Frontline perspective on credentialing and privileging of ambulatory care pharmacists

OBJECTIVES

To present the current state of, and frontline advice on, the implementation of successful credentialing and privileging processes for practicing pharmacists in the United States.

METHODS

The American Society of Health-System Pharmacists (ASHP) Section Advisory Group on Compensation and Practice Sustainability surveyed ambulatory care pharmacists via ASHP Connect about the status, structure and oversight of their ambulatory care clinical practice sites with credentialed and privileged (C&P) pharmacists.

KEY FINDINGS

Over 80% of survey respondents identified themselves as a C&P pharmacist, and over 90% indicated it is 'Important' or 'Very Important' for pharmacists to be C&P. Qualitative survey responses indicated the most important considerations for establishing or expanding a credentialing and privileging process for ambulatory care pharmacists were 'don't re-create the wheel', 'establish a physician champion and/or obtain leadership buy-in', 'be persistent and patient', 'develop a guidance document' and 'work within existing processes'.

CONCLUSIONS

Starting a credentialing and privileging process is critical in preparation for, or response to, provider status recognition of pharmacists in the United States. When used with existing guidance documents on credentialing and privileging, 'front line' advice from practicing pharmacists can help promote expanded roles for pharmacists within healthcare systems.

Community Pharmacist Preferences in Transition of Care Communications

OBJECTIVE

To determine community pharmacist preferences in transition of care (TOC) communications.

METHODS

In this cross-sectional study, data were gathered via electronic survey of community pharmacists regarding their preferences for TOC communications. The survey was distributed via email by the North Carolina Board of Pharmacy. Results were analyzed using descriptive statistics.

RESULTS

Survey responses were received from 343 community pharmacists (response rate = 6.1%). Responders most commonly worked in an independent, single store (29.2%, n = 100) or national chain (29.2%, n = 100) pharmacy setting. Preferred method for a TOC communication was via electronic health record (63.0%, n = 184). Preferred TOC communication content are mentioned as follows: active (93.2%, n = 274) and discontinued (86.4%, n = 254) medications and reason for hospitalization (85.0%, n = 250). The top 3 self-identified barriers to utilizing a TOC communication: lack of care coordination with community pharmacy (35.0%, n = 14), lack of support from other health-care providers (22.5%, n = 9), and absence of compensation for providing the service (17.5%, n = 7). When asked if TOC communications were available, 97.5% (n = 278) indicated it would be useful.

CONCLUSION

Community pharmacists acknowledged a need for TOC communications and shared their preferences in the content and method of communication. Future research is warranted to implement TOC communications between a health system and community pharmacy.

Pharmacist-coordinated multidisciplinary hospital follow-up visits improve patient outcomes

BACKGROUND

The Affordable Care Act of 2010 allows for the adjustment of reimbursement to health care centers based on 30-day readmission rates. High readmission rates may be explained by multiple events at discharge, including medication errors that occur during the transition of care from inpatient to outpatient. Pharmacist involvement at discharge has been shown to improve health outcomes in patients with chronic disease; however, there is limited knowledge regarding the benefits of a clinic appointment with a pharmacist postdischarge.

OBJECTIVE

To compare hospital readmission rates and interventions in a multidisciplinary team visit coordinated by a clinical pharmacist practitioner with those conducted by a physician-only team within an internal medicine hospital follow-up program.

METHODS

A retrospective observational study was completed. Patients seen between May 2012 and January 2013 in 1 of the 2 hospital follow-up program models (multidisciplinary team or physician-only team) were included.

RESULTS

A total of 140 patient visits were included for 124 patients. Patients seen by the multidisciplinary team had a 30-day readmission rate of 14.3% compared with 34.3% by the physician-only team (P=0.010). Interventions completed during the visits, including addressing nonadherence, initiating a new medication, and discontinuing a medication were also statistically different between the groups, with the multidisciplinary team completing these interventions more frequently.

CONCLUSIONS

Hospital follow-up visits coordinated by the multidisciplinary team decreased 30-day hospital readmission rates compared with follow-up visits by a physician-only team.

Third molar changes following second molar extractions

Third molars, both upper and lower, do usually erupt into the place of electively removed second molars. None of the third molars in this study group became impacted during the observation period. Second molars in this study were removed before the roots had formed on the third molars. The bifurcation line appears to be a stable reference on the panoramic radiograph. It is the Author's conclusion that the extraction of permanent second molars is best for many patients, and when judiciously applied it is a reasonably safe and conservative modality in orthodontic care.

Rhabdomyolysis due to acute dystonic reaction to antipsychotic drugs

Rhabdomyolysis is a rarely reported complication of antipsychotic drug-induced dystonia. The history, signs, symptoms, and laboratory findings in such a case are reported. The pathogenetic mechanisms of the rhabdomyolysis and the treatment in this case are discussed. Physicians who prescribe these drugs are advised to be aware of this potentially serious complication.