Pub Date : 2017-02-01DOI: 10.1177/8755122516677081
Kevin N. Hansen, Kathryn A. Morbitzer, Kayla M. Waldron, Lindsey B. Amerine
Background: Hospital length of stay (LOS) is an important measure to determine resource utilization and efficiency of care for inpatients. No existing objective methodology is available to determine where and how pharmacy departments can have maximal impact on reducing extended LOS. Objective: An objective methodology to guide decisions by hospital pharmacy departments on reducing extended LOS is described. Methods: University of North Carolina Medical Center’s LOS was compared to hospitals with similar inpatient bed size and case mix index. Objective methodology using pharmacy intensity weight, LOS index, and relative number of cases overall and by hospital service was developed to identify targets of impacting LOS for a pharmacy department. Results: The novel Pharmacy Opportunity Length of Stay (POLOS) formula was developed to prioritize each Medicare Severity Diagnosis Related Group (MSDRG) based on the overall impact pharmacy can have on reducing extended LOS at an individual institution. An additional novel formula, Service Specific POLOS (SSPOLOS), was created to strategically target hospital services, as opposed to MSDRGs, allowing for effective deployment of targeted pharmacy interventions to decrease extended LOS. Conclusion: POLOS and SSPOLOS are novel formulas to guide pharmacy departments in objectively prioritizing and targeting resources to reduce extended LOS. The novel formulas can be used to quantify LOS performance at the hospital and pharmacy specific levels, in addition to providing a hospital service approach to launch LOS initiatives at health care institutions. To our knowledge, this represents the first opportunity for hospital pharmacy departments to objectively target and reduce extended LOS.
{"title":"Development of Novel Formulas to Determine Hospital and Pharmacy Opportunities to Reduce Extended Length of Stay","authors":"Kevin N. Hansen, Kathryn A. Morbitzer, Kayla M. Waldron, Lindsey B. Amerine","doi":"10.1177/8755122516677081","DOIUrl":"https://doi.org/10.1177/8755122516677081","url":null,"abstract":"Background: Hospital length of stay (LOS) is an important measure to determine resource utilization and efficiency of care for inpatients. No existing objective methodology is available to determine where and how pharmacy departments can have maximal impact on reducing extended LOS. Objective: An objective methodology to guide decisions by hospital pharmacy departments on reducing extended LOS is described. Methods: University of North Carolina Medical Center’s LOS was compared to hospitals with similar inpatient bed size and case mix index. Objective methodology using pharmacy intensity weight, LOS index, and relative number of cases overall and by hospital service was developed to identify targets of impacting LOS for a pharmacy department. Results: The novel Pharmacy Opportunity Length of Stay (POLOS) formula was developed to prioritize each Medicare Severity Diagnosis Related Group (MSDRG) based on the overall impact pharmacy can have on reducing extended LOS at an individual institution. An additional novel formula, Service Specific POLOS (SSPOLOS), was created to strategically target hospital services, as opposed to MSDRGs, allowing for effective deployment of targeted pharmacy interventions to decrease extended LOS. Conclusion: POLOS and SSPOLOS are novel formulas to guide pharmacy departments in objectively prioritizing and targeting resources to reduce extended LOS. The novel formulas can be used to quantify LOS performance at the hospital and pharmacy specific levels, in addition to providing a hospital service approach to launch LOS initiatives at health care institutions. To our knowledge, this represents the first opportunity for hospital pharmacy departments to objectively target and reduce extended LOS.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"20 1","pages":"15 - 22"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86911515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1177/8755122516678266
Michelle N. Schroeder, J. Potter, K. DiDonato, Aaron J. Lengel, M. F. Powers
Background: Convenient Care Clinics (CCCs) located within the same facility as a retail pharmacy offer the opportunity for immediate fill of prescriptions from the CCC and may also provide a source of new customers for the pharmacy. Objective: To assess the impact of a follow-up intervention on new patients seen at a CCC returning to the pharmacy for subsequent prescription fills compared to the control group. Methods: New patients who filled a prescription from the CCC in November and December 2015 received an initial follow-up telephone call or letter, respectively, from the pharmacist within 10 days of their prescription fill date. The primary end point of the percentage of patient return was assessed for 3 months following the initial fill date. Secondary end points included number of prescriptions transferred and customer satisfaction scores. Results: Thirty-four out of 214 patients in the control group returned to the pharmacy for subsequent prescription fills (15.9%). Fourteen out of 52 patients in the telephone group returned to the pharmacy for additional prescription fills following a telephone call from the pharmacist. (26.9%, P = .063) Sixteen out of 77 patients in the letter group returned to the pharmacy after their first prescription. (20.8%, P = .329). Conclusions: Following-up with new patients to the pharmacy in the form of a personalized telephone call increases the likelihood of patients continuing to utilize the pharmacy for their prescription needs.
