Health care professionals' perceptions of a community based 'virtual ward' medicines management service: A qualitative study

This article describes a qualitative research study using focus groups to explore the views and experiences of a medicines management team (MMT) on the service they deliver within a 'Virtual Ward' (VW); and those of the wider multidisciplinary team of healthcare professionals on the service provided by the MMT. Several themes emerged from the focus groups, including impact on patients and carers, team working and issues and challenges. A dedicated MMT was seen as a positive contribution to the VW, which potentially increased the quality of patient care, and appeared to be a positive experience for both the MM and wider multidisciplinary team.

Provider Perception of Pharmacy Services in the Patient-Centered Medical Home

BACKGROUND

Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile.

OBJECTIVE

To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation.

METHODS

A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group.

RESULTS

The survey response rate was 78%. Top-tier clinical services were identified as medication counseling, reconciliation, adherence assessment, polypharmacy assessment, and drug information. Formulary review was the only top-tier cost- or access-related service. Top-tier educational services included new black-boxed warnings, drug market withdrawals, and new drug reviews. Ninety-one percent of providers were comfortable referring to a pharmacist for diabetes medication selection and dose titration, but no other disease state eclipsed 75%. More than twice as many providers found the pharmacy service to be very or extremely valuable when the pharmacist is physically located in the office versus virtual interactions (70% vs 34%).

CONCLUSION

Top-tier clinical, cost/access, and educational services considered worthwhile by providers in a PCMH have been identified. In addition to these services, when developing or evaluating a pharmacy service, special attention should be paid to provider preference for physical location in the office and perceived barriers to the pharmacist availability, concern over complex disease management competency and patient confusion as to the role of the pharmacist.

Collaborative drug therapy management and comprehensive medication management-2015

The American College of Clinical Pharmacy (ACCP) previously published position statements on collaborative drug therapy management (CDTM) in 1997 and 2003. Since 2003, significant federal and state legislation addressing CDTM has evolved and expanded throughout the United States. CDTM is well suited to facilitate the delivery of comprehensive medication management (CMM) by clinical pharmacists. CMM, defined by ACCP as a core component of the standards of practice for clinical pharmacists, is designed to optimize medication-related outcomes in collaborative practice environments. New models of care delivery emphasize patient-centered, team-based care and increasingly link payment to the achievement of positive economic, clinical, and humanistic outcomes. Hence clinical pharmacists practicing under CDTM agreements or through other privileging processes are well positioned to provide CMM. The economic value of clinical pharmacists in team-based settings is well documented. However, patient access to CMM remains limited due to lack of payer recognition of the value of clinical pharmacists in collaborative care settings and current health care payment policy. Therefore, the clinical pharmacy discipline must continue to establish and expand its use of CDTM agreements and other collaborative privileging mechanisms to provide CMM. Continued growth in the provision of CMM by appropriately qualified clinical pharmacists in collaborative practice settings will enhance recognition of their positive impact on medication-related outcomes.

Rural access to clinical pharmacy services

OBJECTIVES

To examine the impact of rural residence and primary care site on use of clinical pharmacy services (CPS) and to describe the use of clinical telepharmacy within the Veterans Health Administration (VHA) health care system.

METHODS

Using 2011 national VHA data, the frequency of patients with CPS encounters was compared across patient residence (urban or rural) and principal site of primary care (medical center, urban clinic, or rural clinic). The likelihood of CPS utilization was estimated with random effects logistic regression. Individual service types (e.g., anticoagulation clinics) and delivery modes (e.g., telehealth) were also examined.

RESULTS

Of 3,040,635 patients, 711,348 (23.4%) received CPS. Service use varied by patient residence (urban: 24.9%; rural: 19.7%) and principal site of primary care (medical center: 25.9%; urban clinic: 22.5%; rural clinic: 17.6%). However, in adjusted analyses, urban-rural differences were explained primarily by primary care site and less so by patient residence. Similar findings were observed for individual CPS types. Telehealth encounters were common, accounting for nearly one-half of patients receiving CPS. Video telehealth was infrequent (<0.2%), but more common among patients of rural clinics than those receiving CPS at medical centers (odds ratio [OR] = 9.7; 95% CI 9.0-10.5).

CONCLUSION

We identified a potential disparity between rural and urban patients' access to CPS, which was largely explained by greater reliance on community clinics for primary care than on medical centers. Future research is needed to determine if this disparity will be alleviated by emerging organizational changes, including expanding telehealth capacity and integrating pharmacists into primary care teams, and whether lessons learned at VHA translate to other settings.

