共查询到20条相似文献，搜索用时 547 毫秒
1.
2.
3.
Joshua D. Niznik Harvey He Sandra L. Kane-Gill 《Research in social & administrative pharmacy》2018,14(8):707-717
Background
Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied.Objective
Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings.Methods
A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms “telemedicine”, “telehealth”, and “telephone” were used in combination with “pharmacist” or “pharmacy” and “telepharmacy”. The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence.Results
Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4).Conclusions
Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study. 相似文献4.
5.
6.
7.
Shellie L. Keast Bethany Holderread Terry Cothran Grant H. Skrepnek 《Journal of the American Pharmacists Association》2018,58(5):485-491
Objectives
The market for chronic hepatitis C (HCV) treatment has changed rapidly. New treatments offer high cure rates, fewer adverse effects, and shorter treatments—but also increased costs per therapy. The objective of this study was to compare adherence and cost between HCV patients included in an enhanced prior authorization and management program (PAMP) versus no intervention in Medicaid members undergoing treatment.Design
A retrospective study using longitudinal panel data assessed differences in adherence and costs associated with implementation of the PAMP from the payer perspective. The PAMP included case management, patient education, pharmacy counseling, and medication adherence. Multivariable generalized estimating equations were used to assess associations between program and outcomes.Setting and participants
Patients with HCV enrolled in a state Medicaid program receiving or requesting HCV treatment from January 2014 to November 2015.Outcome measures
Outcomes included medication adherence, treatment gaps, and pharmacy and total direct costs after controlling for demographic and clinical factors between those in the PAMP and those in the preintervention period.Results
There were 384 Medicaid members included (156 pre-PAMP, 228 post-PAMP). Overall adherence was high regardless of PAMP intervention, although an adjusted 1.086-fold increase in medication possession ratio (MPR) was observed with the program and a 2.732-fold higher odds of adherence above 80% (P < 0.05). Members in the program had 0.358 times lower adjusted odds of a greater than 3-day treatment gap, and pharmacy-related costs were 0.940 times lower (P < 0.05); no difference was observed in total medical costs (P = 0.333).Conclusion
This enhanced Medicaid program was associated with increased adherence to HCV therapy, decreased treatment gaps, and decreased pharmacy-related costs compared with the preintervention period. Because challenges exist if patients fail HCV treatment or if viral resistance emerges, ensuring high adherence and persistence remains key. Continued work is needed to develop and assess enhanced management programs for this population. 相似文献8.
Lucy Phan Vo JoAnna Han Souksavong Annie Tran Janet Chang Kajua B. Lor 《Journal of the American Pharmacists Association》2017,57(3):326-332.e6
Objectives
To evaluate the impact of an Act FAST educational intervention performed by student pharmacists on knowledge of stroke recognition and management.Design
Stroke preparedness and knowledge of primary prevention were assessed with the use of pre- and post-intervention surveys targeting community members at health fairs. The intervention was an Act FAST educational session with blood pressure and blood glucose screenings provided by student pharmacists. Act FAST is a quick tool to help recognize and respond to a stroke. The acronym FAST stands for Face, Arms, Speech, and Time.Setting
Community health fairs in Vallejo, CA.Participants
Community members 18 years of age and older.Intervention
Act FAST educational session delivered by student pharmacists.Main outcome measures
Knowledge of signs, symptoms, management, and risk factors of strokes as defined by the American Heart Association.Results
Following the Act FAST educational intervention, total knowledge of signs, symptoms, and management of stroke significantly increased from moderate to high (n = 112; 95% confidence interval [CI] 1.419-2.188; P <0.0001). Total knowledge of risk factors of stroke also significantly increased following the educational intervention (n = 88; 95% CI 0.6496-1.746; P <0.0001).Conclusion
The Act FAST educational intervention delivered by student pharmacists increased knowledge of signs, symptoms, immediate management, and modifiable risk factors of stroke. This suggests that student pharmacists may have a positive impact on community members’ preparedness and knowledge of primary prevention of stroke. The Act FAST campaign may be a useful tool for all training health care professionals. 相似文献9.
10.
11.
12.
