Interdisciplinary medication education in a church environment.

A medication education program for ambulatory care patients implemented in a church setting was studied. The program at each of 20 churches in Ohio consisted of a one-hour orientation for pharmacists/interns, a 20-minute presentation on medications and health, a question-and-answer session led by a pharmacist and a nurse, a one-on-one session with a pharmacist, and an exit interview with a nurse. Before the program, patients completed a form to assess their current experiences with medications and their interactions with health care professionals in the preceding six months. During an exit interview at the end of the program, patients were asked whether the program has been understandable and beneficial and whether taking medications affected their lifestyle. A follow-up interview was conducted six months later. A total of 187 patients completed both the exit and follow-up interviews. Almost all reported that the church setting was a good place for the program and that the program was beneficial. During the six months after the program, the patients took significantly fewer drugs each day than during the six months before the program and had fewer drug-related problems. Significantly more patients sought drug information after completing the program than before it. High rates of medication misuse were identified, leading to 359 pharmacist recommendations. An interdisciplinary program in a church setting successfully provided medication education.     

Evaluation of the Iowa Medicaid pharmaceutical case management program.

OBJECTIVE: To test the effect of pharmaceutical case management (PCM) on medication safety and health care utilization. DESIGN: Prospective cohort design with 9-month follow-up period (enrollment from October 1, 2000, through July 1, 2001, with follow-up through July 1, 2002). SETTING: Iowa Medicaid program. Participants: 2,211 noninstitutionalized, continuously eligible Iowa Medicaid patients taking four or more chronic medications including at least one agent commonly used in at least 1 of 12 specific diseases who were cared for by pharmacists in 117 pharmacies. INTERVENTIONS: Reimbursement for PCM services (initial patient assessment, written recommendations to physician, follow-up assessments and communication of progress and new problems to physician). MAIN OUTCOME MEASURES: Use of high-risk medications, Medication Appropriateness Index (MAI) score, health care utilization. RESULTS: Pharmacists in 114 pharmacies had eligible patients during at least one quarter during the study period; 28 pharmacies were classified as high intensity based on the number of PCM patients they managed. A total of 524 of the eligible patients received 1,599 PCM services; 90% of claims were filed by pharmacists, and the remainder by physicians. Nearly one half (46.1%) of medications and 92.1% of patients had at least one medication problem before PCM. By closeout, the percentage of medications with problems decreased in 8 of 10 MAI domains for those who received PCM. Compared with baseline, mean MAI score improved significantly from 9.4 to 8.3 among PCM recipients (P < .001). Percentage of PCM recipients using high-risk medications decreased significantly compared with PCM eligibles who did not receive the service. In the 28 pharmacies that adopted the new service most intensely, patients had a significant decrease in high-risk medication use, compared with patients of low-intensity pharmacies (P < .001). No difference was observed between PCM recipients and PCM eligibles who did not receive PCM in health care utilization or charges, even after including reimbursements for PCM. CONCLUSION: Medication safety problems were prevalent in this high-risk population. The PCM program improved medication safety during a 9-month follow-up period.     

Pharmaceutical care in an integrated health system.

OBJECTIVES: An integrated health system in a large metropolitan area, to maximize its manpower and resources, developed a pharmacist-operated Health Management Center (HMC). The primary objectives of the HMC are to provide a continuum of patient care, decrease emergency department visits, decrease episodes of hospitalization, and increase patient satisfaction and quality of life. SETTING: The HMC based at a 300-bed community hospital of an integrated health system in a large metropolitan area. PRACTICE DESCRIPTION/INNOVATION: Chronic diseases, including coagulation disorders, asthma, diabetes, hypertension, congestive heart failure, and dyslipidemia, will be managed by the primary care pharmacist at the HMC. The HMC pharmacist uses a team approach to promote good health by cooperating with patients, the physician clinic director, and other professionals in designing, implementing, and monitoring therapeutic plans that produce specific therapeutic outcomes. The pharmacist evaluates patients using physical assessment skills; performs point-of-care laboratory tests; obtains medication history, including information on compliance, response to drug therapy, and adverse reactions; adjusts and orders medications; and schedules follow-up appointments. INTERVENTIONS: The anticoagulation service was the first program to be established. The pharmacist is authorized to perform point-of-care testing for prothrombin times, adjust doses of anticoagulants, order vitamin K, and schedule return visits per established guidelines. MAIN OUTCOME MEASURES: Emergency department visits, episodes of hospitalization, patient satisfaction, and quality of life. RESULTS: The results for 39 patients 6 months before their enrollment in the HMC's anticoagulation service and for the first 6 months following their enrollment, after adjusting for a 1-month-washout period, showed a decrease in hospitalization rate by 57.9% (p = .078) and total hospital days by 71.1% (p = .108). No change was observed in use of emergency department services. CONCLUSION: The role of the pharmacist at the HMC is a reflection of changes in the health care system that are leading to greater pharmacist involvement in direct patient care. The pharmacist-operated HMC can serve as a model for other hospitals in this and other integrated health systems.     

Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma

ObjectivesTo determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers’ knowledge of asthma is described.DesignThis study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients’ homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36.SettingA local Medicaid managed care organization.ParticipantsPediatric African American patients (4-17 years old) with uncontrolled asthma.Main outcome measuresOutcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score.ResultsOverall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline.ConclusionRates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.     

慢性病长期用药处方开展情况的英文文献分析

摘 要 目的：本文检索关于慢性病长期用药处方的英文文献并进行系统评价,探索其取药模式和管理举措,以期为我国开展慢性病药物治疗管理和相关服务提供借鉴。方法: 在PubMed数据库中检索2016年4月以前发表的与长期用药处方相关的文献。对文献发表年份、国家/地区、涉及药物类型等信息进行分类分析。结果:美国、英国、瑞典是研究长期用药处方最多的国家,高血压、糖尿病、高脂血症等慢性病治疗药物是被提及最多的药物类型。年龄、受教育程度、种族、语言、药物类型等等都是影响患者依从性的因素。药师在长期用药处方项目中发挥审核、干预和随访等作用。结论:长期用药处方项目在欧美国家已发展成熟,管理有序。我国引入长期用药处方项目,是解决病情稳定的慢性非传染病患者的取药需求和长期药物治疗需求的良策。     

Improving patient access to hepatitis C virus treatment

Objectives

To discuss the current barriers to hepatitis C virus (HCV) treatment; to provide information and resources to assist health care providers with the prior authorization process; to provide resources for potential access to medications if a patient's third-party payer may not be an option; and to discuss the pharmacist's vital role as a patient advocate and considerations once medications are approved.

Pharmacist membership in a medical group's diabetes health management program.

PURPOSE: An evaluation of the effectiveness of a program at achieving improved glycemic control, lipid levels, and adherence to preventive care measures in diabetes mellitus patients was conducted. SUMMARY: An interdisciplinary diabetes health management program (DHMP) was implemented, which included physicians, clinical pharmacists, registered nurses, and registered dieticians. The patients are seen by a clinical pharmacist with the option of individual or group visits with other members of the multidisciplinary team. Clinical pharmacist interventions include education and comprehensive medication management through collaborative practice agreements held with physicians. The collaborative agreements allow the clinical pharmacist to initiate, adjust, or discontinue pharmacotherapy and order pertinent laboratory tests and podiatry referrals that are within the scope of the medication management protocol. A retrospective review was conducted of the 707 patients enrolled in the program between April 2002 and April 2004. The mean +/- S.D. number of days between baseline and follow-up values was 140 +/- 62. Eighty-four percent of the enrolled patients were diagnosed with type 2 diabetes mellitus, 69% met the National Cholesterol Education Program's criteria for metabolic syndrome, and 51% were male. The mean glycosylated hemoglobin (HbA(1c)) value dropped significantly, and the percentage of patients who were at or below the American Diabetes Association's established HbA(1c) goal of < or = 7% increased significantly. Lipid values for enrolled patients improved, with the percentage achieving a low-density-lipoprotein cholesterol concentration of <100 mg/dL increasing from 25% to 44% [corrected] Adherence to preventive care measures (e.g., annual eye and foot examinations) also significantly improved from baseline to follow-up. CONCLUSION: Involvement of pharmacists in an interdisciplinary DHMP has improved patient care.