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Lias N, Lindholm T, Holmström AR, Uusitalo M, Kvarnström K, Toivo T, Nurmi H, Airaksinen M. Harmonizing the definition of medication reviews for their collaborative implementation and documentation in electronic patient records: A Delphi consensus study. Res Social Adm Pharm 2024; 20:52-64. [PMID: 38423929 DOI: 10.1016/j.sapharm.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/04/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Medication review practices have evolved internationally in a direction in which not only physicians but also other healthcare professionals conduct medication reviews according to agreed practices. Collaborative practices have increasingly highlighted the need for electronic joint platforms where information on medication regimens and their implementation can be documented, kept updated, and shared. OBJECTIVE The aim of this study was to harmonize the definition of medication reviews and create a unified conceptual basis for their collaborative implementation and documentation in electronic patient records (definition appellation: collaborative medication review). METHODS The study was conducted using the Delphi consensus survey with three interprofessional expert panel rounds in September-December 2020. The consensus rate was set at 80%. Experts assessed the proposed definition of collaborative medication review based on an international and national inventory of medication review definitions. The expert panel (n = 41) involved 12 physicians, 13 pharmacists, 10 nurses, and six information management professionals. The range of response rates for the rounds was 63-88%. RESULTS The experts commented on which of the pre-selected items (n = 75) characterizing medication reviews should be included in the definition of collaborative medication review. The items were divided into the following five themes and 51 of them reached consensus: 1) Actions included in the collaborative medication review (n = 24/24), 2) Settings where the review should be conducted (n = 5/5), 3) Situations where the review should be considered as needed and carried out (n = 10/11), 4) Prioritization of top five benefits to be achieved by the review and 5) Prioritization of top five patient groups to whom the review should be targeted. CONCLUSIONS A strong interprofessional consensus was reached on the definition of collaborative medication review. The most challenging was to identify individual patient groups benefiting from the review.
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Affiliation(s)
- Noora Lias
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
| | - Tanja Lindholm
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
| | - Marjo Uusitalo
- Innovation and Development Unit, Istekki Ltd., P.O. Box 4000, FI-70601, Kuopio, Finland; Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland.
| | - Kirsi Kvarnström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland; HUS Pharmacy, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland; HUS Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland.
| | - Terhi Toivo
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland; Hospital Pharmacy, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, P.O. Box 272, FI-33101, Tampere, Finland.
| | - Harri Nurmi
- Finnish Medicines Agency Fimea, P.O. Box 55, FI-00034, Fimea, Finland.
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014, Finland.
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Kogut SJ. A primer on quality measurement and reporting in pharmacy benefit plans. J Manag Care Spec Pharm 2024; 30:386-396. [PMID: 38427331 PMCID: PMC10981972 DOI: 10.18553/jmcp.2024.23240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pharmacy benefit plans in the United States are evaluated on quality measures and other requirements of the government and accrediting organizations. This primer describes the roles of key organizations involved in measuring and reporting quality in pharmacy benefit plans and explains the methods that pharmacy benefit plans use to promote quality of medication use.
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Affiliation(s)
- Stephen J. Kogut
- College of Pharmacy, Department of Pharmacy Practice and Clinical Research, University of Rhode Island, Kingston
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Langhinrichsen-Rohling J, Richie F, Kelley M, Selwyn C, Archer S, Blejwas E. Charitable Pharmacies as Catalysts for Coordinated Care: Pharmacist Management of Blood Glucose Among Under-Resourced Patients With Type 2 Diabetes. Health Promot Pract 2024; 25:254-262. [PMID: 36627769 DOI: 10.1177/15248399221115082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This community-academic-pharmacy partnership evaluated the impact of a pharmacist-led approach to diabetes management in under-resourced charitable pharmacy patients. Charitable pharmacies serve a large volume of under-resourced patients; pharmacist involvement may improve blood glucose management due to the frequency with which patients access the pharmacy for medications. The purpose of this study was to examine the impact of a pharmacist-led approach to diabetes management (measured by blood glucose levels) by providing medication therapy management (MTM) and leveraging communication between the pharmacist and patients' primary care providers (PCPs). Study participants were Federally Qualified Health Center (FQHC) patients with type 2 diabetes who obtained free diabetes-related medications from the pharmacy. Participants were randomly assigned to treatment as usual (TAU), MTM, or MTM plus coordinated care between the pharmacist and the patient's PCP. The blood glucose levels of patients who received MTM remained stable throughout the duration of the study while blood glucose levels for TAU patients significantly increased. A previously non-existent communication channel between pharmacists and FQHC providers was established and recommendations were exchanged. This relatively small investment on behalf of the pharmacy (e.g., routinely checking blood glucose, sharing medication recommendations) led to a return on health outcomes for a high-risk, low-resource patient population. This study yielded a beneficial change in practice as the pharmacy has institutionalized measuring at-risk patients' blood glucose levels during pharmacy visits. The pharmacy has also continued to enhance their relationship with the FQHC to provide integrated, patient-centered care to this shared vulnerable patient population.
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Affiliation(s)
| | - Fallon Richie
- University of South Alabama, Mobile, AL, USA
- The University of North Carolina-Charlotte, Charlotte, NC, USA
| | | | | | | | - Emily Blejwas
- Gulf States Health Policy Center, Bayou La Batre, AL, USA
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Little MA, Reid T, Moncrief M, Cohn W, Wiseman KP, Wood CH, You W, Anderson RT, Krukowski RA. Testing the feasibility of the QuitAid smoking cessation intervention in a randomized factorial design in an independent, rural community pharmacy. Pilot Feasibility Stud 2024; 10:41. [PMID: 38409089 PMCID: PMC10895740 DOI: 10.1186/s40814-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. METHODS Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. RESULTS Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). CONCLUSIONS This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.
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Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA.
| | - Taylor Reid
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Matthew Moncrief
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Wen You
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
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Chong MT, Chong DS. Web-Based Electronic Health Record Program: A Twelve-Month Evaluation on Pharmacist's Intervention in Medicare Part D Annual Comprehensive Medication Review. J Pharm Pract 2024; 37:132-139. [PMID: 36122167 DOI: 10.1177/08971900221129009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective:The objective of this study was to evaluate the impact of pharmacist's intervention on annual comprehensive medication review (Annual CMR) for Medicare Part D beneficiaries. Background: To develop a new approach to assess Medicare Part D Annual CMR using a technological tool. Methods: One hundred sixty-three (163) eligible Medicare Part D beneficiaries were enrolled. By using an Electronic Health Record (EHR) Program, the pharmacist was able to assess laboratory, pharmacy, diagnosis, and patient information. A post-medication review summary was provided to the medical providers and patients which included a medication action plan. At the end of 3 months, 6 months and 12 months after the medication review, data were collected, assessed and compared. Results: The study showed that pharmacist's interventions were recommended to seventy-four (74) enrollees which comprised of 45% of the total enrollees. It showed that at 3-month, 6-month, and 12-month intervals after the medication review, the recommended interventions acknowledged and implemented by the medical providers were 20%, 51% and 64% respectively, which showed a significant difference over a 12-month period (P-value <.05). Different types of pharmacist's interventions that were recommended may include to initiate, to adjust and to discontinue medication. The most common disease states that required interventions were psychiatric disorder, cardiovascular disease, pulmonary disease, gastrointestinal disease, diabetes, dyslipidemia and pain. Conclusion: The finding of this study revealed that such a web-based EHR system was a very meaningful and effective tool in assisting pharmacists to assess the proper and safe use of medication in elderly patients.
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Affiliation(s)
- Mok Thoong Chong
- School of Pharmacy, American University of Health Sciences, Signal Hill, California, USA
- Liga Health, LLC, Henderson, NV, USA
| | - Desiree S Chong
- College of Pharmacy, Roseman University of Health Sciences, Henderson, NV, USA
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Alghamdi KS, Petzold M, Alsugoor MH, Makeen HA, Al Monif KH, Hussain-Alkhateeb L. Community pharmacists' perspectives towards automated pharmacy systems and extended community pharmacy services: An online cross-sectional study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100363. [PMID: 38023630 PMCID: PMC10679933 DOI: 10.1016/j.rcsop.2023.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Private sector partnerships through community pharmacies are essential for effective healthcare integration to achieve the United Nations 2030 Agenda for Sustainable Development Goals. This partnership can provide significant clinical outcomes and reduce health system expenditures by delivering services focused on patient-centred care, such as public health screening and medication therapy management. Objectives To assess the understanding of the proposed strategic and health system reform in Saudi Arabia by exploring community pharmacists' perspectives towards the capacity and readiness of community pharmacies to use automated pharmacy systems, provide extended community pharmacy services, and identify perceived barriers. Materials and methods This multicentre, cross-sectional, web-based survey was conducted in Saudi Arabia (October-December 2021). Graphical and numerical statistics were used to describe key dimensions by the background and characteristics of the respondents, and multiple ordinal logistic regression analyses were sought to assess their associations. Results Of the 403 consenting and participating community pharmacists, most were male (94%), belonged to chain pharmacies (77%), and worked >48 h per week (72%). Automated pharmacy systems, such as electronic prescriptions, were never utilised (50%), and health screening services, such as blood glucose (76%) and blood pressure measurement (74%), were never provided. Services for medication therapy management were somewhat limited. Age groups ≤40 years, chain pharmacies, >10 years of experience and ≥ 3 pharmacists in place with <100 daily medication prescriptions and Jazan province were significantly more likely to provide all medication therapy management services than others. Operational factors were the barriers most significantly associated with the independent variables. Conclusion The results showed that most services and automated pharmacy systems remained limited and well-needed. When attempting to implement these services to drive change, community pharmacies face numerous challenges, and urgent efforts by private and government sectors are essential to improve pharmaceutical care in community pharmacy settings.
