Medical staff perceptions of medication-assisted treatment in a federally qualified health center.

OBJECTIVES: To describe medical staff attitudes and perceived behaviors toward medication-assisted treatment (MAT) in a federally qualified health center (FQHC). The secondary objective was to identify the staff's perceptions of using pharmacists during MAT. DESIGN: A cross-sectional, descriptive study using a 26-item Web-based survey was developed using the theory of planned behavior (TPB) and consisted of Likert scale and multiple-select options. SETTING AND PARTICIPANTS: Medical staff located at an FQHC in northwest Indiana were eligible to participate if they were 18 years or older. Corporate and administrative staff were not eligible to participate. OUTCOME MEASURES: Perceptions were measured using the 4 constructs of the TPB: attitude, perceived behavioral control, subjective norm, and intent. The data were analyzed using descriptive statistics. RESULTS: Of the 240 eligible respondents, 104 employees completed the survey, yielding a 43.3% response rate. The providers generally believed they had the knowledge (83.9% agree or strongly agree) to diagnose patients with opioid use disorder (OUD). From the perceived behavioral control construct, staff were confident of their ability to identify patients for MAT (65.2%); however, most believed they needed additional training on MAT (75%) from the attitude construct. From the subjective norm construct, more than half of the respondents believed that their employer wanted them to be involved in the treatment of a patient with OUD (60.7%). Commonly, from the intent construct, the staff favored adding pharmacists to the care team when managing patients with MAT (57.7%). CONCLUSION: The staff expressed the need for additional training to provide MAT services and believed this would enable them to become an important part of the MAT team. Adding a trained pharmacist to the care team when managing patients with MAT was favored by the staff. The study showed that health professionals would be more comfortable if a pharmacist were available for MAT consultation.

Impact of quality measures performed through pharmacist collaboration with a primary care clinic.

OBJECTIVE: The objective was to assess the clinical and financial impact of a pharmacist integrated within a primary care practice on quality measures of the merit-based incentive payment system (MIPS). SETTING: The study was conducted in a multidisciplinary primary care practice in Charlotte, NC. PRACTICE DESCRIPTION: A collaborating pharmacist from an independent community pharmacy is integrated within clinic workflow. In this team-based model, pharmacists work alongside providers to furnish comprehensive care, focusing on MIPS quality measure improvement through Medicare annual wellness visits (AWVs) and chronic care management (CCM). PRACTICE INNOVATION: Quality measure achievement was assessed from completed face-to-face AWVs, phone call CCM, or both. EVALUATION: From January 1, 2017, to December 31, 2018, 403 patients in 2017 and 565 patients in 2018 were eligible to be seen by the collaborating pharmacist for either an AWV, CCM, or both services. Measure achievement was characterized using descriptive statistics. Billing reports were used to determine the average monthly dollar amount of Medicare Part B claims submitted. RESULTS: The percentage of patients achieving quality measures increased for 3 measures, decreased for 2 measures, and was neutral for 1 measure. The percentage of patients achieving quality measures resulted in a MIPS quality performance score of 60 of 60 points, which contributed to a final MIPS score of 100 of 100 points and a positive (+) 1.88% payment adjustment in 2019. Extrapolating from previous volume, the provider's total MIPS payment adjustment may result in an additional $16,920 in annual reimbursement. CONCLUSION: Pharmacist-provided collaborative clinical services in the primary care setting appear to ensure achievement of MIPS quality measure benchmarks, potentially increasing the practice's annual MIPS reimbursement by $16,920.

Impact of a pharmacist in improving quality measures that affect payments to physicians.

