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1.
BMC Health Serv Res ; 19(1): 493, 2019 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-31311537

RESUMEN

BACKGROUND: The Institute for Healthcare Improvement identifies medication reconciliation as the shared responsibility of nurses, pharmacists, and physicians, where each has a defined role. The study aims to assess the clinical impact of pharmacy-led medication reconciliation performed on day one of hospital admission to the internal medicine service. METHODS: This is a pilot prospective study conducted at two tertiary care teaching hospitals in Lebanon. Student pharmacists who were properly trained and closely supervised, collected the medication history, and pharmacists at the corresponding sites performed the reconciliation process. Interventions related to the unintended discrepancies were relayed to the medical team. The main outcome was the number of unintended discrepancies identified. The time needed for medication history, and the information sources used to complete the Best Possible Medication History were also assessed. The unintended discrepancies were classified by medication class and route of medication administration, by potential severity, and by proximal cause leading to the discrepancy. For the bivariate and multivariable analysis, the dependent variable was the incidence of unintended discrepancies. The "total number of unintended discrepancies" was dichotomized into yes (≥ 1 unintended discrepancy) or no (0 unintended discrepancies). Independent variables tested for their association with the dependent variable consisted of the following: gender, age, creatinine clearance, number of home medications, allergies, previous adverse drug reactions, and number of information sources used to obtain the BPMH. Results were assumed to be significant when p was < 0.05. RESULTS: During the study period, 204 patients were included, and 195 unintended discrepancies were identified. The most common discrepancies consisted of medication omission (71.8%), and the most common agents involved were dietary supplements (27.7%). Around 36% of the unintended discrepancies were judged as clinically significant, and only 1% were judged as serious. The most common interventions included the addition of a medication (71.8%) and the adjustment of a dose (12.8%). The number of home medications was significantly associated with the occurrence of unintended discrepancies (ORa = 1.11 (1.03-1.19) p = 0.007). CONCLUSIONS: Pharmacy-led medication reconciliation upon admission, along with student pharmacist involvement and physician communication can reduce unintended discrepancies and improve medication safety and patient outcomes.


Asunto(s)
Medicina Interna/estadística & datos numéricos , Conciliación de Medicamentos/organización & administración , Admisión del Paciente/estadística & datos numéricos , Servicio de Farmacia en Hospital/organización & administración , Anciano , Anciano de 80 o más Años , Femenino , Investigación sobre Servicios de Salud , Hospitales de Enseñanza , Humanos , Líbano , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Atención Terciaria de Salud
2.
Expert Rev Pharmacoecon Outcomes Res ; 19(5): 551-559, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31305172

RESUMEN

Introduction: There is a lack of good quality economic evidence for the inclusion of pharmacists on hospital ward rounds in addition to, or as an alternative to, traditional ward-based clinical pharmacy services. There has been no systematic review of the cost or cost-effectiveness of pharmacists attending and contributing on ward rounds. Areas covered: A literature search was conducted in Medline, Embase, Cochrane, and CINAHL and reported in accordance with the PRISMA guidelines in May 2019. As well, a search using Google Scholar and a targeted hand search were undertaken. Studies that reported any estimate of the cost or cost-effectiveness were included if pharmacist participation on inpatient hospital ward rounds was the predominant focus of the intervention. The identified studies were subsequently screened by three reviewers who extracted data on their clinical and economic design. A bias assessment was completed using the ROBINS-I tool. Expert opinion: Seven studies were identified investigating a clinical pharmacist's inclusion on hospital ward rounds where there was a cost estimated. However, none were deemed to be a full economic evaluation and all were found to be open to a serious risk of bias. Future evaluations should include a comparator group and investigate the cost and cost savings of the service, alongside their clinical outcomes.


Asunto(s)
Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Rondas de Enseñanza/organización & administración , Sesgo , Análisis Costo-Beneficio , Humanos , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Rol Profesional , Proyectos de Investigación , Rondas de Enseñanza/economía
3.
Expert Opin Drug Saf ; 18(8): 745-752, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31232612

RESUMEN

Objectives: Adverse drug reactions (ADRs) are a pervasive global problem, and its management is integral to patient safety and healthcare quality. Pharmacists play a pivotal role in monitoring and reporting ADRs, which has a direct impact on patient care. The aim of this study was to identify potential factors that facilitate pharmacists in community and hospital settings to report ADRs. Methods: A cross-sectional, online survey using a validated questionnaire was administered to pharmacists working in community and hospital pharmacies in Saudi Arabia. Results: 1,717 community and 153 hospital pharmacists participated in this study. Only 10.2% and 26.8% of community and hospital pharmacists, respectively, admitted ever reporting an ADR. The most reported factors that may facilitate ADRs reporting have included ongoing improvements in therapeutic knowledge about ADRs, attending educational programs with continuous medical education credits, the seriousness of the experienced ADRs and accessibility to patients' medical profile. The impact of peers by seeing colleagues reporting ADRs and ADRs due to herbal or traditional medicine were the least important factors reported by pharmacists. Conclusion: The study identified factors that can effectively address the under-reporting of ADRs by pharmacists. A multi-stakeholder, multi-pronged approach of ADR reporting is needed to develop greater awareness of this issue among pharmacists.


Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Farmacéuticos/estadística & datos numéricos , Adulto , Servicios Comunitarios de Farmacia/organización & administración , Estudios Transversales , Femenino , Humanos , Masculino , Farmacovigilancia , Servicio de Farmacia en Hospital/organización & administración , Rol Profesional , Arabia Saudita , Encuestas y Cuestionarios
4.
J Manag Care Spec Pharm ; 25(7): 765-769, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31232209

RESUMEN

BACKGROUND: Patients with cancer often face financial toxicity. They may face financial distress because of high out-of-pocket costs that in turn can result in delays in treatment, treatment abandonment, and higher overall costs of care, all of which can have have a negative effect on patient care. A specialty pharmacy practice model can play a role in decreasing financial toxicity. OBJECTIVE: To evaluate the patient out-of-pocket costs after enrollment in manufacturer patient assistance programs, copay cards, and foundation grants by an oncology specialty pharmacy at University of Chicago Medicine (UCM). METHODS: For this quality improvement project, a retrospective analysis of prescription claims from January 2017 to June 2017 was performed. The primary outcomes included the number of patients enrolled in manufacturer patient assistance programs, copay cards, and foundation grants, along with the total dollars applied to pharmacy claims. The secondary outcome was the average days to approval of a foundation grant. Inclusion criteria for this quality improvement project included prescriptions filled at UCM Specialty Pharmacy in the 6-month time frame for an oncology indication. Exclusion criteria were prescriptions that were not filled at UCM Specialty Pharmacy due to out-of-network insurance and prescriptions that were part of a patient assistance program where the medication was directly shipped from the manufacturer. RESULTS: In the 6-month time frame, 75 patients received financial assistance, with a total cost savings of $314,857. Financial assistance was most frequently applied to the following medications: peg-filgrastim, dasatinib, abiraterone, filgrastim and filgrastim-sndz, palbociclib, venetoclax, and ruxolitinib. The cost savings of these interventions ranged between $5 and $13,138 per prescription claim. The average days from date of insurance approval to date of financial grant approval was 1.2 days. CONCLUSIONS: This project demonstrates the importance of an oncology specialty pharmacy team in ensuring timely approval of a foundation grant and reducing financial toxicity, which can play a major role in access to therapy. DISCLOSURES: No outside funding supported this project. The authors have no conflicts of interest to report. This project was presented at the Vizient University Health System Consortium Pharmacy Network Resident Poster Session; December 1, 2017; Orlando, FL.


Asunto(s)
Antineoplásicos/economía , Gastos en Salud/estadística & datos numéricos , Neoplasias/tratamiento farmacológico , Servicio de Farmacia en Hospital/economía , Centros Médicos Académicos , Ahorro de Costo , Costos de los Medicamentos , Industria Farmacéutica/economía , Accesibilidad a los Servicios de Salud/economía , Humanos , Oncología Médica , Neoplasias/economía , Servicio de Farmacia en Hospital/organización & administración , Mejoramiento de la Calidad , Estudios Retrospectivos , Factores de Tiempo
5.
Farm. hosp ; 43(3): 82-86, mayo-jun. 2019. tab
Artículo en Español | IBECS | ID: ibc-183009

RESUMEN

Objetivo: Analizar la situación y la posible variabilidad de la prestación farmacéutica a centros sociosanitarios residenciales públicos incluidos en un proyecto piloto vinculados a un servicio de farmacia de hospital del Servicio Andaluz de Salud. Método: Estudio multicéntrico transversal. Se diseñó un cuestionario que incluye preguntas englobadas en: características del centro, legislación, guía farmacoterapéutica y prescripción, preparación y transporte, dispensación, administración, actividad farmacéutica y datos asistenciales. Resultados: Se incluyeron los 13 centros del proyecto piloto; todos respondieron las 36 preguntas del cuestionario. Todos disponían de depósito de medicamentos. Todos dispensaban en dosis unitaria individualizada. Tres centros sociosanitarios no disponían de puesto de trabajo para el farmacéutico. El farmacéutico no se desplazaba al centro en tres de ellos. Conclusiones: Aunque existe cierta variabilidad en la prestación farmacéutica a los centros sociosanitarios del pilotaje, se han identificado tanto fortalezas (por ejemplo, dispensación de medicamentos en dosis unitaria), como puntos de mejora (como el aumento de la presencia del farmacéutico en los centros)


