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Fennelly JE, Coe AB, Kippes KA, Remington TL, Choe HM. Evaluation of Clinical Pharmacist Services in a Transitions of Care Program Provided to Patients at Highest Risk for Readmission. J Pharm Pract 2020; 33:314-320. [PMID: 30343615 PMCID: PMC9827459 DOI: 10.1177/0897190018806400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND An ambulatory transition of care program, including a pharmacist-provided comprehensive medication review (CMR), was implemented. OBJECTIVES The objectives were to: (1) compare 30-day hospital readmission rates between those who received the pharmacist CMR versus eligible patients not scheduled, (2) describe identified problems and recommendations, and (3) quantify recommendation acceptance rates. METHODS A retrospective cohort study was conducted between March and October 2016. Inclusion criteria were: LACE score of ≥13, established Michigan Medicine primary care, and discharged from specific inpatient services to home. The primary outcome was 30-day hospital readmission rates. Pharmacist-identified problems, recommendations, and recommendation acceptance rates were examined. χ2 analysis and descriptive statistics were used. RESULTS 355 discharges met inclusion criteria and pharmacists provided CMRs for 159 patients. The average age was 60 years (standard deviation [SD]: 14.3), the majority were female (54%), and white/Caucasian (69%). There was no significant difference in 30-day readmission rates in patients who received a CMR (p = .96). A mean of 3.1 problems were identified per visit (SD: 1.8, range: 1-10). 509 recommendations were provided and approximately 50% were provider accepted. CONCLUSIONS Reduced readmission rates were not observed; however, pharmacists identified many areas for intervention in highest risk patients during the transition from hospital to home.
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Affiliation(s)
- Jessica E. Fennelly
- Pharmacy Innovations and Partnerships, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Kellie A. Kippes
- Pharmacy Innovations and Partnerships, Michigan Medicine, Ann Arbor, MI, USA,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Tami L. Remington
- Pharmacy Innovations and Partnerships, Michigan Medicine, Ann Arbor, MI, USA,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Hae Mi Choe
- Pharmacy Innovations and Partnerships, Michigan Medicine, Ann Arbor, MI, USA,University of Michigan College of Pharmacy, Ann Arbor, MI, USA,University of Michigan Medical Group, Ann Arbor, MI, USA
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McPhail EJ, Marshall VD, Remington TL, Vordenberg SE. Readmission Rates Associated with Pharmacist Involvement in a Geriatric Transitional Care Management Clinic. Innov Pharm 2019; 10. [PMID: 34007564 PMCID: PMC8127088 DOI: 10.24926/iip.v10i3.2211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To evaluate the impact of a post-discharge pharmacist telephone call on 30- and 90- day readmission rates as part of a transitional care management (TCM) service in a geriatric patient-centered medical home (PCMH). Methods: Adults 60 years of age and older who had established primary care at the PCMH for at least one year and were discharged from the hospital between 7/1/2013 and 2/21/2016 were included. Readmission rates for patients who received and did not receive a pharmacist TCM phone call were compared. Secondary data analysis was conducted between individuals who received all three components of the service compared with those who received on a nurse navigator plus primary care provider (PCP) visit. Results: Among 513 discharges of unique patients (mean age, 80.4 years; women 63%), 269 (52.4%) received a pharmacist phone call. Readmission rates at 30 days were 8.9% for patients who received a pharmacist TCM phone call compared to 12.7% for those who did not receive this service (OR 0.67 [95% CI, 0.38-1.18; P=0.17]). When comparing only those individuals who received all three components of the service (pharmacist, nurse navigator, and PCP) (n=215) compared to those who received only a nurse navigator plus PCP visit (n=66), there was no difference in 30-day readmission rates (7.9% vs. 10.6%, p=0.49). However, there were significantly fewer readmissions within 90-days (16.3% vs. 31.8%, p=0.01). Conclusion: Pharmacist phone calls as part of an interdisciplinary TCM service did not result in a statistically significant difference regarding readmission rates at 30 days; however, patients who received all three components of the service had significantly fewer readmissions at 90 days, compared to patients who did not speak with a pharmacist but did complete a visit with a nurse navigator and physician. Future research is needed to determine which patients may benefit the most from this service and to identify strategies to increase patient participation.