OBJECTIVES: The objective was to assess the impact of a pharmacist embedded within a primary care practice on quality measures of the Merit-Based Incentive Payment System (MIPS) and patient-centered medical home (PCMH) by characterizing (1) measure achievement after pharmacist involvement in care and (2) measure achievement separately for patients seen by the pharmacist and patients not seen by the pharmacist. SETTING: Multidisciplinary primary care practice in Charlotte, North Carolina. PRACTICE DESCRIPTION: Pharmacists from an independent community pharmacy are highly integrated into the clinic. Pharmacists work alongside providers to furnish comprehensive care with a team-based approach. The initial focus for the pharmacist was on the Medicare annual wellness visits (AWV) and chronic care management (CCM). PRACTICE INNOVATION: Quality measure achievement during face-to-face AWV, telephone-call CCM, or both. EVALUATION: From January 1, 2017, to February 2, 2018, 193 patients had an AWV, CCM, or both from the pharmacist. Measure achievement was characterized with the use of descriptive statistics. RESULTS: When characterizing quality measures before, during, and after pharmacist intervention for the clinic population, achievement of some measures improved and others worsened. However, for every measure evaluated, the cohort of patients seen by the pharmacist had a greater proportion of patients achieving the quality measure than the cohort of patients not seen by the pharmacist. The greatest differences were observed for influenza vaccination (41% of pharmacist cohort vs. 10% of nonpharmacist cohort), hemoglobin A1C control less than 9% (94% of pharmacist cohort vs. 67% of nonpharmacist cohort), and colorectal cancer screening (55% of pharmacist cohort vs. 28% of nonpharmacist cohort). CONCLUSION: Pharmacist provision of clinical services may increase the likelihood of quality measure achievement. The pharmacist integration model addressed gaps in care that appeared to positively affect MIPS and PCMH quality measures. This has the potential to increase reimbursement through value-based payment models.

Conflict resolution in a pediatric inpatient unit: a best practice implementation project.

OBJECTIVES: The aim of this project was to promote evidence-based practices regarding conflict resolution in the hospital setting on a pediatric inpatient unit. INTRODUCTION: Conflict is an inevitable reality in healthcare organizations. Evidence suggests that to facilitate constructive conflict resolution among staff, organizational-level education, as well as formal policies and procedures are both necessary. METHODS: A baseline audit on conflict resolution utilizing the JBI Practical Application of Clinical Evidence System program was undertaken and involved 34 nurses and two nursing assistants. The implementation project used a three-phase approach, with audits and feedback for the evaluation of compliance with best practices. Following baseline audits, an intervention, including conflict resolution education, was implemented, and recommendations to update the current policy and procedure were communicated to unit leadership. Then a postimplementation audit was undertaken. RESULTS: Postimplementation audits revealed improvements in compliance across all seven audit criteria. The greatest improvement was for audit criterion 4, having a structured formal process for remediation if conflict occurs, and criterion 7, having a follow-up of agreed solutions occur, which garnered 75 and 83% improvements, respectively. CONCLUSION: For all seven audit criteria, compliance improved from 24% at baseline to 71% after the implementation of an educational module regarding conflict resolution strategies, tools, and best practices and a recommendation to update the existing policy to include the use of a conflict resolution documentation tool. Recommendations for the next steps include making educational materials and visual reminders about conflict resolution strategies readily available and easily accessible to staff.

Ontologizing health systems data at scale: making translational discovery a reality.

Common data models solve many challenges of standardizing electronic health record (EHR) data but are unable to semantically integrate all of the resources needed for deep phenotyping. Open Biological and Biomedical Ontology (OBO) Foundry ontologies provide computable representations of biological knowledge and enable the integration of heterogeneous data. However, mapping EHR data to OBO ontologies requires significant manual curation and domain expertise. We introduce OMOP2OBO, an algorithm for mapping Observational Medical Outcomes Partnership (OMOP) vocabularies to OBO ontologies. Using OMOP2OBO, we produced mappings for 92,367 conditions, 8611 drug ingredients, and 10,673 measurement results, which covered 68-99% of concepts used in clinical practice when examined across 24 hospitals. When used to phenotype rare disease patients, the mappings helped systematically identify undiagnosed patients who might benefit from genetic testing. By aligning OMOP vocabularies to OBO ontologies our algorithm presents new opportunities to advance EHR-based deep phenotyping.

