Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
Artículo en Inglés | MEDLINE | ID: mdl-32389555

RESUMEN

OBJECTIVE: To explore the implementation strategy of a recombinant zoster vaccine (RZV) clinical decision support (CDS) intervention in community pharmacy workflow to increase second-dose vaccination rates. SETTING: The level of analysis was the unit (e.g., pharmacy). The participants were selected from across approximately 2200 pharmacies in 37 states on the basis of criteria believed to affect implementation success (e.g., size, location) using a sampling matrix. PRACTICE DESCRIPTION: Large supermarket pharmacy chain. PRACTICE INNOVATION: Vaccine-based CDS intervention in community pharmacy workflow. EVALUATION: A mixed-methods contextual inquiry approach explored the implementation of a new RZV CDS workflow intervention. Data collection involved key informant, semistructured interviews and an electronic, Web-based survey. The survey was based on a validated instrument and was made available to all pharmacists nationwide within the study organization to assess views of the implementation's appropriateness, acceptability, and feasibility during early implementation. Afterward, a series of semistructured, in-depth interviews were conducted until a point of saturation was reached. The interview guide was based on selected constructs of the Consolidated Framework for Implementation Research. RESULTS: A total of 1128 survey responses were collected. Survey respondents agreed or strongly agreed that the implementation was acceptable (78.34%), appropriate (79.92%), and feasible (80.53%). Twelve pharmacist participants were interviewed via telephone. Five themes emerged from the interviews, revealing facilitators and barriers that affected implementation of the intervention: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. CONCLUSION: The implementation of the RZV CDS "nudge" intervention was welcomed, suitable, and operable in the community pharmacy setting to meet the needs of the organization, employees, and patients. The contextual factors identified during the implementation process of this CDS intervention in a community pharmacy setting may be used in scaling this and future CDS interventions for public health initiatives aimed at pharmacists in this setting.

2.
Ophthalmology ; 127(5): 589-598, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31767436

RESUMEN

PURPOSE: The majority of patients with glaucoma do not take their medications as prescribed. Estimates of the cost-utility value of adherence to prescribed glaucoma medication are vital to implement potentially effective interventions. DESIGN: Cost-utility analysis using Monte Carlo microsimulations incorporating a series of Markov cycles (10 000 iterations per strategy). PARTICIPANTS: Patients with glaucoma aged ≥40 years with a full lifetime horizon (up to 60 years). METHODS: The analysis estimated glaucomatous progression on the basis of data from the United Kingdom Glaucoma Treatment Study. Participants with glaucoma entered the model at age 40 years with a mean deviation in the better-seeing eye of -1.4±-1.9 decibels (dB) and -4.3±-3.4 dB in the worse-seeing eye. Participants whose glaucoma worsened each year accumulate -0.8 dB loss compared with -0.1 dB loss for those who remained stable. Data from the Glaucoma Laser Trial and the Tube versus Trabeculectomy Studies were used to assign probabilities of worsening disease among treated patients. Claims data estimating rates of glaucoma medication adherence over 4 years were used to assign probability of adherence. Those with poor adherence were modeled as having outcomes similar to the placebo arm of the clinical trials. As patients' mean deviation deteriorated, they transitioned between health states from mild (≥-6 dB), to moderate (<-6 to ≥-12 dB), to severe glaucoma (<-12 to ≥23 dB), to unilateral (<-20 dB) and bilateral blindness. At each health state, patients incurred the costs of treatment and established health utilities; ultimately, societal costs of low vision and blindness were included. MAIN OUTCOME MEASURES: Cost and quality-adjusted life year (QALY) of glaucoma medication adherence. RESULTS: Beginning at an initial glaucoma diagnosis at age 40 years, patients proceeded to single-eye blindness as early as 19 years among those who were nonadherent and 23 years for those remaining adherent. Total healthcare costs for adherent patients averaged $62 782 (standard deviation [SD], 34 107), and those for nonadherent patients averaged $52 722 (SD, 38 868). Nonadherent patients had a mean loss of 0.34 QALYs, resulting in a cost-effectiveness ratio of $29 600 per QALY gained. CONCLUSION: At a conservative willingness to pay of $50 000/QALY, there is room to expand services to improve patient adherence.

3.
Cureus ; 11(9): e5743, 2019 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-31723504

RESUMEN

Introduction Text messaging (TM) is increasingly used by the U.S. medical practices and healthcare delivery systems, but little is known about preferences of medically underserved minority patients for TM supporting improved self-care decisions. We sought to determine the characteristics of text messages and TM programs preferred by African-American patients with diabetes in medically underserved areas. Methods This convergent mixed methods study employed a self-administered survey and focus group interviews. Quantitative and qualitative data were collected simultaneously, analyzed separately, and merged to provide a holistic view of the TM characteristics patients preferred. Participants (N = 36) were recruited from a medically underserved area in Memphis, Tennessee. Focus group data were uploaded into the NVivo qualitative data analysis software program, and main themes were identified. Standard frequencies were calculated for survey responses. Results Participants ranged in the age of 22-74 years (M = 54.1; SD = 14.6) were predominantly female (77.8%), African-Americans (88.9%), and had at least a high school education (91.7%). A majority used mobile phones for sending (69.4%) and receiving (72.2%) text messages. Participants wanted to receive daily (44.4%) or weekly (47.2%) text messages from their healthcare provider (61.1%), or a motivational message program (33.3%). They preferred actionable messages with a positive tone and wanted options to customize message type, content, and frequency according to their preferences, goals, and needs. Discussion Medically underserved African-American diabetes patients want customized text messages that are practical, actionable, encouraging, and from their doctor. Healthcare providers seeking to develop patient-centered TM programs for medically underserved minority patients should personalize and tailor messages according to patient preferences, health goals, and self-care needs.

