INNOVATIONS in pharmacy (Iip - E-Journal)
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Effects of Medication Reconciliation Service Provided by Student Pharmacists in a Tertiary Care Emergency Department
Get PDFObjective: The primary objective of this case study was to evaluate the impact of a medication reconciliation service (MRS) provided by student pharmacists in an emergency department (ED).
Methods: Eligible patients were assigned to two groups, MRS or non-MRS. Patients in the MRS group were seen by student pharmacists while the non-MRS group followed usual care. As part of the services provided by the student pharmacists, medication reconciliation was provided under the supervision of a clinical pharmacist. At the conclusion of their ED visit, patients were asked to complete a survey addressing knowledge of medications, confidence in medication taking and patient satisfaction. To evaluate the impact of provision of MRS by student pharmacists on readmission rates in the ED, the electronic health records of the institution were queried for subsequent inpatient hospitalizations and ED visits.
Results: Based on the study, patients in MRS group were more likely to be satisfied with the education provided to them in the ED (p=0.016) and had greater confidence in taking their medications (p=0.03). Sixty days post ED visit MRS group readmissions were significantly lower compared to non-MRS group (P= 0.047).
Conclusions: Students' participation in the provision of medication reconciliation led to reduction of readmission in the tertiary care ED, improved patient satisfaction and confidence in medication use.
Type: Case Stud
The impact of a community pharmacist conducted comprehensive medication review (CMR) on 30-day re-admission rates and increased patient satisfaction scores: A pilot study
Get PDFObjective: To determine the impact of pharmacist conducted Comprehensive Medication Review (CMR) follow-up within seven days after discharge on (1) readmission rates, (2) detection of drug related problems, (3) and changes in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
Design: Rates of re-admission for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI), within 30 days of discharge are compared between patients receiving a CMR from the pharmacist to a historical control group not receiving the service. The CMR documentation is reviewed to classify any detected drug related problems. Overall HCAHPS scores for the hospital are compared for the three months prior to instituting this service and the three months during the service.
Setting: Patients were discharged from a 101-bed acute care hospital located in rural West Virginia. The community pharmacist worked with the hospital to contact patients after discharge to demonstrate a partnership between inpatient and outpatient care.
Patients: Patients were included if they had a discharge diagnosis of pneumonia, congestive heart failure (CHF), or myocardial infarction (MI), and were returning to self-care or family-care. If discharged between 10/12/2012 and 12/11/2012 they were included in the historical control group. If discharged between 12/12/2012 and 2/12/2012 they were offered the CMR service and included in the intervention group.
Intervention: Patients received a telephone call two to seven days following discharge from a pharmacist who conducted the Comprehensive Medication Review (CMR)
Results: Patients who participated in a CMR via the telephone had decreased 30-day readmission rates compared to the historical control group (16% v 33%). Overall 22 significant drug therapy problems were identified among patients. HCAHPS scores for the questions "Did you receive communication regarding your medications" increased during the study time period (65% vs 72%).
Conclusion: The mixed results of available data from previous studies on pharmacist inclusion in the discharge process focuses heavily on counseling before the patient is discharged. Results of this study show community pharmacist partnership in discharge follow-up can also assist in decreasing readmissions, detecting drug related problems, and increasing patient satisfaction.
Type: Original Researc
Evaluation of a Patient Perspective Module in a Required Medication Safety and Quality Course at a College of Pharmacy
Get PDFObjectives: To develop and evaluate the impact of a module discussing the patient's perspective on medication errors in a required medication safety course at a college of pharmacy.
Methods: Students were required to read Josie's Story, a true story written by a mother after her daughter died from a medical error, and attend an in-class discussion regarding the book. A questionnaire, which employed a pre-post retrospective method and extracted items from the Caring Ability Inventory, was then administered to measure the change in students' perceptions of patient care. Additional questions gathered students' perceptions of the assignment, their personal experiences with the topic, and the importance of medication safety. Results: 120 out of 138 students (response rate = 87%) completed the questionnaire. 56% of students indicated they would be more likely to speak with a patient directly about a medication error after reading the book, whereas only 3% were less likely, and 42% indicated they were just as likely. Most students (59%) reported that they felt more motivated to learn about medication safety after reading Josie's Story.
Implications: This course previously addressed strategies to prevent medication errors. Successfully adding a component that introduces how a medication error impacted a patient and her family may help motivate students to recognize the importance and need for a culture of safety, personalize how medication errors impact patients, and provide a venue for students to gain patient centeredness and caring skills.