Objective: To analyse the situation and the possible variability of pharmaceutical provision to public nursing homes included in the "Project pilot" from hospital pharmacy services of the Andalusian Health Service. Method: Cross-sectional multicenter study. A questionnaire of 36 questions including: nursing homes characteristics, legislation, pharmacotherapeutic guide and prescription, preparation and transport, dispensation, administration, pharmaceutical activity and healthcare data. Results: We included 13 nursing homes. Everyone had a medicines store. All dispensed in individualized unit dose. Three nursing homes did not have a work space for the pharmacist. The pharmacist did not move to the nursing home in three of them. Conclusions: Although there is variability in the pharmaceutical provision to nursing homes included in the "Pilot Project", we have identified strengths (unit dose system of medication distribution) and opportunities to improve (increase of the time of presence of the pharmacist in the nursing homes)


Asunto(s)
Humanos , Casas de Salud , Servicio de Farmacia en Hospital/organización & administración , Proyectos Piloto , Medicamentos del Componente Especializado de los Servicios Farmacéuticos , Servicios Públicos de Salud , Estudios Transversales , Encuestas y Cuestionarios , Medicamentos con Supervisión Farmacéutica
6.
BMC Health Serv Res ; 19(1): 325, 2019 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-31118002

RESUMEN

BACKGROUND: Of the various types of medication administration error that occur in hospitals, dose omissions are consistently reported as among the most common. It has been suggested that greater involvement from pharmacy teams could help address this problem. A pilot service, called pharmacy TECHnician supported MEDicines administration (TECHMED), was introduced in an English NHS hospital for a four-week period in order to reduce preventable medication dose omissions. The objective of this study was to evaluate the implementation, delivery and impact of the pilot TECHMED service using qualitative methods. METHODS: Semi-structured interviews with pharmacy technicians, nursing staff and senior management involved with the pilot service were undertaken to evaluate TECHMED. Interviews were transcribed verbatim and analysed using the framework approach, guided by Weiss's Theory Based Evaluation model. RESULTS: Twenty-two stakeholder interviews were conducted with 10 ward-based pharmacy technicians, nine nurses and three members of senior management. Most technicians performed a range of activities in line with the service specification, including locating drugs from a variety of sources, and identified situations where they had prevented missing doses. Nurses reported positive impacts of TECHMED on workload. However, not all technicians fully adhered to the service specification in regard to directly following nursing staff during each medication round, citing reasons related to productivity or perceived intrusiveness towards nursing staff. Some participants also reported a perceived lack of impact of TECHMED on medicine omissions. Seventeen of the 22 interviewees supported an extension of the service. There were however, concerns about the impact on technician workload and some participants advocated support for targeted service extension to wards/rounds with high schedule dose volumes and omitted dose rates. CONCLUSIONS: The findings of this study suggest that the implementation of a pharmacy technician-supported medicines administration scheme to reduce omitted doses may be acceptable to staff in an NHS hospital, and that issues with service fidelity, staff resource/capacity and perceived interventions to avoid dose omissions have important implications for the feasibility of extending the service. The study has identified targets for future development in relation to individual and system factors to improve operationalisation of technician-led initiatives to reduce medicines omissions.


Asunto(s)
Errores de Medicación/prevención & control , Servicio de Farmacia en Hospital/organización & administración , Técnicos de Farmacia/estadística & datos numéricos , Inglaterra , Femenino , Hospitalización , Hospitales/estadística & datos numéricos , Humanos , Masculino , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Medicina Estatal , Carga de Trabajo/estadística & datos numéricos
7.
BMC Health Serv Res ; 19(1): 156, 2019 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-30866925

RESUMEN

BACKGROUND: The increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists' activities, including interactions with patients and health professionals, and their perceptions of medication safety risks. METHODS: A mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors. RESULTS: Observations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors. CONCLUSION: This study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists' activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure 'business as usual' by enhancing and adapting their role.


Asunto(s)
Prescripción Electrónica , Farmacéuticos/organización & administración , Inglaterra , Personal de Salud/organización & administración , Personal de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Errores de Medicación/prevención & control , Errores de Medicación/estadística & datos numéricos , Seguridad del Paciente , Percepción , Farmacéuticos/estadística & datos numéricos , Servicio de Farmacia en Hospital/organización & administración , Servicio de Farmacia en Hospital/estadística & datos numéricos , Rol del Médico , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos
8.
Artículo en Inglés | MEDLINE | ID: mdl-30893906

RESUMEN

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.