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Farhat NM, Vordenberg SE, Marshall VD, Suh TT, Remington TL. Evolution of interdisciplinary geriatric transitions of care on readmission rates. Am J Manag Care 2019; 25:e219-e223. [PMID: 31318513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the effect of an interdisciplinary transitions of care (TOC) service on readmission rates in a geriatric population. STUDY DESIGN Single-center retrospective cohort study of adults 60 years or older discharged from an academic medical center. METHODS From July 1, 2013, to February 21, 2016, a total of 4626 patients discharged from 1 hospital, including inpatient, emergency department, observation, and short-stay units, were included. Cases were scheduled for a TOC service with the interdisciplinary team. Controls received usual care at other sites. All-cause 14-, 30-, and 90-day readmission rates between propensity score-matched study groups were evaluated by intention-to-treat (ITT), per-protocol (PP), and as-treated methods. RESULTS During the study period, 513 patients were scheduled for at least 1 component of the TOC intervention (ITT group). Of those patients, 215 completed all scheduled visits (PP group). Readmission rate after 30 days demonstrated no difference in the ITT group compared with the control group (12.8% vs 10.7%; P = .215), although it was significantly lower in the PP group in comparison with the control group (12.8% vs 7.9%; P = .042). CONCLUSIONS An interdisciplinary team based in a patient-centered medical home improved readmission rates for all patients who completed the intervention (PP group).
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Affiliation(s)
- Nada M Farhat
- Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202.
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Vordenberg SE, Smith MA, Diez HL, Remington TL, Bostwick JR. Using the Plan-Do-Study-Act (PDSA) Model for Continuous Quality Improvement of an Established Simulated Patient Program. Innov Pharm 2018; 9:1-6. [PMID: 34007687 DOI: 10.24926/iip.v9i2.989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the use of a continuous quality improvement process for strengthening our simulated patient (SP) program and the initial steps that have been implemented. Innovation A workgroup that included five clinical faculty with significant experience working with SPs and a strong interest in improving the SP program was developed. The Plan-Do-Study-Act model was used as it allowed for incremental quality improvement changes, in order to ensure a high-quality SP program designed to optimize student learning. Data were gathered from students, SPs, and faculty. Opportunities for improvement were prioritized based on anticipated benefits and available resources. Changes related to planning, implementation, and evaluation and feedback have been executed. Critical Analysis Changes related to planning that were implemented included developing handbooks for SPs, faculty, and graduate student instructors, as well as material for students in order to better describe the program. SPs are now referred to as "simulated" as opposed to "standardized" as part of a broader effort to clarify the purpose of SP interactions to students. Streamlined rubrics have been piloted, including electronic rubrics for first year students. SPs are being trained on fewer cases, in order to improve the training program. When possible, activities now take place in one large classroom instead of many small classrooms to improve oversight. Finally, additional feedback has been obtained from SPs via a retreat. These changes have been well received by students, SPs, and faculty. Next Steps The collection of this data and initial quality improvement changes provided a basis for hiring a full-time employee who will: dedicate 50% of their time to programmatic assessment of the SP program, support faculty with logistics and training, and be the face of our program to the students and SPs. Further, formal quantitative and qualitative assessment of the SP program has begun.