Reina Haque Jiaxiao Shi Joanie Chung Xiaoqing Xu Chantal Avila Christopher Campbell Syed A. Ahmed Lei Chen Joanne E. Schottinger 《Journal of the American Pharmacists Association》2017,57(3):303-310.e2
Objective
Our objective was to examine the association between adherence to tyrosine kinase inhibitors (TKIs) and molecular monitoring and the risk of disease progression or mortality among patients with chronic phase chronic myeloid leukemia (CML).Design
We assembled a retrospective cohort of patients with CML (chronic phase, no prior cancer history, and confirmed to be Philadelphia chromosome positive) using data from electronic health records and chart reviews. Medication possession ratio (MPR) was used to measure drug adherence.Setting
A large, community-based, integrated health plan in Southern California.Participants
The cohort consisted of 245 adult patients (≥18 years old) with Philadelphia positive chronic phase CML diagnosed from 2001 to 2012 and followed through 2013.Main outcome measures
In survival analyses, we examined the association of TKI adherence (MPR) and polymerase chain reaction (PCR) monitoring test frequency with the composite clinical outcome, progression to accelerated phase disease–blast crisis or mortality (progression-free survival). The cohort was followed for a maximum of 13 years (median 4.6 years).Results
Over 90% of the cohort initiated TKI therapy within 3 months of diagnosis, and the mean MPR was 88% (SD 18%). Virtually all patients (96%) started on imatinib. The rates of progression to accelerated phase–blast crisis and mortality were lower in patients with greater TKI adherence (20.4/1000 person-years) versus lower adherence (27.0/1000 person-years). Patients who underwent PCR monitoring had a significantly reduced risk of progression or mortality, which was seen in patients with high and low TKI adherence status from both the groups (hazard ratio [HR] 0.07 [95% CI 0.03-0.19 if MPR >90%] and HR 0.70 [95% CI 0.02-0.21 if MPR<90%]).Conclusion
Our results suggest that close clinical monitoring, which includes PCR monitoring in patients with high and low TKI drug adherence, is associated with a lower risk of progression or mortality. 相似文献13.
14.
Thomas J. Matta Katherine S. O&#x;Neal Jeremy L. Johnson Sandra M. Carter Michelle M. Lamb Lourdes G. Planas 《Journal of the American Pharmacists Association》2017,57(2):183-187
Objective
The purpose of this study was to assess provider awareness of routine vaccinations recommended for patients with diabetes and to determine whether pharmacist-led interventions are associated with increased provider implementation of recommendations for hepatitis B vaccination.Methods
This study was conducted in 3 phases at 2 outpatient clinics affiliated with an academic institution. In phase 1, adults with diabetes who visited the clinics between January and November 2012 and who were eligible for the hepatitis B vaccine were identified. In phase 2, medical residents were surveyed twice for vaccine recommendations and reasons for (not) recommending the hepatitis B vaccine, specifically. Residents were then provided a pharmacist-led in-service about hepatitis B vaccine recommendations. The third phase was initiated in April 2013, following postintervention observation from December 2012 through March 2013.Results
Forty-eight of 100 (48%) medical residents attended the in-service and completed both surveys, with 77% indicating they did not recommend the hepatitis B vaccine. During phase 1, 1441 patients were identified, 0.6% (n = 8) of whom had received at least the first dose of the series. In phase 3, 946 patients were identified with 1.7% (n = 16) having received at least the first dose (P = 0.007).Conclusion
An attempt to disseminate updated recommendations to providers via educational in-service was successful in increasing the percentage of eligible patients vaccinated with the hepatitis B vaccine. 相似文献15.
Juanita A. Draime Douglas C. Anderson Timothy S. Anderson 《Journal of the American Pharmacists Association》2018,58(3):275-280
Objectives
1) To describe reported medication diversion within the practice of pharmacy; and 2) to compare diversion by employee type.Design
Retrospective study.Setting
A sample of state board of pharmacy records was examined from 9 states. Disciplinary actions were obtained from the records for the time period of May 2008 to May 2013.Participants
Pharmacy employees (pharmacist, technician, interns).Intervention
Not applicable.Main outcome measures
When a diversion case was identified, the following items were obtained for each case of medication diversion: 1) category of pharmacy employee (pharmacist, technician, intern); 2) type of substance (control, noncontrol, both); 3) use of diverted substance (sale, personal use, both, undetermined); and 4) action taken by the board.Results
A total of 811 medication diversion cases in 9 states were identified. Most cases involved a pharmacy technician (71.4%), controlled substances only (94.2%), and diversion for personal use (46.6%) and resulted in license or registration revocation or surrender (62.5%). When examining medication diversion use by purpose for diversion, there were significant differences by pharmacy employee type (sale use: P = 0.003; personal use: P = 0.032; unknown use: P < 0.001).Conclusion
Medication diversion is a pressing problem. There were 811 cases examined by 9 state boards, and many cases may be unreported. Technicians represent nearly three-fourths of diversions. It is essential that the practice of pharmacy identifies and assesses strategies to reduce medication diversion. 相似文献16.