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Affiliation(s)
- Khalid S. Alghamdi
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Faculty of Clinical Pharmacy, Al Baha University, Al Baha, Saudi Arabia
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Mahdi H. Alsugoor
- Department of Emergency Medical Services, Faculty of Health Sciences, Al-Qunfudah, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hafiz A. Makeen
- Clinical Pharmacy Department, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Kudaisi H. Al Monif
- Medical Supply Department, Najran Health Affairs, Ministry of Health, Najran, Saudi Arabia
| | - Laith Hussain-Alkhateeb
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Population Health Research Section, King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Alotaibi FM, Bukhamsin ZM, Alsharafaa AN, Asiri IM, Kurdi SM, Alshayban DM, Alsultan MM, Almalki BA, Alzlaiq WA, Alotaibi MM. Knowledge, Attitude, and Perception of Health Care Providers Providing Medication Therapy Management (MTM) Services to Older Adults in Saudi Arabia. Healthcare (Basel) 2023; 11:2936. [PMID: 37998428 PMCID: PMC10671085 DOI: 10.3390/healthcare11222936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Medication Therapy Management (MTM) is identified as a group of services provided to the patient in order to optimize the medication use in order to mitigate adverse drug reactions (ADRs), drug-drug interaction (DDI), and polypharmacy. Elderly populations above 60 years old are at high risk for Medication-related Problems (MRPs) due to several factors. Therefore, MTM programs showed good contributions globally regarding enhancing medication use in the elderly population. Thus, evident information regarding its implementation in Saudi Arabia is lacking in the literature. OBJECTIVE Our objective is to assess community pharmacists' knowledge, attitude, and barriers to providing MTM services to the older adult population in Saudi Arabia. METHODOLOGY A cross-sectional study has been conducted among community pharmacists across the Kingdom. It was survey-based research that was designed and conducted through (QuestionPro). The survey was distributed for the community pharmacists from Feb-May 2023 via (QuestionPro). Descriptive analysis was performed using SAS OnDemand to analyze the categorical variables and test it with the outcome of interest. RESULTS Out of the 528 participants who have viewed our questionnaire, 319 participants have completed the survey in 5 min average time. Most of our participants were male, holding a bachelor's degree, and had an average working load of more than 40 h a week, respectively (84.95%, 92.48%, and 76.18%). In addition, the participants were from different regions of the Kingdom, which enhanced the generalizability of our findings. Moreover, 65.52% have reported a higher level of knowledge, while 34.48% have reported a moderate to low level of knowledge regarding MTM service. Most of those with a higher level of knowledge maintain a positive attitude regarding MTM service, its implementation, and dealing with older adult patients in the community pharmacy. In addition, lacking the time, training, and presence of a private consultation room were the top barriers to provide MTM services in the community pharmacy in Saudi Arabia. CONCLUSION Educational sessions regarding MTM services among the older adult population are highly recommended for community pharmacists before its implementation.
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Affiliation(s)
- Fawaz M. Alotaibi
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Zainab M. Bukhamsin
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Alanoud Nasser Alsharafaa
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Ibrahim M. Asiri
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Sawsan M. Kurdi
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Dhafer M. Alshayban
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Mohammed M. Alsultan
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Bassem A. Almalki
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Wafa Ali Alzlaiq
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia; (Z.M.B.); (A.N.A.); (I.M.A.); (S.M.K.); (D.M.A.); (M.M.A.); (B.A.A.)
| | - Mansour M. Alotaibi
- Pharmacy Practice Department, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
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Fahey MC, Krukowski RA, Anderson RT, Cohn WF, Porter KJ, Reid T, Wiseman KP, You W, Wood CH, Rucker TW, Little MA. Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment. Contemp Clin Trials 2023; 134:107335. [PMID: 37730197 PMCID: PMC10841546 DOI: 10.1016/j.cct.2023.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS NCT05660525.
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Affiliation(s)
- M C Fahey
- Medical University of South Carolina, Charleston, SC, USA
| | - R A Krukowski
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - R T Anderson
- University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - W F Cohn
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K J Porter
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - T Reid
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K P Wiseman
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - W You
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - C H Wood
- My Pharmacy, Greensboro, NC, USA
| | - T W Rucker
- University of Virginia, Health Systems, Nellysford, VA, USA
| | - M A Little
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA.
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Al-Dujaili Z, Hallit S, Al Faraj A. Knowledge, attitude, and readiness of pharmacists toward medication therapy management for patients with attention deficit hyperactivity disorder: a cross-sectional quantitative study. Int J Clin Pharm 2023; 45:1277-1285. [PMID: 37695404 DOI: 10.1007/s11096-023-01628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/18/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Medication Therapy Management (MTM) is a patient-centered service that optimizes drug therapy, improves clinical outcomes, and enhances quality of life. Pharmacists play a critical role in MTM services and provide comprehensive medication management for patients with attention deficit hyperactivity disorder (ADHD). AIM The aim of this study was to assess the knowledge, attitude, and readiness of Iraqi community pharmacists regarding MTM services for ADHD patients. METHOD A cross-sectional study was conducted among 480 Iraqi pharmacists working in community pharmacies in Baghdad. Data were collected using a pre-validated, self-administered questionnaire with 34 items. RESULTS Results showed that only 127 (26.5%) pharmacists had good knowledge, 146 (30.4%) had good attitude, and 148 (30.8%) had high readiness regarding MTM services in ADHD patients. Multivariate analyses showed that a higher number of hours worked per week in the hospital was significantly associated with a lower likelihood of high attitude, whereas practicing MTM services, high knowledge, and high attitude were significantly associated with a higher likelihood of high readiness. CONCLUSION The findings of this study indicate that knowledge, attitudes, and readiness for MTM services for ADHD patients are inadequate. Therefore, there is an urgent need for effective educational strategies to better prepare pharmacists for their potential role in the community, particularly for providing MTM services to ADHD patients.
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Affiliation(s)
- Zahraa Al-Dujaili
- College of Pharmacy, American University of Iraq-Baghdad (AUIB), Baghdad, 10023, Iraq
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Achraf Al Faraj
- College of Pharmacy, American University of Iraq-Baghdad (AUIB), Baghdad, 10023, Iraq.
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Westerholm A, Leiman K, Kiiski A, Pohjanoksa-Mäntylä M, Mistry A, Airaksinen M. Developing Medication Review Competency in Undergraduate Pharmacy Training: A Self-Assessment by Third-Year Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5079. [PMID: 36981990 PMCID: PMC10049528 DOI: 10.3390/ijerph20065079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Pharmacists are increasingly involved in medication history taking, medication reconciliation, and review in their daily practice. The objectives of this study were to investigate third-year pharmacy students' self-assessed competency in medication reviews and gather their feedback for further development of medication review training in their curriculum. The study was conducted as a self-assessment of third-year pharmacy students at the completion of their second three-month internship period in a community pharmacy in 2017-2018. The students were assigned to review medications of a real patient under the supervision of a medication review accredited pharmacist during their internship. The self-assessment was carried out via an e-form, which was created for this study. Recently established national medication review competence recommendations for pharmacists were used as a reference. Students (n = 95, participation rate: 93%) self-assessed their competency as good or very good in 91% (n = 28) of the competency areas listed in the self-assessment. The highest proportion of competencies that were self-assessed as good or very good included using medication risk management databases and evaluating the clinical importance of the information (97%, n = 92). The lowest proportion of competencies was found in applying clinical information from the key laboratory tests to patient care and knowing which laboratory tests are most important to monitor in each condition and medication (36%, n = 34). The students suggested that their pharmacy education should contain more medication review assignments as group work and that an elective course on medication reviews should be compulsory for all pharmacy students.
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Affiliation(s)
- Aleksi Westerholm
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Katja Leiman
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Annika Kiiski
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Marika Pohjanoksa-Mäntylä
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
| | - Anita Mistry
- Faculty of Pharmacy, Pharmacy and Bank Building, Camperdown/Darlington Campus, University of Sydney, Darlington, NSW 2050, Australia
| | - Marja Airaksinen
- Clinical Pharmacy Group, Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, P.O. Box 56, 00014 Helsinki, Finland
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Smith NI, Martinez AI, Huffmyer M, Eckmann L, George R, Abner EL, Jicha GA, Moga DC. Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study. BMC Geriatr 2023; 23:137. [PMID: 36894900 PMCID: PMC9999619 DOI: 10.1186/s12877-023-03876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer's Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD. METHODS Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations. RESULTS Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications. CONCLUSION The evaluation of modifications to MTM recommendations demonstrated that pharmacists' initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations. TRIAL REGISTRATION Study registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016.
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Affiliation(s)
- Noah I. Smith
- University of Kentucky College of Pharmacy, Lexington, KY USA
| | - Ashley I. Martinez
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA USA
| | - Mark Huffmyer
- University of Kentucky College of Pharmacy, Lexington, KY USA
- University of Kentucky Healthcare, Lexington, KY USA
- LLC Consulting Services, Lexington, KY PRO2RX USA
| | | | - Rosmy George
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
| | - Erin L. Abner
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Public Health, Lexington, KY USA
| | - Gregory A. Jicha
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Medicine, 789 S Limestone, Lexington, KY 40536 USA
| | - Daniela C. Moga
- University of Kentucky College of Pharmacy, Lexington, KY USA
- Sanders-Brown Center On Aging, University of Kentucky, Lexington, KY USA
- University of Kentucky College of Public Health, Lexington, KY USA
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12
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Lee Y, Jang S, Kang HJ, Jang S. Comparative analysis of potentially inappropriate medication use in long-term care facility residents and community-dwelling elders: A matched cohort study. Medicine (Baltimore) 2022; 101:e31739. [PMID: 36626501 PMCID: PMC9750672 DOI: 10.1097/md.0000000000031739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.