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Affiliation(s)
- Sarah E Vordenberg
- University of Michigan College of Pharmacy, Department of Clinical Pharmacy, Ann Arbor, MI
| | - Michael A Smith
- University of Michigan College of Pharmacy, Department of Clinical Pharmacy, Ann Arbor, MI
| | - Heidi L Diez
- University of Michigan College of Pharmacy, Department of Clinical Pharmacy, Ann Arbor, MI
| | - Tami L Remington
- University of Michigan College of Pharmacy, Department of Clinical Pharmacy, Ann Arbor, MI
| | - Jolene R Bostwick
- University of Michigan College of Pharmacy, Department of Clinical Pharmacy, Ann Arbor, MI
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Remington TL, Bleske BE, Bartholomew T, Dorsch MP, Guthrie SK, Klein KC, Tingen JM, Wells TD. Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course. Am J Pharm Educ 2017; 81:55. [PMID: 28496275 PMCID: PMC5423071 DOI: 10.5688/ajpe81355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/19/2016] [Indexed: 05/15/2023]
Abstract
Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.
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Affiliation(s)
| | - Barry E Bleske
- University of New Mexico College of Pharmacy, Albuquerque, New Mexico
| | - Tracy Bartholomew
- Center for Research on Learning and Teaching, University of Michigan, Ann Arbor, Michigan
| | | | - Sally K Guthrie
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Kristin C Klein
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Jeffrey M Tingen
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Trisha D Wells
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
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Albabtain M, Brenner MJ, Nicklas JM, Hummel SL, McCormick MP, Pawlowski JL, Remington TL, Gure TR, Dorsch MP, Bleske BE. Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population. Med Sci Monit 2016; 22:4978-4985. [PMID: 27988787 PMCID: PMC5193121 DOI: 10.12659/msm.898538] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The association of hyponatremia with cognitive impairment and mobility in heart failure (HF) patients is unknown. The purpose of this study was to determine if hyponatremia is associated with cognitive and mobility impairment as measured by simple, validated, and time-sensitive tests. Material/Methods This was a prospective study in patients with reduced and preserved ejection fraction (HFrEF, HFpEF) seen in outpatient HF clinics. Hyponatremia was defined as sodium level ≤136 mEq/L. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) tool, and mobility was measured with the Timed Up and Go test (TUG-t). Results A total of 121 patients were evaluated; 30% were hyponatremic (134±1.9 mEq/l, range 128–136 mEq/l). Overall, 92% of hyponatremic patients had cognitive impairment (MoCA <26) compared to 76% of the non-hyponatremic patients [relative risk 1.2 (confidence interval: 1.02–1.4, p=0.02)]. In regard to mobility, 72% of hyponatremic patients and 62% of non-hyponatremic patients (p=0.4) had TUG-t times that were considered to be worse than average. A total of 84% (N=76) of HFrEF and 71% (N=22) of HFpEF patients had cognitive impairment (p=0.86). HFrEF patients had significantly lower overall MoCA scores (21.2±3.7 vs. 23.3±3.6, p=0.006) and similar TUG-t times compared to HFpEF patients. Conclusions Most heart failure patients (HFrEF and HFpEF) seen in an ambulatory setting had impairment of cognitive function and mobility, with a higher prevalence among those with hyponatremia. Screening can be done using tests that can be administered in a clinical setting.
