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1.
Maria Sjölander Lars Lindholm Bettina Pfister Jeanette Jonsson Jörn Schneede Hugo Lövheim Maria Gustafsson 《Research in social & administrative pharmacy》2019,15(3):287-291
Background
Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far.Objectives
To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments.Methods
Economic evaluation of a randomised controlled trial conducted in two hospitals in Northern Sweden between January 2012 and December 2014. Participants included 460 hospital-admitted older patients with dementia or cognitive impairments. Patients were randomly assigned to usual care, or usual care with pharmacist intervention; the intervention consisted of medication reconciliation, medication review, and participation in ward rounds. The outcomes were measured as drug-related readmissions to hospital as assessed by a group of external experts, 180 and 30 days after discharge. Costs included pharmacists' direct labour costs for the interventions, average costs for drug-related readmissions, and from this the total cost per person was calculated.Results
The effect of the intervention on drug-related readmissions within 180 days was significant in patients without heart failure (subgroup analysis), and the intervention resulted in cost savings of €950 per person in this subgroup. Drug-related readmissions within 30 days were reduced in the total sample (post-hoc analysis), and the cost-savings in this intervention group were €460 per person.Conclusions
Post-hoc and subgroup analyses indicate that engagement of pharmacists in hospital ward teams reduced the number of drug-related readmissions, and that the cost per person was lower in the intervention group compared to the control group. Including clinical pharmacists created savings in the subgroups of older patients with dementia or cognitive impairments. 相似文献2.
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3.
Kyle R. Frazier Kimberly C. McKeirnan Sorosh Kherghehpoush Lisa J. Woodard 《Journal of the American Pharmacists Association》2019,59(2):210-216
Objective
To understand rural patient opinions regarding their willingness to participate in pharmacist-provided chronic condition management.Design
Qualitative semi-structured key informant interview using The Concept of Access as a theoretical framework.Setting
Three community pharmacies serving patients in rural Washington State from November 2016 to November 2017.Participants
Current patients from 3 rural independent community pharmacies.Main Outcome Measures
Qualitative analysis of patient attitudes, acceptance, perceptions, and preferences regarding pharmacist-provided chronic condition management services in a community pharmacy.Results
Eighteen key informant interviews were conducted between November 2016 and November 2017. Five themes were identified: trust between the pharmacist, patient, and physician is key; patients already value pharmacists’ knowledge about chronic condition medications; participants identified the pharmacist as the first point of contact with regard to understanding appropriate use of medications to treat medical conditions; implementing clinical services in the community pharmacy setting may reduce the need for doctors’ visits and improve timely patient care; and creating designated clinical space, appointment options, and efficient service may increase patient accommodation.Conclusion
Management of chronic conditions continues to be one of the largest health care expenditures in the United States. One promising method of addressing this public health concern is through sustainable clinical pharmacy services. The themes identified in this study provide insight into factors that community pharmacists might consider as medical provider status continues to gain momentum and the use of clinical pharmacy services becomes more prominent. 相似文献4.
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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6.
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Ashley N. Hannings Lori J. Duke Linda D. Logan Bradford L. Upchurch Jodi C. Kearney Andrew Darley Lindsey H. Welch Kay L. Brooks Michelle B. McElhannon 《Journal of the American Pharmacists Association》2019,59(2):228-231.e1
Objective
To assess patients’ perceptions of student pharmacist–run mobile influenza immunization clinics, including satisfaction, comfort, comparison to other experiences, and the views of pharmacists as immunizers.Methods
A 7-item survey was designed to assess patient satisfaction with receiving influenza vaccinations from student pharmacists, to compare the experience with vaccines received in nonpharmacy settings, and to determine the impact of the experience on patients’ views of pharmacist-administered vaccines. The anonymous survey was provided to patients in the postvaccination monitoring area for campus and non–campus mobile clinics from September through October of 2017.Results
Student pharmacists administered 1303 immunizations to patients at 27 campus or community-based mobile clinics. Of 928 patients (71.2% response rate) completing the survey, 90.9% had previously received at least 2 prior influenza vaccinations. More than 98% of patients were very satisfied or satisfied with the student pharmacist–run mobile flu clinic. Similarly, more than 98% of patients were very comfortable or comfortable receiving immunizations from a student pharmacist, and 99.9% of patients rated the experience as either better or similar to previous vaccinations received in nonpharmacy settings. Although 53.4% already used pharmacists as an immunization resource, an additional 38.5% reported they were more comfortable with pharmacists providing vaccinations as a result of the experience. Only 8.1% of patients reported that they would rather receive vaccinations from a physician or nurse. Reasons cited for choosing the mobile clinic for vaccination included convenience (92.2%), cost (35.8%), and positive past experience (28.9%).Conclusion
Patients were very satisfied with influenza vaccinations provided by student pharmacists in mobile clinics. The experience appeared to positively affect participants’ views of pharmacists as vaccine providers. Proper training, education, and skill development of student pharmacists are essential for ensuring patient safety and for obtaining and maintaining the trust of the patient and health care community. 相似文献11.