Integration of a clinical pharmacist into the healthcare home (HCH)

Mental health is intrinsically linked to general medical health. People with severe and persistent mental illnesses (SPMIs) have been reported to have higher rates of infectious diseases, type 2 diabetes, respiratory illnesses, and cardiovascular disease. They also have 1.5 to 2 times the prevalence of dyslipidemia, hypertension, and obesity than the general population. Healthcare Homes (HCHs) are an integrated treatment approach allowing for psychiatric and medical conditions to be addressed collaboratively. The HCH model promotes open communication among healthcare providers, wellness education, and preventative care. Physicians and nurses are mandatory providers within the HCH. Pharmacists are not routine members of this new approach to care. This article will describe an example of how psychiatric pharmacy services have been incorporated into a HCH. It also calls for advocacy within the specialty of psychiatric pharmacy in an effort to encourage state and government policy changes that mandate the addition of pharmacists into the HCH model of care.

Exploratory study of community pharmacists' perceptions about new or transferred prescription incentives

OBJECTIVES

To assess community pharmacists' perceptions of new or transferred prescription incentives on quality of care, pharmacy practice (e.g., workload), and patient base.

DESIGN

Cross-sectional study.

SETTING

Texas from March through August 2010.

PARTICIPANTS

Texas community pharmacists.

INTERVENTION

In-person and online surveys.

MAIN OUTCOME MEASURE

Pharmacists' perceptions of the impact of new or transferred prescription incentives on pharmacy practice and patient care.

RESULTS

74 usable surveys were analyzed. Most pharmacists (74%) worked for employers who participated in prescription incentive promotions (e.g., $10 gift cards). Regarding quality of care, pharmacists perceived patients as being less likely to receive thorough drug interaction screenings (4.0 ± 1.4 [mean ± SD]) and reported medication-related problems "sometimes to very often" (3.0 ± 0.9) as a result of transferring prescriptions. Pharmacists also reported that patients commonly fill prescriptions regardless of medical necessity in order to receive incentives (4.1 ± 1.0). With respect to pharmacy practice, the majority believed that prescription incentives devalue the profession (4.3 ± 1.1) and should be eliminated (4.4 ± 1.0). Pharmacists were not inclined to believe that incentives were effective in attracting new patients and retaining their business (2.0 ± 1.0).

CONCLUSION

Pharmacists believed that prescription incentives are ineffective tools for increasing patient base and may lead to lower quality of care for patients. Pharmacists view prescription incentives as devaluing the profession of pharmacy and exposing patients to medication-related problems.

Why pharmacists belong in the medical home

Pharmacists can affect the delivery of primary care by addressing the challenges of medication therapy management. Most office visits involve medications for chronic conditions and require assessment of medication effectiveness, the cost of therapies, and patients' adherence with medication regimens. Pharmacists are often underused in conducting these activities. They perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs, and recommend cost-effective therapies. Pharmacists should play key roles as team members in medical homes, and their potential to serve effectively in this role should be evaluated as part of medical home demonstration projects.

Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

Background

Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence.

Methods

This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey—Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression.

Results

We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck.

Conclusions

Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.

Integrating medication therapy management in the primary care medical home: A review of randomized controlled trials

PURPOSE

Randomized controlled trials (RCTs) that evaluated the effect of medication therapy management (MTM) on patient outcomes in the primary care medical home were reviewed to determine how these services may be integrated into the primary care medical home.

METHODS

A literature search was conducted to identify RCTS published between 1989 and 2009 that evaluated the impact of MTM services on patient outcomes. To qualify as MTM services, the interventions had to include both a review of medication therapy and patient interactions, including educating patients about drug therapy, identifying potential barriers to medication adherence, and helping patients manage their diseases. The internal validity of the studies was evaluated using previously published criteria. The description, specification, and appropriateness of study objectives, study population, intervention, randomization, blinding, outcome measures, statistical analysis, and conclusions were evaluated.

RESULTS

A total of 1795 publications were identified, but only 8 met the inclusion criteria. These studies targeted patients with specific medical conditions or patients with multiple medications without specifying a medical condition. The interventions varied in intensity (i.e., frequency and length of patient contact), ranging from a single patient contact in a community pharmacy setting to multiple visits with an ambulatory care pharmacist practicing in a collaborative care model. Two of the 8 studies obtained expected results. These studies targeted patients with unrealized therapeutic goals, and the interventions involved collaboration between pharmacists and physicians and extensive patient follow-up.

CONCLUSION

Of 1795 publications identified, 8 were RCTs meeting selection criteria for evaluation of the effect of MTM services on patient outcomes. Two service elements that benefit patient care were identified: (1) selecting patients with specific therapeutic problems and (2) implementing MTM services that involve timely communication with primary care providers to discuss therapeutic problems, along with routine patient follow-up to support medication adherence to changes in therapy.

Recent Publications on Medications and Pharmacy

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.