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Affiliation(s)
- Monirah Albabtain
- Department of Pharmacy, Prince Sultan Military Medical City, Riyad, Saudi Arabia
| | | | - John M Nicklas
- Division of Cardiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Scott L Hummel
- Division of Cardiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | | | | | - Tami L Remington
- College of Pharmacy and Health System, University of Michigan, Ann Arbor, MI, USA
| | | | - Michael P Dorsch
- College of Pharmacy and Health System, University of Michigan, Ann Arbor, MI, USA
| | - Barry E Bleske
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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Smith AL, Garwood CL, Bailey T, DeCator D, Elder J, Green A, Kostoff D, Lucarotti RL, MacDonald NC, Malburg D, Ottney A, Remington TL, Shuster J. State affiliate initiative to advance ambulatory care practice. Am J Health Syst Pharm 2016; 73:1909-1914. [DOI: 10.2146/ajhp160392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amber Lanae Smith
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit, MI
| | - Candice L. Garwood
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit, MI
| | - Teresa Bailey
- Department of Pharmacy Practice Ferris State University Big Rapids, MI
| | - Devin DeCator
- Department of Pharmacy Mercy Health Muskegon Muskegon, MI
| | - Jodie Elder
- Department of Pharmacy Practice Ferris State University Big Rapids, MI
| | - Angela Green
- Department of Pharmacy Mercy Health Muskegon Muskegon, MI
| | - Diana Kostoff
- Department of Pharmacy Services Henry Ford Hospital Detroit, MI
| | - Richard L. Lucarotti
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit, MI
| | | | | | - Anne Ottney
- Department of Pharmacy Practice Ferris State University Lansing, MI
| | - Tami L. Remington
- Department of Pharmacy University of Michigan Health System Ann Arbor, MI
| | - Jesse Shuster
- Department of Pharmacy Services Detroit Medical Center and Harper University Hospital Detroit, MI
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Bleske BE, Remington TL, Wells TD, Klein KC, Guthrie SK, Tingen JM, Marshall VD, Dorsch MP. A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes. Am J Pharm Educ 2016; 80:120. [PMID: 27756928 PMCID: PMC5066923 DOI: 10.5688/ajpe807120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 05/22/2023]
Abstract
Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.
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Affiliation(s)
- Barry E. Bleske
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
- University of New Mexico College of Pharmacy, Albuquerque, New Mexico (at time of publication)
| | | | - Trisha D. Wells
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | | | | | - Jeffrey M. Tingen
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
- University of Virginia Health System, Charlottesville, Virginia (at time of publication)
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Bleske BE, Remington TL, Wells TD, Dorsch MP, Guthrie SK, Stumpf JL, Alaniz MC, Ellingrod VL, Tingen JM. Team-based learning to improve learning outcomes in a therapeutics course sequence. Am J Pharm Educ 2014; 78:13. [PMID: 24558281 PMCID: PMC3930237 DOI: 10.5688/ajpe78113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/27/2013] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To compare the effectiveness of team-based learning (TBL) to that of traditional lectures on learning outcomes in a therapeutics course sequence. DESIGN A revised TBL curriculum was implemented in a therapeutic course sequence. Multiple choice and essay questions identical to those used to test third-year students (P3) taught using a traditional lecture format were administered to the second-year pharmacy students (P2) taught using the new TBL format. ASSESSMENT One hundred thirty-one multiple-choice questions were evaluated; 79 tested recall of knowledge and 52 tested higher level, application of knowledge. For the recall questions, students taught through traditional lectures scored significantly higher compared to the TBL students (88%±12% vs. 82%±16%, p=0.01). For the questions assessing application of knowledge, no differences were seen between teaching pedagogies (81%±16% vs. 77%±20%, p=0.24). Scores on essay questions and the number of students who achieved 100% were also similar between groups. CONCLUSION Transition to a TBL format from a traditional lecture-based pedagogy allowed P2 students to perform at a similar level as students with an additional year of pharmacy education on application of knowledge type questions. However, P3 students outperformed P2 students regarding recall type questions and overall. Further assessment of long-term learning outcomes is needed to determine if TBL produces more persistent learning and improved application in clinical settings.