The Emerging Role of Community Pharmacists in Remote Patient Monitoring Services.

Remote physiologic monitoring (RPM) services involve the transmission of patient-collected physiologic data to the healthcare team. These data are then analyzed to determine what changes may be needed to enhance patient care. While pharmacists may not be recognized as billing providers through some payers, there are opportunities for pharmacist collaboration with providers to enhance patient access to RPM services. Community pharmacist services are traditionally tied to a product, but pharmacists are skilled in medication management, disease state evaluation, and patient counseling, which are skills that can contribute to an elevated RPM program.

The crystal structure of PD1, a Haemophilus surface fibril domain.

The Haemophilus surface fibril (Hsf) is an unusually large trimeric autotransporter adhesin (TAA) expressed by the most virulent strains of H. influenzae. Hsf is known to mediate adhesion between pathogen and host, allowing the establishment of potentially deadly diseases such as epiglottitis, meningitis and pneumonia. While recent research has suggested that this TAA might adopt a novel `hairpin-like' architecture, the characterization of Hsf has been limited to in silico modelling and electron micrographs, with no high-resolution structural data available. Here, the crystal structure of Hsf putative domain 1 (PD1) is reported at 3.3 Šresolution. The structure corrects the previous domain annotation by revealing the presence of an unexpected N-terminal TrpRing domain. PD1 represents the first Hsf domain to be solved, and thus paves the way for further research on the `hairpin-like' hypothesis.

Understanding death in custody: a case for a comprehensive definition.

Prisoners sometimes die in prison, either due to natural illness, violence, suicide, or a result of imprisonment. The purpose of this study is to understand deaths in custody using qualitative methodology and to argue for a comprehensive definition of death in custody that acknowledges deaths related to the prison environment. Interviews were conducted with 33 experts, who primarily work as lawyers or forensic doctors with national and/or international organisations. Responses were coded and analysed qualitatively. Defining deaths in custody according to the place of death was deemed problematic. Experts favoured a dynamic approach emphasising the link between the detention environment and occurrence of death rather than the actual place of death. Causes of deaths and different patterns of deaths were discussed, indicating that many of these deaths are preventable. Lack of an internationally recognised standard definition of death in custody is a major concern. Key aspects such as place, time, and causes of death as well as relation to the prison environment should be debated and incorporated into the definition. Systematic identification of violence within prison institutions is critical and efforts are needed to prevent unnecessary deaths in prison and to protect vulnerable prisoners.

The investigation of deaths in custody: a qualitative analysis of problems and prospects.

The right to be treated humanely when detained is universally recognized. Deficiencies in detention conditions and violence, however, subvert this right. When this occurs, proper medico-legal investigations are critical irrespective of the nature of death. Unfortunately, the very context of custody raises serious concerns over the effectiveness and fairness of medico-legal examinations. The aim of this manuscript is to identify and discuss the practical and ethical difficulties encountered in the medico-legal investigation following deaths in custody. Data for this manuscript come from a larger project on Death in Custody that examined the causes of deaths in custody and the conditions under which these deaths should be investigated and prevented. A total of 33 stakeholders from forensic medicine, law, prison administration or national human rights administration were interviewed. Data obtained were analyzed qualitatively. Forensic experts are an essential part of the criminal justice process as they offer evidence for subsequent indictment and eventual punishment of perpetrators. Their independence when investigating a death in custody was deemed critical and lack thereof, problematic. When experts were not independent, concerns arose in relation to conflicts of interest, biased perspectives, and low-quality forensic reports. The solutions to ensure independent forensic investigations of deaths in custody must be structural and simple: setting binding standards of practice rather than detailed procedures and relying on preexisting national practices as opposed to encouraging new practices that are unattainable for countries with limited resources.