PCImpact: A modeling tool for forecasting impact of primary care pharmacist services

BackgroundThe role of the pharmacist in primary care (PC) has expanded to focus on medication optimization and management for chronic conditions. However, identifying the optimal pharmacist practice model to maximize pharmacist workload capacity, patient care quality, and PC provider satisfaction remains a challenge. PC clinical and administrative leaders could benefit from pharmacist impact forecasts to justify initiating new or optimizing/expanding current pharmacist services.Objectives(1) To describe the development of a PC pharmacist services modeling tool, PCImpact (2) To discuss the use of PCImpact by PC leaders to initiate, optimize, or expand integrated pharmacist services.MethodsPCImpact was developed and internally tested with 6 clinical/administrative leaders within a federally qualified health center and health system-affiliated primary care organization by: (1) identifying pharmacist practice models, (2) obtaining data input values for PCImpact, and (3) calculating PCImpact output values.Two types of pharmacist practice models are defined: population health (PH) and direct patient care (DPC). In the PH models, a centralized pharmacist performs one-time, comprehensive or targeted medication reviews with no direct patient interaction. PC providers review and implement pharmacist recommendations. In DPC models, an embedded pharmacist in a PC practice performs patient visits with or without collaborative practice agreements with PC providers.Default values for all PCImpact data inputs were obtained/tested through literature reviews and discussions with pharmacy and physician leaders, including pharmacist and PC provider time required, and implementation percentage of pharmacist recommendations. PCImpact calculates: (1) pharmacist workload capacity, (2) PC provider time impact, and (3) patient care impact.ConclusionsPCImpact presents a novel method to objectively forecast the impact of PH and DPC pharmacist services in 2 PC settings. PCImpact outputs showed that a DPC pharmacist practice model can save PC provider time and impact a greater number of patients compared to a PH pharmacist practice model.     

Clinical pharmacists in diabetes management: What do minority patients with uncontrolled diabetes have to say?

ObjectiveClinical pharmacist support for patients with type 2 diabetes mellitus (T2DM) can optimize patient outcomes and medication adherence. However, there is limited understanding of what pharmacist roles patients perceive as most helpful in T2DM management interventions. This study describes experiences of minority patients with uncontrolled T2DM in terms of perceived pharmacist helpfulness and specific roles found to be most helpful within diabetes management.DesignA secondary analysis of a 2-year randomized, crossover trial was conducted.Setting and participantsThis study included 244 African American and Hispanic adults with uncontrolled T2DM who received clinical pharmacist support within a team-based model.Outcome measuresThe patients completed a mixed-methods survey regarding their experience with the intervention that included a general helpfulness rating on a 10-point unipolar Likert scale and described the support qualitatively, including their perception of the pharmacist roles. Thematic analysis guided coding of the responses.ResultsOne hundred forty-seven (60%) patients completed the survey and had at least 1 encounter with a clinical pharmacist. Of these, 108 (74%) were African American, 39 (27%) were Hispanic, and 101 (69%) were women. The median rating of clinical pharmacist helpfulness was 10 (very helpful). Only 10 (7%) participants rated pharmacist helpfulness as 1 (not at all helpful). “Medication education and management” was the most frequently perceived supportive role of the clinical pharmacists, followed by “non–medication-related patient education,” “social support,” and “care coordination.” Miscommunication related to scheduling was the most common reason cited for not meeting with the clinical pharmacist.ConclusionThis sample of minority patients with uncontrolled T2DM recognized many roles outlined within the American Pharmacists Association Medication Therapy Management framework. Patient experiences with clinical pharmacist T2DM support are crucial for developing effective programs, maximizing patient engagement, satisfying patient needs, and ensuring that a program’s intended purpose aligns with the patient perspective.     

Perceptions of patients on Medicare Part D medication therapy management services

ObjectivesTo determine patients’ perceptions and expectations about medication therapy management (MTM) services pertaining to the core elements of an MTM service in the community pharmacy setting, and to develop educational strategies and outreach programs aimed at increasing patients’ knowledge of MTM services and the expanded role of pharmacists in the community pharmacy setting.DesignMulticenter, cross-sectional, anonymous study.SettingFour regional community chain pharmacies in Maryland and Delaware in January and February 2006.Patients81 patients who were 18 years of age or older and able to complete the survey.InterventionSurvey containing 14 questions administered within pharmacies, two of which had patient care centers that were providing clinical services.Main outcome measurePatients’ perceptions and expectations regarding MTM services.Results49 of 81 patients (60%) had never heard of MTM services. A total of 65 patients (80%) had never had or received a medication therapy review, 63 (78%) never had or received a personal medication record, and 70 (86%) never had or received a medication action plan. Some 56% of participants (n = 45) thought that pharmacist provision of medication therapy reviews, personal medication records, medication action plans, recommendations about medications, and referral to other health care providers was very important. At least 70% of participants (n = 57) thought that having one-on-one consultation sessions with pharmacists to improve communication and relationships with their pharmacists and to improve their medication use and overall health was very important. More than 50% of participants indicated that they would like to receive brochures or talk to their pharmacist to learn more about MTM services.ConclusionPatients have very limited knowledge of the core elements of an MTM service in the community pharmacy setting. Patients reported that pharmacist provision of MTM services was important, but they were concerned about privacy and pharmacists’ time. Patients are also supportive of and believe that MTM services can improve communication and relationship with their pharmacist and improve medication use. Patients appear to prefer receiving brochures and talking to pharmacists to learn more about MTM services. This survey identified a key opportunity for pharmacists to inform patients about MTM services.     

