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1.
Kenneth C. Hohmeier Sharon L.K. McDonough Leanne Justis Rein Andrea L. Brookhart Mara L. Gibson Mary F. Powers 《Journal of the American Pharmacists Association》2019,59(2):187-194
Objectives
To explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at “high-performing” community pharmacies within a nationwide supermarket chain.Design
Qualitative research study using methodologic triangulation with the use of semistructured interviews of key informants, direct observation at “high-performing” pharmacy sites, and respondent journals.Setting and participants
High-performing pharmacy sites within a large supermarket pharmacy chain in Tennessee. A high-performing site was defined as a pharmacy that has successfully implemented MTM into its pharmacy workflow.Main outcome measures
Themes related to pharmacy technician roles in the delivery of direct patient care services.Results
A total of 28 key informants were interviewed from May 2015 to May 2016. Key informants included 10 certified technicians, 5 noncertified technicians, and 13 pharmacists across 8 pharmacies in central and eastern Tennessee. Three themes were identified. At high-performing sites, pharmacy technicians were engaged in both clinical support activities as well as nonclinical support activities with the goal of improving clinical service implementation. Several barriers and facilitators were revealed.Conclusion
Within high-performing teams, expanded technician roles to support patient care service delivery were associated with successful clinical service implementation. Future studies should further explore these expanded technician duties, as well as the role of organizational culture, climate, and team dynamics, in the delivery of patient care and clinical services across a heterogeneous pharmacy setting. 相似文献2.
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Joshua L. Akers Geoffrey Meer Jeffrey Kintner Anna Shields Laurel Dillon-Sumner Jennifer L. Bacci 《Journal of the American Pharmacists Association》2019,59(2):243-251
Objectives
To describe one independent pharmacy group’s experience delivering and being reimbursed for in-home medication coaching, or home visits, to high-risk and high-complexity community-dwelling patients.Setting
A nondispensing clinical division of an independent community pharmacy in Seattle, Washington.Practice innovation
A community pharmacist–led in-home medication coaching program delivered through partnerships with 3 community-based organizations for referrals and payment over a 4.5-year period. Community-based partners included a state comprehensive care management program, a local health system’s cardiology clinic, and the local Area Agency on Aging.Evaluation
A retrospective analysis of patient demographics, drug therapy problems, interventions, and pharmacy and technician time was conducted with the use of the pharmacy’s internal patient care documentation and billing systems from January 1, 2012, to June 31, 2016.Results
A total of 462 home visits (142 initial, 320 follow-up) were conducted with 142 patients. Patients averaged 13 disease states (range 3–31) and 16 medications (range 1–44) at their initial visit. Pharmacists identified an average of 11 drug therapy problems per patient (range 1–36) and performed an average of 13 interventions per patient (range 1–48). The most common drug therapy problem identified was nonadherence, and the most common intervention performed was education. The median pharmacist time in the home was 1.5 hours (range 0.67–2.75) for an initial visit and 1 hour (range 0.08–2.25) for a follow-up visit.Conclusion
Home visits can be successfully implemented by community pharmacists to provide care to high-risk and high-complexity community-dwelling patients. Our experience may inform other community pharmacy organizations looking to develop similar home visit services. 相似文献4.
Christian Díaz de León-Castañeda Jéssica Gutiérrez-Godínez Juventino III Colado-Velázquez Cairo Toledano-Jaimes 《Research in social & administrative pharmacy》2019,15(3):321-329
Background
In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services.Objectives
To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision.Methods
A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti.Results
Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision.Conclusions
The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision. 相似文献5.
Background
Self-care advice and management of minor ailments have long been provided in community pharmacies across England. However, formal pharmacy minor ailment service provision is geographically variable and has yet to gain recognition and political support as a valued sustainable service for nationwide adoption and commissioning.Objective
To investigate the sustainability potential of pharmacy minor ailment services from the perspective of community pharmacy stakeholders within the North East of England.Methods
A mixed methods approach was adopted to survey and interview stakeholders from the North East of England who commission; provide; and/or represent groups influencing the design, delivery and investment in community pharmacy clinical and public health services. The 40-item Programme Sustainability Assessment Tool, a validated instrument to assess a public health programme's capacity for sustainability across eight domains, was administered to fifty-three stakeholders, identified from a pharmacy minor ailments showcase event. The same stakeholders were invited for a semi-structured interview to explore issues further. Interviews were audio-recorded, transcribed verbatim, and underwent framework analysis.Results
Forty-two (79.2% response rate) stakeholders representing commissioning, provider and influencing (e.g. Local Professional Network) organisations completed the assessment tool. Pharmacy minor ailment services were rated as unsustainable across the majority of the domains. Elements within the domain ‘Partnerships’ demonstrated potential for sustainability. Stakeholder interviews provided detailed explanation for the low scoring sustainability domains, highlighting the multifaceted challenges threatening these services.Conclusion
The Programme Sustainability Assessment Tool allowed stakeholders to evaluate the potential of pharmacy minor ailment services in England. Follow-up interviews highlighted that initial design and implementation of services was poorly conceived and lacked evidence, thereby impeding the services' sustainability. There are many challenges facing a widespread provision of pharmacy ailment services, but it is clear the profession needs to be clear on the service objectives to secure future interest and investment. 相似文献6.