背景:便利护理诊所(CCCs)与零售药房位于同一设施内，提供了从CCC立即配药的机会，也可能为药房提供新客户的来源。目的:与对照组相比，评估随访干预对在CCC就诊的新患者返回药房进行后续处方填充的影响。方法:2015年11月和12月在CCC配药的新患者，在配药后10天内，分别收到药师的电话或信件进行首次随访。在初始填写日期后的3个月内评估患者返回百分比的主要终点。次要终点包括转移处方数量和客户满意度得分。结果:对照组214例患者中有34例(15.9%)再次到药房补药。在电话组的52名患者中，有14人在接到药剂师的电话后返回药房补充处方。(26.9%， P = 0.063)信组77例患者中有16例在第一次开处方后又回到药房。(20.8%， p = .329)。结论:以个性化电话的形式对新患者进行随访，增加了患者继续利用药房满足其处方需求的可能性。
{"title":"Impact of Pharmacist Follow-up Intervention on Patient Return to a Community Pharmacy From a Convenient Care Clinic","authors":"Michelle N. Schroeder, J. Potter, K. DiDonato, Aaron J. Lengel, M. F. Powers","doi":"10.1177/8755122516678266","DOIUrl":"https://doi.org/10.1177/8755122516678266","url":null,"abstract":"Background: Convenient Care Clinics (CCCs) located within the same facility as a retail pharmacy offer the opportunity for immediate fill of prescriptions from the CCC and may also provide a source of new customers for the pharmacy. Objective: To assess the impact of a follow-up intervention on new patients seen at a CCC returning to the pharmacy for subsequent prescription fills compared to the control group. Methods: New patients who filled a prescription from the CCC in November and December 2015 received an initial follow-up telephone call or letter, respectively, from the pharmacist within 10 days of their prescription fill date. The primary end point of the percentage of patient return was assessed for 3 months following the initial fill date. Secondary end points included number of prescriptions transferred and customer satisfaction scores. Results: Thirty-four out of 214 patients in the control group returned to the pharmacy for subsequent prescription fills (15.9%). Fourteen out of 52 patients in the telephone group returned to the pharmacy for additional prescription fills following a telephone call from the pharmacist. (26.9%, P = .063) Sixteen out of 77 patients in the letter group returned to the pharmacy after their first prescription. (20.8%, P = .329). Conclusions: Following-up with new patients to the pharmacy in the form of a personalized telephone call increases the likelihood of patients continuing to utilize the pharmacy for their prescription needs.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"44 1","pages":"23 - 30"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89955875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1177/8755122516675635
Amber L. Smith, Valerie Palmer, Nada M Farhat, J. Kalus, K. Thavarajah, B. Digiovine, Nancy Macdonald
Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group (P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days (P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.
