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1.
Am J Health Syst Pharm ; 80(13): 842-851, 2023 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-37144568

RESUMEN

PURPOSE: Ambulatory care and specialty pharmacy practices are rapidly growing in tandem with the accelerated development of advanced therapies for complex disease states. A coordinated and standardized interprofessional team-based approach is critical to providing high-quality care to specialty patients on complex, expensive, and high-risk therapies. Yale New Haven Health System dedicated resources to the creation of a medication management clinic under a unique care model that integrates ambulatory care pharmacists within specialty clinics who coordinate with centralized specialty pharmacists. The new care model workflow encompasses ambulatory care pharmacists, specialty pharmacists, ambulatory care pharmacy technicians, specialty pharmacy liaisons, clinicians, and clinic support staff. The strategies employed to design, implement, and optimize this workflow to meet the increasing demand for pharmacy support in specialty care is discussed. SUMMARY: The workflow incorporated key activities from highly diverse existing specialty pharmacy, ambulatory care pharmacy, and specialty clinic practices. Standard processes were developed for patient identification, referral placement, visit scheduling, encounter documentation, medication fulfillment, and clinical follow-up. Resources were created or optimized to support successful implementation, including an electronic pharmacy referral, specialty collaborative practice agreements to facilitate pharmacist-led comprehensive medication management, and a standardized note template. Communication strategies were developed to facilitate feedback and process updates. Enhancements focused on eliminating documentation redundancies and delegating nonclinical tasks to a dedicated ambulatory care pharmacy technician. The workflow was implemented in 5 ambulatory rheumatology, digestive health, and infectious diseases clinics. Pharmacists utilized this workflow to complete 1,237 patient visits, serving 550 individual patients over 11 months. CONCLUSION: This initiative created a standard workflow to support an interdisciplinary standard of specialty patient care that is robust to accommodate planned expansion. This workflow implementation approach can serve as a road map for other healthcare systems with integrated specialty and ambulatory pharmacy departments undertaking similar models for specialty patient management.


Asunto(s)
Servicios Farmacéuticos , Farmacéuticos , Humanos , Flujo de Trabajo , Derivación y Consulta , Atención Ambulatoria
2.
Am J Health Syst Pharm ; 79(22): 2047-2052, 2022 11 07.
Artículo en Inglés | MEDLINE | ID: mdl-35913890

RESUMEN

PURPOSE: To expand health-system specialty pharmacy (HSSP) clinical continuity by implementing a specialty integrated model for clinical services in target sites. SUMMARY: After evaluation of baseline clinical continuity and institutional goals, select clinics were identified as target sites to which to expand this integrated approach of a medication management clinic (MMC). In this MMC model, the key steps included engaging stakeholders, workflow training, optimization of the electronic health record, service evaluation, compliance with regulatory standards, and development of marketing strategies. The initial focus was development of innovative collaborative practice agreements (CPAs) to expand the scope of ambulatory care pharmacists' practice. Analysis of existing specialty and ambulatory workflows and technology was completed before development of the integrated workflow. Existing credentialing policies were updated to support expanded practices, and marketing collaterals were developed to support growth of pharmacy referrals. Meetings with stakeholders took place to ensure smooth transitions into integrated areas. Primary endpoints included clinical continuity, as determined by prescription orders placed within the health system sent to the HSSP, and number of signed referrals to MMC. Secondary endpoints included disease state-specific clinical outcomes as well as overall outcomes such as medication adherence, laboratory test adherence, immunization rates, and patient and clinician satisfaction. An MMC model was successfully implemented in 5 target specialty practices. Specialty clinic CPAs were developed for rheumatology and digestive health (including viral hepatitis). Since implementation, clinical continuity increased 23% and referrals exceeded the target at 165%. Data on secondary endpoints are currently being collected to evaluate quality of pharmacy services. Pharmacy services have enhanced patient care and received positive feedback from clinicians. CONCLUSION: Expansion of integrated decentralized pharmacists into target practices has increased clinical continuity and the number of pharmacist referrals. Clinicians have regarded pharmacists as vital members of the team. Creation of additional specialty CPAs will be needed to support further growth in other clinics.


Asunto(s)
Servicios Farmacéuticos , Farmacias , Humanos , Farmacéuticos , Cumplimiento de la Medicación , Atención Ambulatoria
3.
Am J Health Syst Pharm ; 79(8): e96, 2022 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33483755

RESUMEN

This article has been withdrawn due to a publisher error that caused the article to be duplicated. The definitive version of this article is published under DOI 10.1093/ajhp/zxab063.


