INNOVATIONS in pharmacy (Iip - E-Journal)
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Project ImPACT: Hypertension Outcomes of a Pharmacist-Provided Hypertension Service
Get PDFObjective: To evaluate the impact of pharmacists, working collaboratively with patients, on blood pressure control, lifestyle goal setting, adherence to antihypertensive therapy, patient knowledge and satisfaction, and modification of cardiovascular risk factors.
Methods: Self-declared hypertensive patients met with the pharmacist for blood pressure monitoring, lifestyle goal setting, and education about medications and disease state on four occasions over a 6-month period.
Practice innovation: A community pharmacy partnered with an employer wellness plan to provide education and monitoring for patients with hypertension based on home blood pressure readings obtained using monitors that wirelessly transmit information to the pharmacist.
Main outcome measure(s): Percentage of patients at blood pressure goal, mean blood pressure, percentage of patients with lifestyle goals, medication adherence, patient knowledge and satisfaction, and modification of cardiovascular risk factors.
Results: Patients not at their goal blood pressure at baseline had a significant decrease in blood pressure and a significant increase in achievement of their blood pressure goals. Across the population, no significant changes were seen in the primary outcome, lifestyle goals, medication adherence or modification of cardiovascular risk factors. Patient knowledge increased from baseline and satisfaction with the service was high.
Conclusion: Blood pressure control improved in patients not at their treatment goal. All patients increased their knowledge about hypertension and reported high satisfaction with the pharmacy service. Pharmacy services should be offered to patients who are more likely to reap a benefit. Home blood pressure readings are useful to inform clinical decision making and supplement patient consultation within the pharmacy setting.
Type: Original Researc
Leadership: Three Key Employee-Centered Elements with Case Studies - Editor's Commentary
Get PDFType: Commentar
Development of an Active Follow-up Process in a Stand-alone Medication Therapy Management (MTM) Clinic
Get PDFWithout following-up with patients, one cannot determine the outcomes of interventions made with patients. To ensure follow-up was occurring in a stand-alone MTM clinic, a process for active follow-up and an easy-to-use way to trigger and document follow-up was developed.
Type: Clinical Experienc
Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population
Get PDFObjective: To describe successes and barriers with the development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population.
Setting: A single supermarket chain pharmacy
Practice description: Community pharmacists provide dispensing and non-dispensing pharmacy services including medication therapy management, biometric wellness screenings, and immunizations.
Practice innovation: Developed and implemented a community pharmacy medication therapy management-based transition of care program for patients with managed Medicaid
Main outcome measures: Feasibility of developing and implementing a transition of care service in a community pharmacy
Results: During the first six months, a total of 17 patients were seen as part of the program. Study pharmacists identified successes and potential strategies for overcoming barriers.
Conclusion: Developing and implementing a community pharmacy transition of care program for patients with managed Medicaid was logistically feasible.
Type: Original Researc
The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic
Get PDFObjective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV) clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit.
Design: Retrospective, single-centered, chart review.
Setting: Free, bilingual clinic in Richmond, VA.
Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011.
Main Outcome Measure: Types of interventions documented during the patient-pharmacist visit, categorized as medication review, patient education, or adherence monitoring.
Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%), patient education (23.3%), and adherence monitoring (9.8%). Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS) (P = 0.01), have current or history of opportunistic infection (OI) (P=0.01), and have current or history of OI prophylaxis (P = 0.03). Adherence monitoring was less common amongst the non-Hispanics (7.1%) compared to the Hispanic sub-population (16.5%), (P = 0.04).
Conclusion: The role of ambulatory care pharmacists in a free and bilingual clinic goes beyond adherence monitoring. Pharmacists can be a valuable part of the patient care team by providing medication review and patient education for HIV and other co-morbidities within free clinics. Further research is warranted to assess outcomes and to further explore the underlying barriers to early HIV diagnosis and adherence within the Hispanic population.
Type: Original Researc
Exploring a Laboratory Model of Pharmacogenetics as Applied to Clinical Decision Making
Get PDFObjective: To evaluate a pilot of a laboratory model for relating pharmacogenetics to clinical decision making.