{"title":"Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease","authors":"Amber L. Smith, Valerie Palmer, Nada M Farhat, J. Kalus, K. Thavarajah, B. Digiovine, Nancy Macdonald","doi":"10.1177/8755122516675635","DOIUrl":"https://doi.org/10.1177/8755122516675635","url":null,"abstract":"Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group (P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days (P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"20 1","pages":"14 - 8"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90069726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1177/8755122516680621
Nicole A. Fabiilli, M. F. Powers
Objective: To provide an overview of medication reconciliation and to identify opportunities for pharmacy technicians to help improve patient safety and quality of care. Data Sources: Articles were identified through searches conducted in May 2016 by means of MEDLINE/PubMed (2000-2016) using search terms designed to identify English-language articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Additionally, resources on medication reconciliation were used from The Joint Commission, the Institute for Healthcare Improvement, American Pharmacists Association, American Society of Health-System Pharmacists, and Agency for Healthcare Research and Quality. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list. Pharmacy technicians can help resolve discrepancies in medication lists, therefore improving patient care, the ability of pharmacists to communicate with physicians, and thus to clinically intervene in patient care. Furthermore, with proper training, pharmacy technicians may take on expanded roles designed to aid pharmacists with advanced patient care services to eliminate medication discrepancies and improve transition of care. Conclusions: Pharmacy technicians can play a vital role in helping pharmacists to obtain accurate patient medication histories in order to decrease medication discrepancies at transitions of care.
{"title":"Roles for Pharmacy Technicians in Medication Reconciliation During Transitions of Care","authors":"Nicole A. Fabiilli, M. F. Powers","doi":"10.1177/8755122516680621","DOIUrl":"https://doi.org/10.1177/8755122516680621","url":null,"abstract":"Objective: To provide an overview of medication reconciliation and to identify opportunities for pharmacy technicians to help improve patient safety and quality of care. Data Sources: Articles were identified through searches conducted in May 2016 by means of MEDLINE/PubMed (2000-2016) using search terms designed to identify English-language articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Additionally, resources on medication reconciliation were used from The Joint Commission, the Institute for Healthcare Improvement, American Pharmacists Association, American Society of Health-System Pharmacists, and Agency for Healthcare Research and Quality. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, medication reconciliation, and transitions of care. Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list. Pharmacy technicians can help resolve discrepancies in medication lists, therefore improving patient care, the ability of pharmacists to communicate with physicians, and thus to clinically intervene in patient care. Furthermore, with proper training, pharmacy technicians may take on expanded roles designed to aid pharmacists with advanced patient care services to eliminate medication discrepancies and improve transition of care. Conclusions: Pharmacy technicians can play a vital role in helping pharmacists to obtain accurate patient medication histories in order to decrease medication discrepancies at transitions of care.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"11 1","pages":"3 - 7"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79646867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-01DOI: 10.1177/8755122516681820
S. Mohamed, Tariq Abdul Razak, R. Hashim, Zarina Mohd Ali
Bacground: Atrial fibrillation (AF) patients are 5 times more likely to have stroke than non-AF patients. Stroke prevention (SP) using anticoagulation therapy was recommended in AF patients. Knowledge about AF and SP (KAFSP) is one of the essential factors that can improve patients’ adherence. Yet no established studies were found to determine patients’ KAFSP among AF patients. Objectives: To develop and validate the questionnaire used to measure KAFSP. Methods: A cross-sectional survey was conducted in 4 hospitals in Malaysia. The psychometric of the KAFSP Questionnaire (KAFSP-Q) were performed using content validity index (CVI), internal consistency, test-retest, exploratory factor analysis (EFA), and sensitivity test. Results: A total of 304 patients completed a face-to-face interview to answer the KAFSP-Q. Content and face validity was assessed by 6 experts who are knowledgeable in this field and 15 AF patients, respectively. The KAFSP-Q had good CVI and were well understood by AF patients. The KAFSP-Q also had good reliability and stability with Cronbach’s α of .83 and intraclass correlation coefficient values in test-retest for stability of .9. The EFA results indicated that there were 6 factors with factor loadings above .30. The low correlations between subscales ranged between .01 and .48, which indicated that good discriminant and construct validity were achieved. The scale was able to differentiate between patients’ knowledge levels before and after counseling given. Conclusions: The KAFSP-Q is reliable and valid to measure patients’ KAFSP. Further validation studies are recommended to validate the KAFSP-Q in different contexts and in other languages.