Amy Shaver Melissa Morano Jill Pogodzinski Stacy Fredrick David Essi Erin Slazak 《Journal of the American Pharmacists Association》2019,59(2):202-209
Objectives
The primary objective of this study was to evaluate the impact of a transitions-of-care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmissions.Design, setting, and participants
A TOC program in an outpatient pharmacy, driven primarily by student pharmacists, provided telephone-based counseling to recently discharged patients. The calls were conducted within 2 to 7 days after discharge and focused on medication counseling and reconciliation, as well as promotion of a physician follow-up visit. The goal of this program was to decrease hospital readmissions among patients discharged with a cardiovascular-related diagnosis. Patient-specific information was recorded in a spreadsheet, including discharge diagnosis, and readmission diagnosis for those who returned to an inpatient facility within 30 days. This study was a retrospective chart review. Data were manually extracted from the program’s data spreadsheet and the institution’s electronic medical record for patients referred to the TOC program from June through November 2017. Patients discharged to hospice, prison, or a long-term care facility were excluded from analysis. Researchers collected information on patient demographics, diagnoses, and readmissions. Data analyses were performed with the use of SAS 9.4.Outcome measures
The primary outcome measure was 30-day all-cause readmission, and the secondary measure was 30-day related readmission.Results
A total of 1219 encounters were examined. Compared with those patients without TOC participation, those who used the TOC program had a 67% decreased odds of all-cause 30-day readmission (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.22–0.48; P < 0.0001) and a 62% decreased odds of a related readmission (OR 0.38, 95% CI 0.18–0.82; P = 0.008).Conclusion
Community pharmacists and Advanced Pharmacy Practice Experience–level student pharmacists have the potential to make a significant impact on reducing hospital readmission rates. 相似文献12.
Bram J. Mertens Henk-Frans Kwint Rob J. van Marum Marcel L. Bouvy 《Research in social & administrative pharmacy》2019,15(3):303-309
Background
Multidose drug dispensing (MDD) is used to help patients take their medicines appropriately. Little is known about drug regimen changes within these MDD systems and how they are effectuated by the community pharmacist. Manual immediate adjustments of the MDD system could introduce dispensing errors. MDD guidelines therefore recommend to effectuate drug regimen changes at the start of a new MDD system.Objective
The aim of this study was to investigate the frequency, type, procedure followed, immediate necessity, and time taken to make MDD adjustments.Methods
This was a cross-sectional study in eight community pharmacies in the Netherlands. All adjustments to MDD systems were systematically documented for 3 weeks by the community pharmacist.Results
Overall, 261 MDD adjustments involving 364 drug changes were documented for 250 patients: 127 (35%) drug changes involved the addition of a new drug, 124 (34%) a change in dosage, and 95 (26%) drug discontinuation. Of the MDD adjustments, 135 (52%) were effectuated immediately: 81 (31%) by adjusting the MDD system manually, 49 (19%) by temporarily dispensing the drug separately from the MDD system, and 5 (2%) by ordering a new MDD system. Pharmacists considered that 36 (27%) of the immediate MDD adjustments could have been deferred until the next MDD system was produced. Immediate adjustment took significantly longer than deferred adjustment (p?<?0.001).Conclusions
This study shows that in patients using MDD systems, over half of the drug regimen changes are adjusted immediately. The necessity of these immediate changes should be critically evaluated. 相似文献13.
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Monica Zolezzi Oraib Abdallah Nadir Kheir Abdelsalam Gomaa Abdelsalam 《Research in social & administrative pharmacy》2019,15(3):252-259
Background
Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD.Objectives
To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services.Methods
A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin® and Crestor®) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation.Results
The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin® scenario than to the Crestor® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p?=?0.03); whereas significantly more pharmacists in the Crestor® scenario compared to the Aspirin® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p?=?0.02). Significantly more pharmacists exposed to the Aspirin® scenario provided explanation about CVD risk than those exposed to the Crestor® scenario 36% versus 8%, p?<?0.01).Conclusion
The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services. 相似文献15.
Mai H. Duong Rebekah J. Moles Betty Chaar Timothy F. Chen 《Research in social & administrative pharmacy》2019,15(3):260-266
Background
Persistent medicine shortages have highlighted that global access to essential medicines remain problematic. Existing supply chain vulnerabilities impact health systems and risk consumer safety.Objectives
This study aimed to examine how different key stakeholders’ roles facilitate access to essential medicines.Methods
In depth interviews were conducted with 47 participants across seven stakeholder groups globally. Stakeholders included government, academics, consumer groups, non-profit organizations, hospital healthcare providers, manufacturers, and wholesaler/distributors. An inductive approach to data analysis was undertaken. A pragmatic Grounded Theory “approach” was adopted, using tools such as open, axial, and selective coding. Thematic content analysis was applied to the comprehensive theory of collaboration to provide a contextual management framework to interpret themes. Results were displayed in Ishikawa fishbone diagrams for decision making and the logistics process.Results
Findings showed that logistics management and therapeutic decision making were managed separately by stakeholders. Interestingly, hospital pharmacists had overlapping roles in patient care decisions and supply chain logistics, highlighting their importance as supply chain managers. Furthermore, despite the significant role that wholesalers/distributors had in managing supply disruptions and shortages, they were not involved in the decision-making process and did not participate in therapeutic selection committees. Additionally, sometimes stakeholders’ intended control mechanisms contributed to increasing the complexity of the supply chain.Conclusion
There is a need for improved and innovative stakeholder engagement. Expanding the role of pharmacy to include hospital formulary pharmacists and including wholesaler/distributors in therapeutic selection committee decisions could improve these collaborations, may help to align the selection and procurement of medicines processes. 相似文献16.
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17.
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18.
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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20.
Kenneth C. Hohmeier Nancy Borja-Hart Maureen Cooper James Kirby Cindy Fisher 《Journal of the American Pharmacists Association》2017,57(1):82-85