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Journal of the American Pharmacists... 2022Primary care may offer innovations in delivering comprehensive medication reviews (CMRs).
BACKGROUND
Primary care may offer innovations in delivering comprehensive medication reviews (CMRs).
OBJECTIVES
This study aimed to (1) describe innovations to improve delivery and impact of CMR, (2) quantify CMR completion rates and patient satisfaction, and (3) characterize medication changes and impact on medication costs.
PRACTICE DESCRIPTION
Board-certified ambulatory care pharmacists with collaborative practice agreements embedded in primary care provided CMRs in 5 clinics for eligible university prescription plan retirees.
PRACTICE INNOVATION
Innovations included (1) physician review of potential CMR recipient list, (2) use of trained student pharmacists to recruit and set up CMR visits, (3) use of clinical information in a standardized CMR 2-visit approach by embedded pharmacists, and (4) enrollment into disease management programs or referrals to other providers.
EVALUATION METHODS
Data from a retrospective cohort were collected. The CMR completion rate and therapeutic interventions were documented. Prescription fill data were available for 6 months before and after the CMR. An anonymous survey assessed patient satisfaction. Frequencies and descriptive statistics characterized completion rate, interventions, and patient satisfaction. The median cost to the plan of deleted versus added medications and per member per month total drug costs before and after the CMR were compared.
RESULTS
Among 729 beneficiaries screened, 489 were eligible and 223 (46%) received a CMR. There were 388 medication interventions: the most common intervention was to delete medications (41.0%). One in 4 was enrolled into the pharmacists' disease management programs. Individuals reported 4.68 (SD 0.67) of 5 for helpfulness of the CMR. The ratio of median costs for medication deletions versus additions was $1.46 vs. $1.00.
CONCLUSION
Innovations to deliver CMRs capitalized on well-established physician-pharmacist relationships and nonpharmacist personnel to recruit and prepare the intake. Almost half of eligible beneficiaries received a CMR, and the CMRs were impactful for patients and payers. The most prevalent intervention was to discontinue medications for efficacy reasons.
Topics: Humans; Medicare Part D; Medication Review; Medication Therapy Management; Pharmaceutical Preparations; Pharmacists; Primary Health Care; Retrospective Studies; United States
PubMed: 34696978
DOI: 10.1016/j.japh.2021.09.015 -
Pharmacotherapy Jan 2014Drug shortages affect every aspect of patient care, including and especially, nutrition therapy. The purpose of this review is to discuss current parenteral... (Review)
Review
Drug shortages affect every aspect of patient care, including and especially, nutrition therapy. The purpose of this review is to discuss current parenteral nutrition-related drug shortages, including causes and duration of the disruptions, and provide recommendations for managing specific nutritional shortages that minimize negative patient care outcomes. A general framework for the management of current and future shortages is presented.
Topics: Adult; Disease Management; Humans; Micronutrients; Parenteral Nutrition; Pharmaceutical Preparations
PubMed: 24399661
DOI: 10.1002/phar.1350 -
American Journal of Health-system... Mar 2014An integrated clinical and specialty pharmacy practice model for the management of patients with multiple sclerosis (MS) is described. (Review)
Review
PURPOSE
An integrated clinical and specialty pharmacy practice model for the management of patients with multiple sclerosis (MS) is described.
SUMMARY
Specialty medications, such as disease-modifying therapies (DMTs) used to treat MS, are costly and typically require special administration, handling, and storage. DMTs are associated with high rates of nonadherence and may have associated safety risks. The University of Illinois Hospital and Health Sciences System developed an MS pharmacy practice model that sought to address the many challenges of coordinating care with multiple entities outside the health system. Several key features of the integrated model include a dedicated clinical pharmacist on the MS specialty team, an integrated specialty pharmacy service, direct access to the electronic medical record, and face-to-face interaction with patients. Through the active involvement of the neurology clinical pharmacist and an onsite specialty pharmacy service, targeted assessments and medication and disease education are provided to the patient before DMT initiation and maintained throughout therapy. In addition, the regular point of contact and refill coordination encourages improved compliance, appropriate medication use, ongoing safety monitoring, and improved communication with the provider for quicker interventions. This fosters increased accessibility, convenience, and patient confidence. Improving patient outcomes--the priority goal of this service model--will be assessed in future planned studies. Through this new practice model, providers are empowered to incorporate specialty medication management into transitions in care, admission and discharge quality indicators, readmissions, and other core measures.