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Affiliation(s)
- Yumin Lee
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Hee-Jin Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * Correspondence: Sunmee Jang, College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea (e-mail: )
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13
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Deng ZJ, Ding YF, Peng SS, Wang L, Wei AH. Multiple beneficial outcomes of medication therapy management interventions in randomized control trials and non-randomized control trials: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31491. [PMID: 36316852 PMCID: PMC9622691 DOI: 10.1097/md.0000000000031491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Medication therapy management (MTM) service is an effective method to reduce medication-related problems and improve patients' multiple kinds of outcomes. However, the lack of comprehensive review for MTM services has hindered its development. As a result, we are aiming to evaluate the current benefits of MTM services with multiple outcomes. METHOD An electronic search will be performed for randomized controlled trials (RCTs) or non-randomized control trials (NRCTs) that reported MTM services or pharmaceutical services as interventions from PubMed, The Cochrane Library, Embase, and ClinicalTrial. gov. The odds ratios, mean differences, and standard mean differences and their 95% confidence intervals (95% confidence intervals) will be calculated with fixed or random effect models. RESULTS This study will evaluate the multiple benefits of MTM services in clinical endpoints, quality of life, economy, and drug-related problems. CONCLUSION The results will review eligible studies released in the past twenty years and provide more comprehensive evidence of the efficacy of MTM services. ETHICS AND DISSEMINATION Ethical approval is not applicable for this study.
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Affiliation(s)
- Zhi-Jie Deng
- Department of Pharmacy, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Feng Ding
- Department of Pharmacy, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shun-Shun Peng
- Department of Pharmacy, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Wang
- Department of Pharmacy, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-Hua Wei
- Department of Pharmacy, Tongji Hospital, Tongji medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: An-Hua Wei, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (e-mail: )
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14
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Beerlage-Davids CJ, Ponjee GHM, Vanhommerig JW, Kuper IMJA, Karapinar-Çarkit F. Correlation between the number of patient-reported adverse events, adverse drug events, and quality of life in older patients: an observational study. Int J Clin Pharm 2022; 44:1434-1441. [PMID: 36243833 DOI: 10.1007/s11096-022-01481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies on medication therapy management services, e.g. medication reconciliation and medication review, do not show consistent improvements in patient's health-related quality of life. However, these services can reduce adverse drug events. AIM To evaluate the correlation between health-related quality of life and adverse events/adverse drug events reported by patients. METHOD Older patients (≥ 65 years) with polypharmacy (≥ 5 medicines) admitted to orthopaedic or surgical wards were included. Patients were contacted post-discharge to evaluate patient-reported adverse events, health-related quality of life using the EuroQol questionnaire and self-perceived health status on a 5-point Likert scale. The outcomes were the correlation between health-related quality of life and the number of adverse events/adverse drug events, and potential predictors for these events. Spearman correlation and Poisson regression were used for data analysis. RESULTS 102 patients were included. The correlation between health-related quality of life and adverse events was weak but significant (Spearman correlation coefficient: - 0.328, p = 0.001). No correlation was found for adverse drug events (- 0.064, p = 0.521). Self-perceived health status was a predictor for adverse events, not for adverse drug events. Health-related quality of life was neither a predictor for adverse events, nor for adverse drug events. CONCLUSION The correlation between the number of patient-reported adverse events, adverse drug events and health-related quality of life measured by the EuroQol was weak. There is a need for a questionnaire that includes the impact of medication use and is sensitive to outcomes that are affected by medication therapy management services.
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Affiliation(s)
- Cathelijn J Beerlage-Davids
- Department of Internal Medicine, Section of Geriatric Medicine, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Godelieve H M Ponjee
- Department of Clinical Pharmacy, Amsterdam UMC Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | - Ingeborg M J A Kuper
- Department of Internal Medicine, Section of Geriatric Medicine, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
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15
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Alalawneh M, Berardi A, Nuaimi N, Basheti IA. Improving Syrian refugees' knowledge of medications and adherence following a randomized control trial assessing the effect of a medication management review service. PLoS One 2022; 17:e0276304. [PMID: 36240214 PMCID: PMC9565448 DOI: 10.1371/journal.pone.0276304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Syrian refugees living in Jordan have many chronic conditions and use many medications. Pharmacists delivering the Medication Management Review (MMR) service can have a role in improving this growing global refugees' problem. OBJECTIVES To assess the effect of the MMR service on adherence to treatment therapy and knowledge of chronic medications for Syrian refugees residing in Jordan. METHODS This randomized intervention control single-blinded study was conducted in Jordan. Syrian refugees were recruited and randomized into intervention and control groups. Two home visits were delivered to each participant, at baseline and three months later. All participants completed questionnaires regarding adherence and knowledge. As a part of the MMR service, treatment-related problems (TRPs) were recognized for all patients; recommendations to resolve these TRPs were only delivered to intervention group refugees' physicians; TRPs were corrected. At follow-up, TRPs assessment, adherence and medication knowledge were assessed for all refugee participants. RESULTS Participants (n = 106; intervention n = 53, control n = 53) had a number of medications and diagnosed chronic diseases of 5.8 ± 2.1 and 2.97 ± 1.16 per participant respectively. A significant improvement in the adherence and knowledge scores were noted in the intervention (P < 0.001 for both) but not the control group (P = 0.229, P = 0.07 respectively). CONCLUSION The MMR service can significantly improve refugees' TRPs, adherence to therapy and knowledge of chronic medications. If this approach was extended to the large scale, many refugees in need would be able to access a quality essential health-care service; a step towards achieving universal health coverage. TRIAL REGISTRATION Registry: ClinicalTrials.gov Identifier: NCT04554810.
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Affiliation(s)
- Majdoleen Alalawneh
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Alberto Berardi
- Department of Pharmaceutical Sciences and Pharmaceutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Nabeel Nuaimi
- Department of Clinical Pharmacy, College of Pharmacy, AlNoor University College, Mosul, Iraq
| | - Iman A. Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan
- School of Pharmacy, The University of Sydney, Sydney, Australia
- * E-mail:
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16
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Jaberi E, Kassai B, Berard A, Grenet G, Nguyen KA. Drug-related risk of hospital readmission in children with chronic diseases, a systematic review. Therapie 2022:S0040-5957(22)00164-0. [PMID: 36192191 DOI: 10.1016/j.therap.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) are one of the leading causes of hospital readmissions. Children with chronic diseases are more likely to experience DRPs than adults. The burden and characteristics of drug-related readmissions at and after hospital discharge in children remain unclear. OBJECTIVE We aimed to summarize the impact of DRPs at and after hospital discharge on the risk of readmissions in children with chronic diseases. METHODS We conducted a systematic review searching PubMed from inception until January 2022. Study selection criteria were studies assessing the impact of different factors at discharge and after discharge on the risk of hospital readmissions in children with chronic diseases, reporting an assessment of DRPs. DRP could be the only risk factor assessed or one among others. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Exposure (ROBINS-E) tool. We summarized the qualitative impact of the reported DRPs on hospital readmission as conclusive (significant association) or inconclusive. RESULTS Of the 4734 studies initially identified, 13 met inclusion criteria. Eleven studies were retrospective, using electronic health records. The studies assessed the impact of DRPs at or after discharge according to the type of medication (in 6 studies), number of medication (in 5 studies) and medication nonadherence (in 2 studies). From the 44 reported associations between DRPs and the risk of readmission 26 (59% [95% CI, 43%-73%]) were conclusive, of which 81% increased the risk and 19% decreased the risk, and 17 (39% [95% CI, 24%-55%]) were inconclusive. CONCLUSION The impact of DRPs on hospital readmissions in children with chronic diseases displayed conflicting results, estimated associations having potentially a serious risk of bias. We need more evidence with a lower risk of bias.
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17
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Marquez C, Thompson R, Feinstein JA, Orth LE. Identifying opportunities for pediatric medication therapy management in children with medical complexity. J Am Pharm Assoc (2003) 2022; 62:1587-1595.e3. [PMID: 35527209 PMCID: PMC9464681 DOI: 10.1016/j.japh.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite potential benefits of medication therapy management (MTM) for complex pediatric patients, implementation of pediatric MTM services is rare. OBJECTIVES To describe how a standardized pediatric MTM model identifies potential interventions and their impact on medication regimen complexity index (MRCI) scores in children with medical complexity (CMC) and polypharmacy. METHODS This retrospective proof-of-concept study included pediatric patients receiving primary care in a large outpatient primary care medical home for CMC within a tertiary freestanding children's hospital from August 2020 to July 2021. Medication profiles of established patients aged 0-18 years with at least 5 active medications at the time of the index visit were assessed for medication-related concerns, potential interventions, and potential impact of proposed interventions on MRCI scores. RESULTS Among 100 patients, an average of 3.4 ± 2.6 medication-related concerns was identified using the pediatric MTM model. Common medication-related concerns (>25% of patients) included inappropriate or unnecessary therapy, suboptimal therapy, undertreated symptom, adverse effect, clinically impactful drug-drug interaction, or duplication of therapy. A total of 97% had opportunities for 5.0 ± 2.9 potential interventions. Most common proposed interventions included drug discontinuation trial (69%), patient or caregiver education (55%), dosage form modification (51%), dose modification (49%), and frequency modification (46%). The mean baseline MRCI score was 32.6 (95% CI 29.3-35.8) among all patients. MRCI scores decreased by a mean of 4.9 (95% CI 3.8-5.9) after application of the theoretical interventions (P < 0.001). Mean potential score reduction was not significantly affected by patient age or number of complex chronic conditions. Potential impact of the proposed interventions on MRCI score was significantly greater in patients with higher baseline medication counts (P < 0.001). CONCLUSION Most CMC would likely benefit from a pharmacist-guided pediatric MTM service. A standardized review of active medication regimens identified multiple medication-related concerns and potential interventions for nearly all patients. Proposed medication interventions would significantly reduce medication regimen complexity as measured by MRCI. Further prospective evaluation of a pharmacist-guided pediatric MTM service is warranted.