Case Study: This pilot was undertaken and evaluated to help determine if a pharmacogenetics laboratory should be included in the core Doctor of Pharmacy curriculum. The placement of the laboratory exercise in the curriculum was determined by identifying the point in the curriculum where the students had been introduced to the chemistry of deoxyribonucleic acid (DNA) as well as instructed on the chemistry of genetic variation. The laboratory included cytochrome P450 2C19 genotyping relative to the *2 variant. Twenty-four students served as the pilot group. Students provided buccal swabs as the source of DNA. Students stabilized the samples and were then provided instructions related to sample preparation, polymerase chain reaction, and gel electrophoresis. The results were reported as images of gels. Students used a reference gel image to compare their results to. Students then applied a dosing algorithm to make a "clinical decision" relative to clopidogrel use. Students were offered a post laboratory survey regarding attitudes toward the laboratory. Twenty-four students completed the laboratory with genotyping results being provided for 22 students (91.7%). Sixteen students were wild-type (*1/*1), while six students were heterozygous (*1/*2). Twenty-three students (96%) completed the post laboratory survey. All 23 agreed (6, 26.1%) or strongly agreed (17, 73.9%) that the laboratory "had relevance and value in the pharmacy curriculum"
Conclusion: The post pilot study survey exploring a laboratory model for pharmacogenetics related to clinical decision making indicated that such a laboratory would be viewed positively by students. This model may be adopted by colleges to expand pharmacogenetics education.
Type: Case Stud
Design and Implementation of an Interdisciplinary Elective Course in Drug Discovery, Development, and Commercialization
Get PDFObjective: To describe the design and implementation of an elective course in drug discovery, development, and commercialization for pharmacy, medical, biomedical graduate, business, and law students.
Case Study: This course included didactic lectures, student group discussions, a longitudinal assignment, and a question and answer panel session. A 9-item instrument using a 5-point response scale was used for course evaluation. The longitudinal assignment was the creation and presentation of a product lifecycle strategic plan (PLSP). Respondents rated 'agree' and 'strongly agree' in the course providing useful information on drug discovery (39% and 53%), drug development (39% and 60%), and drug commercialization (33% and 60%). The majority of student-reported overall understanding of the drug discovery and drug development process was rated 'very good' (49% and 46%), while the drug commercialization process was rated 'good' (46%).
Conclusions: An elective course on drug discovery, development, and commercialization included enrollment of students with diverse educational training. The course provided useful information and improved overall student understanding.
Type: Case Stud
Developing a Respiratory Depression Scorecard for Capnography Monitoring
Get PDFPulse oximetry is the most common way to measure a patient's respiratory status in the hospital setting; however, capnography monitoring is a more accurate and sensitive technique which can more comprehensively measure respiratory function. Due to the limited number of capnography monitoring equipment at the University of Minnesota Medical Center-Fairview (UMMC-Fairview), we analyzed which patients should preferentially be chosen for capnography monitoring over pulse oximetry based on risk of respiratory depression. We conducted a retrospective chart review of all serious opioid-induced over-sedation events that occurred at UMMCFairview between January 1, 2008 and June 30, 2012. Thirteen risk factors were identified which predispose patients to respiratory depression. The average patient demonstrated 3.75 risk factors. The most commonly occurring risk factor was the concomitant use of multiple opioids or an opioid and a CNS-active sedative, followed by an ASA score 䊫 3. Based on this data, we developed a scorecard for choosing patients at the most risk of developing respiratory depression; these patients are the best candidates for capnography. Although further studies are necessary to corroborate this research, at this time giving extra consideration to patients demonstrating the previously stated risk factors is prudent when assessing those patients most in need of capnography.
Type: Student Projec
Acceptance Rates for Pharmacist-Initiated Interventions in Long-Term Care Facilities
Get PDFObjectives: Describe individualized medication interventions, categorize intervention types, and report acceptance rates by prescribers following a pilot medication intervention program in which a pharmacist rounded with the patient care team in long-term care facilities in addition to their traditional medication regimen review (MRR) process.
Design: Prospective Chart review
Setting: Two primary long-term care (LTC) facilities
Participants: Fifty randomly selected patient charts. Inclusion criteria were adult patients (18 years old or older) residing in one of the LTC facilities receiving consultant pharmacist services. Patient charts not meeting inclusion criteria were excluded from the review.
Interventions: Recommendations made according to the needs of each patient and categorically reported.
Main Outcome Measures: Intervention acceptance rates by prescribers and aggregate reporting for type of medication interventions.
Results: For 50 patient charts (68% female, 32% male) 66 interventions were reported. The average patient age was 81.5 years. Approximately 45% of the interventions pertained to drug utilization concerns, and 21% involved pain management. Additional categories included treatment of eye and skin conditions and pharmacotherapy for mental health. A 'nonpharmacotherapy' designation was given to individual interventions not fitting into a larger category. New medications and regimen changes were the most common medication therapy outcomes (42% and 32%, respectively). Overall 92% of all pharmacist interventions were either fully or partially accepted by the prescriber where partial acceptance was defined as implementation of the recommendation with an adjustment. Interventions related to drug utilization or pain management each approached a 93% acceptance rate.
Conclusions: The consultant pharmacist provided personalized recommendations following extensive chart review and patient assessment. Our chart review suggests that high prescriber acceptance rates along with medication therapy optimization may produce similar benefits in other LTC facilities.
Type: Original Researc