Improving 30-day readmissions: Student pharmacists’ role in transitions of care

BackgroundPharmacists have reduced 30-day hospital readmissions when involved with transitions of care (TOC). The impact of student pharmacists on readmissions is more limited.ObjectiveThe goal of this study was to describe student pharmacists’ role in a new TOC service and determine their impact on 30-day hospital readmissions.MethodsWe designed a 3-step TOC service spanning inpatient, discharge, and follow-up led by student pharmacists and involving both inpatient and ambulatory care pharmacy preceptors. The student pharmacists followed inpatient care and discussed medications with the patients. Discharge orders were reviewed, and the student pharmacists provided discharge education. On discharge, the student pharmacists wrote a handoff to the ambulatory care pharmacist describing inpatient care, discharge medication list, follow-up, and unresolved medication issues. Finally, the student pharmacists participated in the outpatient follow-up at the primary care provider office with the provider and an ambulatory care pharmacist. Readmissions were compared between this process and a standard-of-care historical control group using chi-square analysis.ResultsThe student pharmacist–led TOC service reduced 30-day hospital readmissions by 13.1% (P = 0.018) compared with standard of care.ConclusionStudent pharmacists are effective members of the health care team in reducing readmissions. Student pharmacists are cost-effective, appropriately trained, and well positioned to assist with these services.     

Report of the APhA Stakeholder Conference on Improving Patient Access to Injectable Medications

Objectives

The APhA Stakeholder Conference on Improving Patient Access to Injectable Medications was convened to foster national dialogue to advance the pharmacist's role in the provision of injectable medication administration services (MAS) and related patient care services, and to establish pharmacy as a site of care for these injections. Participants discussed the distinct opportunities to maximize pharmacist scope of services, expand patient access to care, improve medication adherence, and enhance outcomes for patients on injectable medication therapies for a range of conditions. These elements were framed in terms of the practice model, the business model, and the necessary training and resources to support these activities.

Development of a screening tool to identify patients likely to benefit from clinical pharmacist review in a home-based primary care population

ObjectiveTo create a novel screening tool that identified patients who were most likely to benefit from pharmacist in-home medication reviews.DesignSingle-center, retrospective study.Setting and participantsA total of 25 homebound patients in Forsyth County, NC, aged 60 years or older with physical or cognitive impairments and enrolled in home-based primary care or transitional and supportive care programs participated in the study. Pharmacy resident-provider pairs conducted home visits for all patients in the study. Pharmacy residents assessed the subjective risk (high, medium, low) of medication nonadherence using information obtained from home visits (health literacy, support network, medications, and detection of something unexpected related to medications). An electronic medical record–based risk score was simultaneously calculated using screening tool components (i.e., electronic frailty index score, LACE+ index [length of stay in the hospital, acuity of admission, comorbidity, emergency department utilization in the 6 months before admission], and 2015 American Geriatric Society Beers Criteria).Outcome measuresThe electronic medical record–based screening tool numerical risk scores were compared with pharmacy resident subjective risk assessments using tree-based classification models to determine screening tool components that best predicted pharmacy residents’ subjective assessment of patients' likelihood of benefit from in-home pharmacist medication review. Following the study, satisfaction surveys were given to providers and pharmacy residents.ResultsThe best predictor of high-risk patients was an electronic frailty index score greater than 0.32 (indicating very frail) or LACE+ index greater than or equal to 59 (at high risk for hospital readmission). Pharmacy residents and providers agreed that homebound patients at high-risk for medication noncompliance benefited from pharmacist time and attention in home visits.ConclusionIn homebound older persons, this screening tool allowed for the identification of patients at high-risk for medication nonadherence through targeted in-home pharmacist medication reviews. Further studies are needed to validate the accuracy of this tool internally and externally.     