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Peter Doshi Jan Sieluk Anna Hung 《Journal of the American Pharmacists Association》2019,59(2):195-201
Objectives
To evaluate the degree to which health care professionals and patients receive consistent messages regarding the possible harms of statins.Design
Cross-sectional study of prescribing information (PI), patient package inserts (PPIs), and pharmacy leaflets for 8 statins approved by the U.S. Food and Drug Adminstration.Setting
Not applicable.Participants
Not applicable.Main Outcome Measures
All passages describing 7 adverse events (diarrhea, arthralgia, dyspepsia, confusion, memory loss, rhabdomyolysis, and kidney failure) were extracted from PIs, PPIs, and pharmacy leaflets. For each type of information source and adverse event (drug-harm pair), 2 reviewers independently judged passages as indicating either a confirmed, unconfirmed, or mixed causal relationship between statin and adverse event (drug-harm pair). Disagreements were resolved through consensus, and the consistency between information sources was calculated.Results
PI and PPI consistently conveyed the relationship between a given statin and given adverse event (either both “confirmed” or both “unconfirmed”) in 12 of 17 evaluable drug-harm pairs. PPIs and pharmacy leaflets were consistent in 10 of 10 evaluable drug-harm pairs. PIs indicated a confirmed, causal relationship in 15 drug-harm pairs that were not mentioned in pharmacy leaflets. Likewise, PPIs indicated a confirmed, causal relationship in 7 drug-harm pairs that were not listed in pharmacy leaflets.Conclusion
Despite the widespread use of statins, we discovered considerable ambiguity in language used to describe the evidence concerning their possible harms and variable consistency between PIs, PPIs, and pharmacy leaflets. Further study is needed to understand the reason why pharmacy leaflets did not list, in 15 cases, adverse events that PIs indicated were causally related to the statin. 相似文献8.
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Chelsea Phillips Renfro Benjamin Y. Urick Mohamad A. Mansour Stefanie P. Ferreri 《Journal of the American Pharmacists Association》2019,59(2):275-279
Objective
To assess the correlation between pharmacy characteristics and a broad set of performance measures used to support a community pharmacy network.Methods
Baseline characteristics regarding demographics, services provided, technology, and staffing were collected via a 68-item survey for 123 pharmacies participating in the North Carolina community pharmacy enhanced services network. Performance metric data were collected, and scores were calculated for each pharmacy. Outcome measures for this study comprised of 4 adherence measures, a risk-adjusted hospitalization measure, a risk-adjusted emergency department visit measure, a total cost of medical care measure, and a composite pharmacy performance measure. Generalized estimating equations (GEE) were used to create multivariable statistical models measuring the correlation between pharmacy characteristics and performance measures.Results
After inclusion criteria were applied, 115 pharmacies remained in the analysis. These pharmacies were primarily single and multiple independent pharmacies, at 36.5% and 59.1%, respectively. Five characteristics were significantly associated with 3 measures, and none were associated with 4 or more. Having pharmacists in non dispensing roles was positively associated with total score, diabetes adherence, and chronic medication adherence. Home visits were positively associated with hypertension adherence, ED visit rate, and total score. Offering a smoking cessation program was positively associated with chronic medication, hypertension, and statin adherence. Offering free home delivery was positively associated with diabetes adherence but negatively associated with total medical spending and ED visit rate. Using dispensing automation was negatively associated with adherence to chronic medications, renin-angiotensin system antagonists, and statins.Conclusion
No pharmacy characteristics were associated with a majority of performance measures chosen. Additional research is needed to identify structural variables that can be used as minimum participation criteria for high-performing pharmacy networks. 相似文献10.