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Choe HM, Farris KB, Stevenson JG, Townsend K, Diez HL, Remington TL, Rockafellow S, Shimp LA, Sy A, Wells T, Standiford CJ. Patient-centered medical home: Developing, expanding, and sustaining a role for pharmacists. Am J Health Syst Pharm 2012; 69:1063-71. [DOI: 10.2146/ajhp110470] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hae Mi Choe
- College of Pharmacy, University of Michigan (UM), Ann Arbor, and Director of Innovative Ambulatory Pharmacy Practices, University of Michigan Health System (UMHS), Ann Arbor
| | | | | | - Kevin Townsend
- Medical Outcomes Specialist, Pfizer, Chelsea, MI, and Adjunct Clinical Associate Professor, College of Pharmacy, UM
| | - Heidi L. Diez
- College of Pharmacy, UM, and Clinical Pharmacist, Kroger Patient Care Center, Ann Arbor
| | - Tami L. Remington
- College of Pharmacy, UM, and Clinical Pharmacist, West Ann Arbor Health Center and Turner Geriatric Clinic, UMHS
| | - Stuart Rockafellow
- College of Pharmacy, UM, and Clinical Pharmacist, Canton Health Center, UMHS
| | - Leslie A. Shimp
- College of Pharmacy, UM, and Clinical Pharmacist, Briarwood Medical Group and Saline Health Center, UMHS
| | - Annie Sy
- Quality Improvement and Decision Support Team, Faculty Group Practice Quality Management Program, UMHS
| | - Trisha Wells
- College of Pharmacy, UM, and Clinical Pharmacist, UMHS
| | - Connie J. Standiford
- Department of Internal Medicine, College of Medicine, UM, and Associate Medical Director, Ambulatory Care Services, Faculty Group Practice, UMHS
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Remington TL, Foulk MA, Williams BC. Evaluation of evidence for interprofessional education. Am J Pharm Educ 2006; 70:66. [PMID: 17136186 PMCID: PMC1636959 DOI: 10.5688/aj700366] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 10/16/2005] [Indexed: 05/12/2023]
Abstract
Based on recommendations from numerous organizations, educators in healthcare disciplines are implementing interprofessional training programs. Our objective was to summarize relevant literature in a way that would be most useful to clinician educators. Studies involving educational interventions in health professions to enhance learner-based outcomes relevant to the provision of interprofessional care were identified. We sought prospective, controlled trials in which at least 2 health care disciplines were represented, and 1 of which was medicine. Thirteen reports met the criteria for inclusion. Interventions varied widely in design and intensity, but generally included both didactic and clinical components and lasted several weeks or longer. Most studies used pretest/posttest controls and observed positive effects on learners' attitudes and knowledge. Combined clinical and didactic experiences may produce short-term improvements in learners' knowledge and attitudes about interprofessional care. Future research should employ control groups and validated, behaviorally oriented outcome measures whenever possible.
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Abstract
Interdisciplinary health care training is advocated by numerous government and philanthropic organizations. Educators in the health professions are increasingly offering training in interdisciplinary health care in a variety of contexts, including ambulatory settings. This paper describes a three-year program to teach skills in interdisciplinary care to learners from internal medicine, social work, pharmacy, and nursing in a geriatrics clinic at a major academic institution in the United States. Framed in a critical review of existing evidence for the effectiveness of interdisciplinary training and health care and expert recommendations, specific recommendations are made to educators interested in interdisciplinary training in ambulatory settings.
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Affiliation(s)
- Brent C Williams
- University of Michigan, 300 N Ingalls Bldg, Room 7E18, Ann Arbor, MI 48109-0429, USA.
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Sharabash HM, Remington TL, Mar P, Winston R, Walker PC. Retrospective review of metformin in inpatients and outpatients at the University of Michigan. Diabetes Care 2006; 29:170-1. [PMID: 16373921 DOI: 10.2337/diacare.29.1.170-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Fitzgerald JT, Williams BC, Halter JB, Remington TL, Foulk MA, Persky NW, Shay BR. Effects of a geriatrics interdisciplinary experience on learners' knowledge and attitudes. Gerontol Geriatr Educ 2006; 26:17-28. [PMID: 16446269 DOI: 10.1300/j021v26n03_02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study examines the impact of an interdisciplinary training program on knowledge and attitudes of learners from four health care programs: medicine, pharmacy, social work, and nursing. Sixty-two learners participated in a 4-day educational program (one day each week for 4 weeks) focusing on interdisciplinary geriatric care. After completing the program, learner scores improved on a knowledge test and two attitudinal subscales, and they reported a positive training experience. A short-term interdisciplinary educational intervention can have an impact on learners' knowledge of and attitudes toward older adults, and improve their understanding and confidence in participating in an interdisciplinary collaborative care team.