{"title":"Knowledge of Atrial Fibrillation and Stroke Prevention","authors":"S. Mohamed, Tariq Abdul Razak, R. Hashim, Zarina Mohd Ali","doi":"10.1177/8755122516681820","DOIUrl":"https://doi.org/10.1177/8755122516681820","url":null,"abstract":"Bacground: Atrial fibrillation (AF) patients are 5 times more likely to have stroke than non-AF patients. Stroke prevention (SP) using anticoagulation therapy was recommended in AF patients. Knowledge about AF and SP (KAFSP) is one of the essential factors that can improve patients’ adherence. Yet no established studies were found to determine patients’ KAFSP among AF patients. Objectives: To develop and validate the questionnaire used to measure KAFSP. Methods: A cross-sectional survey was conducted in 4 hospitals in Malaysia. The psychometric of the KAFSP Questionnaire (KAFSP-Q) were performed using content validity index (CVI), internal consistency, test-retest, exploratory factor analysis (EFA), and sensitivity test. Results: A total of 304 patients completed a face-to-face interview to answer the KAFSP-Q. Content and face validity was assessed by 6 experts who are knowledgeable in this field and 15 AF patients, respectively. The KAFSP-Q had good CVI and were well understood by AF patients. The KAFSP-Q also had good reliability and stability with Cronbach’s α of .83 and intraclass correlation coefficient values in test-retest for stability of .9. The EFA results indicated that there were 6 factors with factor loadings above .30. The low correlations between subscales ranged between .01 and .48, which indicated that good discriminant and construct validity were achieved. The scale was able to differentiate between patients’ knowledge levels before and after counseling given. Conclusions: The KAFSP-Q is reliable and valid to measure patients’ KAFSP. Further validation studies are recommended to validate the KAFSP-Q in different contexts and in other languages.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"189 1","pages":"31 - 39"},"PeriodicalIF":1.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78067060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/8755122516669379
Leanne Justis, Jeremy Crain, M. Marchetti, K. Hohmeier
Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.
{"title":"The Effect of Community Pharmacy Technicians on Industry Standard Adherence Performance Measures After Cognitive Pharmaceutical Services Training","authors":"Leanne Justis, Jeremy Crain, M. Marchetti, K. Hohmeier","doi":"10.1177/8755122516669379","DOIUrl":"https://doi.org/10.1177/8755122516669379","url":null,"abstract":"Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"50 1","pages":"230 - 233"},"PeriodicalIF":1.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75092979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/8755122516663219
S. Erickson, Kayla Kornexl
Background: Little is known about the adequacy of screening for and treatment of hypertension for people with developmental disabilities (DD). Pharmacists may assist in identifying and treating this special patient population. Objective: To characterize and compare the screening, treatment, and control of blood pressure (BP) in patients with DD to patients without DD. Methods: This retrospective study identified adult patients of primary care practices within a large academic health system who had DD (DD group) and a comparator group without DD (GenMed group). Outcomes assessed included percentage of patients screened, mean BP, percentage of patients with controlled BP, and antihypertensive medications prescribed. Results: The DD (n = 183) and GenMed groups (n = 497) were nearly all screened for BP. Mean systolic BP was significantly lower in the DD group (119.9 ± 14.6 mm Hg vs 122.8 ± 15.4 mm Hg GenMed, P = .03), while diastolic BP was no different (P = .7). Stroke was documented significantly more often in the DD group (5.5% vs 1.4%, P = .005). Of patients with uncontrolled BP, the DD group had significantly higher systolic BP (155.8 ± 14.1 mm Hg vs 147.4 ± 9.5 mm Hg GenMed, P = .02). Hypertension was documented in 32% of DD group versus 38.5% of GenMed group, P = .15. Of this group, 88.1% of the DD group had controlled BP versus 78.0% of the GenMed group, P = .09. Antihypertensive prescribing was not different between the groups. Conclusion: DD group patients had similar outcomes for hypertension therapy compared to patients without DD. Those with uncontrolled BP in the DD group tended to have higher systolic BP. Significantly more DD patients had a history of stroke.
