Using a pharmacist–community health worker collaboration to address medication adherence barriers

ObjectivePharmacists are positioned to evaluate and educate patients regarding medication adherence; however, opportunities exist to leverage a collaborative approach in eliciting barriers encountered by patients, especially in minority groups. Community health workers (CHWs) are individuals from the communities who form relationships with patients and help increase their access to health care resources. This study aimed to evaluate the effectiveness of a collaboration between CHWs and pharmacists in identifying and addressing medication adherence barriers faced by hypertensive patients.MethodsAfter receiving training in medication therapy management support, CHWs from the South East American Indian Council collaborated with students and pharmacists from the Center for Quality Medication Management at the University of Florida to identify and address medication adherence barriers encountered by hypertensive patients who were mainly Native American or black. The CHWs documented information from the patient interviews during the initial and follow-up visits. The team collaborated to identify intervention opportunities on the basis of the adherence barriers identified. Follow-up visits were conducted to measure progress.ResultsThirty-three hypertensive patients with or without diabetes were included in the study. The pharmacists, in partnership with the CHWs, offered 149 interventions related to medication adherence barriers. The most commonly identified barriers included forgetfulness, adverse effects, and knowledge concerns. By the final visits, 75.6% of the barriers related to antihypertensive medications and 63.9% of the barriers related to antidiabetic medications were resolved. In addition, a paired t test indicated a significant difference in the mean blood pressure values (P = 0.006 for systolic and P = 0.008 for diastolic) recorded at the initial (mean = 136/85.7 mm Hg) and final (mean = 130.1/81.2 mm Hg) visits.ConclusionThe findings of this pilot project support the collaboration between pharmacists and CHWs to help improve medication adherence and patient outcomes. Additional research is recommended to validate these study findings.     

General practitioner–pharmacist collaboration in Germany: an explanatory model

International Journal of Clinical Pharmacy - Background In Germany, no validated measure and model of pharmacist-physician collaboration existed. Objectives To provide evidence for the factor...     

Influence of a ward-based pharmacist on the medication quality of geriatric inpatients: a before–after study

Background Despite several international studies demonstrating that ward-based pharmacists improve medication quality, ward pharmacists are not generally established in German hospitals. Aim We assessed the effect of a ward-based clinical pharmacist on the medication quality of geriatric inpatients in a German university hospital. Method The before-after study with a historic control group was conducted on the geriatric ward. During the control phase, patients received standard care without the involvement of a pharmacist. The intervention consisted of a clinical pharmacist providing pharmaceutical care from admission to discharge. Medication quality was measured on admission and discharge using the Medication Appropriateness Index (MAI). A linear regression analysis was conducted to calculate the influence of the intervention on the MAI. Results Patients in the intervention group (n?=?152, mean 83 years) were older and took more drugs at admission compared to the control group (n?=?159, 81 years). For both groups, the MAI per patient improved significantly from admission to discharge. Although the intervention did not influence the summated MAI score per patient, the intervention significantly reduced the MAI criteria Dosage (p?=?0.006), Correct Directions (p?=?0.016) and Practical Directions (p?=?0.004) as well as the proportion of overall inappropriate MAI ratings (at least 1 of 9 criteria inappropriate) (p?=?0.015). Conclusion Although medication quality was already high in the control group, a ward-based clinical pharmacist could contribute meaningfully to the medication quality on an acute geriatric ward.

     

Using theory to predict implementation of a physician–pharmacist collaborative intervention within a practice-based research network

BackgroundStudies have demonstrated that physician/pharmacist collaboration can improve management of chronic conditions.ObjectiveThe purpose of this study was to determine whether a correlation exists between existing clinical pharmacy services within a practice-based research network (PBRN) and provider attitudes and beliefs regarding implementing a new pharmacy intervention based on the Theory of Planned Behavior (TPB).MethodsA validated survey was completed by one clinical pharmacist from each office. This instrument evaluated the current clinical pharmacy services provided in the medical office. TPB instruments were developed that measured beliefs concerning implementation of a clinical pharmacy intervention for either blood pressure or asthma. The pharmacy services and TPB surveys were then administered to physicians and pharmacists in 32 primary care offices throughout the United States.ResultsPhysicians returned 321 (35.9%) surveys, while pharmacists returned 40 (75.5%). The Cronbach's alpha coefficients generally ranged from 0.65 to 0.98. TPB subscale scores were lower in offices rated with lower pharmacy service scores, but these differences were not statistically significant. There was no correlation between clinical pharmacy service score and providers' TPB subscale scores. In both the hypertension and asthma groups, pharmacists scores were significantly higher than physicians' scores on the attitudes subscale in the multivariate analysis (P < 0.001 and P < 0.05, respectively).ConclusionsPharmacists consistently scored higher than physicians on the TPB, indicating that they felt the hypertension or asthma intervention would be more straightforward for them to implement than did physicians. There was no significant correlation between clinical pharmacy service scores and attitudes toward implementing a future physician/pharmacist collaborative intervention using the TPB. Future studies should investigate the ability of the TPB instrument to predict implementation of a similar intervention in offices of physicians never exposed to clinical pharmacy services.     

Lack of pharmacist–physician communication associated with nimesulide-induced oligohydramnios during pregnancy

Case

The consequences of medication errors can be serious, especially in pregnant women. When decision-making is critical, physician–pharmacist communication has the potential to improve patient safety. In this report, we describe the case of a pregnant woman who developed oligohydramnios after taking nimesulide for neuropathic pain. The drug was improperly prescribed by a family physician and mistakenly dispensed by a community pharmacist. Oligohydramnios was observed during ultrasound examination and an iatrogenic cause was suspected. This case is presented to raise awareness that patient safety is threatened because of a lack of physician–pharmacist communication, especially for pregnant patients.

