INNOVATIONS in pharmacy (Iip - E-Journal)
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Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting
Get PDFObjective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system.
Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence.
Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine.
Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation.
Type: Original Researc
Interview with the Medicine Man: A Case Study of a Traditional Malian Healer
Get PDFPharmacists are commonly members of medical mission teams that provide health care services in underdeveloped countries. Although pharmacists and others often find their service on a mission trip to be positive and life changing, critics of such missions note that Western providers trained in biomedicine frequently lack the cultural awareness to practice effectively in such settings. This paper is a case study of one traditional healer who practices in rural Mali. Although the results of one case from one practice setting may not be generalizable to all cultures, a basic understanding of the healer's beliefs and practices concerning the etiology and treatment of disease, the role of magic and other supernatural therapies, his experience with Western trained providers and the regulatory environment in which he works should assist pharmacists who serve on mission trips to be better culturally prepared.
Type: Case Stud
Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities
Get PDFObjectives: 1) Conduct team building activities for provider-community pharmacist teams in small communities and 2) Determine the impact of the team approach on practitioner-reported consequences and 3) Identify obstacles to the team approach and ways to overcome them.
Methods: Eleven provider-pharmacist teams were recruited in rural/micropolitan communities in Iowa. The teams participated in team building sessions facilitated by the project leaders, to discuss the team approach. Decisions included patient identification, practitioner roles, and communications. Most pharmacists conducted blood pressure (BP) checks in the pharmacy and assessed the anti-hypertensive medications. If the BP was not at goal, the pharmacist worked with the patient and provider to make improvements. Teams followed their strategies for 3-5 months. Data were collected from pharmacy logs and on-line surveys of team members before and after the team period.
Results: Using a multi-case approach, 4 cases were classified as Worked-Well, 5 as Limited-Success, and 2 as No-Team-Care. The Worked-Well teams provided an average of 26.5 BP visits per team, while the Limited-Success teams averaged 6.8 BP visits. The Worked-Well teams established and used a system to support the team approach. The Limited-Success teams either didn't fully establish their team system, or used it sparingly. The No-Team-Care cases did not provide any team care.
Conclusions: Factors supporting success were: positive provider-pharmacist relations, established team system, commitment to team care, and patient willingness to participate. While this program had some success, potential improvements were identified: more follow-up after the team building session, additional patient materials, and guidance for practice changes.
Type: Case Stud
How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration
Get PDFPurpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support.
Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital's pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy's influence on a hospital's bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI.
Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together - and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families.
Type: Commentar
Student pharmacists' and recent graduates' perception of and interest in independent pharmacy ownership
Get PDFObjectives: To assess student pharmacists' and recent graduates' interest in independent community pharmacy ownership and compare perceptions of pharmacy ownership among students and recent graduates.
Methods: An anonymous online survey was administered to student pharmacists currently licensed as interns and pharmacists licensed by examination from January 2010 to October 2012 within the state of Ohio.
Results: 355 surveys were completed during the study period, with 200 (56.3%) completed by student pharmacists. Student pharmacists were significantly more interested in pharmacy ownership (p < 0.001) and had significantly higher self-reported likelihood of ownership (p = 0.03) compared to recent graduates. Top ranked advantages to ownership for both groups included professional autonomy, development of innovative services, and amount of time spent in patient care activities. The majority of respondents had been exposed to pharmacy ownership within a course, student organization, or experiential rotation, but felt they needed more training in financial, legal, and regulatory issues.
Conclusion: Many student pharmacists and recent graduates are interested in pharmacy ownership. However, the majority of respondents feel it is unlikely they will own a pharmacy in the future. Resources need to be expanded for those interested in this career path.
Type: Original Researc
On house calls, healthcare, and hope: one student's perspective
Get PDFHealthcare providers spend years studying pathophysiology and therapeutics, often neglecting to consider the whole picture of influences on a person's health. House calls are a beneficial tool in that they provide the opportunity for trainees to experience these concepts firsthand, often opening student eyes to suffering, poverty, and unexpectedly, hope. Exposure to this broader perspective may empower health care providers to see beyond the limitations of disease and medication, into deeper issues that affect patient health.
Type: Idea Pape
Implementation of a financially incentivized weight loss competition into an already established employee wellness program
Get PDFObjective: To assess improvement in clinical outcomes and patient satisfaction of a financially incentivized weight loss competition adjunct to a currently established pharmacist-directed employee wellness program.