背景:对于发育障碍(DD)患者的高血压筛查和治疗的充分性知之甚少。药剂师可以协助识别和治疗这一特殊患者群体。目的:表征和比较DD患者与非DD患者的血压(BP)筛查、治疗和控制。方法:本回顾性研究确定了大型学术卫生系统中有DD的成年患者(DD组)和无DD的比较组(GenMed组)。评估的结果包括筛查患者的百分比、平均血压、血压控制患者的百分比和抗高血压药物处方。结果:DD组(n = 183)和GenMed组(n = 497)几乎全部筛查出BP。DD组的平均收缩压明显降低(119.9±14.6 mm Hg vs 122.8±15.4 mm Hg, P = 0.03)，而舒张压无差异(P = 0.7)。卒中在DD组的发生率明显更高(5.5% vs 1.4%， P = 0.005)。在血压未控制的患者中，DD组的收缩压明显升高(155.8±14.1 mm Hg vs 147.4±9.5 mm Hg, P = 0.02)。DD组高血压发生率为32%，GenMed组为38.5%，P = 0.15。在该组中，DD组88.1%的患者血压得到控制，而GenMed组78.0%，P = 0.09。两组间抗高血压处方无差异。结论:DD组患者与非DD组患者相比，高血压治疗的结果相似。DD组血压不受控制的患者倾向于有更高的收缩压。DD患者卒中史明显增加。
{"title":"Blood Pressure Screening, Control, and Treatment for Patients With Developmental Disabilities in General Medicine Practices","authors":"S. Erickson, Kayla Kornexl","doi":"10.1177/8755122516663219","DOIUrl":"https://doi.org/10.1177/8755122516663219","url":null,"abstract":"Background: Little is known about the adequacy of screening for and treatment of hypertension for people with developmental disabilities (DD). Pharmacists may assist in identifying and treating this special patient population. Objective: To characterize and compare the screening, treatment, and control of blood pressure (BP) in patients with DD to patients without DD. Methods: This retrospective study identified adult patients of primary care practices within a large academic health system who had DD (DD group) and a comparator group without DD (GenMed group). Outcomes assessed included percentage of patients screened, mean BP, percentage of patients with controlled BP, and antihypertensive medications prescribed. Results: The DD (n = 183) and GenMed groups (n = 497) were nearly all screened for BP. Mean systolic BP was significantly lower in the DD group (119.9 ± 14.6 mm Hg vs 122.8 ± 15.4 mm Hg GenMed, P = .03), while diastolic BP was no different (P = .7). Stroke was documented significantly more often in the DD group (5.5% vs 1.4%, P = .005). Of patients with uncontrolled BP, the DD group had significantly higher systolic BP (155.8 ± 14.1 mm Hg vs 147.4 ± 9.5 mm Hg GenMed, P = .02). Hypertension was documented in 32% of DD group versus 38.5% of GenMed group, P = .15. Of this group, 88.1% of the DD group had controlled BP versus 78.0% of the GenMed group, P = .09. Antihypertensive prescribing was not different between the groups. Conclusion: DD group patients had similar outcomes for hypertension therapy compared to patients without DD. Those with uncontrolled BP in the DD group tended to have higher systolic BP. Significantly more DD patients had a history of stroke.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"1 1","pages":"234 - 239"},"PeriodicalIF":1.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90066309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-03DOI: 10.1177/8755122516672693
Haley M. Phillippe, B. Wright, Kathryn E. Bowerman, Miranda Andrus
Background: Direct oral anticoagulants (DOACs) have become available recently as an alternative to warfarin in appropriate patients. Few studies have been conducted that evaluate pharmacist-managed services for the management of the DOACs. Objective: To review the appropriateness of DOAC therapy and warfarin therapy in adult patients in a university-affiliated outpatient clinic and the need for further monitoring of these agents. Methods: A retrospective chart review was conducted of patients receiving a DOAC or warfarin therapy. Indication, dose, duration, age, weight, adherence, drug interactions, bleeding risk/history, renal function, and hepatic function were evaluated for DOACs and warfarin. If prescribed warfarin, international normalized ratio readings were also obtained. The pharmacists made verbal recommendations to primary care prescribers regarding findings, and changes to therapy were reviewed and documented. Results: A total of 175 patient charts were reviewed (49% DOACs, 51% warfarin). Twenty-five percent of prescribed DOACs should have been avoided due to inappropriate indication or renal function. The majority of these were switched to warfarin after discussion with the primary care provider. Of patients prescribed DOACs, 22% had a history of poor adherence to therapy and half of these were switched to warfarin. An additional 24% of prescribed DOACs were inappropriate due to incorrect dosing, major drug interactions, and/or renal dosing; however, these medications could be appropriate if adjustments are made. Nineteen percent of patients on warfarin therapy would be a candidate for DOAC therapy. Conclusion: Although there were limitations to this analysis, the results demonstrate that additional intervention is needed to improve appropriate prescribing and monitoring of the DOACs. Pharmacists can meet this need by providing medication reviews of novel anticoagulants and educating physicians.
{"title":"Pharmacist Interventions Regarding the Appropriateness of Apixaban, Rivaroxaban, Dabigatran, and Warfarin in a University-Affiliated Outpatient Clinic","authors":"Haley M. Phillippe, B. Wright, Kathryn E. Bowerman, Miranda Andrus","doi":"10.1177/8755122516672693","DOIUrl":"https://doi.org/10.1177/8755122516672693","url":null,"abstract":"Background: Direct oral anticoagulants (DOACs) have become available recently as an alternative to warfarin in appropriate patients. Few studies have been conducted that evaluate pharmacist-managed services for the management of the DOACs. Objective: To review the appropriateness of DOAC therapy and warfarin therapy in adult patients in a university-affiliated outpatient clinic and the need for further monitoring of these agents. Methods: A retrospective chart review was conducted of patients receiving a DOAC or warfarin therapy. Indication, dose, duration, age, weight, adherence, drug interactions, bleeding risk/history, renal function, and hepatic function were evaluated for DOACs and warfarin. If prescribed warfarin, international normalized ratio readings were also obtained. The pharmacists made verbal recommendations to primary care prescribers regarding findings, and changes to therapy were reviewed and documented. Results: A total of 175 patient charts were reviewed (49% DOACs, 51% warfarin). Twenty-five percent of prescribed DOACs should have been avoided due to inappropriate indication or renal function. The majority of these were switched to warfarin after discussion with the primary care provider. Of patients prescribed DOACs, 22% had a history of poor adherence to therapy and half of these were switched to warfarin. An additional 24% of prescribed DOACs were inappropriate due to incorrect dosing, major drug interactions, and/or renal dosing; however, these medications could be appropriate if adjustments are made. Nineteen percent of patients on warfarin therapy would be a candidate for DOAC therapy. Conclusion: Although there were limitations to this analysis, the results demonstrate that additional intervention is needed to improve appropriate prescribing and monitoring of the DOACs. Pharmacists can meet this need by providing medication reviews of novel anticoagulants and educating physicians.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"40 1","pages":"245 - 252"},"PeriodicalIF":1.0,"publicationDate":"2016-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81527800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-21DOI: 10.1177/8755122516670415
T. Steckler
Telepharmacy involves pharmacist provision of clinical services at a distance and often includes electronic health record integration, audio-video connections, and increased patient access to pharmaceutical care. With the rapid expansion of this field comes critical questions that need to be answered by forward-thinking people in the profession. These issues include centralized checking workflows, potential reductions in patient counseling, and increased technician independence and responsibilities. If these points can be addressed with the needs of patients at the forefront, telepharmacy is poised to significantly advance access to care.