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Affiliation(s)
- James T Fitzgerald
- Department of Medical Education, University of Michigan Medical School, The Towsley Center, Room 1107, Box 0201, Ann Arbor, MI 48109-0201, USA.
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Abstract
OBJECTIVE: To review the scientific literature evaluating the efficacy and tolerability of tiotropium bromide, a new bronchodilator indicated for treatment of chronic obstructive pulmonary disease (COPD). DATA SOURCES: Articles were identified through searches of MEDLINE (1966–January 2005) using the key words tiotropium, BA 679 BR, chronic obstructive pulmonary disease, and anticholinergic agents. Additional citations were identified from bibliographies of publications cited. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of tiotropium bromide were selected. Trials of the efficacy of the drug in humans were the focus of the review. DATA SYNTHESIS: Tiotropium bromide is an effective bronchodilator for patients with COPD. It produces clinically important improvements in lung function, symptoms of dyspnea, quality of life, and exacerbation rates compared with placebo. In comparative studies, tiotropium does not appear to be more efficacious than salmeterol or ipratropium. CONCLUSIONS: Tiotropium is an effective inhaled anticholinergic agent that is recommended among preferred long-acting bronchodilators for the chronic management of moderate to very severe COPD. Although similar to ipratropium in efficacy and tolerability, it has the advantage of once-daily dosing.
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Affiliation(s)
- Heather Somand
- College of Pharmacy, University of Michigan, Ann Arbor, MI 48109-0008, USA
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Abstract
PURPOSE OF REVIEW Contemporary asthma management calls for combination inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) for patients with moderate to severe persistent asthma. This combination has consistently shown superior clinical efficacy compared with monotherapy with higher doses of ICS. It is unclear whether ICS and LABA act additively because of their complementary mechanisms of action, or whether they act synergistically based on possible favorable interactions between them. The purpose of this review is to summarize research findings on the anti-inflammatory activity of LABA published since October 2002 and to speculate on how these findings will affect future asthma management recommendations. RECENT FINDINGS Combination ICS plus LABA consistently demonstrates superiority over ICS monotherapy in clinical outcomes such as pulmonary function, symptoms, and exacerbation rates, and is consistent with definitive data published before the review period. However, investigations into possible effects of LABA on inflammatory mediators are preliminary. Positive effects of LABA on some serum and bronchial inflammatory measures have been observed, but the clinical importance of these findings has not been established. SUMMARY Current asthma treatment recommendations are based on clinical trials demonstrating improved clinical outcomes of combination ICS plus LABA over ICS alone. Whether LABA possesses clinically important benefits beyond bronchodilation remains to be established. Distinguishing anti-inflammatory activity of LABA will help define optimal long-term treatment regimens for asthma that not only improve pulmonary function, symptoms, and exacerbation rates but also protect against airway remodeling.
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Affiliation(s)
- Tami L Remington
- University of Michigan College of Pharmacy and University of Michigan Health System, Ann Arbor, MI 48109, USA.
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Abstract
OBJECTIVE To review and analyze medical literature documenting drug-induced esophageal injury and dysphagia and to formulate strategies to enhance pharmacists' prevention, detection, and treatment of these iatrogenic complications. DATA SOURCES A MEDLINE search (1966-April 2002) was conducted to identify primary and secondary literature using variable combinations of the following search terms: pill-induced, drug-induced, or iatrogenic with esophageal injury, esophageal damage, or dysphagia. Bibliographies were also reviewed to identify additional relevant references. STUDY SELECTION AND DATA EXTRACTION All case reports, reviews, and clinical studies relating to drug-induced esophageal injury or swallowing dysfunction were evaluated. DATA SYNTHESIS Drug-induced esophageal injury may be under-recognized. Several drugs have been associated with physical or chemically mediated injuries. Risk factors for injury have been identified and preventive and treatment strategies have been successful in limiting esophageal injury. Drug-induced dysphagia can have serious complications and is most often associated with typical neuroleptics such as haloperidol. CONCLUSIONS Pharmacists can play a pivotal role in proactively identifying situations where there is a higher likelihood of drug-induced esophageal injury or dysphagia. They can recommend preventive strategies to promote safe medication use, help identify iatrogenic complications when they occur, and assist in formulation of appropriate treatment strategies.