Design: Retrospective, cohort, pilot study
Setting: 6 independent community pharmacy chain locations, two long-term care pharmacies, and a pharmacy corporate office in northwest and central Missouri, from January 2013 to April 2013.
Participants: 24 benefit-eligible patients employed by the self- insured pharmacy chain.
Intervention: A financially incentivized weight loss competition focusing on healthy lifestyle practices was implemented at nine pharmacy locations over an eight week period.
Main outcome measure(s): Change from baseline in mean total cholesterol, serum triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI). Patient satisfaction was also assessed after completion.
Results:24 patients completed the competition. The average weight loss among all participants was 10 ± 7.3 pounds. A mean decrease in serum triglycerides was significant at 36.9 mg/dL per participant (p
Conclusion: The implementation of a financially incentivized weight loss competition provided significant short-term weight loss to a patient population that was already enrolled in an established pharmacist-directed employee wellness program and had not shown clinical improvement prior to the intervention. Overall the patients were satisfied, felt healthier, and agreed to continue following the recommendations of the program.
Type: Original Researc
Examining the Impact of a Pharmacists Postpartum Counseling Service; Evidence from a University Hospital
Get PDFPurpose: To describe a pharmacist's counseling service pertaining to methods of contraception on the postpartum unit of a university hospital and to evaluate the number of postpartum patients who desire information on contraception with the demographics of age, public or private insurance, and whether the patient was English or Spanish-speaking.
Methods: Retrospective cohort data analysis of postpartum women who received the option of counseling by a pharmacist or pharmacy intern at a university hospital over a year and 7 month period. There were 2,048 cases included for this study. The total number of patients who wanted information as well as pharmacist preparation time and counseling time were also noted.
Results: Patients who were interested in a hormonal contraception method were 3 times more likely to desire counseling compared with patients who declined information (p<0.05). Also, patients who wanted an implantable form of contraception were 8 times more likely to desire information compared with patients who declined counseling (p<0.05). Patients in the age range of 18-25, 26-30, and 31-45 years were less likely (56%, 64%, & 65%) to want counseling compared with the age range of 12-17 years (all p<0.05). Lastly, patients who spoke Spanish were 3 times more likely to have been counseled compared with non-Spanish speaking patients. The number of postpartum patients counseled on different contraception methods was 1,546 versus 699 patients who declined counseling. Total pharmacist preparation time totaled 160.95 hours, while total patient counseling time totaled 204.55 hours.
Conclusion: Overall, postpartum women who chose to be counseled by a pharmacist were considering either a hormonal or implantable method of contraception, were younger than the age of 17 and were Spanish speaking. The average amount of pharmacist preparation time spent was 4.3 minutes per patient and actual counseling time on average was 5.5 minutes per patient.
Type: Original Researc
Introducing Pharmacogenetics and Personalized Medicine via a Weblog
Get PDFObjectives: To evaluate a weblog (blog)-based course introducing pharmacogenetics (PGt) and personalized medicine (PM) relative to freshmen pharmacy students' knowledge base.
Methods: Incoming freshmen pharmacy students were invited by email to enroll in a one semester-hour, elective, on-line blog-based course entitled "Personal Genome Evaluation". The course was offered during the students' first semester in college. A topic list related to PGt and PM was developed by a group of faculty with topics being presented via the blog once or twice weekly through week 14 of the 15 week semester. A pre-course and post-course survey was sent to the students to compare their knowledge base relative to general information, drug response related to PGt, and PM.
Results: Fifty-one freshmen pharmacy students enrolled in the course and completed the pre-course survey and 49 of the 51 students completed the post-course survey. There was an increase in the students' general, PGt and PM knowledge base as evidenced by a statistically significant higher number of correct responses for 17 of 21 questions on the post-course survey as compared to the pre-course survey. Notably, following the course, students had an increased knowledge base relative to "genetic privacy", drug dosing based on metabolizer phenotype, and the breadth of PM, among other specific points.
Conclusions: The study indicated that introducing PGt and PM via a blog format was feasible, increasing the students' knowledge of these emerging areas. The blog format is easily transferable and can be adopted by colleges/schools to introduce PGt and PM.
Type: Case Stud