Characterizing medication management and the role of pharmacists in caring for people living with cystic fibrosis: A work system approach

BackgroundCystic fibrosis (CF) is an autosomal recessive genetic disease requiring complex, lifelong medication regimens. Given the importance of medication in CF treatment, pharmacists are vital CF care team members in the care of people living with CF (PwCF).ObjectivesThis study aimed to (1) define patients’ CF medication experiences and educational needs and (2) investigate the CF outpatient clinic and community pharmacist’s role in addressing patient challenges.MethodsA work system approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) model was used to characterize knowledge and perception of CF medication regimens, educational modalities, and pharmacist interactions for PwCF. Semistructured interviews were conducted with adults living with CF at a CF center clinic. Data analyses identified relationships between the themes in the data and 4 SEIPS work system domains: tasks, tools and technology, person, and environment.ResultsThirty PwCF interviews highlighted 4 themes regarding health care experiences: (1) medication use experience, (2) medication education needs, (3) disease experience, and (4) pharmacist and pharmacy interactions. Patients reported complex medication regimens leading to challenges with medication adherence, although the benefit of treatment was recognized. Although a high level of disease-state knowledge was identified among the participants, PwCF desired to learn about CF medication benefits and adverse effects through credible sources using multiple modalities. Many reported a benefit of pharmacist involvement in their care.ConclusionPharmacists are well-positioned to support PwCF in adherence, medication regimen management, and medication education. Opportunities exist for growth in these supportive roles of a pharmacist in both community and outpatient clinic settings.     

1例瓣膜置换联合冠状动脉旁路移植术后患者抗栓治疗的药学监护

摘 要 目的：探讨临床药师对冠状动脉旁路移植术（CABG）合并瓣膜置换的患者实施药学监护的方法和思路。 方法：临床药师对1例CABG合并瓣膜置换术后的患者进行查房密切观察和药学教育,参与个体化抗栓方案的制定,规范患者用药问题,监测疗效与药品不良反应,给患者提供用药教育。结果：通过药师治疗全过程中细致的药学监护和医嘱干预,确定符合患者特点的抗栓方案,避免不良反应的发生,提高患者治疗的依从性和药物治疗效果。结论：临床药师积极开展药学监护,协同临床医师优化给药方案,有利于患者用药的安全性和有效性。     

临床药师参与伏立康唑治疗方案调整1例并文献复习

目的 探讨临床药师参与1例使用伏立康唑治疗肺部真菌感染患者的治疗方案调整,为复杂患者的个体化用药提供信息支持。方法 临床药师利用治疗药物监测及基因检测作为技术支持,药学指南及文献作为信息支持,为临床医师提供参考意见,改善治疗效果。结果 治疗过程中,临床药师根据患者情况提出用药调整建议,与医师共同制定个体化治疗方案并随时调整,节省了医疗费用,提高了患者的依从性。结论 临床工作中,部分患者存在治疗疗程长、联合用药复杂的问题,治疗药物监测、基因检测等技术的应用,为临床个体化用药提供了技术保障,而临床药学人员的参与,也为个体化用药的逐步完善提供了一定的支持。     

The provision of pharmaceutical care in a Veterans' Affairs Medical Center outpatient HIV clinic

Recognizing the unique needs and demands of HIV-infected patients, it was decided to implement pharmaceutical care in a VAMC outpatient HIV clinic. Services provided to the patients by the pharmacist include drug information, medication counseling with the help of educational handouts, and drug-related problem identification and resolution. The pharmacist also serves as a liaison between the patient and the VAMC outpatient pharmacy if conflicts arise. Services provided to the other members of the HIV clinic team include the provision of drug information and participation in clinical research. In addition, the HIV clinic provides a training site for pharmacy practice residents and Doctor of Pharmacy students on their ambulatory care rotation.     

临床药师在普外科开展药学服务的实例分享及体会

摘 要 目的：总结临床药师在普外科开展药学服务的经验, 探索药师参与临床药物治疗实践模式。方法: 从药物重整、药物不良反应的发现及处置、药物治疗方案的参与制定三方面分享临床药师在普外科参与药物治疗的典型实例并进行分析。结果: 临床药师通过药物重整提高了患者用药的准确性和有效性,通过及时发现肝素引起的血小板减少症并停药避免了患者发生出血不良事件的风险,参与制定抗感染方案使得患者切口感染得到迅速而有效的控制。结论:临床药师深入病区开展“以患者为中心”的药学服务,提高了患者用药安全性及合理性,对提高临床医疗质量具有重要的作用。     

临床药师培训对专业型临床药学硕士培养的启示

目的：分析我国开展临床药师培训的具体情况,为专业型临床药学硕士培养提供思路。方法：搜索CNKI、万方、维普数据库,查询我国临床药师培训相关文献,分析临床药师培训与临床药学专业硕士培养的比较优势。结果：专业型临床药学硕士的培养应设置与临床实践密切结合的课程,同时须布置药学实践作业。考核内容应侧重于临床,注重过程考核。结论：临床药师的基本功是医嘱审核、用药教育、药物不良反应判断等,一切工作都应围绕临床,以患者为中心。在学习期间,专业型临床药学硕士更应着重锻炼这些基本功。只有这样,才能为今后参与临床治疗团队、提供药学服务、缩短执业过渡期打好基础。