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18
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Basheti MM, Tran M, Wong K, Gordon C, Grunstein R, Saini B. Australian Consultant Pharmacists' Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia. Behav Sleep Med 2022; 20:622-637. [PMID: 34520308 DOI: 10.1080/15402002.2021.1975718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The first-line treatment for insomnia is cognitive-behavioral therapy. However, there is persistent use of pharmacotherapy, particularly, sedative-hypnotics. Consultant pharmacists can provide medication review services for people using multiple medications. Therefore, they are well placed to provide sleep health/insomnia care with regard to sedative-hypnotic use and behavioral treatment recommendations/sleep health education. However, this avenue is, as yet, unexplored. OBJECTIVES To explore consultant pharmacists' current sleep health-related provisions and what their perspectives are around developing/implementing a consultant pharmacist-led behavioral service for insomnia. METHODS Qualitative semi-structured interviews were conducted with a convenience-based sample of consultant pharmacists. Interviews were audio-recorded, transcribed, and inductively analyzed. RESULTS Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Trivializing insomnia and sleep health, 2) Providing patient-centered care, 3) Service implementation - What do we need to consider? Participants commonly dealt with older patients and frequently encountered patients with sleep complaints/taking sleep medications. Generally, it was believed that sleep health was given minimal priority, with other comorbidities taking precedence in health provisions. Patients' attitudes toward management approaches were regarded critical to future treatment developments. While interested in expanding their sleep health/insomnia practice, participants expressed the need for appropriate education/training, funding, and collaborative treatment frameworks. CONCLUSION Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health-care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies; however, factors such as education/training, service configuration support, and patient attitudes should be addressed.
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Affiliation(s)
- Mariam M Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Minh Tran
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Australian Association of Consultant Pharmacy, Australia
| | - Keith Wong
- Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Gordon
- Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Ronald Grunstein
- Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
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19
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Development, validation and evaluation of an online medication review tool (MedReview). PLoS One 2022; 17:e0269322. [PMID: 35657965 PMCID: PMC9165870 DOI: 10.1371/journal.pone.0269322] [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: 02/13/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To develop, validate and evaluate a computerized clinical decision support system (MedReview) that aids medication reviewers with pharmacological decision-making. Methods This study included three phases; the development phase included computerizing a consolidated medication review algorithm (MedReview), followed by validation and evaluation of MedReview and responding to a web-based survey designed using patient scenarios. Participants had to be ‘fully registered’ with the Malaysian Pharmacy Board and work full-time at a community pharmacy. Results MedReview was developed as a web app. It was validated among 100 community pharmacists from May-July 2021 using the Technology Acceptance Model (TAM). There was acceptable content validity and fair inter-rater agreement, and good convergent and discriminant validity. Exploratory factor analysis resulted in five domains to determine the attitude of pharmacists about using MedReview: perceived ease of use, perceived usefulness, intention to use, trust, and personal initiatives and characteristics; the total variance explained by five factors was 76.36%. The survey questionnaire had a high overall reliability value of 0.96. Evaluation of MedReview was based on mean scores of survey items. Of all items included in the survey, the highest mean score (out of 7) was achieved for ‘I could use MedReview if it is meaningful/relevant to my daily tasks’ (5.78 ± 1.10), followed by ‘I could use MedReview if I feel confident that the data returned by MedReview is reliable’ (5.77 ± 1.21), and ‘I could use MedReview if it protects the privacy of its users’ (5.73 ± 1.20). Conclusion Community pharmacists generally had a positive attitude towards MedReview. They found that MedReview is trustworthy and they had the intention to use it when conducting medication reviews. The adaptation of the TAM in the survey instrument was reliable and internally valid.
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Wondesen A, Berha AB, Woldu M, Mekonnen D, Engidawork E. Impact of medication therapy management interventions on drug therapy problems, medication adherence and treatment satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia: a one-group pre-post quasi-experimental study. BMJ Open 2022; 12:e054913. [PMID: 35414550 PMCID: PMC9006832 DOI: 10.1136/bmjopen-2021-054913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients. STUDY DESIGN, SETTING AND PARTICIPANTS A one-group pre-post quasi-experimental study was conducted on 423 ambulatory HF patients at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia. All ambulatory HF patients ≥18 years old attending the adult cardiac clinic of TASH and having a complete medical record and fully met the inclusion criteria were taken as study participants. INTERVENTIONS Educational interventions along with a brochure with information on the nature of HF disease and its treatment were provided to study participants. DTPs encountered were resolved by a team of pharmacists and physicians. RESULTS In the preintervention phase, 288 DTPs were identified with a mean (SD) of 1.3±1.1. A significant reduction of DTPs (0.67±1.1, p<0.001) was observed in the postintervention phase compared with the preintervention phase. At the postintervention phase, 36.4%, 61.9% and 1.7% of HF patients were highly, medium and low adherent to their treatment regimens, respectively. The total composite score for treatment satisfaction of the study participants was 80.35%. CONCLUSIONS The findings of this study demonstrated that by teaming up clinical pharmacists with cardiologists and cardiology fellows, it was possible to reduce the occurrence of DTPs, improve medication adherence and increase treatment satisfaction of HF patients attending at the outpatient cardiac clinic.
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Affiliation(s)
- Abate Wondesen
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Woldu
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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21
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Lexow M, Wernecke K, Sultzer R, Bertsche T, Schiek S. Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities. BMC Geriatr 2022; 22:307. [PMID: 35397527 PMCID: PMC8994296 DOI: 10.1186/s12877-022-03025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/11/2022] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Medication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far.
Objective
We examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints).
Methods
A prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved.
Results
107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved.
Conclusions
We found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved.
Trial registration
German Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).
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22
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Pharmacists’ knowledge and attitudes toward Medication Therapy Management service and the associated challenges and barriers for its implementation. Saudi Pharm J 2022; 30:842-848. [PMID: 35812151 PMCID: PMC9257923 DOI: 10.1016/j.jsps.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/10/2022] [Indexed: 11/20/2022] Open
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23
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Wu W, Tang Q, Wang C, Cao Y, Liu Z, Li X, Chen G, Lu J. Elderly patients with comorbid hypertension who prefer primary care have a lower rate of polypharmacy: A cross-sectional study in Shanghai, China. Biosci Trends 2022; 16:99-106. [PMID: 35197398 DOI: 10.5582/bst.2022.01021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2017, the World Health Organization highlighted polypharmacy as one of the key focus areas of the Global Patient Safety Challenge on Medication Safety. According to the experience of developed countries, the provision of primary pharmaceutical care plays a very important role in the intervention of polypharmacy in the elderly. It is necessary to assess the associations between elderly polypharmacy status and primary care in developing countries. The findings of this paper provide the prevalence of polypharmacy in patients with comorbid hypertension, and the factors associated with it. A total of 19,332 elderly patients with hypertension were completed, among which the mean (SD) number of diseases was 4.83 (1.99), the mean (SD) daily maximum number of drugs was 5.13 (2.89), and the rate of polypharmacy was 50.5%. Age, living areas, total number of visits, preference for medical institutions and the number of diseases were associated with polypharmacy. Among them, advanced age, greater number of visits and diseases are the risk factors of polypharmacy for elderly patients with comorbid hypertension. The rate of polypharmacy in patients who intend to seek treatment in community healthcare centers is low. A total of 9,603 pharmaceutical workers worked in Shanghai public hospitals in 2020, among them 52.0% worked in the central city area, and more than 70% worked in secondary and tertiary hospitals. There was a large mismatch between patients' medical preference and the number of pharmaceutical personnel. As a consequence, it is necessary to strengthen the development of community pharmaceutical care in primary medical institutions for elderly polypharmacy management.
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Affiliation(s)
- Wenhui Wu
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Qi Tang
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Cao Wang
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Yu Cao
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Zhenwei Liu
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Xiaohong Li
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
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24
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Song Z, Hu Y, Ren Z, Wang G, Liu S, Zheng S, Yang L, Zhao R. Optimal Management of the Public and Patients by Pharmacists in the Era of COVID-19: An Evidence-Based Review and Practical Recommendations. Front Public Health 2022; 9:758325. [PMID: 35087781 PMCID: PMC8787106 DOI: 10.3389/fpubh.2021.758325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Currently, managing the public and patients during the COVID-19 pandemic is constituting a health care challenge worldwide. Patient-oriented management is of crucial importance to promote emergency preparedness and response. This study aims to formulate an integrated pharmacist management strategy of the public and patients and to provide evidence-based and practical references. Methods: Evidence-based review and practical analysis were utilized. First, PubMed, EMBASE and Chinese database were searched. Studies about patient management in major public health emergencies were included. Second, the Chinese experience of patient management was analyzed and identified. Finally, combining evidence-based and practical analysis, the pharmacist management strategy of the public and patients was researched and summarized. Results: Regarding the home quarantine period, pharmacist management services should include medication guidance, guidance on risk monitoring, sanitation measures education, health management guidance and psychological support. Regarding the outpatient visit period, pharmacists should participate in the control of in-hospital infections and provide physician-pharmacist joint clinic services, pharmacy clinic services, medication therapy management, medication consultation services, drug supply guarantee and drug dispensing services. Regarding the hospitalization period, pharmacist management services should include monitoring and evaluating the safety and efficacy of medications, providing strengthened care for special populations and other pharmaceutical care. For non-hospitalized or discharged patients, pharmacist management services should include formulating medication materials and establishing pharmacy management files for discharged patients. Conclusion: An evidence-based, patient-centered and entire-process-integrated pharmacist management strategy of the public and patients is established, which remedies the gaps in the existing patient management and can be implemented to support pharmacists' contributions to COVID-19 pandemic control.
