RESUMEN
An estimated 20% of patients experience a postdischarge adverse event in the 30 days after hospital discharge, with approximately two-thirds of these events considered preventable or ameliorable. Numerous transitional care interventions have been developed and implemented by clinical pharmacists to reduce postdischarge adverse drug events and readmissions; however, most efforts are focused on the admission and discharge process. Low-quality evidence and mixed results from evaluations of postdischarge interventions have left health care organizations unsure which interventions provide the greatest value and how to optimize their implementation. Comprehensive medication management (CMM) is an approach, usually delivered by a pharmacist in collaboration with the health care team, which aims to standardize the wide variability in medication-specific pharmacist-led services to optimize medication use and improve clinical outcomes. This article aims to discuss how CMM can be used to cultivate best practices in care transitions.
Asunto(s)
Administración del Tratamiento Farmacológico , Transferencia de Pacientes , Cuidados Posteriores , Humanos , Conciliación de Medicamentos , Alta del Paciente , FarmacéuticosRESUMEN
BACKGROUND: The role of the pharmacist in wound healing management among patients with diabetic and nondiabetic foot ulcers (DFU) is unclear. We sought to implement and evaluate an integrated pharmacist-driven comprehensive medication management (CMM) program in a multidisciplinary podiatrist-led wound healing center (WHC). OBJECTIVES: The objectives were to determine the role of the clinical pharmacist in a WHC and evaluate the impact of CMM interventions on prescribing rates and wound healing rates. METHODS: A pharmacist-driven CMM program was implemented in a podiatrist-led WHC, and an evaluation spanning 6 years was conducted. RESULTS: Overall, 1018 patients were treated over 6 years, and 515 received wound treatment after the CMM period, of which, 309 received CMM services. A total of 441 medication related problems (MRPs) were identified; most were related to medication safety (35.1%) and inappropriate or ineffective therapy (31.3%), and problems with adherence accounted for 22.5% of documented MRPs. An average of 3.41 interventions per patient were documented, and most were related to patient education (40.8%). Only metformin (20.3 vs. 34.2%; P < 0.001) and insulin prescription (57.3 vs. 73.8%; P < 0.001) prevalence increased after CMM implementation. Other prescriptions were not significantly different among patients presenting in the pre- and post-CMM periods, respectively. Wound healing rates among patients with DFU were similar before and after implementation (55 vs. 52%; P = 0.49). Likewise, wound healing rates among those with non-DFUs were similar before- and after implementation (56 vs. 53%; P = 0.56). CONCLUSION: The implementation of a novel pharmacist-driven CMM program embedded within a multidisciplinary podiatrist-managed WHC provided the initial evidence of the potential benefits of providing pharmacist-driven CMM services to patients with lower extremity ulcers. Prospective studies of CMM in this patient population are needed.
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Administración del Tratamiento Farmacológico , Farmacéuticos , Humanos , Pacientes Ambulatorios , Estudios Prospectivos , Cicatrización de HeridasRESUMEN
INTRODUCTION: The objective of this study was to identify perceived barriers and factors influencing student pursuit of research during pharmacy school. METHODS: A voluntary, paper-based or electronic questionnaire was administered to all pharmacy students at a private college of pharmacy in mandatory courses during the 2016-2017 academic year. Survey questions collected information pertaining to demographics, factors influencing student pursuit of research, and barriers to pursuit of research. Participation was incentivized with gift cards. RESULTS: A total of 623 students completed the survey (79% response rate). The average respondent was female (69.1%), 25-years old (IQR 23-26 years), employed (69.9%), and had a prior degree (66.6%). During pharmacy school, 27.3% of respondents pursued a research project. Of students not pursuing a research project during pharmacy school, the amount of interest to complete a project differed significantly between professional years (P < .01) with the second-year class having the highest interest. Lack of time (91.3%), unfamiliarity with the research process (81.8%), and too much coursework (80.5%) were cited as the top three perceived barriers that prevented students from pursuing research. A mandatory research class (87.6%), presentations describing faculty research interests (83.4%), and ability to work with a friend (83.9%) would most strongly influence students to complete research. CONCLUSIONS: Students report additional information regarding research opportunities would positively influence their decision to pursue research while in pharmacy school. Future studies should evaluate strategies to familiarize students with the research process.