4.
BMC Health Serv Res ; 18(1): 855, 2018 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-30428877

RESUMEN

BACKGROUND: Diabetes remains a growing public health threat but evidence supports the role that pharmacists can play in improving diabetes medication use and outcomes. To improve the quality of care, the Veterans Health Administration has widely adopted care models that integrate clinical pharmacists, but more data are needed to interpret the impact of these services. Our objective was to assess clinical pharmacy services' impact on outcomes and oral antidiabetic medication (OAD) use among veterans with uncontrolled diabetes in the first year of therapy. METHODS: This was a retrospective cohort analysis using the Veterans Affairs (VA) Corporate Data Warehouse to identify the first diagnosis of and initiation of OAD therapy for uncomplicated, uncontrolled diabetes (A1C > 7.0%) during 2002-2014. Receipt of clinical pharmacy services was identified using codes within VA electronic health records, and clinical values were obtained at or near the initial fill date and 365 days later. Use of OADs was assessed by proportion of days covered (PDC) for one year following the first filled prescription. Veterans having received clinical pharmacy services were matched 1:1 to those having not seen a clinical pharmacist in the first year of therapy, and generalized linear models assessed changes and differences in outcomes. RESULTS: The analysis included 5749 patients in each cohort. On average, patients saw a clinical pharmacist 2.5 times throughout the first year of OAD therapy. Adherence to OAD medications was higher in veterans having seen a pharmacist (84.3% vs. 82.4%, p < 0.0001) and more such patients achieved a PDC of at least 80% (72.2% vs. 68.2%, p < 0.0001). After one year of OAD therapy, mean change in hemoglobin A1C was greater among those receiving pharmacy services (- 1.5% vs. -1.4%, p < 0.0001). CONCLUSION: Pharmacist participation in diabetes patients' primary care positively affects the multifaceted needs of patients with this condition and comorbid chronic disease.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación , Servicio de Farmacia en Hospital/estadística & datos numéricos , Anciano , Diabetes Mellitus/sangre , Métodos Epidemiológicos , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos/organización & administración , Farmacéuticos/estadística & datos numéricos , Servicio de Farmacia en Hospital/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Relaciones Profesional-Paciente , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estadística & datos numéricos
5.
J Manag Care Spec Pharm ; 24(4): 379-389, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29578849

RESUMEN

BACKGROUND: Medication nonadherence is a prevalent public health issue, particularly among patients with diabetes mellitus (DM), and negatively affects health outcomes. Because of the prevalence of DM among U.S. veterans, it is crucial to understand how well these patients adhere to oral antidiabetic (OAD) medication and whether certain subgroups are more likely to be nonadherent. OBJECTIVE: To assess initial OAD medication use among veterans with uncomplicated DM and determine factors associated with adherence in the first 2 years of treatment. METHODS: This was a retrospective cohort study using data from the Veterans Affairs (VA) Corporate Data Warehouse from 2002 through 2014. The first diagnosis for uncomplicated DM was determined, and then medication use was assessed following OAD initiation. OAD use was assessed by proportion of days covered (PDC) for the first 2 years of therapy using outpatient VA pharmacy records. Adherence was determined both continuously and categorically, with a PDC of ≥ 80% used to indicate adherence. Logistic regression was used to determine if certain patient characteristics were associated with being adherent to OADs. RESULTS: A total of 148,544 veterans with uncomplicated DM were assessed, most of whom were white, aged ≥ 55 years, and initiated OAD therapy on metformin. A large portion resided in the southern part of the United States. In the first year, PDC averaged 79.2% (SD = 25.9), and 63.2% were adherent to OAD therapy; however, these numbers declined in the second year, when the average PDC was 71.3% (SD = 35.8), and only 59.1% were adherent. Over the course of both years, PDC averaged 75.3% (SD = 28.4), and 50.9% were adherent. The odds of being adherent were higher among older adults and significantly lower among veterans self-identifying as either African American (OR = 0.61; 95% CI = 0.59-0.63), Native American (OR = 0.67; 95% CI = 0.61-0.75), or Hawaiian/Pacific Islander (OR = 0.84; 95% CI = 0.76-0.92) when compared with whites. Veterans who were either divorced/separated (OR = 0.86; 95% CI = 0.83-0.88) or never married (OR = 0.89; 95% CI = 0.86-0.93) also had lower odds of being initially adherent to OAD therapy compared with those who reported being married. Being nonadherent in year 1 was highly predictive of remaining nonadherent in year 2 (OR = 12.8; 95% CI = 12.23-12.94), with only 22.2% nonadherent in the first year (8.2% overall) becoming adherent in the second year of therapy. Across both years, all minorities were less likely to be adherent (compared with whites), and average adherence differed among all geographic regions of the country. CONCLUSIONS: Within the first year of OAD therapy, medication adherence was suboptimal among veterans with DM, and second-year results indicate that adherence is likely to decline over time. Future studies should consider deeper regional and subgroup analysis to determine what contributes to variation in medication use in communities across the country. DISCLOSURES: This study was supported by a KL2 Career Development Grant from the University of Tennessee Health Science Center's Institute for Research, Innovation, Synergy and Health Equity and by resources from the U.S. Department of Veterans Affairs. Hung and Kovesdy are employees of the Department of Veterans Affairs. Opinions expressed are those of the study authors and do not necessarily reflect the views of the Department of Veterans Affairs. None of the authors declared significant relevant financial conflicts of interest. Results of this study were presented as a poster at the Academy of Managed Care Pharmacy Nexus Conference on October 3-6, 2016, in National Harbor, Maryland.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Disparidades en el Estado de Salud , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Metformina/uso terapéutico , Persona de Mediana Edad , Servicios Farmacéuticos/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos , United States Department of Veterans Affairs/estadística & datos numéricos
6.
J Glaucoma ; 26(11): 1056-1061, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29099436