CONCLUSION
An integrated pharmacy practice model that includes an interdisciplinary team of physicians, nurses, and pharmacists improved patient compliance with MS therapies.
Topics: Delivery of Health Care, Integrated; Disease Management; Humans; Multiple Sclerosis; Patient Care Team; Patient Compliance; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacists; Professional Role
PubMed: 24589537
DOI: 10.2146/ajhp130495 -
American Journal of Health-system... Aug 2020As health systems continue to expand pharmacy and clinical services, the ability to evaluate potential medication safety risks and mitigate errors remains a high...
PURPOSE
As health systems continue to expand pharmacy and clinical services, the ability to evaluate potential medication safety risks and mitigate errors remains a high priority. Workload and productivity monitoring tools for the assessment of operational and clinical pharmacy services exist. However, such tools are not currently available to justify medication safety pharmacy services. The purpose of this study is to determine methods used to assess, allocate, and justify medication safety resources in pediatric hospitals.
METHODS
A 32-question survey was designed and distributed utilizing the Research Electronic Data Capture (REDCap) tool. The survey was disseminated to 46 pediatric hospitals affiliated with the Children's Hospital Association (CHA). The survey was distributed in October 2018, and the respondents were given 3 weeks to submit responses. Data analysis includes the use of descriptive statistics. Categorical variables were summarized by frequencies and percentages to distinguish the differences between pediatric health systems.
RESULTS
Of 26 respondents, 15.4% utilized metrics to justify medication safety resources. Metrics utilized were based on medication dispenses, projects, and error coding. Twenty-three percent of respondents were dissatisfied with current pharmacy-based medication safety resources within the organization. There was variability of medication safety resources within pediatric hospitals, including the number of dedicated full-time equivalents, time spent on tasks, and task prioritization.
CONCLUSION
Assessing medication safety resources at various pediatric hospitals highlights several potential barriers and opportunities. This information will serve as the foundation for the creation of a standardized workload assessment tool to assist pharmacy leaders with additional resource justification.
Topics: Benchmarking; Efficiency, Organizational; Hospitals, Pediatric; Humans; Medication Errors; Patient Safety; Pharmaceutical Preparations; Pharmacy Service, Hospital; Surveys and Questionnaires; Workload
PubMed: 32815535
DOI: 10.1093/ajhp/zxaa177 -
Family Medicine May 2011Electronic personal health records (PHRs) allow patients access to their medical records, self-management tools, and new avenues of communication with their health care... (Review)
Review
BACKGROUND AND OBJECTIVES
Electronic personal health records (PHRs) allow patients access to their medical records, self-management tools, and new avenues of communication with their health care providers. They will likely become a valuable component of the primary care Patient-centered Medical Home model. Primary care physicians, who manage the majority of chronic disease, will use PHRs to help patients manage their diabetes and other chronic diseases requiring continuity of care and enhanced information flow between patient and physician. In this brief report, we explore the evidence for the value of PHRs in chronic disease management.
METHODS
We used a comprehensive review of MEDLINE articles published in English between January 2000 and September 2010 on personal health records and related search terms.
RESULTS
Few published articles have described PHR programs designed for use in chronic disease management or PHR adoption and attitudes in the context of chronic disease management. Only three prospective randomized trials have evaluated the benefit of PHR use in chronic disease management, all in diabetes care. These trials showed small improvements in some but not all diabetes care measures. All three trials involved additional interventions, making it difficult to determine the influence of patient PHR use in improved outcomes.
CONCLUSIONS
The evidence remains sparse to support the value of PHR use for chronic disease management. With the current policy focus on meaningful use of electronic and personal health records, it is crucial to investigate and learn from new PHR products so as to maximize the clinical value of this tool.
