Senior Care Pharmacist最新文献

Background: Effective secondary stroke prevention is crucial in reducing recurrence and improving patient outcomes, particularly in low-income community-dwelling older individuals who face barriers to health care access. Proper management of modifiable risk factors, such as hypertension, hyperlipidemia, and atrial fibrillation (AF), is essential to prevent subsequent strokes in this vulnerable population. Objective This study describes medication use for secondary stroke prevention among low-income community-dwelling older individuals in Richmond, Virginia. Design: This study involved a retrospective chart review using data provided by the Mobile Health and Wellness Program (MHWP), formerly known as Richmond Health and Wellness Program. The data included patient-reported disease states and prescription medications, which was collected by faculty and students during medication reviews in the last two years. Setting The MHWP was established by the Virginia Commonwealth University in 2012 to provide free health care coordination services for older individuals living in low-income communities, including five Section 8 housing buildings in the east end of Richmond, Virginia. Patients, Participants: The study included 499 participants who were patients in the MHWP system between 2021 and 2023. Most participants were 65 years of age and older, female, and Black or African descent with a reported income of less than $1,000 per month. Interventions: Data from the MHWP charting system (2021-2023) were analyzed using SPSS 29.0 to determine antiplatelet and anticoagulation use among participants with a history of stroke/transient ischemic attack (TIA) or AF/flutter. Results: Of 499 participants, 62 (12.4%) reported having a history of stroke/TIA, and 19 (3.8%) reported AF/flutter. Aspirin was the most prescribed antiplatelet (46.8% for stroke/TIA, 36.8% for AF/flutter). However, 33.8% of stroke/TIA survivors and 21% of participants with AF/flutter were not taking any antiplatelet or anticoagulant. Stroke/TIA survivors had higher rates of hypertension (P = .011), atherosclerotic cardiovascular disease (P = .005), and epilepsy (P = .006) versus those without prior stroke/TIA. Discussion: Understanding the unique socioeconomic and health care challenges of this population in the context of secondary stroke prevention is crucial for developing effective interventions tailored to this population. In comparing disease states reported by patients with a history of stroke/TIA with other MHWP participants, hypertension emerges as the most prevalent condition. Hypertension stands out as an important modifiable risk factor for ischemic stroke due to its role in atherosclerosis development.⁹ Conclusion: More than one-third of stroke/ TIA survivors were not receiving antiplatelet or anticoagulation therapy, and almost 40% of stroke/ TIA survivors were not receiving statin

Background: Patients being discharged from acute care facilities have a high risk of hospital readmission due to medication errors. Pharmacist interventions during transitions of care (TOC) may be beneficial in identifying medication errors and improving patient outcomes when discharging to a skilled nursing facility (SNF). Objective The objective of this study was to evaluate the impact of pharmacist interventions in reducing medication errors for patients being discharged from an acute care facility to a SNF. Setting A community hospital that is part of a larger health network in Southern California. Practice Description Clinical pharmacists provide TOC interventions to high-risk patients discharging home. Practice Innovation Over a three-month period, pharmacists provided TOC interventions to patients discharging from a hospital to a SNF. A retrospective chart review evaluated documented pharmacist interventions to identify and categorize medication errors based on the potential for harm. Results Pharmacists saw 324 patients being discharged from the hospital and identified a total of 33 medication errors. A total of 61% of errors were related to incorrect dose, frequency, or route of administration, while 51.5% had a capacity to cause temporary harm. Only 1 error could have necessitated intervention to sustain life. Ultimately, 76% of pharmacist interventions were accepted by the patients' physicians or health care teams. Discussion Pharmacists' interventions, in addition to communication with the health care team, were able to prevent medication errors with potential to cause harm as patients transitioned from a hospital to a SNF. Conclusion Pharmacists can support safe transitions for patients discharging from the hospital to the SNF.