RESUMEN

PURPOSE: To compare use of topical medications between a wireless monitoring device and validated self-reported measures of glaucoma medication adherence. PATIENTS AND METHODS: This study involved adults from a group ophthalmology practice diagnosed with and being medicinally treated for glaucoma who were not scheduled for a surgery during the study period. Subjects were required to use a new wireless device to dispense their glaucoma medication for 2 months, and were surveyed at baseline and immediately following the study to assess mobile phone use, glaucoma-related self-efficacy, and medication adherence. RESULTS: Complete data (survey and accurate device recordings) were available for 23 subjects at both baseline and endpoint. Median adherence, as measured by the device, was 82% and dropped slightly between 30-day periods, from 83% to 77%. Similarly, the percent adherent (dosing at least 75% of the time) dropped significantly between months according to both the device (78.3% and 52.2%) and a self-reported measure (63% and 56%). Kappa statistics indicated low agreement between the device and self-report when classifying adherent status. A majority of subjects interviewed found the device easy to use, indicated that it did not interfere with medication-taking or normal activities, and were not bothered by their physician knowing when medication was dispensed. CONCLUSION: In this pilot, nearly all Kali Drop devices performed as expected, providing real-time data on medication use over a 60-day period. Data suggested that self-reported and electronic estimates of glaucoma medication use differ, but additional testing of this new device is needed to corroborate the data observed.


Asunto(s)
Antihipertensivos/administración & dosificación , Monitoreo de Drogas/instrumentación , Glaucoma/tratamiento farmacológico , Presión Intraocular/efectos de los fármacos , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas/administración & dosificación , Proyectos Piloto , Estudios Prospectivos , Autoinforme , Encuestas y Cuestionarios
7.
J Am Med Inform Assoc ; 18 Suppl 1: i51-61, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21486876

RESUMEN

OBJECTIVE: To develop a theoretically informed and empirically validated survey instrument for assessing prescribers' perception of computerized drug-drug interaction (DDI) alerts. MATERIALS AND METHODS: The survey is grounded in the unified theory of acceptance and use of technology and an adapted accident causation model. Development of the instrument was also informed by a review of the extant literature on prescribers' attitude toward computerized medication safety alerts and common prescriber-provided reasons for overriding. To refine and validate the survey, we conducted a two-stage empirical validation study consisting of a pretest with a panel of domain experts followed by a field test among all eligible prescribers at our institution. RESULTS: The resulting survey instrument contains 28 questionnaire items assessing six theoretical dimensions: performance expectancy, effort expectancy, social influence, facilitating conditions, perceived fatigue, and perceived use behavior. Satisfactory results were obtained from the field validation; however, a few potential issues were also identified. We analyzed these issues accordingly and the results led to the final survey instrument as well as usage recommendations. DISCUSSION: High override rates of computerized medication safety alerts have been a prevalent problem. They are usually caused by, or manifested in, issues of poor end user acceptance. However, standardized research tools for assessing and understanding end users' perception are currently lacking, which inhibits knowledge accumulation and consequently forgoes improvement opportunities. The survey instrument presented in this paper may help fill this methodological gap. CONCLUSION: We developed and empirically validated a survey instrument that may be useful for future research on DDI alerts and other types of computerized medication safety alerts more generally.


Asunto(s)
Actitud del Personal de Salud , Interacciones Farmacológicas , Sistemas de Entrada de Órdenes Médicas , Sistemas Recordatorios , Encuestas y Cuestionarios , Actitud hacia los Computadores , Recolección de Datos , Quimioterapia Asistida por Computador , Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA