TL, Bennett AA, Brien JAE. Evaluating outpatient pharmacy services: a literature review of specialist heart failure services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.14.1.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify appropriate methods to evaluate a specialist pharmacy service for heart failure patients in an ambulatory care setting.
Method
An extensive literature review was undertaken to identify the published data on evaluative studies of specialist pharmacy services, including those directed at heart failure patients in an ambulatory care model of service provision.
Key findings
Six studies were identified evaluating outpatient pharmacy services for heart failure. The pharmacy services provided in these settings were not well defined. The impact of the pharmacist was compared to ‘usual care’, that is care delivered without a pharmacist, by either a prospective randomised controlled trial (RCT), or before and after studies. In most cases the service was delivered by one pharmacist at one site. Services were primarily targeted at patients and focused on medication and lifestyle education, adverse drug reaction monitoring, and compliance/adherence. In all studies, there was a trend for improvement in the outcomes measured. Different study endpoints were examined, including process indicators such as compliance and outcome measures such as morbidity (clinical), quality of life (humanistic), and hospital admissions (economic). The ideal evaluative study would be an adequately powered, prospective, randomised controlled trial, comparing the effect of the pharmacist service to usual care (without the specified pharmacy service). Appropriate study endpoints including process indicators and outcome measures are needed. Identification of specific components and the extent of the service that would provide the most benefit to selected patient groups would be of interest.
Conclusions
Specialist ambulatory care pharmacy services have not been well defined or evaluated in the literature. Limited randomised controlled data exist.
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Affiliation(s)
| | - Alexandra A Bennett
- Therapeutics Centre, St Vincent's Hospital, Sydney, Australia
- Faculty of Pharmacy, University of Sydney, Australia
| | - Jo-anne E Brien
- Therapeutics Centre, St Vincent's Hospital, Sydney, Australia
- Faculty of Pharmacy, University of Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Cohen SM, Kwasny MJ, Ahn J. Use of specialty care versus standard retail pharmacies for treatment of hepatitis C. Ann Pharmacother 2009; 43:202-9. [PMID: 19193591 DOI: 10.1345/aph.1l227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Treatment for hepatitis C virus (HCV) is associated with significant adverse events. Improved adherence increases the probability of achieving sustained virologic response (SVR). Despite a lack of supporting literature, the use of specialty care pharmacies has increased in recent years in an attempt to improve HCV treatment outcomes. OBJECTIVE To compare specialty care versus standard retail pharmacies in HCV treatment outcomes, utilization of office resources, and the use of supplemental medications. METHODS A retrospective chart review was performed at a single academic institution for adults with HCV infection treated between 2001 and 2006. SVR was the primary endpoint. Secondary endpoints included therapy completion rates, HCV treatment dose reductions, additional phone calls and clinic visits, and the use of supplemental medications. RESULTS One hundred ninety-seven patients were identified (102 standard and 95 specialty care pharmacy). There were no differences in baseline demographics between the groups, except for a higher proportion of African Americans using specialty care pharmacies. Overall SVR was 103/197 (52%). SVR was 57/102 (56%) in the standard pharmacy group and 46/95 (48%) in the specialty care pharmacy group. There were no statistically significant differences with regard to SVR (even after accounting for differences in ethnicity), the use of supplemental medications, additional clinic phone calls and visits required, and the reasons for HCV therapy discontinuation. There was a statistically significantly higher incidence of HCV medication dose reductions in the standard retail pharmacy group (45% vs 28%; p = 0.016). CONCLUSIONS The use of specialty care pharmacies for the treatment of HCV was not associated with higher SVR rates. Patients using specialty care pharmacies had a lower incidence of interferon and/or ribavirin dose reductions, but there was no difference between the groups in therapy completion rates, use of additional office resources, or use of supplemental medications.
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Divine H, Nicholas A, Johnson CL, Perrier DG, Steinke DT, Blumenschein K. PharmacistCARE: description of a pharmacist care service and lessons learned along the way. J Am Pharm Assoc (2003) 2009; 48:793-802. [PMID: 19019810 DOI: 10.1331/japha.2008.07132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the PharmacistCARE program, an innovative pharmacy practice model implemented within a self-insured employer and to describe lessons learned by the authors in implementing and maintaining the program. SETTING University of Kentucky (UK), March 2003 to present. PRACTICE DESCRIPTION A free-standing pharmacist clinic located within an ambulatory care facility owned by UK HealthCare. PRACTICE INNOVATION PharmacistCARE, a pharmacist-provided patient care service for UK Health Plan members that includes comprehensive disease and medication therapy management. MAIN OUTCOME MEASURES Various lessons learned by the authors during development, implementation, and maintenance of the program. RESULTS The program has been recognized by the university as a positive contribution to health plan service enhancement and cost savings and has documented enhanced patient care outcomes. CONCLUSION The PharmacistCARE program is a unique pharmacist-provided service delivered in a free-standing pharmacist clinic that enhances health outcomes for adult members in a self-insured employer group.
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Affiliation(s)
- Holly Divine
- College of Pharmacy, University of Kentucky, Lexington, KY 40536-0082, USA.
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Machado M, Nassor N, Bajcar JM, Guzzo GC, Einarson TR. Sensitivity of Patient Outcomes to Pharmacist Interventions. Part III: Systematic Review and Meta-Analysis in Hyperlipidemia Management. Ann Pharmacother 2008; 42:1195-207. [DOI: 10.1345/aph.1k618] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Hyperlipidemia increases the risk of cardiovascular diseases, and control is pivotal ror preventing disease complications. Multidisciplinary interventions, including those performed by pharmacists, are important for improving patients’ outcomes. Objective: To quantify the impact of pharmacist interventions in enhancing patients’ outcomes. Methods TWO reviewers searched International Pharmaceutical Abstracts, MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials. 3rd Quarter, and Cumulative Index to Nursing and Allied Health Literature (all from inception to July 2007) for pharmacist interventions in hyperlipidemia. Quality was assessed using the Downs-Black scale. Data extracted included the number of patients enrolled; study characteristics; intervention type; and pre- and postintervention measures for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, total cholesterol, adherence, and quality of life. A random effects meta-analysis combined data. Heterogeneity of effects was tested using χ5 analysis. Publication bias was assessed using funnel plots and the Begg-Mazumdar statistic. Results: Forty-eight studies were found; 23 met inclusion criteria. Study settings included medical clinic/center (n = 12), community pharmacy (n = 8), hospital (n = 2), and patient homes (n = 1). Article quality was good (71% ± 7.0%). Patient education (78%) and medication management (74%) were the most common interventions. Total cholesterol was significantly reduced from baseline (mean ± SD; 34.3 ± 10.3 mg/dL; p < 0.001) and above that for controls (22.0 ± 10.4 mg/dL: p = 0.034). LDL-C was reduced significantly from baseline (32.6 ± 11.3 mg/dL; p = 0.004), but not significantly more than controls (17.5 ± 10.9 mg/dL; p = 0.109). A clinically relevant but not statistically significant reduction in triglycerides was found. No impact on HDL-C levels was found. Patients’ adherence to pharmacotherapeutic regimens and quality of life were considered possibly not sensitive and possibly sensitive to pharmacist interventions, respectively. Conclusions: Total cholesterol is sensitive to pharmacist interventions, while LDL-C and triglyceride levels are possibly sensitive to those interventions. Further research is required for these outcomes.
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Affiliation(s)
- Márcio Machado
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
| | | | - Jana M Bajcar
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Giovanni C Guzzo
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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McConnell KJ, Denham AM, Olson KL. Pharmacist-Led Interventions for the Management of Cardiovascular Disease. ACTA ACUST UNITED AC 2008. [DOI: 10.2165/00115677-200816030-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Villeneuve J, Lamarre D, Vanier MC, Lussier MT, Genest J, Hudon E, Blais L, Perreault S, Lalonde L. How to help patients manage their dyslipidemia: A primary care physician–pharmacist team intervention. Can Pharm J (Ott) 2007. [DOI: 10.3821/1913-701x(2007)140[300:hthpmt]2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Evans C, Blackburn D, Semchuk W, Taylor J. Collaborative Cardiovascular Risk-reduction in Primary Care: Design of the CCARP study. Can Pharm J (Ott) 2007. [DOI: 10.3821/1913-701x(2007)140[240:ccripc]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Andrus MR, Clark DB. Provision of pharmacotherapy services in a rural nurse practitioner clinic. Am J Health Syst Pharm 2007; 64:294-7. [PMID: 17244879 DOI: 10.2146/ajhp060044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Clinical pharmacy interventions and services provided in collaboration with a nurse practitioner in a medically underserved rural health center are described. METHODS Data were collected via retrospective chart review of clinical pharmacy notes for all patients referred to the clinical pharmacist from July 2001 through February 2004. Data collected included demographic information, reasons for referral, duration of follow-up, insurance status, use of medication assistance programs, educational interventions, clinical interventions, and clinical outcomes. Changes in mean low-density-lipoprotein (LDL) cholesterol levels, blood pressures, and glycosylated hemoglobin (HbA(1c)) were analyzed using a paired Student's t test. Smoking cessation, the number of times the international normalized ratio (INR) was in a goal range, and attainment of goal LDL cholesterol, blood pressure, and HbA(1c) levels were also recorded. RESULTS Clinical pharmacy interventions were summarized for 101 patients who were seen in 708 patient visits. A mean of 5.6 educational interventions were provided per visit, and a mean of 1.0 clinical intervention occurred per visit. Initiation of new drug therapy or dosage adjustment accounted for 52% of the clinical interventions. A large percentage of patients attained their goals for LDL cholesterol (76%), blood pressure (86%), HbA(1c) (69%), INR (82%), and smoking cessation (43%) during the study period. CONCLUSION Pharmacotherapy services provided by a clinical pharmacist at a rural nurse practitioner clinic positively affected clinical outcomes and increased patients' attainment rates for LDL cholesterol, systolic and diastolic blood pressures, and HbA(1c).
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Affiliation(s)
- Miranda R Andrus
- Harrison School of Pharmacy, Auburn University, Auburn University, AL, USA.
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31
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John EJ, Vavra T, Farris K, Currie J, Doucette W, Button-Neumann B, Osterhaus M, Kumbera P, Halterman T, Bullock T. Workplace-Based Cardiovascular Risk Management by Community Pharmacists: Impact on Blood Pressure, Lipid Levels, and Weight. Pharmacotherapy 2006; 26:1511-7. [PMID: 16999661 DOI: 10.1592/phco.26.10.1511] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To assess the effectiveness of a community pharmacist-delivered cardiovascular case-management program by comparing body mass index (weight), systolic and diastolic blood pressure, and full lipid profile at the beginning of the program with these outcome measures at the end of the program. DESIGN Retrospective data analysis using billing data submitted between July 1, 2001, and October 31, 2004, with a pre-post design in which subjects served as their own controls. SETTING Manufacturing workplace in rural Iowa. PARTICIPANTS Fifty-six workers with risk factors for cardiovascular disease (mean age 40.67 yrs), 37 had diabetes mellitus and 19 did not. INTERVENTION During visits to the workers, pharmacists provided education about cardiovascular disease, identification of drug therapy problems, and importance of routine blood pressure, pulse, and weight measurements; they communicated with participants' physicians as needed. MEASUREMENTS AND MAIN RESULTS The number of pharmacist visits/participant ranged from 1-13 (mean +/- SD 6.97 +/- 3.05). Outcome measures were weight, systolic and diastolic blood pressures, full lipid profiles (in patients with diabetes), and percentage of patients achieving treatment goal by the end of the 3 years. Statistically significant differences between the first and last visits were achieved for both systolic (124.12 +/- 11.07 and 120.36 +/- 14.39 mm Hg, respectively, p=0.016) and diastolic (80.4 +/- 9.01 and 77.43 +/- 9.14 mm Hg, respectively, p=0.019) blood pressure. The 19 patients without diabetes showed a statistically significant improvement in diastolic blood pressure (p=0.039), but the 37 patients with diabetes did not show a significant difference. A nonsignificant increase was seen in the percentage of patients with diabetes achieving low-density lipoprotein cholesterol (LDL) level goal between the first and last visits (p=0.06). CONCLUSION A cardiovascular case-management program delivered in the workplace to middle-aged working adults by community pharmacists improved blood pressure and reduced LDL levels. The program was not effective, however, in weight reduction.