Background There is an urgent need to prepare our health care workforce for the aging population. Pharmacy programs should equip students with foundational knowledge about aging and therapeutic skills for the rising demands of health care for older adults. Objectives This study examined the relationship between initial student interest in working with older adults and change in attitudes toward aging and providing pharmacy services to older patients after participation in required aging-focused curricula. Methods We measured student pharmacists' interest and attitudes regarding aging and care of older adults in required aging-focused courses in five PharmD programs in the United States and Canada. The University of Arizona Aging and Health Care-Pharmacy (UA AHC-Pharmacy) survey, containing one student-interest question and a 40-item attitudes scale, was used. Pre- and post comparisons were used for the matched student data. The University of Arizona Institutional Review Board (IRB) approved the study (#1912243064), and other colleges received permission to participate from their college or university IRB. Results After completing the required aging-focused course, PharmD students' interest and attitudes toward aging and providing health care to older adults improved significantly compared with the beginning of the course. Less agreement with negative stereotypes of older adults and working with this population was shown. Even those with initially low interest had significantly increased attitude scores post-course. Conclusion Assessment of the impact of aging-focused curricula on student pharmacists' interest and attitudes toward aging and caring for older adults may facilitate meeting the health care demands of the growing older population.

Background In the United States, pharmacist-administered immunization is associated with increased rates of vaccination. But older adults may reside in long-term care settings not served by the community pharmacies associated with immunization gains. This descriptive summary of the Advancing Pharmacist Immunization Initiative (APII) presents an overview of our efforts to advance pharmacist-led immunization among older adults, including those in long-term care sites in communities with health disparities, through pharmacist education and outreach activities. Setting Communities with high and very high Social Vulnerability Index (SVI) and COVID-19 Vaccine Coverage Index (CVAC) scores, including those in longterm care, in a pilot region in the United States. Methods Through pharmacist education and community outreach, the APII seeks to advance pharmacist-led immunization practices. Guided by our Subject Matter Experts and Technical Expert Panel, we seek to improve pharmacist vaccine administration and advocacy nationally and improve trust and confidence in vaccines in the community. Our initial steps have focused on identifying a pilot region to test our strategies, as we prepare to scale up in subsequent years. The Institutional Review Board of the American Institutes for Research has determined that the research reported in this paper is exempt, IRB00000436 / FWA00003952. Results Based on an environmental scan, the San Antonio, Texas region was chosen as the APII pilot region; it met the criteria of high or very high SVI (0.83-very high) and CVAC (0.87-very high), 12.1% of the population is at least 65 years of age, with older adult vaccination rates below the 2021 national average for pneumococcal disease and influenza. We launched a national pharmacist education program, which showed increases in pharmacist knowledge and confidence in immunization. Conclusion Immunization reduces preventable morbidity and mortality, but it is underused. Pharmacist education could help meet access or information needs, especially since disparities in immunization and health outcomes vary geographically. By identifying communities of older adults in need of pharmacist-led immunization, and offering outreach, our program may help advance immunization.

Background Urinary incontinence is a condition prevalent in older adults and has the potential to impact health and quality of life in patients. Commonly prescribed anticholinergic medications have significant side effects that are often heightened in older adults and should be optimized and de-escalated as warranted. Given pharmacists' focus on medication regimens, pharmacists are uniquely equipped to help optimize overactive bladder (OAB) medications in long-term care. Objective To reduce inappropriate use of OAB medications in older adults residing within long-term care facilities. Methods An intervention-based quality improvement project was completed including 27 patients who were residing at multiple care settings within the long-term care facilities studied. A medication review and patient interview were conducted by a clinical pharmacist to assess OAB medication appropriateness. Recommendations for therapy modification were made to the medical team to reduce anticholinergic adverse effects while maintaining treatment effect. Results A total of eight patients (57.1%) in the intervention group reported experiencing lessened or eliminated anticholinergic adverse effects compared with only one patient (10%) reporting the same in the non-intervention group (P = 0.0333; OR [95% CI] = 10.7 [1.007-587.8]). Effects of intervention on OAB symptoms were variable but most patients did not experience worsening of symptoms. A total of 14 OAB medications were deprescribed or dose-reduced. Conclusion Pharmacist optimization of OAB medications for older individuals residing in longterm care facilities is associated with elimination of potentially unnecessary medications, potentially with improvement of adverse effects and without worsening of the OAB symptoms.