Conclusion

Healthcare professionals are continually at-risk for making errors at work. Effective inter-professional communication should be an organisational tool to prevent adverse events for pregnant women.

     

Evaluation of substrate–binder interaction in a model granule system

The real binder function in granules made of PVP and glass ballotini as model substrates, and its effect on the mechanical properties of rectangular beam specimens consisting of these granules was investigated by use of the four-point beam-bending technique. The mechanical properties of the rectangular beam specimens were correlated with the granulation liquid characteristics (contact angle, surface tension and binder concentration). The mechanical strength and Young's modulus of the specimens both reached a maximum value when the binder concentration in the granulation liquid was increased to 20% (w/v) for all granulation liquid volumes used. Above a 20% PVP concentration, the increasing granulation liquid contact angle hindered the binder spreading, creating weak regions in the compact and decreasing its mechanical strength. This was confirmed by scanning electron microscopy pictures showing a non-homogeneous distribution of the PVP in the granulated mass. No differences were observed in the stress/strain behaviour of the beams made with PVP of different molecular weight.     

The value of domiciliary medication reviews – a thematic analysis of pharmacist’s views

International Journal of Clinical Pharmacy - Domiciliary medication reviews are thought to enable comprehensive medication reviews centred around the needs of individuals. However, there is no...     

The signal attenuation rat model of obsessive–compulsive disorder: a review

During the last 30 years, there have been many attempts to develop animal models of obsessive–compulsive disorder (OCD), in the hope that they may provide a route for furthering our understanding and treatment of this disorder. The present paper reviews a recently developed rat model of OCD, namely, signal attenuation. Results of pharmacological and lesion studies are presented and evaluated with respect to the pharmacology and pathophysiology of OCD. It is argued that signal attenuation is a rat model of OCD with construct (derived from similarity in the underlying mechanisms), predictive (derived from similarity in response to treatment), and face (derived from phenomenological similarity between “compulsive” behavior in the model and compulsions in OCD patients) validity.     

Evaluation of the impact of pharmacist-led medication reconciliation intervention: a single centre pre–post study from Ethiopia

International Journal of Clinical Pharmacy - Background The role of pharmacists in medication reconciliation (MedRec) is highly acknowledged in many developed nations. However, the impact of this...     

Stakeholder perspectives on pharmacist involvement in a memory clinic to review patients’ medication management and assist with deprescribing

BackgroundMemory clinics usually involve a team of health professionals who assess and review people with memory impairment. Memory clinic patients are typically older, have multiple comorbidities and potentially inappropriate polypharmacy. Pharmacists are not typically part of memory clinic teams.ObjectiveTo explore stakeholder perspectives on pharmacist involvement in a memory clinic to conduct medication reviews and assist with deprescribing potentially inappropriate/unnecessary medications.MethodsQuantitative and qualitative evaluation of stakeholder perspectives within a deprescribing feasibility study. Patient/carer questionnaires were administered at 6-month follow-up. Fax-back surveys were sent to general practitioners (GPs) shortly after the pharmacist review. A focus group was conducted with memory clinic staff and semi-structured interviews with pharmacists at conclusion of the study. Focus group/interviews were transcribed and thematically analysed.ResultsMost patients/carers found the pharmacist medication review helpful (84%, 31/37) and believed it was important to have pharmacists in the memory clinic (92%, 36/39). Twenty-one (48%) GPs responded to the survey; most found the pharmacist reports useful for identifying inappropriate medication and providing deprescribing recommendations (86% and 81%, respectively), and 90% thought a pharmacist review should be part of the memory clinic service. Feedback from memory clinic staff and pharmacists was largely positive. Questions were raised by some staff about whether deprescribing fell within the clinic's scope of practice. Challenges associated with memory clinic-GP communication were highlighted.ConclusionPatients, GPs and memory clinic staff were receptive to increased pharmacist involvement in the memory clinic. Stakeholder feedback will inform the development and delivery of pharmacist medication reviews and deprescribing in memory clinics.     

Effect of pharmacist care on medication adherence and cardiovascular outcomes among patients post-acute coronary syndrome: A systematic review

Background

The impact of collaborative and multidisciplinary health care on the outcomes of care in patients with acute coronary syndromes (ACS) is well-established in the literature. However, there is lack of high quality evidence on the role of pharmacist care in this setting.

Enhancing teachers’ medication literacy and teaching through school–pharmacist partnership in Taiwan

Abstract

Objective: Adolescents in Taiwan generally have a low level of knowledge concerning medications. This study evaluates a school–pharmacist partnership in Taiwan and describes the impact this association has on enhancing teachers’ medication literacy and on their compliance with imparting this information to their students.

Method: In 2013, the results from baseline and follow-up self-administered online structured questionnaire surveys received from 358 teachers in intervention primary and middle schools were compared with those received from 452 teachers in comparative primary and middle schools. Generalized Estimating Equation (GEE), regression analyses, and logistic regression analyses were conducted to examine the effects.

Results: The results indicated that the partnership between schools and pharmacists had significantly enhanced teachers’ knowledge, attitudes, self-efficacy, and skills concerning correct medication usage and pain medication literacy. In addition, the implementation of the school–pharmacist partnership had also significantly increased teachers’ participation in the teaching of the proper uses of medication and in their implementation of school campaigns.

Conclusion: The school–pharmacist partnership had a positive impact on enhancing teachers’ medication literacy and participation in medication teaching in Taiwan.