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Affiliation(s)
- Elizabeth J John
- Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, Iowa 52242-1112, USA
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Ismail HM, Jackson K, Smith D. Diagnosis and Treatment of Peripheral Arterial Disease Compared with Other Atherosclerotic Vascular Diseases in a University Primary Care Clinic. J Investig Med 2006; 54:255-61. [PMID: 16984798 DOI: 10.2310/6650.2006.05049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the fact that peripheral arterial disease (PAD) significantly increases the risk of cardiovascular mortality, it is significantly underdiagnosed and undertreated. The purpose of this study was to evaluate the practice at a northeast Tennessee university primary care clinic regarding the diagnosis and treatment of PAD. METHODS A retrospective medical record survey was conducted to evaluate practice patterns in diagnosing and treating PAD in a university primary care clinic. A clinic population of 711 patients was selected using International Classification of Diseases-9 codes for coronary artery disease (CAD), cerebovascular disease (CVD), and/or PAD. A sample of 180 patients (25.3%) was randomly selected using a systematic statistical method. Of these, 125 patients met the diagnostic criteria for CAD, CVD, and/or PAD. The study covered a 3-year period, from July 2001 until June 2004. Demographic and other data, including the use of antiplatelet therapy, were collected. RESULTS One hundred ten patients met all of the inclusion and exclusion criteria. Thirty-nine percent were males, and 61% were females. Overall, 79% had CAD, 53% had CVD, and 25% had PAD. Almost half of the patients had some combination of these. Only about 2% had PAD only compared with 36% with CAD only and 17% with CVD only. Although the prevalence of CAD and CVD (among other atherosclerotic vascular diseases) in our clinic was comparable to national figures, the prevalence of PAD was significantly lower (p = .004). The overall use of any antiplatelet agent was 84.2% for patients with only CAD and 80% for only CVD. There was not an adequate number of patients with only PAD to evaluate the use of antiplatelet therapy in this group. CONCLUSION The low prevalence of PAD only (most PAD patients had coexisting CAD and CVD) indicates that PAD is underdiagnosed at our clinic. There was suboptimal use of aspirin and other antiplatelet drugs among patients with atherosclerotic vascular disease.
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Affiliation(s)
- Hassan M Ismail
- Department of Internal Medicine, East Tennessee State University/James Quillen College of Medicine, Johnson City, TN 37604, USA.
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Lenz TL, Stading JA. Lifestyle modification counseling of patients with dyslipidemias by pharmacists and other health professionals. J Am Pharm Assoc (2003) 2006; 45:709-13. [PMID: 16381417 DOI: 10.1331/154434505774909661] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To establish whether patients who are taking lipid-lowering medications receive information on lifestyle modifications from health care providers when originally prescribed and whether they continue to receive follow-up information on lifestyle modifications, and to establish where patients with dyslipidemias are receiving information about lowering their serum cholesterol levels through lifestyle modifications. DESIGN Cross-sectional survey. SETTING Two community pharmacies and two hospitals in two medium-sized cities in the midwestern area of the United States. PARTICIPANTS 234 patients taking medication to lower serum lipids. INTERVENTION Paper-based survey. MAIN OUTCOME MEASURE Responses to survey items. RESULTS Nearly three quarters (73.9%) of participants received information about lowering their serum lipids through lifestyle modifications when they were first diagnosed with elevated serum cholesterol concentrations. Of these, most (83.8%) said that the information came from their physician. Fewer than one half (48.3%) of all participants said that they continued to receive this type of information. Those who received lifestyle modification information at their original diagnosis and who continued to receive this type of information were more likely to be actively trying to lower their serum lipid levels through diet (93.1%) and exercise (71.6%). Participants visited their pharmacy more often than their physician's office each year, yet they recalled pharmacists offering less patient counseling on lifestyle modifications than did physicians and nurses. CONCLUSION Despite being well positioned to assist patients with elevated serum cholesterol concentrations, pharmacists offer less patient counseling about therapeutic lifestyle modifications compared with physicians and nurses.
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Affiliation(s)
- Thomas L Lenz
- Department of Pharmacy Practice, School of Pharmacy and Health Professions, Creighton University Medical Center, 2500 California Plaza, Omaha, NE 68178, USA.
