Informing collaborative relationships between community pharmacists and health care professionals in primary care practices.

BACKGROUND: Collaborative relationships between community pharmacists and health care professionals in primary care practices can assist with the provision of medication and disease management services in community pharmacy settings. OBJECTIVES: The objective was to describe the attitudes of providers working in primary care practices with on-site pharmacist collaborators to understand how to facilitate similar collaborations with pharmacists in community pharmacy settings. METHODS: This qualitative study was conducted among physicians, nurse practitioners, and nurses of 3 primary care practice sites in the Commonwealth of Pennsylvania. A demographic survey and a semistructured interview were conducted to elicit feedback on participant perceptions about building relationships with community pharmacists. Interviews were audio-recorded and transcribed. A qualitative analysis was performed to identify emerging themes using an inductive approach. Demographic data were summarized using descriptive statistics. This study was approved by the University's Institutional Review Board. RESULTS: Nineteen interviews were conducted. Fifty-eight percent of participants were physicians and 68% were female with a mean age of approximately 46 years. Five themes were identified: (1) Pharmacists were highly valued and were effective team members to promote coordination of medication-related care; (2) Direct access to pharmacists facilitates efficient communication and effective patient care; (3) Trust is the foundation of an effective collaboration between pharmacists and providers; (4) Pharmacists demonstrating responsibility for patients enables collaboration with providers who view themselves as stewards of patient care; and (5) Providers believe that community pharmacists' dispensing requirements may limit their ability to participate in patient care. CONCLUSIONS: The following strategies to establish relationships with primary care practices are suggested: pharmacists should initiate face-to-face relationships with providers in practices; communication and patient interventions should be conveyed directly to providers and be conducted by the same person; and pharmacists need to demonstrate their commitment to patient care by following up promptly on patient interventions.

Non-interventional cardiologists' perspectives on the role of pharmacogenomic testing in cardiovascular medicine.

AIM: To evaluate factors influencing cardiologists' perspectives about pharmacogenomic (PGx) testing in clinical practice. PATIENTS & METHODS: Semistructured interviews with practicing cardiologists were qualitatively analyzed to identify common themes. RESULTS: Five themes were identified among 16 cardiologists from four specialties (n = 5 general cardiology, n = 3 electrophysiology, n = 2 adult congenital and n = 6 heart failure/transplant): cardiologists' knowledge and needs, perceived clinical validity and utility of PGx testing, dissemination and management of PGx results, patient-related considerations and incidental findings. CONCLUSION: Lack of evidence was considered by many cardiologists to be a major barrier hindering the use of PGx testing. However, they would consider adopting PGx if they were provided additional education, ongoing support and evidence supporting the clinical utility of PGx testing in cardiovascular medicine.

Metabolic monitoring in children 5 years of age and younger prescribed second-generation antipsychotic medications.

INTRODUCTION: The objective of this article was to identify the rates of patients ≤5 years of age who received recommended monitoring before and after second-generation antipsychotic (SGA) initiation and had an SGA metabolic adverse effect (MAE). METHODS: This was a retrospective cohort analysis conducted at Kaiser Permanente Colorado, an integrated health care delivery system, between January 1, 2002, and June 30, 2011. Commercially insured patients ≤5 years of age newly initiated on an SGA were included. Patients were followed for up to 3 years. Metabolic monitoring included lipid profile, blood glucose, blood pressure, and weight measurements. Patient characteristics and outcomes were described using descriptive statistics. RESULTS: A total of 40 patients were included. Overall, 2 (5.0%) patients received all recommended baseline monitoring, and no (0.0%) patients received all recommended follow-up monitoring. Weight monitoring was completed most frequently with rates of completion of 57.5%, 95.0%, 85.0%, and 76.5% at baseline and years 1, 2, and 3, respectively. At least 1 MAE was identified in 14/40 (35.0%), 5/28 (17.9%), and 2/17 (11.8%) patients during years 1, 2, and 3, respectively. The most frequent MAE identified was weight gain. Among patients identified with at least 1 MAE, 4/14 (28.6%), 2/5 (40.0%), and 2/2 (100%) received a behavioral intervention during years 1, 2, and 3, respectively. DISCUSSION: Overall, baseline and follow-up metabolic monitoring were poor. Future studies should focus on examining barriers to monitoring in order to improve health care quality.

Patient Specific Factors Influencing Adherence to INR Monitoring.

OBJECTIVE: The specific reasons underlying nonadherence to monitoring the international normalized ratio (INR) from the patient's perspective have not been formally studied. Understanding why patients do or do not adhere has the potential to reveal useful targets for improving adherence to INR monitoring or alternative treatment strategies. The objective of this study was to gain further insight into INR monitoring nonadherence from the patient's perspective. METHODS: This qualitative study was conducted among members of Kaiser Permanente Colorado; patients were characterized as adherent or nonadherent and recruited from the Clinical Pharmacy Anticoagulation and Anemia Service to participate in an individual interview. Qualitative analysis was performed to identify emerging themes using an inductive approach. Demographic data were summarized using descriptive statistics. RESULTS: Patients were primarily white and employed with a mean age of 61.3 years. Perspectives and experiences were similar for all interviewed patients regardless of classification as adherent or nonadherent. The most common themes were the desire for INR monitoring to be inexpensive, convenient, and accessible; finding reassurance with INR monitoring; and a preference for interacting with the same group of prescribers, pharmacists, and phlebotomists. CONCLUSIONS: The following strategies to improve adherence to INR testing are suggested: (i) assign anticoagulation providers to work with the same patients consistently; (ii) provide formal INR reminders; (iii) avoid harsh language or lecturing patients following missed INR tests; (iv) reinforce the clinical and psychological utility of INR results; and (v) facilitate access to INR testing. Adopting these strategies into clinical practice can support the patient-clinician relationship and empower patients to be more engaged in their health care.