Topics: Chronic Disease; Communication; Databases, Bibliographic; Disease Management; Electronic Health Records; Health Records, Personal; Humans; Medical Record Linkage; Patient-Centered Care; Physician-Patient Relations; Self Care; United States
PubMed: 21557106
DOI: No ID Found -
International Journal of Clinical... Jun 2010Reviewing the current literature to guide clinicians managing medications in the setting of liver disease. (Review)
Review
OBJECTIVE
Reviewing the current literature to guide clinicians managing medications in the setting of liver disease.
LITERATURE SOURCES
Using the terms liver disease, medication management, and therapeutic monitoring, a literature review was conducted to identify peer-reviewed articles in MEDLINE (1966-April 2009). Reference citations were reviewed as an additional resource. Published English-language literatures, articles and trials were reviewed. Emphasis was placed on prospective, randomised, double-blind, placebo-controlled clinical trials.
QUESTION SYNTHESIS
An informed decision on how to manage medications in the setting of liver disease should account for changes that transpire in a medication's first-pass metabolism, protein binding, volume of distribution, clearance and pharmacodynamic interactions. To incorporate these issues within one's thought process, clinicians can utilise the following six questions to evaluate a medication use: (i) Is the patient experiencing acute or chronic liver failure? (ii) Does the drug have high hepatic first-pass metabolism? (iii) Is the medication highly protein-bound? (iv) Is there a change in the volume of distribution for the medication? (v) Is the clearance of the medication significantly altered? and (vi) Is there a pharmacodynamic interaction with the medication?
CONCLUSIONS
The introduction and use of six clinically relevant questions in the setting of liver disease can serve as a guide to clinicians who manage patients with liver disease.
Topics: Biological Availability; Contraindications; End Stage Liver Disease; Humans; Liver Failure, Acute; Pharmaceutical Preparations; Protein Binding; Surveys and Questionnaires
PubMed: 20584219
DOI: 10.1111/j.1742-1241.2010.02364.x -
Nursing ResearchClinicians may place more weight on vocal complaints of pain than the other pain behaviors when making decisions about pain management.
BACKGROUND
Clinicians may place more weight on vocal complaints of pain than the other pain behaviors when making decisions about pain management.
OBJECTIVES
We examined the association between documented pain behaviors and pharmacological pain management among nursing home residents.
METHODS
We included 447,684 residents unable to self-report pain, with staff-documented pain behaviors (vocal, nonverbal, facial expressions, protective behaviors) and pharmacological pain management documented on the 2010-2016 Minimum Data Set 3.0. The outcome was no pharmacological pain medications, as needed only (pro re nata [PRN]), as scheduled only, or as scheduled with PRN medications. We estimated adjusted odds ratios and 95% confidence intervals from multinomial logistic models.
RESULTS
Relative to residents with vocal complaints only, those with one pain behavior documented (i.e., nonverbal, facial, or protective behavior) were more likely to lack pain medication versus scheduled and PRN medications. Residents with multiple pain behaviors documented were least likely to have no treatment relative to scheduled with PRN medications, PRN only, or scheduled only pain medication regimens.
DISCUSSION
The type and number of pain behaviors observed are associated with pharmacological pain management regimen. Improving staff recognition of pain among residents unable to self-report is warranted in nursing homes.
Topics: Aged; Behavioral Symptoms; Female; Humans; Male; Nursing Homes; Pain; Pain Management; Pharmaceutical Preparations
PubMed: 34160183
DOI: 10.1097/NNR.0000000000000509 -
Farmacia Hospitalaria : Organo Oficial... Jun 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Medication Reconciliation; Medication Systems, Hospital; Pandemics; Pharmaceutical Preparations; Pharmacy Service, Hospital; Pneumonia, Viral; Protective Devices; SARS-CoV-2
PubMed: 32533677
DOI: 10.7399/fh.11481 -
Journal of Managed Care & Specialty... Feb 2016All Department of Veterans Affairs Medical Centers (VAMCs) operate under a single national drug formulary, yet substantial variation in prescribing and spending exists...
BACKGROUND
All Department of Veterans Affairs Medical Centers (VAMCs) operate under a single national drug formulary, yet substantial variation in prescribing and spending exists across facilities. Local management of the national formulary may differ across VAMCs and may be one cause of this variation.