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Affiliation(s)
- Zaiwei Song
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Yang Hu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhenyu Ren
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Guanru Wang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Shuang Liu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Siqian Zheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Li Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
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25
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Li Y, Liu G, Liu C, Wang X, Chu Y, Li X, Yang W, Shen Y, Wu F, Zhang W. Effects of Pharmacist Intervention on Community Control of Hypertension: A Randomized Controlled Trial in Zunyi, China. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:890-904. [PMID: 34933984 PMCID: PMC8691874 DOI: 10.9745/ghsp-d-20-00505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/15/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to test the effects of pharmacist intervention on the community control of hypertension through a comparative randomized controlled trial. METHODS We recruited adult hypertensive patients with comorbidity or confusion with medication (n=636) from 2 community health centers in Zunyi, China. They were randomly and equally divided into 2 groups. Both groups received the usual care and participated in the community systematic management program of hypertension. Participants in the intervention group were given interventions from pharmacists, including a monthly review of medications, patient education, and medication adjustment advice to medical doctors over 6 months. Participants' blood pressure was assessed at baseline, 3 months, and 6 months. Participants' knowledge and medication adherence were measured using a questionnaire before and after the trial. RESULTS Compared to the control group (n=298), a significantly higher percentage of participants in the intervention group (n=290) had their blood pressure under control 3 months (46.9% vs. 38.3%, P=.034) and 6 months (60.7% vs. 40.9%, P<.001) after the interventions. Difference-in-differences analyses showed that the pharmacist intervention resulted in an increase in knowledge scores by 12.55 points (P<.001), a decrease in systolic blood pressure by 6.65 mmHg (P=.001), and a decrease in diastolic blood pressure by 7.26 mmHg (P<.001) compared to the controls after adjustment for variations in potential confounding factors. The odds of participants passing the hypertension knowledge tests in the intervention group was 4.45 times those in the control group (P<.001). Similarly, it was found that the intervention group had higher odds of not needing any medication adjustments (adjusted odds ratio [AOR]=2.75, P<.001) and having their blood pressure under control (AOR=2.18, P=.002) compared to the control group. CONCLUSION It is evident that pharmacist intervention has significant short-term effects on improving the knowledge and medication adherence of hypertensive patients, as well as timely medication adjustments from medical doctors, resulting in lowered blood pressure and an increased control rate. Further studies should explore the long-term sustainability of the effects of community pharmacist intervention.
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Affiliation(s)
- Ying Li
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
- The Second Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
| | - Guoqin Liu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne VIC 3086, Australia.
| | - Xianhong Wang
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Yalin Chu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Xiaoqin Li
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wenhao Yang
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Yewei Shen
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Fang Wu
- School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wenzhi Zhang
- Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
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26
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Trends in telephonic comprehensive medication review in the United States from 2000 to present: a scoping literature review. J Am Pharm Assoc (2003) 2021; 62:406-412.e1. [PMID: 35067477 DOI: 10.1016/j.japh.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although comprehensive medication review (CMR) services have been shown to provide value to patients and payers, the extent of uniformity in service delivery is unknown. A variety of standards and recommendations are available from academic and professional sources, but variation in service provision is an important consideration when attempting to measure or compare service quality nationally. OBJECTIVE This study aimed to identify and summarize trends in the peer-reviewed and gray literature describing telephonic CMR delivery and content. METHODS A scoping review of peer-reviewed and gray literature was conducted to quantify and qualify trends in CMR service. Two independent reviewers screened abstracts from 9 bibliographic databases and selected gray literature sources in accordance with the Joanna Briggs Institute guidelines and an internally developed protocol. Inclusion criteria for the review were English language; discussion of telephonic CMR service in the United States; research, legislation, or guidelines that describe CMR content coverage requirements for payment; and publication from the year 2000 to the present. Data relating to publication type, study design, setting, region, and themes of CMR content were collated into a Microsoft Excel data extraction form. Qualitative thematic analysis was conducted, and key findings and concepts were reported contextually. RESULTS Of 374 identified documents screened, 15 were included in this scoping review and thematic analysis. The following characteristics of CMRs were identified: content, coverage, eligibility, frequency, process, and responsiveness. All published documents (n = 15, 100%) included a discussion of CMR content, and 14 sources (93%) addressed process elements of providing a CMR. Discussion of other themes varied in frequency across documents, ranging from 3 articles (20%) addressing organizational goals for CMR to 12 articles (80%) including elements of responsiveness. Within-theme variation was also observed for several CMR content areas. CMR process was the most heterogeneous theme with topics ranging from access to patient health records to pharmacist training. CONCLUSIONS Assessment of telephonic CMR comprised a small but steadily increasing portion of the medication therapy management literature. Publications since 2015 have shown an increasing consensus of CMR content and purpose. Per the identified literature, there is an ongoing demand for higher-quality, more holistic CMRs, but there is no consensus on how to measure CMR quality. Future work should include engaging with CMR experts to understand variability in measures of CMR success.
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27
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Hayashi M, Hamdy DA, Mahmoud SH. Applications for pharmacogenomics in pharmacy practice: A scoping review. Res Social Adm Pharm 2021; 18:3094-3118. [PMID: 34474980 DOI: 10.1016/j.sapharm.2021.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pharmacogenomics (PGx) can provide valuable pharmacokinetic and pharmacodynamic information for the pharmacist's assessment of drug therapy, especially within medication therapy management (MTM) services. However, no review has comprehensively mapped the pharmacists' use of PGx in practice-based research. Doing so would allow future researchers, practitioners, and policy-makers to identify the ideal populations and settings for PGx implementation within the pharmacy. OBJECTIVE The purpose of this review is to identify the evidence to date of PGx use in pharmacy practice. METHODS A scoping review was conducted to find all studied non-oncologic pharmacy practices incorporating PGx testing. Search terms were applied to 5 databases and relevant journals. Characteristics of patients, pharmacy settings, genetic tests, and outcomes were summarized to determine models most likely to benefit patients. RESULTS The search identified 43 studies on the use of PGx by pharmacists published between 2007 and 2020. CYP2C19 testing with antiplatelets was the most studied model, found in both community and institutional settings. It also was the most actionable test: approximately 30% of patients have polymorphisms indicating a need for alternative antiplatelets, and identifying these patients can reduce morbidity and mortality by more than 50%. As technology shifts, broader studies using multi-gene panel tests within MTM demonstrate an approximate 50% decrease in emergency visits and hospitalizations in elderly polypharmacy patients. Clinical benefit or drug-gene interactions are also found in other cardiovascular, psychiatric, analgesic, and gastrointestinal indications. No evaluations of actual costs or of pharmacist prescribing within pharmacy-based PGx have been performed. Facilitators towards successful PGx implementation included pharmacist education, collaboration with other healthcare providers, and the use of clinical decision software. CONCLUSIONS Pharmacogenomic testing has demonstrated feasibility and improved medication outcomes in pharmacy practice, including in the community pharmacy. Further PGx research should be directed towards pharmacist prescribing, pharmacist education, and pharmacoeconomics.
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Affiliation(s)
- Meagan Hayashi
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Dalia A Hamdy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada; AbEx Health Services LTD, Fort Saskatchewan, Alberta, Canada.
| | - Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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28
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Thiruchelvam K, Byles J, Hasan SS, Kairuz T. Innovating medication reviews through a technology-enabled process. Res Social Adm Pharm 2021; 18:2700-2705. [PMID: 34326004 PMCID: PMC8847068 DOI: 10.1016/j.sapharm.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 10/31/2022]
Abstract
Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom.
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
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29
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Zhang W, Lv G, Xiong X, Li M. Effect of Cost-Related Medication Non-adherence Among Older Adults With Medication Therapy Management. Front Med (Lausanne) 2021; 8:670034. [PMID: 34222282 PMCID: PMC8245679 DOI: 10.3389/fmed.2021.670034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Medication therapy management (MTM) was established by the Center for Medicare and Medicaid Services (CMS) with the aim to improve medication adherence. However, the national prevalence of cost-related medication non-adherence (CRN) is still unknown and there is a literature gap in the association between MTM services and CRN. Methods: A cross-sectional study was conducted. A nationally representative study sample from Medicare Current Beneficiary Surveys (MCBS) was used. Survey sampling weights were applied for national estimates of CRN. Weighted multivariable logistic regressions controlling for covariates were conducted to investigate the effect of the MTM on the CRN. Results: The study identified 1,549 MTM-eligible beneficiaries. The prevalence of CRN was higher in MTM-eligible individuals than in non-MTM eligible individuals (24.14 vs. 13.44%; P < 0.001). According to the results of multivariable logistic regressions, we found that MTM eligibility was significantly associated with a higher prevalence of CRN (OR: 1.59; 95% CI: 1.28–1.96). Additionally, some other variables such as health status, with or without low-income subsidy are also associated with CRN. Conclusions: Our findings suggest that the prevalence of CRN in MTM-eligible beneficiaries was higher than in non-MTM eligible beneficiaries. Further studies with the longitudinal design are warranted to clarify the relationship between MTM and CRN. Alternative strategies to improve CRN should be considered in future Medicare Part D Enhanced MTM Models.