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Kolor B. Patient education and treatment strategies implemented at a pharmacist-managed hepatitis C virus clinic. Pharmacotherapy 2005; 25:1230-41. [PMID: 16164396 DOI: 10.1592/phco.2005.25.9.1230] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hepatitis C virus (HCV) infection is a major public health concern. Approximately 4 million people in the United States have been infected with the virus, and up to 85% of them will develop chronic infection. Chronic HCV infection has often been associated with progression of hepatic fibrosis and, in some cases, cirrhosis and end-stage liver disease. The standard of care is combination therapy with pegylated interferon (peginterferon) alfa plus ribavirin. More than 50% of patients with HCV treated with combination therapy achieve a sustained viral response, defined as undetectable hepatitis C viral RNA 6 months after the end of therapy. Effective patient education and drug therapy management are critical in enabling patients to adhere to the treatment regimen, which is either 24 or 48 weeks long, depending on the virus strain. The drug regimen is associated with several possible adverse events as well as weekly subcutaneous administration (of peginterferon alfa). Frequent monitoring of patients and, often, adjustments in the dosage of one or both components of the therapy are necessary during the treatment course. Strategies used by clinical pharmacists at an HCV clinic are discussed that can facilitate a successful treatment outcome for patients with HCV treated with combination therapy, while enabling them to maintain a reasonable quality of life.
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Affiliation(s)
- Bonnie Kolor
- Pharmacy Department, VA Long Beach Healthcare System, Long Beach, California 90822, USA.
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Straka RJ, Taheri R, Cooper SL, Smith JC. Achieving Cholesterol Target in a Managed Care Organization (ACTION) Trial. Pharmacotherapy 2005; 25:360-71. [PMID: 15843283 DOI: 10.1592/phco.25.3.360.61601] [Citation(s) in RCA: 22] [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 OBJECTIVES To objectively compare the results of a collaborative approach using pharmacists with the results of usual care for achieving a low-density lipoprotein cholesterol (LDL) goal of 100 mg/dl or less in outpatients with documented coronary heart disease (CHD) who are not at goal, and to document the effect on LDL after removal of such a collaborative model from the study population. DESIGN Prospective, multiclinic, controlled study. SETTING Four clinics of a 19-clinic staff model health maintenance organization in Minneapolis and St. Paul, Minnesota. Two clinics treated the intervention patients, two the controls; one clinic for each group was suburban, and one for each was urban. PATIENTS Four hundred eighty-one patients aged 18 years or older with CHD and whose LDL levels were not at goal. INTERVENTION Clinical pharmacists implemented the physician-approved care plan for each intervention patient; activities included managing lipid-lowering drug therapy and educating patients on cardiovascular risk reduction. MEASUREMENTS AND MAIN RESULTS Primary outcomes were changes in LDL level and the proportion of patients achieving goal LDL in the intervention versus the usual care (control) group. Secondary outcomes were the sustainability of the impact observed up to 18 months after discontinuation of the intervention. Mean+/-SD baseline LDL levels were 131+/-28 and 131+/-26 mg/dl (p=NS) for the intervention and control groups, respectively. After a mean of 6.5 months follow-up, 107 (72%) patients in the intervention group and 61 (18%) patients in the control group had attained their LDL goal (p<0.001). Mean LDL levels were reduced by 35.6 mg/dl (27.5%) and 6.7 mg/dl (4.6%) in the intervention and control groups, respectively (p<0.001). When the active program was discontinued, results of the 18-month follow-up indicated that 85 (65%) intervention patients remained at goal compared with 96 (42%) controls (p<0.001). CONCLUSION This trial provides quantitative evidence to support the effectiveness of the collaborative approach as an intervention to optimize management of patients with CHD whose LDL levels are not at goal; this approach is specifically called for in the executive summary of the National Cholesterol Education Program Adult Treatment Panel III. Furthermore, this study documents both the magnitude and sustainability of the impact collaborative care models can have in managed care environments.
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Affiliation(s)
- Robert J Straka
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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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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Cziraky MJ. NHBPEP: working to reduce death and disability from high blood pressure. National High Blood Pressure Education Program. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2002; 42:886-8. [PMID: 12482016 DOI: 10.1331/108658002762063763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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