Use of Clinical Practice Guidelines and Quality Metrics to Assess Primary Care Management of Osteoporosis.

Background: Clinical practice guidelines and quality measures provide recommendations for physicians addressing osteoporosis management. This study explored the alignment of osteoporosis clinical practice in a primary care geriatric clinic with recommended guidelines. Methods: This retrospective chart review included 388 patients 65 or older from a primary care geriatric clinic diagnosed with osteopenia or osteoporosis, with or without a fragility fracture. Data included history of falls and use of DXA scans, FRAX® fracture risk assessment tool, osteoporosis medication, and fall risk mitigation plans. Results: For age-related primary fracture prevention, 68% of women and 87% of men had documented DXA scans, and 45% of patients diagnosed with osteoporosis and 42% determined at high risk were prescribed osteoporosis medication. For secondary fracture prevention, 72% of women aged 67 to 85 had DXA scans and 21% were prescribed osteoporosis medication. Only 10% of patients with a history of falls had documented fall risk management plans. Conclusion: Although showing higher rates of primary and secondary prevention outcomes than did research results from general primary care, gaps were identified for high fracture risk patients and fall risk management documentation. Medical record review may not provide sufficient data to capture factors influencing decision-making for fracture prevention.

A systematic approach to team creation and peer evaluation in a large classroom setting.

INTRODUCTION: There is limited data to support a particular method for optimal team creation in pharmacy education. We aimed to implement and evaluate a systematic approach to team creation and compare the impact on team dynamics to teams created via random selection. METHODS: Two concurrent courses were used to assess team creation methods. Student-specific variables were used for team creation in one course while another course utilized teams created via random allocation. Each course conducted similar peer evaluations to provide feedback and assess team dynamics. A matched pre- and post-course survey assessed changes in student perceptions of team creation and peer evaluation. Student-perceived team effectiveness and individual coursework performance were assessed. RESULTS: A total of 109 students were enrolled in each of the two courses, with 98% and 93% providing evaluation of team dynamics within the intervention and control methods, respectively. Students perceived better team effectiveness in intervention-created groups in relation to decreased task (p < 0.01), relationship (p < 0.01), and process conflict (p < 0.01), along with increased task attraction (p < 0.01). There was no significant difference in student performance on individual examinations team creation methods (p = 0.17). CONCLUSIONS: A systematic approach to team creation improved student-perceived team dynamics with no significant impact on coursework scores. A systematic approach to team creation via a web-based platform is feasible in a large classroom setting and may provide an avenue for assessment approaches related to teamwork and team dynamics.

Implementation of a New Clinic-Based, Pharmacist-Managed PCSK9 Inhibitor Consultation Service.

BACKGROUND: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab were approved by the FDA in 2015. In anticipation of provider interest and a potential increase in referrals to the on-site specialty pharmacy, we created a pharmacist-managed consultation service. PROGRAM DESCRIPTION: The development of a clinic-based pharmacist-managed consultation service for the management of the PCSK9 inhibitor agents alirocumab and evolocumab is described. Key implementation steps included (a) creation of a pharmacy team and collaboration with cardiology; (b) completion of a needs assessment; (c) service creation; (d) collaboration with the on-site specialty pharmacy; (e) development of an electronic consult order and consult pool; (f) personnel training; and (g) service approval and marketing. The service development occurred over 9 months (July 2015-April 2016) and was implemented hospital-wide in May 2016. OBSERVATIONS: The University of Illinois Hospital and Health Sciences System PCSK9 inhibitor consultation service successfully integrated the benefits of a clinical review process, information technology capabilities of an electronic medical record system, and collaboration with the on-site specialty pharmacy to provide a comprehensive service that aimed to facilitate appropriate medication management from prescribing to patient administration and provide monitoring for this class of specialty medications. IMPLICATIONS/RECOMMENDATIONS: The PCSK9 pharmacist-managed consultation service provides a method for complex therapies to be managed comprehensively through the collaboration of ambulatory care clinics and outpatient specialty pharmacies. DISCLOSURES: No outside funding supported this study. Groo reports speaker bureau fees from Pfizer and Bristol-Myers Squibb. The other authors have nothing to disclose. All the authors contributed to study concept and design. Atande took the lead in data collection, and data interpretation was performed by Groo and Atanda. The manuscript was written by Atanda and revised by all the authors.