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Affiliation(s)
- Weiwei Zhang
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Gang Lv
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
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30
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Kosari S, Koerner J, Naunton M, Peterson GM, Haider I, Lancsar E, Wright D, Niyonsenga T, Davey R. Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): protocol for a cluster randomised controlled trial. Trials 2021; 22:390. [PMID: 34116708 PMCID: PMC8193166 DOI: 10.1186/s13063-021-05335-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Medication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents' adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management. METHODS Intervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams 2 to 2.5 days per week for 12 months. On-site pharmacists, in collaboration with facility nurses, prescribers, community pharmacists, residents and families will conduct medication management activities to improve the quality use of medicines. Aged care facilities in the control group will continue usual care. The target sample size is 1188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and emergency department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident's allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial. DISCUSSION The results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model. TRIAL REGISTRATION ACTRN12620000430932 . Registered on 1 April 2020 with ANZCTR.
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Affiliation(s)
- Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - Jane Koerner
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Gregory M Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT, Australia.,School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Ibrahim Haider
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich, UK
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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31
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Residential Medication Management Reviews and continuous polypharmacy among older Australian women. Int J Clin Pharm 2021; 43:1619-1629. [PMID: 34091857 DOI: 10.1007/s11096-021-01294-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79-84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professionals.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Geisler AN, Purvis CG, Dao DPD, Feldman SR. Medication therapy management in dermatology: a call to action. J DERMATOL TREAT 2021; 32:373-375. [PMID: 33909523 DOI: 10.1080/09546634.2021.1922571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amaris N Geisler
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caitlin G Purvis
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Diem-Phuong D Dao
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Berry M, Gustafson A, Wai M, Luli AJ. Evaluation of an Outpatient Pharmacist Consult Service at a Large Academic Medical Center. Innov Pharm 2021; 12. [PMID: 34345506 PMCID: PMC8326691 DOI: 10.24926/iip.v12i2.3238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate a novel outpatient pharmacist consult service in a large academic medical center. Setting: Four outpatient pharmacies that are part of a large academic medical center Methods: An outpatient pharmacist consult order was created and embedded in the electronic medical record (EMR). Medical center providers utilized this consult order when identifying patients in need of specific services provided by outpatient pharmacists. Descriptive data about each individual consult was collected including number completed, type of service, and duration. Rate of accepted pharmacy recommendations and patient cost savings were also evaluated. A survey was administered at the completion of the study period to assess provider and pharmacist satisfaction with the service. Patient demographic information was collected for those who had a documented completed consult. Results: A total of 193 consults were completed: 137 immunizations, 37 care affordability, 15 education, 3 polypharmacy and 1 OTC recommendation. 89% of completed consults took pharmacists 20 minutes or less to complete. Of completed care affordability consults (n=31), 55% of patients saved between $100 - $500 per medication fill. Of providers who completed a survey and utilized the service (n=12), 83.3% were extremely satisfied and 16.7% were satisfied with it. The provider acceptance rate of pharmacist’s recommendations was 74%. Conclusion: Implementation of an outpatient pharmacist consult service provided an alternative method for the utilization of pharmacist provided MTM services in outpatient pharmacies at a large academic medical center. The service was well received by both providers and pharmacists.
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Affiliation(s)
| | | | - Maya Wai
- University of Arkansas for Medical Sciences, College of Pharmacy
| | - Alex J Luli
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences
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Dhatt H, Marupuru S, Warholak TL. A motivational factors assessment instrument for medication management center employees providing medication therapy management services: A Rasch analysis. J Am Pharm Assoc (2003) 2020; 61:34-43.e2. [PMID: 32981849 DOI: 10.1016/j.japh.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/15/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Telephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance. OBJECTIVE To assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees' work performance. METHODS Pharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation. RESULTS A total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5-1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (-1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure. CONCLUSIONS The EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.
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Wang X, Zhang M, Zhao S, Lv M, Li Q, He L, Hu M. Investigation on Household Medication-Taking Behavior and Affordability Among Patients Under Chronic Condition: A Survey Study in Gansu Province, China. Front Pharmacol 2020; 11:1280. [PMID: 32973512 PMCID: PMC7472568 DOI: 10.3389/fphar.2020.01280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
Aim This study aimed to investigate the household medication-taking behavior and affordability of patients with chronic diseases in Gansu Province. As well as to propose suggestions to assist improvement of related policies. Methods A multistage stratified cluster sampling technique was used to select the research sites and households according to the WHO manual for the “Household Survey to Measure Access and Use of Medicines”. The impact factors of medication-taking behavior were estimated using binary logistic regression models. Medication treatment affordability of hypertension patients was evaluated. Results A total of 1,080 completed questionnaires were collected, in which 690 families reported to have chronic patients in their home. The total number of chronic disease patients were 915. About 93% of the patient reported scheduled medicine intake. Approximately 86.60% of patients with chronic medical conditions were able to adhere to the physicians’ prescriptions. Age, gender, and the number of household chronic disease patients were the main factors influencing whether the patients take medication. Respondents’ self-reported monthly expenditure on household medicine accounted for 16.95% of their total monthly expenditure. The total cost of irbesartan and valsartan for hypertension treatment was two-fold higher than the minimum daily wage of the families. Conclusion This study found that patients with chronic diseases have a high proportion of medication and medication compliance. However, family drug burden, especially for those living with hypertension are among the key challenges. Related policy needs to be revised to promote the affordability of medication under chronic conditions.
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Affiliation(s)
- Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Ming Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | | | - Meng Lv
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Qinglin Li
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Longjie He
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
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Hale G, Moreau C, Joseph T, Phyu J, Merly N, Tadros N, Rodriguez MM. Improving Medication Adherence in an ACO Primary Care Office With a Pharmacist-Led Clinic: A Report From the ACORN SEED. J Pharm Pract 2020; 34:888-893. [PMID: 32578473 DOI: 10.1177/0897190020934271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As health care moves into the era of value-based medicine, both ambulatory and acute settings are being held accountable for the quality of care provided to patients. Previous studies have shown improved clinical outcomes through medication therapy management (MTM) due to improved medication adherence. OBJECTIVE The purpose of this study is to assess the effects of a pharmacist-led MTM clinic in an accountable care organization (ACO) affiliated primary care office on adherence to renin-angiotensin system (RAS) antagonists, diabetic medications, and/or statin medications reported through Healthcare Effectiveness Data and Information Set (HEDIS) Medicare Star Ratings. METHODS In this retrospective cohort study, data were collected via chart review of pharmacist-led MTM patient interviews and follow-ups between October 2015 and April 2017. Eligible patients were Humana HMO Medicare beneficiaries, with at least one chronic disease state, for which they were treated with a RAS antagonist, statin, or diabetic medication. The primary outcome of this investigation was a change in Star Rating scores for medication adherence to RAS antagonists, diabetic medications, and statins from pre- and postpharmacist MTM intervention. RESULTS A total of 102 patients were referred to the MTM clinic. Out of these, 32 had a follow-up visit, resulting in a total of 25 interventions. One year prior to MTM clinic implementation, most Star Ratings were consistently 3 (out of 5) for RAS antagonists, diabetic medications, and statins. Postintervention, ratings increased to 4 or 5 across these categories. Conclusion: Implementing a pharmacist-led MTM clinic in the ACO primary care setting improves Medicare Star Ratings in patients with chronic conditions.
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Affiliation(s)
- Genevieve Hale
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - Cynthia Moreau
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Tina Joseph
- Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Jessica Phyu
- Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Nemesis Merly
- Nova Southeastern University College of Pharmacy, Palm Beach Gardens, FL, USA
| | - Nicole Tadros
- Nova Southeastern University College of Pharmacy, Davie, FL, USA
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Alawneh MA, Nuaimi N, Abu-Gharbieh E, Basheti IA. A randomized control trial assessing the effect of a pharmaceutical care service on Syrian refugees' quality of life and anxiety. Pharm Pract (Granada) 2020; 18:1744. [PMID: 32256897 PMCID: PMC7104796 DOI: 10.18549/pharmpract.2020.1.1744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/08/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Syrian refugees residing in Jordan suffer from chronic illnesses, low quality
of life (QoL) and anxiety. Pharmacists delivering the medication review
service can have a role in improving this growing worldwide problem. Objectives: To assess the effect of the medication review service on QoL and anxiety
scores for Syrian refugees living with chronic medical conditions. Methods: This randomized single-blinded intervention control study was conducted in
Jordan. Syrian refugees were recruited and randomized into intervention and
control groups. Two home visits were organized with each participant, at
baseline and three months later. The medication review service was delivered
to the participants and questionnaires regarding QoL and anxiety were
completed by all participants. As a part of the medication review service,
drug-related problems (DRPs) were identified by a clinical pharmacist for
all patients, but recommendations to resolve these DRPs were delivered to
intervention group refugees’ physicians only (control group patients
did not receive this part of the service till the end of the study); DRPs
were corrected and pharmacist-delivered counseling and education were
provided as well. At follow-up, DRPs assessment, QoL and anxiety scores were
assessed for refugees in the intervention and control groups. Results: Syrian refugees (n=106) were recruited and randomized into intervention
(n=53) and control (n=53) groups with no significant difference between both
groups at baseline. The number of medications and diagnosed chronic diseases
per participant was 5.8 (SD 2.1) and 2.97 (SD 1.16), respectively. At
follow-up, a significant decrease in the number of DRPs for refugees in the
intervention group was found (from 600 to 182, p<0.001), but not for
the control group (number stayed at 541 DRPs, p=0.116). Although no
significant difference between the groups was found with regards to QoL at
follow-up (p=0.266), a significant difference was found in the anxiety
scores between the groups (p<0.001). Conclusion: The medication review service delivered by clinical pharmacists can
significantly improve refugees’ DRPs and anxiety scores. As for QoL,
significant improvements can be seen for all refugee patients, regardless of
whether the DRPs identified were resolved or not.
