Pharmacist-Led Drug Therapy Problem Management in an Interprofessional Geriatric Care Continuum: A Subset of the PIVOTS Group.

BACKGROUND: Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE: To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS: This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS: A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION: Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.

Point-of-Care Testing in Community Pharmacies: Keys to Success From Pennsylvania Pharmacists.

BACKGROUND: Clinical Laboratory Improvement Amendments (CLIA)-waived tests allow for quick, accurate, and noninvasive laboratory testing. Community pharmacists utilize CLIA-waived tests to provide clinical services such as point-of-care (POC) testing to help manage chronic disease and acute illness. OBJECTIVE: To identify key themes in the successful delivery of POC testing services by community pharmacists in Pennsylvania. RESULTS: An initial search identified 51 Pennsylvania pharmacies with a CLIA waiver. Of these, five independent pharmacies met inclusion criteria, three of which completed interviews. The remaining 38 chain pharmacies were represented by three interviews. In total, five key themes were identified as essential to POC testing services: (1) utilize state resources and professional connections to navigate federal and state regulations, (2) establish relationships with physician partners (3) offer tests that are meaningful to patients and their physicians, (4) evaluate financial impact, workflow adaptations, and marketing approaches when implementing POC testing services, and (5) focus on individualized attention and convenience of community pharmacy-based POC testing to improve patient satisfaction. CONCLUSION: Successful POC testing services in community pharmacy practice rely on utilizing resources, partnering with known physicians, selecting meaningful tests for patients, and analyzing finances, workflow, and marketing to provide individualized attention and convenient care.

Using the Pharmacist Interaction Tracking Tool for Capturing Student-Patient Interactions in Direct and Simulated Patient Care Activities.

Objective. To create and implement a standardized data collection tool for capturing student-patient interactions in direct and simulated patient care activities. Design. Faculty members and students determined key elements, design, and an implementation plan for the tool, which was to be used by students across professional years to quantify numbers and types of interactions with patients for tracking student progression toward achievement of curricular outcomes. Assessment. During the 2013-2014 academic year, 27 778 entries were completed, with 17 767 (64%) advanced pharmacy practice experiences, 7272 (26%) introductory pharmacy practice experiences, and 2739 (10%) simulation. Direct patient care interactions occurred with 11 090 patients and 10 983 providers, with 14 252 drug-related problems identified. Data was used by students for their professional portfolios, by administrators for curricular assessment, and to student impact on patient care. Conclusion. The PITT Form enabled the collection of data from actual and simulated patient care activities, allowed for curricular assessment of activities across years, and was used by individual students.

Adherence: a review of education, research, practice, and policy in the United States / Cumplimiento: revisión de la educación, investigación, práctica y política en Estados Unidos

Objective: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States. Methods: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals. Results: Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication adherence. Education: National pharmacy education groups support the need for pharmacists to learn and use adherence-related skills. Educational efforts involving adherence have focused on students' awareness of adherence barriers and communication skills needed to engage patients in behavioral change. Policy: Several changes in pharmacy practice and national legislation have provided pharmacists opportunities to intervene and monitor medication adherence. Some of these changes have involved the use of technologies and provision of specialized services to improve adherence. Conclusions: Researchers and practitioners need to evaluate feasible and sustainable models for pharmacists in community settings to consistently and efficiently help patients better use their medications and improve their health outcomes (AU)

Objetivo: Describir la educación, investigación, practica y política relacionadas con las intervenciones farmacéuticas para mejorar el cumplimiento de la medicación en establecimientos comunitarios en Estados Unidos. Métodos: Los autores utilizaron Medline e International Pharmaceutical Abstracts (desde 1990) para identificar los estudios de intervención de farmacia comunitaria y ambulatoria que trataban de mejorar el cumplimiento de la medicación. Los autores también buscaron en literatura primaria usando Ovid para identificar estudios relativos a la enseñanza de farmacia sobre cumplimiento de la medicación. Se revisaron las bibliografías de los estudios relevantes para identificar literatura adicional. Buscamos en los sumarios de tres revistas de educación de farmacia de Estados Unidos y se revisó la web de la Asociación Americana de Facultades de Farmacia a la busca de materiales sobre principios de educación sobre cumplimiento. Las políticas relacionadas con cumplimiento de medicación se identificaron mediante lo que era conocido por los autores desde su experiencia profesional, asistencia a congresos y revistas farmacéuticas. Resultados: Investigación y práctica: se identificaron 29 estudios: 18 ensayos controlados aleatorizados; 3 estudios de cohorte prospectivos; 2 estudios de cohorte retrospectivos; 5 estudios de caso control; y otro estudio. Hubo una considerable variabilidad en los tipos de intervenciones y en el uso de medidas del cumplimiento. Muchas de las intervenciones eran realizadas por farmacéuticos con formación clínica avanzada y no por típicos farmacéuticos comunitarios. Los efectos positivos de las intervenciones disminuyeron o no se mantuvieron después de que las intervenciones desaparecieron. Aunque no se evaluó formalmente, en general, las farmacias comunitarias normales no evaluaban rutinariamente y/o intervenían en el cumplimiento de la medicación. Educación: Los grupos nacionales de educación de farmacia apoyan la necesidad de que los farmacéuticos aprendan y usen habilidades relacionadas con el cumplimiento. Los esfuerzos educativos relacionados con el cumplimiento se han centrado en el conocimiento de los estudiantes de las barreras al cumplimiento y en las habilidades de comunicación necesarias para envolver a los pacientes en un cambio actitudinal. Política: Varios cambios en el ejercicio de la farmacia y en la legislación nacional han proporcionado a los farmacéuticos la oportunidad de intervenir y monitorizar el cumplimiento de la medicación. Algunos de estos cambios incluyeron el uso de tecnologías y la provisión de servicios especializados para mejorar el cumplimiento. Conclusiones: Los investigadores y facultativos necesitan evaluar modelos factibles y sostenibles para los farmacéuticos en la comunidad para ayudar consistente y eficientemente a pacientes en su mejor uso de las medicaciones y mejorar sus resultados en salud (AU)

Adherence: a review of education, research, practice, and policy in the United States.

OBJECTIVE: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States. METHODS: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals. RESULTS: RESEARCH AND PRACTICE: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication adherence. EDUCATION: National pharmacy education groups support the need for pharmacists to learn and use adherence-related skills. Educational efforts involving adherence have focused on students' awareness of adherence barriers and communication skills needed to engage patients in behavioral change. POLICY: Several changes in pharmacy practice and national legislation have provided pharmacists opportunities to intervene and monitor medication adherence. Some of these changes have involved the use of technologies and provision of specialized services to improve adherence. CONCLUSIONS: Researchers and practitioners need to evaluate feasible and sustainable models for pharmacists in community settings to consistently and efficiently help patients better use their medications and improve their health outcomes.