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Hammond RW, Schwartz AH, Campbell MJ, Remington TL, Chuck S, Blair MM, Vassey AM, Rospond RM, Herner SJ, Webb CE. Collaborative drug therapy management by pharmacists--2003. Pharmacotherapy 2004; 23:1210-25. [PMID: 14524655 DOI: 10.1592/phco.23.10.1210.32752] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since publication of the initial ACCP position statement on CDTM by pharmacists in 1997, the public, government, and much of the health care community at large have come to better appreciate the growing complexity of providing effective and safe drug therapy in today's health care environment. Increased interest in the issues of cost and quality of drug use is evident in the increasing coverage of the issue in the lay press and professional literature. This represents real progress, as well as real opportunity, for pharmacists. It also heightens the potential for a better understanding of the vital role that pharmacists can play in addressing these concerns. The percentage of patients who take several drugs for chronic diseases will continue to increase. Based on current trends, the number of patients who lack adequate access to care, or who receive either suboptimal, inappropriate, or unnecessarily expensive drug therapy for their acute and chronic diseases, will increase. Even as financial and human resources are increasingly strained within the current health care system, costs will continue to rise unless changes are made. Fortunately, qualified pharmacists are prepared, capable, and willing to help address a significant portion of these challenges. The public, many health care providers, some legislators, and a few insurers now recognize that pharmacists, because of their education and training in drug therapy, are well positioned both to accept additional responsibility for patient care and to provide services that make a real difference in health care quality and outcomes. The health care programs administered by the U.S. Public Health Service, the armed forces, and the Veterans Health Administration, as well as 38 states, now support pharmacist participation in CDTM. Pharmacists, working in an interdisciplinary structure with physicians and other health care providers, have demonstrated that they can improve the effectiveness, efficiency, and safety of drug therapy by providing CDTM. It is time to incorporate this valuable professional skill of the contemporary pharmacist as a core component of the delivery of health care services.
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Affiliation(s)
- Raymond W Hammond
- 2001-2002 ACCP Task Force on Collaborative Drug Therapy Management, USA
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Abstract
OBJECTIVE To provide product information; review and analyze the clinical literature studying combination therapy, budesonide, and formoterol in asthmatics; and to define the role for this therapy in asthma treatment. DATA SOURCES A MEDLINE search (1990-September 2001) was conducted to identify the primary literature. Bibliographies were reviewed for further relevant citations. STUDY SELECTION/DATA EXTRACTION All randomized, blinded, controlled studies at least 3 months in duration exploring the efficacy of the combination of budesonide and formoterol (in 1 or separate formulations) compared with other treatments were selected to be included in the review of clinical studies. DATA SYNTHESIS The combination of budesonide and formoterol was more effective than increasing the dose of budesonide in patients with moderate or severe persistent asthma and in patients with mild asthma not previously controlled with inhaled corticosteroids. Milder corticosteroid-naïve asthmatics did not derive benefit compared with inhaled corticosteroids alone. CONCLUSIONS Combination therapy in 1 device is a preferred treatment option in patients with moderate to severe persistent asthma and in those with milder asthma not controlled with inhaled corticosteroids. Advantages of this product include rapid onset of action, long duration of action, and a wide dosing range to assist with titration. Further research is required to evaluate this therapy in asthmatic children <5 years old and in patients with oral corticosteroid-dependent asthma. Investigations into the effect of this combination product on other disease outcomes, such as quality of life and productivity, will further define the role for this drug therapy.
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Affiliation(s)
- Tami L Remington
- University of Michigan College of Pharmacy and University of Michigan Health System, Ann Arbor 48109, USA.
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