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Affiliation(s)
- Majdoleen Al Alawneh
- MSc. Graduate Teaching Research Assistant. College of Pharmacy, QU Health, Qatar University. Doha (Qatar).
| | - Nabeel Nuaimi
- PhD. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
| | - Eman Abu-Gharbieh
- PhD. Associate Professor. College of Medicine, University of Sharjah. Sharjah (United Arab Emirates).
| | - Iman A Basheti
- PhD. Professor. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University. Amman (Jordan).
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Chong MT. Pharmacist Interventions in Improving Clinical Outcomes in Patients with Type 2 Diabetes Mellitus Among the Underrepresented Population: A Collaborative Ambulatory Care Pharmacy Practice (CAPP) Approach. J Res Pharm Pract 2020; 9:3-9. [PMID: 32489954 PMCID: PMC7235450 DOI: 10.4103/jrpp.jrpp_19_75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of pharmacist's interventions through a collaborative ambulatory care pharmacy practice (CAPP) model in patients with type 2 diabetes mellitus (T2DM) among the underrepresented population. METHODS Eligible patients were 18 years and older with a diagnosis of T2DM with or without comorbid cardiovascular disease risk factors. Patients were enrolled through routine primary care provider referrals. During a one-on-one, face-to-face scheduled clinic visit, the pharmacist provided a comprehensive medication management by reviewing vital signs and laboratory values, provided medication reconciliation and management, followed by medication counseling through a CAPP approach in a primary care setting. The pharmacist worked in close collaboration with the primary care provider to intervene on medication therapy through recommendations to initiate, adjust, modify, or discontinue drug therapy and order laboratory tests and drug concentration levels as appropriate. Each visit was documented as a "PharmD Progress Note" in the patient's electronic medical record. Follow-up visits were scheduled until patients' targeted treatment goals were achieved. Primary and secondary outcome data were collected and then analyzed. FINDINGS A pharmacist saw 47 patients over 12 months. Sixty-four percent of the participating patients were able to achieve targeted treatment goals. A statistically significant decrease in the mean change in hemoglobin A1c, diastolic blood pressure, fasting blood glucose, and triglyceride levels was observed from the baseline which was -2.3%, -7.75 mmHg, -76.1 mg/dL, and -55.5 mg/dL, respectively. No significant changes in other clinical outcomes were observed. CONCLUSION The CAPP model demonstrated a significant reduction in clinical endpoints in patients with T2DM among the high-risk underrepresented population.
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Affiliation(s)
- Mok Thoong Chong
- Department of Clinical and Administrative Sciences, American University of Health Sciences, California, USA
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Chen EYH, Wang KN, Sluggett JK, Ilomäki J, Hilmer SN, Corlis M, Bell JS. Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review. Australas J Ageing 2019; 38 Suppl 2:9-25. [DOI: 10.1111/ajag.12676] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Esa Y. H. Chen
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Kate N. Wang
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
- Kolling InstituteFaculty of Medicine and HealthThe University of Sydney and Royal North Shore Hospital St Leonards NSW Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
- Helping Hand Aged Care North Adelaide South Australia Australia
| | - J. Simon Bell
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
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Using the Theory of Planned Behavior to Understand Factors Influencing South Asian Consumers' Intention to Seek Pharmacist-Provided Medication Therapy Management Services. PHARMACY 2019; 7:pharmacy7030088. [PMID: 31373281 PMCID: PMC6789532 DOI: 10.3390/pharmacy7030088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/16/2022] Open
Abstract
The study purpose was to use the theory of planned behavior to understand factors influencing South Asian consumers’ intention to seek pharmacist-provided medication therapy management services (MTMS). Specific objectives were to assess effects of attitude, subjective norm (SN), perceived behavioral control (PBC), and socio-demographics on South Asian consumers’ intention to seek MTMS. Participants who were ≥18 years of age, of South Asian origin, with a previous visit to a pharmacy in the US for a health-related reason, and with ability to read and comprehend English were recruited from independent pharmacies in New York City. Responses were obtained through a self-administered survey. Descriptive statistics were performed, and multiple linear regression analysis was conducted to assess the study objective. SPSS was used for data analyses. Out of 140 responses, 133 were usable. Mean scores (standard deviation) were 4.04 (0.97) for attitude, 3.77 (0.91) for SN, 3.75 (0.93) for PBC, and 3.96 (0.94) for intention. The model explains 80.8% of variance and is a significant predictor of intention, F (14,118) = 35.488, p < 0.05. While attitude (β = 0.723, p < 0.05) and PBC (β = 0.148, p < 0.05) were significant predictors of intention, SN (β = 0.064, p = 0.395) was not. None of the socio-demographics were significant predictors of intention. Strategies to make South Asians seek MTMS should focus on creating positive attitudes and removing barriers in seeking MTMS.
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Weissenborn M, Krass I, Van C, Dähne A, Ritter CA, Haefeli WE, Seidling HM. Process of translation and cross-cultural adaptation of two Australian instruments to evaluate the physician-pharmacist collaboration in Germany. Res Social Adm Pharm 2019; 16:74-83. [PMID: 31122799 DOI: 10.1016/j.sapharm.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Building interprofessional working relationships between physicians and pharmacists is essential to ensure high-quality patient care. To assess which factors influence the performance and success of their collaboration, validated instruments should be used, such as the Australian "Attitudes Toward Collaboration Instrument (ATCI)" and the "Frequency of Interprofessional Collaboration Instrument (FICI)". Both instruments were already translated in a previous German study, but not pretested for comprehensibility or cultural appropriateness to ensure that the target group is able to adequately answer the translated items. OBJECTIVES To translate and particularly cross-culturally adapt two Australian instruments measuring physicians' and pharmacists' attitudes towards interprofessional collaboration and the frequency of their interactions for use in Germany. METHODS The ATCI and FICI were translated following internationally recognised guidelines. Two-step cognitive interviewing was performed with physicians and pharmacists working in ambulatory care in Germany. The "Standards for Reporting Qualitative Research" were used to report this study. RESULTS Overall, 2 forward and 2 back translations, and 38 cognitive interviews, i.e. cognitive probing (N = 10) and behaviour observation (N = 28), with 18 physicians and 20 pharmacists were performed. Experts discussed all potential changes. The ATCI and FICI were translated introducing 15 minor (e.g. paraphrasing, item order) and 6 major (e.g. 2 more items in FICI, additional response options) adaptations. The ATCI-P/GP-German and FICI-P/GP-German were found to be easy to answer and clearly-phrased. CONCLUSION This study shows the importance of using recognised methods to translate and adapt questionnaires, consisting of at least four steps: forward translation, back translation, cognitive interviewing and finalisation (each reviewed by an expert panel making their decisions by consensus). A profoundly pretested German-speaking instrument is now available to evaluate and describe interprofessional collaboration between physicians and pharmacists. However, collecting further sociodemographic and contextual information seems necessary for enhanced interpretation of future results.
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Affiliation(s)
- Marina Weissenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Connie Van
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna Dähne
- Clinical Pharmacy, Institute of Pharmacy, University of Greifswald, Greifswald, Germany
| | - Christoph A Ritter
- Clinical Pharmacy, Institute of Pharmacy, University of Greifswald, Greifswald, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany; Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany.
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Hindi AMK, Jacobs S, Schafheutle EI. Solidarity or dissonance? A systematic review of pharmacist and GP views on community pharmacy services in the UK. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:565-598. [PMID: 30047617 DOI: 10.1111/hsc.12618] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
There has been a strong policy emphasis over the past decade on optimising patient-centred care and reducing general practitioners' (GPs') workload by extending community pharmacy services and collaboration between pharmacists and GPs. Our aim was to review current evidence of pharmacists' and GPs' views of extended community pharmacy services and pharmacists' roles in the United Kingdom (UK). A systematic review was undertaken looking at UK studies investigating pharmacists' and/or GPs' views of community pharmacy services or roles from 2005 to 2017. A range of databases were searched including EMBASE, PubMed, Scopus, Web of Science, International Pharmaceutical Abstracts (IPA), PsycINFO, Science Direct and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition, reference lists of included studies were screened and grey literature was searched. Following the application of inclusion/exclusion criteria, the quality of papers was critically analysed, findings were extracted into a grid and subjected to narrative synthesis following thematic analysis. The search strategy yielded a total of 4,066 unique papers from which 60 were included. Forty-seven papers covered pharmacists' views, nine combined both pharmacists' and GPs' views and four covered GPs' views. Study designs included interviews (n = 31, 52%), questionnaire surveys (n = 17, 28%) and focus groups (n = 7, 12%). Three main themes emerged from the data: "attitudes towards services/roles", "community pharmacy organisations" and "external influences". Pharmacists and GPs perceived a number of barriers to successful implementation and integration of pharmacy services. Moreover, collaboration between pharmacists and GPs remains poor despite the introduction of extended services. Overall, extending community pharmacy services require quality-driven incentives and joint working between community pharmacists and GPs to achieve better integration within the patient's primary care pathway.