OBJECTIVE
To characterize variation in the management of nonformulary medication requests and pharmacy and therapeutics (P&T) committee member perceptions of the formulary environment at VAMCs nationwide.
METHODS
We performed an online survey of the chief of pharmacy and an additional staff pharmacist and physician on the P&T committee at all VAMCs. Respondents were asked questions regarding criteria for use for nonformulary medications, specific procedures for ordering nonformulary medications in general and specific lipid-lowering and diabetes agents, the appeals process, and the formulary environment at their VAMCs. We compared responses across facilities and between chiefs of pharmacy, pharmacists, and physicians.
RESULTS
A total of 212 chief pharmacists (n = 80), staff pharmacists (n = 78), and physicians (n = 54) responded, for an overall response rate of 49%. In total, 107/143 (75%) different VAMCs were represented. The majority of VAMCs reported adhering to national criteria for use, with 38 (36%) being very adherent and 69 (65%) being mostly adherent. There was substantial variation between VAMCs regarding how nonformulary drugs were ordered, evaluated, and appealed. The nonformulary lipid-lowering drugs ezetimibe, rosuvastatin, and atorvastatin were viewable to providers in the order entry screen at 67 (63%), 67 (63%), and 64 (60%) VAMCs, respectively. The nonformulary diabetes medication pioglitazone was only viewable at 58 (55%) VAMCs. In the remaining VAMCs, providers could not order these nonformulary drugs through the normal order-entry process. For questions about the formulary environment, physician respondent perceptions differed from those of staff pharmacists and chief pharmacists. Compared with pharmacy chiefs and staff pharmacists, physicians were less likely to agree that providers at their VAMC prescribed too many nonformulary medications (47% and 44% vs. 12%, P < 0.001), more likely to agree that providers must jump through too many hoops to prescribe nonformulary medication (5% and 3% vs. 25%, P < 0.001), and more likely to agree that providers make an effort to convert new patients from nonformulary to formulary lipid-lowering (65% and 73% vs. 94%, P <0.02) and diabetic medications (49% and 50% vs. 88%, P < 0.001).
CONCLUSIONS
Although the Department of Veterans Affairs (VA) operates under a single national formulary, we found significant differences among VAMCs regarding their management of nonformulary medication requests. We also found differences among formulary leaders regarding their perception of the environment in which their VAMC's formulary is managed. These findings have important implications not just for VA, but for any organization that develops, implements, and manages drug formularies across multiple facilities.
Topics: Delivery of Health Care; Diabetes Mellitus; Disease Management; Drug Prescriptions; Humans; Hypoglycemic Agents; Pharmacists; Pharmacy; Pharmacy Service, Hospital; Physicians; Veterans
PubMed: 27015250
DOI: 10.18553/jmcp.2016.14251 -
Boletin Medico Del Hospital Infantil de... 2017With the appearance of Homo sapiens, the biological order was gradually replaced by the anthropocentric cultural order (CO), in which traditions, appreciations,... (Review)
Review
With the appearance of Homo sapiens, the biological order was gradually replaced by the anthropocentric cultural order (CO), in which traditions, appreciations, preferences and desires for possession and domination guided their interactions with nature (predation or care), within the group (ranks, classes) and with others groups (commerce, wars). Current CO, characterized by unlimited profit interests, extreme wealth concentration and inequality where moral degradation hits rock bottom and planetary ecosystem is devastated, shows a collapsed civilization with a background of a global media controlled anesthetized societies. Regarding the health field, control works by prevalent ideas and practices: sickness as a strange object to the body, health as an imperative vital ideal and technologically based suppressive medicine shaping life's medicalization, main control "device" and health industry support. Other alternative ideas and practices are discussed: sickness as an inner harmony disturbance or as a differentiated and particular way of human beings, and stimulating medicine, that targets sick people with the purpose of strengthening and harmonizing them so they may recover, alleviate or appease. Considerations about possibilities and significance of stimulating medicine are made at the end.
Topics: Cultural Characteristics; Delivery of Health Care; Disease; Humans; Medicalization; Socioeconomic Factors
PubMed: 29382523
DOI: 10.1016/j.bmhimx.2017.06.002