Type: Original Researc
Developing a Professionalism Plan
Get PDFProfessionalism is a way of being which underlies all the responsibilities of a pharmacist and associated general and professional abilities. The Student Affairs Committee was charged with developing a college-wide professionalism plan to meet the Accreditation Council for Pharmacy Education (ACPE) Standards 15.1 and 23. This plan was developed concurrently with a new curriculum. The plan was developed systematically with the following goals: 1) create a definition of professionalism, 2) determine outcomes of the plan, 3) identify existing components which should be continued and new components to be added, 4) ensure existing and new components are linked to outcomes and 5) develop a continuous assessment process for the plan. The proposed plan consists of curricular, co-curricular and extra-curricular activities designed to help students gain experience in three professionalism pillars: Competence, Connection and Character, as defined by Brown et al in "Taxonomy of Professionalism". While knowledge and skills will be enhanced, the focus of development will be on student virtues, values and attitudesäóîthat what they do defines who they are. The goal is to help students develop as people and professionals who value the high ideals expected of a pharmacist.
Type: Idea Pape
Social Media and Unprofessional Pharmacist Conduct: A Cross-Sectional Survey of Boards of Pharmacy
Get PDFPurpose: To determine how often boards of pharmacy (BOPs) receive complaints related to licensee's online behavior, and what types online behaviors may prompt an investigation of a licensee.
Methods: A survey (consisting of questions related to BOP's management of complaints against licensee online behavior and 10 case vignettes) was adapted from a previous survey of United States medical boards. Vignettes encompassed themes such as patient confidentiality, derogatory language, alcohol use, false or misleading product claims, and others. Following institutional review board approval, survey materials were distributed via email by the National Association of Boards of Pharmacy to 63 domestic and international boards of pharmacy. Completed surveys were analyzed using descriptive statistics. The proportion of respondents who indicated that the vignette would "very likely" or "likely" result in an investigation was used to determine consensus. Proportions of >75%, 50%-75% and <50% were classified as high, moderate and low consensus, respectively.
Results: Fourteen completed surveys (22.2%) were received. Sixty percent of respondents stated that their board has been involved in managing a complaint regarding the online behavior of a licensee, and that disciplinary actions including revocation or suspension of license, letter of reprimand, and monetary fines have been enacted. While 79% of responding BOPs have a policy regarding Internet usage, 36% are unsure whether the policies are sufficient to cover online professionalism. One vignette, where a pharmacist made misleading claims regarding a compounded product, achieved high consensus for likelihood to prompt an investigation. Moderate consensus was achieved for a breach of patient confidentiality, inappropriate alcohol use, and misrepresentation of professional credentials.
Conclusion: Boards of pharmacy are widely varied in what types of online behaviors may prompt an investigation. Additional dialogue is needed among pharmacy leaders to determine best practices.
Type: Original Researc
The Role of Clinical Pharmacists in Modifying Cardiovascular Disease Risk Factors
Get PDFObjective: Assess the effect of intensive clinical and educational interventions aimed at reducing risk factors for Cardiovascular Disease (CVD), implemented by clinical pharmacists, on modifying risk factors in targeted patients at high risk for CVD.
Design: Patients with at least two risk factors for CHD were identified at two clinics by conducting a pre-intervention survey and were monitored over a period of 6 months with follow up conversations conducted every 4 weeks by phone and at subsequent physician visits. A post-intervention survey was conducted at the end of the study period to detect modified risk factors.
Setting: The Jefferson County Public Health Department (JCHD)
Participants: We followed a total of 47 patients over 6 months. The average age at baseline was 51 years old and 80% of the participants were female. The baseline average number of modifiable cardiovascular disease risk factors was 3.7.
Measurements: We assessed total number of CVD risk factors, smoking behavior, blood pressure, LDL, A1C, weight, and level of physical activity (major modifiable risk factors by the American Heart Association).
Results: Over a 6 month follow-up of 47 patients, statistically significant reductions occurred in total number of CVD risk factors, systolic and diastolic blood pressures, and A1C. Reductions also occurred in LDL level, weight, and changes in smoking behavior and physical activity were identified.
Conclusions: Results showed that increased patient counseling on adherence and lifestyle changes along with increased disease state monitoring and medication adjustment led by a clinical pharmacist can decrease risk factors in patients with multiple risk factors for cardiovascular disease.
Type: Student Projec
Consumer Reports - Best Buy Drugs' Outreach Project in Minnesota
Get PDFThe objectives for this study were to apply four different approaches for disseminating Consumer Reports Best Buy Drugs (CR-BBD) information about effectiveness, safety, and cost to patients for therapeutic classes of medications that they were using and then (1) evaluate the usefulness of the information to participants and (2) document resultant information seeking. For the three approaches that utilized face-to-face contact (Approaches 2 through 4), we also compared them in terms of (1) number of medications reviewed per person, (2) availability of CR-BBD information per person, (3) changes that could be made for each person, and (4) potential/likely cost savings (per person per month). Finally, we described the availability of CR-BBD information for each participant categorized by the 19 therapeutic classes of medications for which there were Best Buy Drugs reports. Data were collected via self-administered surveys, in-person interviews, and telephone interviews. The results showed that almost all of the participants in the information sessions held for this study had at least one medication for which Best Buy Drug information was available with significant savings potential to be gained by using the recommended Best Buy Drug. Potential cost savings through the use of recommended Best Buy Drugs was 157.20 per person per month for those with savings over zero dollars (n = 98). Thirty-two percent of respondents to our evaluation survey reportedly sought more information from a physician and 30 percent sought more information from a pharmacist. We concluded that provision of information about effectiveness, safety, and cost to patients has the potential for achieving significant cost savings. Recommendations regarding (1) the timing of provision, (2) targeting of recipients and (3) traversing impediments are given.