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Educación en Farmacia , Farmacia , Estudiantes de Farmacia , Adulto , Femenino , Humanos , Farmacéuticos , Facultades de FarmaciaRESUMEN
PURPOSE: The reliability and validity of a survey tool that aims to assess and stratify patient care services provided by ambulatory care pharmacists were evaluated. METHODS: The Tool for Assessing Ambulatory Care Pharmacist Practice (TAAPP) was developed by updating the Pharmaceutical Care Clinical Pharmacist Questionnaire. The TAAPP is organized into 2 sections that include 5 domains derived from the Pharmacists' Patient Care Process (PPCP). The first section of the TAAPP gathers the demographic information of the respondents as well as practice site characteristics. The second section aims to assess the activities that ambulatory care pharmacists participate in when providing direct patient care, stratified by PPCP domains. After the TAAPP was created, face validity was established by the study investigators and content validity was confirmed by 5 experts in ambulatory care pharmacy. Lastly, a reliability study was conducted and included pharmacists providing ambulatory care services in outpatient clinics who had been working at their clinical practice site for at least 2 years. The survey was disseminated electronically through a national pharmacy organization listserver. RESULTS: The results of this pilot study support both face and content validity of the TAAPP survey as well as internal consistency reliability of the TAAPP scores when used to evaluate pharmaceutical practices of ambulatory care pharmacists practicing in outpatient clinics throughout the United States. CONCLUSION: Internal consistency reliability testing demonstrated that the TAAPP scores were reliable with a Cronbach's α of >0.7 for each domain and the TAAPP overall.
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Atención Ambulatoria/normas , Servicio de Farmacia en Hospital/normas , Garantía de la Calidad de Atención de Salud/métodos , Humanos , Proyectos Piloto , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
BACKGROUND: Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (PCMH) and accountable care organization (ACO) environment. PROGRAM DESCRIPTION: In 2008, the year before PCMH implementation, 36% of patients who were hospitalized at Advocate Trinity Hospital for a heart failure exacerbation were readmitted within 30 days of their hospital stay for heart failure exacerbation. This high rate of heart failure hospital readmissions, compared with national standards, drove the implementation of the PCMH at Advocate Medical Group - Southeast Center (AMG-SE), the adjoining outpatient medical clinic. A clinical pharmacist was added to the health care team to help achieve the collective goal of improving patient outcomes and decreasing hospitalizations. OBSERVATIONS: From November 1, 2009, through August 30, 2010, the clinical pharmacist conducted visits and intervened in the care of 111 chronic heart failure patients. A pre/post analysis of those 111 patients during the 10 months before and after the integration of the clinical pharmacist showed that those patients were hospitalized 63 times in the 10 months before having regularly scheduled visits with the clinical pharmacist and 30 times in the 10 months after establishing care. This reduction from 63 to 30 visits translated to an approximate 50% decrease in heart failure hospitalizations in patients being followed by the clinical pharmacist within the first 10 months. Once the clinical pharmacist became better integrated into the workflow through development of rapport with the medical team, the outcomes improved further. In an 18-month analysis from May 1, 2010, through November 30, 2011, only 2% of patients (3 of 153) designated as high-risk patients managed by the clinical pharmacist had a 30-day readmission for heart failure exacerbation. IMPLICATIONS: Outcomes-based models have expanded opportunities for clinical pharmacist involvement and can provide unique reimbursement options. Demonstration of cost savings and an improvement in quality measures are paramount to establishing and justifying the clinical pharmacist's role in a team-based model of care. DISCLOSURES: No outside funding supported this research. The authors have no conflicts of interest to disclose.
Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Readmisión del Paciente/estadística & datos numéricos , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Organizaciones Responsables por la Atención/economía , Organizaciones Responsables por la Atención/organización & administración , Organizaciones Responsables por la Atención/estadística & datos numéricos , Atención Ambulatoria/economía , Atención Ambulatoria/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Ahorro de Costo , Humanos , Administración del Tratamiento Farmacológico/economía , Administración del Tratamiento Farmacológico/organización & administración , Administración del Tratamiento Farmacológico/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Readmisión del Paciente/tendencias , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/organización & administración , Atención Dirigida al Paciente/estadística & datos numéricos , Servicios Farmacéuticos/economía , Servicios Farmacéuticos/estadística & datos numéricos , Farmacéuticos/economía , Farmacéuticos/estadística & datos numéricos , Planes de Incentivos para los Médicos/organización & administración , Planes de Incentivos para los Médicos/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Reembolso de Incentivo/organización & administración , Reembolso de Incentivo/estadística & datos numéricosAsunto(s)
Atención Ambulatoria/organización & administración , Grupo de Atención al Paciente/organización & administración , Farmacéuticos/organización & administración , Atención a la Salud/organización & administración , Humanos , Servicios Farmacéuticos/organización & administración , Estados UnidosRESUMEN
OBJECTIVE: The primary objective was to identify medication-list components preferred by patients. Secondary objectives included identifying a patient-preferred medication-list template, measuring change in patient knowledge and responsibility after using a medication list tailored to patient preference and assessing patient utilization of a personalized medication list. DESIGN: 12-week prospective presurvey and postsurvey from January 2010 to March 2011. SETTING: Anticoagulation Clinic in Downers Grove, Illinois, with approximately 400 patients. PATIENTS: 53 English-speaking patients, 18 years of age or older, and taking eight or more medications. Cognitively and/or visually impaired patients were excluded. INTERVENTION: Consenting subjects completed the prequestionnaire. Patients were then asked to visually decide their preference between three examples of medication-list templates. Personalized medication lists were created from the preferences chosen in the questionnaire and mailed to each patient. The postinterview was conducted approximately 30 days following, and patients were retested on the knowledge and responsibility questions as well as five new utilization questions about the medication list received. MAIN OUTCOME MEASURE(S): The primary objective was to identify medication-list components preferred by patients. Secondary objectives included: identifying the medication list template that patients preferred, measuring change in patient knowledge and responsibility after using the medication list tailored to patient preference, and assessing patient utilization. RESULTS: Forty-four patients preferred a more detailed medication list. Thirty subjects participated in the postquestionnaire, and 54% preferred the most complex medication list. There was no statistically significant change in knowledge or gain in patient responsibility. CONCLUSION: Patients preferred a more complex medication list as a reference to manage their home medications.
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Conciliación de Medicamentos , Prioridad del Paciente , Preparaciones FarmacéuticasRESUMEN
PURPOSE: Key issues in measuring and improving the quality of healthcare are discussed with an emphasis on applying quality-improvement principles in ambulatory care pharmacy practice. SUMMARY: The various perspectives on healthcare quality (including those of patients, providers, and payers) are reviewed, and the basic principles of quality measurement and improvement are outlined. Many healthcare practitioners believe that the most effective way to improve healthcare is through balanced consideration of the structure, process, and outcomes of healthcare services. Overall progress in improving the quality of healthcare has been slow, in part because of lack of patient engagement, use of improvement methods that have not been fully tested, and inadequate attention to the systems of providing care. Ongoing efforts of national quality-improvement organizations are reviewed, including those of the government, accreditation bodies, payers, and professional associations. Of special interest in pharmacy is the work of the Pharmacy Quality Alliance, the Patient Safety and Clinical Pharmacy Services Collaborative, and the Center for Pharmacy Practice Accreditation. Ambulatory care pharmacists have important opportunities to improve healthcare quality, including by reducing adverse drug events, improving medication reconciliation and transitions of care, fostering medication adherence, improving patient medication self-management, providing immunization services, and reducing disparities in access to medications. CONCLUSION: To be fully effective, the national priority of improving the quality of healthcare must penetrate the work of individual healthcare practitioners, including ambulatory care pharmacists.