Asunto(s)
COVID-19 , Servicios Farmacéuticos , Farmacia , Atención Ambulatoria , Humanos , Pandemias
4.
Am J Health Syst Pharm ; 78(23): 2142-2150, 2021 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-34407179

RESUMEN

PURPOSE: Adherence to self-administered biologic disease-modifying antirheumatic drugs (bDMARDs) is necessary for therapeutic benefit. Health-system specialty pharmacies (HSSPs) have reported high adherence rates across several disease states; however, adherence outcomes in rheumatoid arthritis (RA) populations have not yet been established. METHODS: We performed a multisite retrospective cohort study including patients with RA and 3 or more documented dispenses of bDMARDs from January through December 2018. Pharmacy claims were used to calculate proportion of days covered (PDC). Electronic health records of patients with a PDC of <0.8 were reviewed to identify reasons for gaps in pharmacy claims (true nonadherence or appropriate treatment holds). Outcomes included median PDC across sites, reasons for treatment gaps in patients with a PDC of <0.8, and the impact of adjusting PDC when accounting for appropriate therapy gaps. RESULTS: There were 29,994 prescriptions for 3,530 patients across 20 sites. The patient cohort was mostly female (75%), with a median age of 55 years (interquartile range [IQR], 42-63 years). The median PDC prior to chart review was 0.94 (IQR, 0.83-0.99). Upon review, 327 patients had no appropriate treatment gaps identified, 6 patients were excluded due to multiple unquantifiable appropriate gaps, and 420 patients had an adjustment in the PDC denominator due to appropriate treatment gaps (43 instances of days' supply adjusted based on discordant days' supply information between prescriptions and physician administration instructions, 11 instances of missing fills added, and 421 instances of clinically appropriate treatment gaps). The final median PDC after accounting for appropriate gaps in therapy was 0.95 (IQR, 0.87-0.99). CONCLUSION: This large, multisite retrospective cohort study was the first to demonstrate adherence rates across several HSSPs and provided novel insights into rates and reasons for appropriate gaps in therapy.


Asunto(s)
Antirreumáticos , Productos Biológicos , Farmacias , Adulto , Antirreumáticos/uso terapéutico , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Estudios Retrospectivos
5.
JCO Clin Cancer Inform ; 5: 701-708, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34166064

RESUMEN

PURPOSE: Nonadherence is a significant issue in cancer care, especially as more oral therapies become available. Measuring and optimizing adherence to such therapies is challenging. In this study, we tested a novel technology that records real-time medication-taking behavior from a smart prescription bottle and can communicate with patients via text message to intervene in cases of nonadherence. METHODS: We conducted a 28-patient pilot study to assess the feasibility of this technology in measuring and improving adherence in patients taking capecitabine, an oral chemotherapy agent with a complex, cyclical regimen. The study had a preintervention stage, during which patients were monitored, and an intervention stage, during which the text messaging intervention was enabled. RESULTS: During preintervention, patients had an average self-adherence of 89%, and during post intervention, they had an average adherence of 90%. We defined three categories of patients by change in adherence: category 1 (> 8%), category 2 (-8% to 8%), and category 3 (< -8%). Patients in category 1 tended to live in regions with lower average household income (mean = $58,937 in US dollars [USD]) than those in category 2 (mean = $77,482 USD) and category 3 (mean = $90,972 USD). Of poststudy survey respondents, most indicated that they would want to continue using this technology and that they would recommend it to others. CONCLUSION: This novel technology is able to monitor, measure, and intervene for patients taking capecitabine in real time. Adherence overall was high, and some patients appeared to benefit more from text-message interventions. Future work should focus on patients deemed high risk for nonadherence.


Asunto(s)
Cumplimiento de la Medicación , Envío de Mensajes de Texto , Administración Oral , Humanos , Proyectos Piloto , Encuestas y Cuestionarios
6.
Am J Health Syst Pharm ; 78(8): 720-725, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33647947

RESUMEN

PURPOSE: The objectives and strategies used by an ambulatory care action team operating within a large health system's pharmacy incident command structure during the initial response to the coronavirus disease 2019 (COVID-19) pandemic are discussed. SUMMARY: In a time of crisis, a pharmacy ambulatory action team was formed to provide ambulatory clinical pharmacy expertise and meet an immediate and ongoing need to limit nonemergent care during the COVID-19 pandemic. By building a strong communication infrastructure and partnership with ambulatory care providers, clinic medical and operational leaderships, clinical laboratory staff, and infusion centers, the team was able to swiftly execute solutions and respond to new issues and requests. Ambulatory care pharmacy practice continued to advance through provision of services to vulnerable patient populations with chronic conditions that were anticipated to experience gaps in care management during the COVID-19 pandemic. These efforts resulted in expansion of pharmacists' involvement in collaborative drug therapy management, support of patients' transition from in-clinic injection to home self-administration, provision of medication assistance support, and management of 1,300 patients via protocol-based warfarin management. Additionally, ambulatory pharmacy services in 15 primary care, anticoagulation, and specialty clinic sites were transitioned to telehealth. The ambulatory action team also implemented several strategies to manage medication therapy associated with COVID-19-related shortages and implemented electronic decision support to guide prescribing of hydroxychloroquine and azithromycin. CONCLUSION: Building a strong communication infrastructure and a pharmacy ambulatory action team were essential to respond to a crisis and continue ambulatory clinical pharmacy services expansion.


Asunto(s)
Instituciones de Atención Ambulatoria , COVID-19 , Pandemias , Servicio de Farmacia en Hospital , Farmacia , SARS-CoV-2 , Telemedicina , Connecticut , Humanos
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