Type: Original Researc
Accessibility to Essential Medicines in New York City by Zip Code Income Levels and Boroughs
Get PDFAccess to essential medicines is fundamental to medication adherence, continuity of care and hence population health outcomes and overall quality of life. Disparities in the availability and the cost of these medications in New York City, especially for low income neighborhoods, would compound the underlying health disparities in these neighborhoods. This study examined the physical and financial accessibility to 8 of the 150 Most Frequently Prescribed Drugs in New York, 2 each for Asthma, Diabetes, Hypertension, and Hyperlipidemia, 4 conditions that are among the top 10 most costly conditions in the United States. The study did not find any significant differences in mean drug prices between the high, medium, and low income neighborhoods in the City. However, the significantly different income levels and uninsured rates across neighborhood income strata in the City (p<0.001 for both), coupled with the high disease burden and other underlying disparities in low income neighborhoods, would point to potential affordability challenges for needed medications in these neighborhoods. On the other hand, significant differences in mean prices between the 5 City boroughs were found for 3 of the study drugs: Advair™, p=0.009; Amlodipine 10mg, p<0.001; and Lisinopril 10mg, p=0.046. No such significant differences were observed for the mean prices of the other 5 study drugs-Proventil HFA,™ Metformin HCL 500mg, Glipizide ER 5mg, Simvastatin 20mg, and Atorvastatin 10mg. The study findings did not also suggest that drug prices are dictated by the number of pharmacies in a neighborhood. Further studies would be needed to better understand the complexities associated with the accessibility of essential medicines in New York City. These studies could include qualitative ones which would examine the perceptions and experiences of City residents with respect to the accessibility of prescribed medications as the basis for targeted interventions directed at promoting access to needed medications for all New Yorkers.
Type: Student Projec
Attitudes of Iraqi society towards the role of community pharmacists
Get PDFObjectives: The main aims of this study were to assess society's use of community pharmacies; evaluate attitudes towards the role of the community pharmacist; and describe required pharmacist characteristics and future services.
Study design: A cross-sectional survey with a stratified sampling technique.
Methods: A self-administered, validated, questionnaire was distributed to 500 consumers in attendance at 50 community pharmacies in Baghdad, Iraq. Data were gathered from January to April 2012. Mann-Whitney and Kruskal-Wallis tests were performed to test for statistical differences among the study variables. Further analysis through the Chi-square test and logistic regression was completed to assess the predictors of society's attitudes.
Results: Twenty-six percent of respondents visited their community pharmacies at least once per week and an additional 65% reported visiting their pharmacy at least once per month. Fifty-five percent of respondents listed the community pharmacist as the first person they would contact in case of any drug-related problem. However, the pharmacist's role was under-appreciated by the majority of respondents (79.8%). These attitudes varied significantly with regard to the demographic characteristics of respondents. Logistic regression analysis showed that gender and age were the influential predictors of favourable versus non-favourable attitudes towards the role of pharmacist.
Conclusions: The use of community pharmacies in Iraq was characterized by frequent visits to purchase medicines. Selection of the pharmacy primarily depended on its location. Overall, an under-appreciation of the professional performance of pharmacists was predominant. Raising public awareness towards the important role of community pharmacists in providing public health is warranted.
Type: Original Researc
Awareness of and Readiness for Medication Therapy Management Among Community Pharmacists in New York City: Results from a Focus Group
Get PDFFor pharmacist-provided Medication Therapy Management (MTM) services to operate effectively and efficiently, pharmacists must understand the process of MTM delivery, assess the barriers and challenges in creating a sustainable MTM program, and realize the willingness and readiness of their colleagues to deliver such services. In order to assess feasibility of such services among high-risk neighborhoods in New York City (NYC), a focus group design was used to qualitatively assess pharmacists' perceptions of MTM. Findings showed that reimbursement and allocation of resources were the most discussed challenges/barriers to the provision of pharmacist-provided MTM services. Overall, pharmacists were willing, but not yet ready, to provide MTM services on a large scale. Lack of understanding of MTM structure/process, reimbursement challenges, and the need for collaboration between providers were key components to pharmacists' willingness to provide services. Additional training opportunities were deemed necessary for them to feel confident to conduct clinical services. Although pharmacists discussed several issues regarding MTM, they were still interested in participating and seeing how MTM would impact their community practice settings. Understanding these perceptions of pharmacists on MTM allowed us to better understand and assess ways for continuous quality improvement of services that will enhance patient care.
Type: Original Researc