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Affiliation(s)
- Ali M K Hindi
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sally Jacobs
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ellen I Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Al-Tameemi NK, Sarriff A. Knowledge, attitude and practice of pharmacists on medication therapy management: a survey in Hospital Pulau Pinang, Penang, Malaysia. J Pharm Health Care Sci 2019; 5:1. [PMID: 30652009 PMCID: PMC6327512 DOI: 10.1186/s40780-019-0131-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/02/2019] [Indexed: 02/04/2023] Open
Abstract
Background Medication therapy management (MTM) service provides set of clinical activities to optimize therapeutic outcomes for patients. It requires the collaboration between patient, pharmacist and other healthcare providers to ensure safe and effective use of medicines. The objective of the current study was to assess Hospital Pulau Pinang pharmacists’ knowledge, attitude and practice on MTM service. Methods A self-administrated validated survey was carried out among all pharmacists working at Hospital Pulau Pinang. Results A total of 93 pharmacists out of 130 (71.5%) were included in the study (61.3% between the age of 20–30 years old, 74.2% female, 68.8% Chinese, 88.2% holding bachelor’s degree and 48.4% working in medication therapy adherence clinic and outpatient pharmacy). Majority of pharmacists had a high level of knowledge and positive attitudes regarding MTM service. All pharmacists agreed that MTM service could improve the quality of health services and most pharmacists were interested in providing MTM service (92.5%). Moreover, 95.7% were interested in acquiring more information about MTM service. About the barriers that might affect MTM service implementation, the most common barriers identified by pharmacists were lack of training (88.2%), need of high budget to implement MTM service (51.6%) and lack of time (46.2%). Conclusions Overall, the research findings provide some insights about the Hospital Pulau Pinang pharmacists’ knowledge, attitude and practice regarding MTM service. Majority of pharmacists agreed and showed their interest towards the implementation of MTM service.
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Affiliation(s)
- Noor Kifah Al-Tameemi
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang, Malaysia
| | - Azmi Sarriff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pinang, Malaysia
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Rose O, Richling I, Voigt K, Gottschall M, Köberlein-Neu J. Patient selection and general practitioners' perception of collaboration in medication review. Res Social Adm Pharm 2018; 15:521-527. [PMID: 30139537 DOI: 10.1016/j.sapharm.2018.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implementation of collaborative Medication Review (MR) into routine care faces several barriers. OBJECTIVE The study aim was to gain information on patient selection for a MR by general practitioners (GPs). GP selection was compared to objective selection criteria on identifying patients, who would benefit from a MR the most. A secondary objective of this study was to get insight into GPs perception on interprofessional collaboration with pharmacists. METHODS GPs were interviewed for a qualitative study on expected outcomes of MR in former study patients. They were asked to select patients, for whom they expected a major benefit from the MR. Results were compared to objective selection criteria, obtained from the WestGem study. Further interviews were done on aspects of patient selection and perception of interprofessional collaboration, results were presented descriptively. RESULTS The study covered 6 GPs with 78 former study patients. GPs would have chosen 45 out of the 78 patients (57.7%) for a MR. According to changes in the Medication Appropriateness Index, 24 of these patients had a greater benefit from the MR. Patient selection by the number of prescribed drugs had reached a higher specificity at a cut-off of 9 drugs, compared to selection by the GP (67% vs. 61.5%). GPs mentioned medication safety, certain diseases, polymedication, multimorbidity as selection criteria. Increasing quality of therapy and better insight into the patient's drug regimen was appreciated by the GPs as perceived personal advantage of the MR. GPs preferred to have a MR initiated by themselves, but appraised concise interprofessional collaboration with pharmacists. CONCLUSIONS Patient selection for MR should take objective parameters into account and combine them with subjective impressions. GPs preferred the initiation of a MR by themselves but expressed a positive attitude towards collaboration with a pharmacist afterwards. Recommendations should be relevant and concise.
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Affiliation(s)
- Olaf Rose
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA.
| | - Ina Richling
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, College of Pharmacy, University of Florida, USA
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Mandy Gottschall
- Department of General Practice/Medical Clinic III, Medical School, Technische Universität Dresden, Dresden, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Germany
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Eshetie TC, Nguyen TA, Gillam MH, Kalisch Ellett LM. A narrative review of problems with medicines use in people with dementia. Expert Opin Drug Saf 2018; 17:825-836. [DOI: 10.1080/14740338.2018.1497156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tesfahun C. Eshetie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Tuan A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Marianne H. Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Implementation of a medication therapy management collaborative within a pediatric health system. J Am Pharm Assoc (2003) 2018; 58:S114-S119. [DOI: 10.1016/j.japh.2018.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/22/2022]
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Evaluation of quality indicator instruments for pharmaceutical care services: A systematic review and psychometric properties analysis. Res Social Adm Pharm 2018; 14:405-412. [DOI: 10.1016/j.sapharm.2017.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/20/2017] [Accepted: 05/20/2017] [Indexed: 11/22/2022]
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Mailloux L, Yates S, Spencer K, Davis J, Chen AMH, Franz T. Changing Patient Perceptions of MTM: Determining an Effective Method of Education. Innov Pharm 2018; 9:1-12. [PMID: 34007691 DOI: 10.24926/iip.v9i2.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Medication Therapy Management (MTM) is a vital resource in reducing medication nonadherence, yet many individuals who are eligible for MTM services are unaware of what MTM is and how to enroll. Little is known about how to best educate patients on MTM services and its benefits. Objective To determine the difference between in-person education community education versus brochure community education on MTM services on perceptions of and enrollment in MTM services. Methods A pre-post quasi experimental study, where patients were allocated to receive information about MTM through an educational brochure or an in-person education session and completed survey assessments pre- and post-intervention, was conducted at a federally-qualified health center. Patients who were ages 18 years or older, MTM-eligible, and had received no prior MTM service were eligible to participate. Changes in patient perceptions of and enrollment in MTM from pre- to post-intervention were assessed by survey instruments developed for this study. Results A total of 35 patients (brochure=25, in-person=10) were recruited for this study. Most participants (94.2%) either reported having never heard of MTM or not being sure if they had heard of MTM. There were no significant between-group differences on pre-survey questions or pre-post within-group changes (p>0.05). There were significant between-group differences on 11 post-assessment questions and MTM enrollment (p<0.05), with the in-person education group showing improved perceptions and greater enrollment. Conclusion Patients remain largely unaware of MTM services; there is a need for education to increase awareness. Even though educating patients in a face-to-face context had a more positive impact on perceptions of MTM and enrollment in MTM, more research is needed regarding the best educational methods as it was difficult for patients to find time to attend an educational session.
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Joseph T, Hale GM, Eltaki SM, Prados Y, Jones R, Seamon MJ, Moreau C, Gernant SA. Integration Strategies of Pharmacists in Primary Care-Based Accountable Care Organizations: A Report from the Accountable Care Organization Research Network, Services, and Education. J Manag Care Spec Pharm 2018; 23:541-548. [PMID: 28448780 PMCID: PMC10397758 DOI: 10.18553/jmcp.2017.23.5.541] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. PROGRAM DESCRIPTION As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care. OBSERVATIONS Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings. IMPLICATIONS/RECOMMENDATIONS As more organizations realize benefits and overcome barriers to the integration of pharmacists into patient care, programs involve pharmacists will become an increasingly common approach to improve outcomes and reduce the total cost of care and will improve the financial viability of primary care-based ACOs. DISCLOSURES No outside funding supported this research. The authors report no conflicts of interest related to this manuscript. Study concept and design were contributed by Joseph, Hale, and Eltaki, with assistance from the other authors. Prados and Jones took the lead in data collection and data interpretation and analysis, with assistance from the other authors. The manuscript was written primarily by Joseph and Hale, along with the other authors, and revised primarily by Seamon and Gernant, along with the other authors.
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Affiliation(s)
- Tina Joseph
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Genevieve M Hale
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Sara M Eltaki
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Yesenia Prados
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Renee Jones
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Matthew J Seamon
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Cynthia Moreau
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
| | - Stephanie A Gernant
- 1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida
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Renfro CP, Ferreri S, Barber TG, Foley S. Development of a Communication Strategy to Increase Interprofessional Collaboration in the Outpatient Setting. PHARMACY 2018; 6:E4. [PMID: 29316609 PMCID: PMC5874543 DOI: 10.3390/pharmacy6010004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022] Open
Abstract
Managing patient health is a complex task, requiring the support of an interprofessional healthcare team. Collaboration between neighboring community pharmacies and primary care practices can be an alternate solution for team-based patient care. The purpose of this project was to design and implement a communication strategy for patients with diabetes and hypertension between a community pharmacy and physician practice. An interprofessional team for the practice settings was formed to develop a strategy for collaboration. After agreeing on the common goals and target patient population for the disease states, the team devised a way to communicate via electronic health record (EHR). The communication strategy allowed for more frequent follow-up with the patients which has the potential to result in better clinical outcomes. A communication strategy between a community pharmacy and a physician practice office can be achieved using EHR technology. The greatest outcome of this project was the formation of the collaborative team between the practice settings that continues to work together on additional patient-centered initiatives. Further research is warranted to allow for incorporation of patient perspectives in development of communication strategies.
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Affiliation(s)
- Chelsea Phillips Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA.
| | - Stefanie Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | | | - Stephanie Foley
- UNC Family Medicine at Hillsborough, Hillsborough, NC 27278, USA.
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