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Atención Ambulatoria , Evaluación de Resultado en la Atención de Salud , Servicios Farmacéuticos , Garantía de la Calidad de Atención de Salud , HumanosRESUMEN
OBJECTIVES: To identify factors that have led to successful involvement of pharmacists in patient-centered medical home (PCMH) practices, identify challenges and suggested solutions for pharmacists involved in medical home practices, and disseminate findings. DATA SOURCES: In July 2011, the American Pharmacists Association Academy of Pharmacy Practice & Management convened a workgroup of pharmacists currently practicing or conducting research in National Committee for Quality Assurance-accredited PCMH practices. DATA SYNTHESIS: A set of guiding questions to explore the early engagement and important process steps of pharmacist engagement with PCMH practices was used to conduct a series of conference calls during an 8-month period. CONCLUSION: Based on knowledge gained from early adopters of PCMH, the workgroup identified 10 key findings that it believes are essential to pharmacist integration into PCMH practices.
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Servicios Comunitarios de Farmacia , Atención Dirigida al Paciente , Farmacéuticos , American Public Health Association , HumanosRESUMEN
PURPOSE: Pharmacists' provision of services unrelated to anticoagulant therapy at an anticoagulation clinic in an area of prevalent health disparities (health status differences between minority and nonminority populations) was evaluated. SUMMARY: A prospective cohort study was conducted to compare the frequency and types of additional services (i.e., services unrelated to anticoagulation) provided by pharmacists during an eight-week period at an urban clinic serving a primarily minority and socioeconomically disadvantaged patient population (clinic A) and a suburban clinic serving a primarily nonminority and affluent population (clinic B). Over the study period, additional services were provided during 42% of all patient visits (n = 444) at clinic A and 8% of all visits (n = 443) at clinic B. The most commonly provided additional services involved nonanticoagulation-related medical problems, which were addressed during about 9% of visits at clinic A and 3% of visits at clinic B; other additional services included setting up appointments, arranging transportation, and providing refills of nonanticoagulant medications. Missed appointments, early or late arrivals, and walk-in appointments were much more common at clinic A. The average daily pharmacist-staffing requirement was 3.8 hours higher at clinic A; over the entire study period, clinic A required a total of about 60 more staffed hours than clinic B. CONCLUSION: Pharmacists practicing in an anticoagulation clinic serving an area of prevalent health disparities frequently spent a substantial amount of time addressing medical problems and administrative tasks unrelated to anticoagulation therapy.
Asunto(s)
Disparidades en el Estado de Salud , Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Carga de Trabajo , Instituciones de Atención Ambulatoria/organización & administración , Anticoagulantes/administración & dosificación , Chicago , Estudios de Cohortes , Humanos , Grupos Minoritarios/estadística & datos numéricos , Estudios Prospectivos , Factores Socioeconómicos , Servicios de Salud Suburbana , Factores de Tiempo , Servicios Urbanos de Salud , Recursos HumanosRESUMEN
PURPOSE: Experience with a referral-based medication therapy management (MTM) clinic in a university medical center is described. SUMMARY: The MTM clinic's mission is to assist patients who take multiple medications due to multiple chronic conditions with the management of their drug therapy to improve or maintain their health and prevent or minimize drug-related problems. The clinical services provided at the clinic have evolved into a comprehensive program providing five distinct service areas: access, adherence, coordination of care, medication therapy review, and education. During initial visits, patient information is collected, patients are interviewed, medications are reconciled, and the pharmacist identifies and attempts to solve any immediate drug-related problems and concerns. Routine visits are scheduled monthly to coincide with a patient's medication refills. On a typical day, a minimum of two MTM pharmacists and one pharmacy technician staff the clinic. On two days of the week, three MTM pharmacists are available in the clinic. The clinic averages 9-13 scheduled patient visits per day. The MTM clinic functions as a subset of the outpatient pharmacy and is merged financially in the general operational budget of the ambulatory care pharmacy. This model of MTM patient care is intensive and comprehensive and is significantly different from the majority of MTM models currently provided by Medicare Part D plans. CONCLUSION: A referral-based MTM clinic managed by pharmacists at a university medical center outpatient pharmacy provides care to patients with the goal of improving medication access, medication adherence, continuity of care, medication therapy management, and patient education.