{"title":"Telepharmacy","authors":"T. Steckler","doi":"10.1177/8755122516670415","DOIUrl":"https://doi.org/10.1177/8755122516670415","url":null,"abstract":"Telepharmacy involves pharmacist provision of clinical services at a distance and often includes electronic health record integration, audio-video connections, and increased patient access to pharmaceutical care. With the rapid expansion of this field comes critical questions that need to be answered by forward-thinking people in the profession. These issues include centralized checking workflows, potential reductions in patient counseling, and increased technician independence and responsibilities. If these points can be addressed with the needs of patients at the forefront, telepharmacy is poised to significantly advance access to care.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"139 1","pages":"227 - 229"},"PeriodicalIF":1.0,"publicationDate":"2016-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85588000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-02DOI: 10.1177/8755122516667128
J. Goldman, J. White
Objective: To review 2 new basal insulin analogs that have been approved in the United States for use in type 1 and type 2 diabetes—insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL. Data Sources: PubMed was searched using the terms “insulin glargine 300 units/mL,” “Gla-300,” “insulin degludec,” “IDeg,” “insulin degludec 200 units/mL,” and “insulin degludec 100 units/mL” for articles published between 1995 and May 2016. Study Selection and Data Extraction: Clinical trials, meta-analyses and subanalyses were identified; review articles were excluded. Relevant citations from identified articles were also reviewed. Data Synthesis: The new basal insulins, insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL, have improved pharmacokinetic and pharmacodynamic profiles compared to insulin glargine 100 units/mL. All demonstrate longer durations of action, beyond 24 hours, and less variability. These improved profiles translate into comparable A1C reductions and comparable, or improved, levels of hypoglycemia compared to insulin glargine 100 units/mL. Conclusions: These benefits may lead to improved glycemic control in a range of patients with type 1 and type 2 diabetes with true once-daily dosing.
{"title":"Advances in Basal Insulin Therapy","authors":"J. Goldman, J. White","doi":"10.1177/8755122516667128","DOIUrl":"https://doi.org/10.1177/8755122516667128","url":null,"abstract":"Objective: To review 2 new basal insulin analogs that have been approved in the United States for use in type 1 and type 2 diabetes—insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL. Data Sources: PubMed was searched using the terms “insulin glargine 300 units/mL,” “Gla-300,” “insulin degludec,” “IDeg,” “insulin degludec 200 units/mL,” and “insulin degludec 100 units/mL” for articles published between 1995 and May 2016. Study Selection and Data Extraction: Clinical trials, meta-analyses and subanalyses were identified; review articles were excluded. Relevant citations from identified articles were also reviewed. Data Synthesis: The new basal insulins, insulin glargine 300 units/mL and insulin degludec 100 units/mL and 200 units/mL, have improved pharmacokinetic and pharmacodynamic profiles compared to insulin glargine 100 units/mL. All demonstrate longer durations of action, beyond 24 hours, and less variability. These improved profiles translate into comparable A1C reductions and comparable, or improved, levels of hypoglycemia compared to insulin glargine 100 units/mL. Conclusions: These benefits may lead to improved glycemic control in a range of patients with type 1 and type 2 diabetes with true once-daily dosing.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"46 1","pages":"260 - 268"},"PeriodicalIF":1.0,"publicationDate":"2016-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90051547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：