Kevin C. Readdean Albert J. Heuer J. Scott Parrott 《Research in social & administrative pharmacy》2018,14(4):321-331
Background
Depression is a widespread disease with effective pharmacological treatments, but low medication adherence. Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients.Purpose
The aim of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders.Methods
A systematic review of controlled trials (both randomized and non-randomized) was conducted. Studies were obtained through a search of PubMed, Academic Search Premier, and Cochrane Library databases. Studies which included a pharmacist intervention to improve medication adherence in outpatients age 17 and above with a depressive disorder diagnosis and antidepressant treatment were included. Twelve publications met inclusion criteria, representing a total of 15,087 subjects: 1379 (9%) intervention and 13,708 (91%) control.Results
The interventions in each selected publication included some level of in-person counseling and education to promote antidepressant adherence. The pooled odds ratio for medication adherence at 6 months was 2.50 (95% CI 1.62 to 3.86). There were no significant differences noted in subgroup meta-analyses except study location (US, Middle East or Europe) and setting. Only one of the identified studies reported statistically significant impacts of the pharmacist intervention on patient depression symptoms.Conclusions
The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. Additional longitudinal research is recommended to investigate the multidimensional relationships between pharmacist interventions, patient adherence, and clinical outcomes.Article synopsis
Pharmacists play a key role in supporting medication adherence in patients with depression given their accessibility to patients. The purpose of this review was to systematically evaluate the impact of pharmacist interventions on adherence to antidepressants and clinical symptomology among adult outpatients with depressive disorders. A systematic review of randomized and non-randomized controlled trials was conducted of the twelve studies which met inclusion criteria. The findings suggest that pharmacist interventions can enhance patient adherence to antidepressant medication in adult outpatients. However, this review failed to demonstrate a positive effect of these interventions on clinical symptoms. 相似文献17.
Haesuk Park Ayoade Adeyemi Wei Wang Teresa E. Roane 《Journal of the American Pharmacists Association》2017,57(1):62-66.e2
Objectives
To determine the impact of a telephone call reminder program provided by a campus-based medication therapy management call center on medication adherence in Medicare Advantage Part D (MAPD) beneficiaries with hypertension.Methods
The reminder call services were offered to eligible MAPD beneficiaries, and they included a live interactive conversation with patients to assess the use of their medications. This study used a quasi-experimental design for comparing the change in medication adherence between the intervention and matched control groups. Adherence, defined by proportion of days covered (PDC), was measured using incurred medication claims 6 months before and after the adherence program was implemented. A difference-in-differences approach with propensity score matching was used.Results
After propensity score matching, paired samples included 563 patients in each of the intervention and control groups. The mean PDC (standard deviation) increased significantly during postintervention period by 17.3% (33.6; P <0.001) and 13.8% (32.3; P <0.001) for the intervention and the control groups, respectively; the greater difference-in-differences increase of 3.5% (36.3) in the intervention group over the control group was statistically significant (P = 0.022). A generalized estimating equation model adjusting for covariates further confirmed that the reminder call group had a significant increase in pre-post PDC (P = 0.021), as compared with the control group.Conclusions
Antihypertensive medication adherence increased in both reminder call and control groups, but the increase was significantly higher in the intervention group. A telephonic outreach program was effective in improving antihypertensive medication adherence in MAPD beneficiaries. 相似文献18.
Milena Kovačević Milica Ćulafić Marija Jovanović Katarina Vučićević Sandra Vezmar Kovačević Branislava Miljković 《Research in social & administrative pharmacy》2018,14(6):603-611
Background
Asthma self-management is aimed to improve the quality and effectiveness of asthma care by supporting the patients to manage their illness by themselves.Objective
The aim of the study was to evaluate the impact of pharmacist-delivered counselling on patients knowledge and beliefs about the medicines, adherence level, and asthma control.Methods
A prospective intervention study was conducted in community pharmacies. A total of 90 patients completed the study. Four questionnaires were used: (1) Beliefs about medicines questionnaire (BMQ), (2) Knowledge of asthma and asthma medicine (KAM), (3) Asthma control test (ACT), and (4) 8-item Morisky medication adherence scale questionnaire (MMAS-8). Questionnaires were completed at baseline and 3 months later.Results
Low level of adherence and poor asthma control were determined initially. Better asthma control was significantly associated with higher adherence level, lower concerns regarding the medication use, and knowledge of triggers. Statistically significant improvement was found after 3 months in patients knowledge of asthma and its medications, their attitude towards medications (decrease in harm, overuse and concern; increase in necessity score), asthma control score (increased from 19 to 20, p < 0.05) and level of adherence (MMAS-8 score decreased from 3 to 2 p < 0.05). Better asthma control was achieved in 60% of patients. Sixteen patients (18%) were transferred from poor to well-controlled asthma, implying no need for patients' referral to the doctor and no additional cost for the health system.Conclusions
Improved disease control could be a result of enhanced knowledge and understanding of the disease-medication relationship, improved inhalation technique, and support on patients' adherence. Acquired knowledge and skills, as well as improved attitude, empowered patients to take a more active part in asthma management. Education in further patients' follow-up should consider topics tailored to the patients' characteristics, needs, and prior counselling schedule with issues discussed. 相似文献19.
Karen Suchanek Hudmon Robin L. Corelli Carl de Moor Alan J. Zillich Christine Fenlon Lyndsay Miles Alexander V. Prokhorov Susan M. Zbikowski 《Journal of the American Pharmacists Association》2018,58(4):387-394