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Harjit K. Singh Gerard A. Kennedy Ieva Stupans 《Research in social & administrative pharmacy》2019,15(3):244-251
Background
Pharmacy health coaching is a nascent topic offering promise on several fronts. There is considerable benefit to discerning the contributions thus far and future directions of pharmacy health coaching and research of the topic.Objective
The objective of this review was to synthesize the available empirical evidence regarding pharmacy health coaching and to define it.Methods
This systematic review followed the PRISMA guidelines. CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS) were searched (2000–2017) to identify sources related to pharmacy health coaching. Included articles were reviewed for their definition and outcomes of health coaching as well as recurring terms/themes pertaining to health coaching.Results
Ten papers met the eligibility criteria. The results of each empirical study as well as the definitions were used to identify the key outcomes associated with pharmacy health coaching and were then cross tabulated. The most commonly occurring outcome of health coaching was an improvement in a health outcome of a target population. An improvement in medication management/adherence and the relationship between health professionals was equally evident. Lastly, an improved attitude towards drug therapy was referred to more often than the cost-effectiveness of health coaching.Conclusions
The evaluations enabled the formulation of a grounded definition of health coaching. 相似文献14.
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Eric A. Wright Jove H. Graham Daniel Maeng Lorraine Tusing Lori Zaleski Richard Martin Rick Seipp Bruce Citsay Bette McDonald Kelly Bolesta Kim Chaundy Charles J. Medico Steve Gunderman Fred Leri Kelly Guza Rebecca Price Christina Gregor Dean T. Parry 《Journal of the American Pharmacists Association》2019,59(2):178-186
Objectives
To determine the impact of pharmacist-provided continuous care and electronic communication on readmissions among a group of high-risk patients.Design
Pragmatic interventional study with 5:1 matched control.Setting and participants
Patients discharged from any of 4 hospitals with chronic obstructive pulmonary disease, pneumonia, heart failure, acute myocardial infarction, or diabetes within Pennsylvania. Patients in the intervention group received consultative services from inpatient pharmacists before discharge and inpatient–to–community pharmacist communication of hospitalization information facilitated with the use of a secure messaging system. After discharge, patients received up to 5 in-person or telephonic medication management consultations with their community pharmacists.Main outcome measures
The principal end point was 30-day readmission. Secondary end points included time to event (readmission, emergency department [ED] visit, death, or composite of hospitalization, ED, or death) over 90 days after discharge. Financial feasibility and sustainability were also assessed with the use of a return-on-investment (ROI) model based on information within the subset of patients with health plan coverage.Results
Among patients who received inpatient intervention plus consultation with community pharmacists compared with matched control patients, we observed a lower 30-day readmission rate (9% vs. 15%, respectively; P = 0.02), 30-day all-cause mortality (2% vs. 5%; P = 0.04), and composite 30-day end point of readmission, ED visit, or death (22% vs. 28%; P = 0.09). Differences between the groups diminished and no longer maintained statistical significance at 90 days. An estimated average ROI of 8.1 was also observed among the subset with health plan information (worst base case range 1.9–16.3).Conclusion
Connecting community pharmacists to inpatient pharmacists during the transitional hospital-to-home time frame is feasible and resulted in lower 30-day readmissions and significant ROI, that is, significant impact on health care utilization and total health care costs. Results of this study have broad implications for improving the care of high-risk patients moving from hospital to home, most notably in the engagement of community pharmacists after discharge to assure medication use and follow-up to reduce readmissions and total costs of care. 相似文献16.
William R. Doucette Julia J. Rippe Caroline A. Gaither David H. Kreling David A. Mott Jon C. Schommer 《Journal of the American Pharmacists Association》2017,57(1):72-76.e1
Objectives
To describe services provided by community pharmacies and to identify factors associated with services being provided in community pharmacies.Design
Cross-sectional national mail survey.Setting and participants
Pharmacists actively practicing in community pharmacies (independent, chain, mass merchandisers, and supermarkets).Outcome measures
Frequency and type of pharmacy services available in a community pharmacy, including medication therapy management, immunization, adjusting medication therapy, medication reconciliation, disease state management, health screening or coaching, complex nonsterile compounding, and point-of-care testing.Results
With a 48.4% response rate, the survey showed that community pharmacies offered on average 3 of the 8 services studied. Pharmacy chains and supermarket pharmacies reported providing significantly more services than did mass merchandise pharmacies. The number of pharmacy services provided was positively associated with involvement in an interprofessional care team, innovativeness, and perceived workload. The number of pharmacy services was negatively correlated with having 3.5 or more pharmacy technicians on duty.Conclusion
Pharmacy chains and supermarkets are providing the most pharmacy services among community pharmacy settings. The number of services provided was associated with innovativeness, technician staffing, and perceived workload. Also, involvement with an interprofessional care team supported greater service delivery. Community pharmacies vary in their provision of services beyond dispensing. 相似文献17.
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Amy Shaver Melissa Morano Jill Pogodzinski Stacy Fredrick David Essi Erin Slazak 《Journal of the American Pharmacists Association》2019,59(2):202-209