Asunto(s)
Hospitales Públicos/organización & administración , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Femenino , Hospitales Públicos/normas , Humanos , Laboratorios de Hospital/organización & administración , Laboratorios de Hospital/normas , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Pakistán , Servicio de Farmacia en Hospital/organización & administración , Servicio de Farmacia en Hospital/normas , Relaciones Médico-Paciente , Encuestas y Cuestionarios
9.
J Manag Care Spec Pharm ; 25(3): 411-416, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30816815

RESUMEN

BACKGROUND: The establishment of a formulary management system ensures that health care professionals work together in an integrated patient care process to promote clinically sound, safe, and cost-effective medication therapy. Pharmacists have a foundational role within this system. A pharmacist-adjudicated prior authorization drug request (PADR) consult service has the potential to optimize drug therapy by decreasing medication misuse, minimizing adverse drug events (ADEs), and preventing medication errors. OBJECTIVES: To (a) determine cost avoidance associated with pharmacist-adjudicated PADR safety interventions within the Durham Veterans Affairs Health Care System and (b) evaluate cost savings associated with pharmacist-adjudicated PADRs not approved due to a safety intervention, evaluate cost avoidance and direct cost savings based on clinical specialty of pharmacist adjudicating PADR, and characterize severity of avoided ADEs. METHODS: Pharmacist-adjudicated PADRs not approved between July 1, 2016, and June 30, 2017, because of safety interventions were retrospectively reviewed. Cost avoidance was determined by multiplying the probability of ADE occurrence in the absence of PADR safety intervention by the estimated cost avoided based on the type of intervention. Direct cost savings was calculated by totaling the cost of requested medications not approved for each PADR and subtracting the cost of recommended alternative therapies and cost of pharmacist PADR review. All potential ADEs avoided were reviewed by a panel of 3 clinical pharmacists to validate ADE classification and ADE probability and severity scores. Descriptive statistics were used for all analyses. RESULTS: Of the 910 PADRs that were not approved during the study period, 96 met inclusion criteria. Pharmacist-adjudicated PADR safety interventions resulted in a total cost avoidance of $24,485.34 (mean = $255.06) and a direct cost savings of $288,695.63 (mean = $3,007.25). The practice settings of anticoagulation and infectious diseases PADRs resulted in the largest contribution to cost avoidance and direct cost savings, respectively. Prevented ADEs were classified as major for 64.6% of the PADRs. CONCLUSIONS: Pharmacist-adjudicated PADR safety reviews resulted in substantial economic benefit and prevention of major ADEs. This analysis supports the pharmacist's role in a formulary management system to optimize medication therapy. DISCLOSURES: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors. The authors have nothing to disclose.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Autorización Previa/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Consultores , Ahorro de Costo , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/economía , Femenino , Formularios de Hospitales como Asunto , Hospitales de Veteranos/economía , Hospitales de Veteranos/organización & administración , Humanos , Masculino , Errores de Medicación/economía , Errores de Medicación/prevención & control , Persona de Mediana Edad , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Autorización Previa/economía , Rol Profesional , Estudios Retrospectivos
10.
Ann Pharm Fr ; 77(2): 168-177, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30678804

RESUMEN

OBJECTIVES: Medication reconciliation is widely promoted by international health authorities. Its expansion requires human resources, which are limited and unequally distributed among health care facilities. Recent international studies support the involvement of pharmacy technician in the medication reconciliation process but his role remains unstructured in France. We aimed to assess pharmacy technicians' opinions and willingness to be involved in the medication reconciliation process expansion and to identify the levers and barriers of the project. METHODS: A field study was conducted among health facilities of our territory hospital group. Semi-structured interviews were carried out with different pharmacy technicians. Data were analyzed using a qualitative thematic analysis approach. RESULTS: Overall, 12 pharmacy technicians from 5 hospitals were interviewed and almost all assumed their rightful place in the medication reconciliation process (n=11), with a view to revaluating tasks. For all pharmacy technicians, the main barriers to participate in medication reconciliation were the lack of time and training. The spread of a "patient culture", the supervision by pharmacists, the desire to be part of the care team in the ward and additional training requests were major levers of change. CONCLUSIONS: Pharmacy technicians' role in expanding medication reconciliation process is legitimate and must be standardized in France. The deployment of the project requires to be formalized within a territory and should consider and develop local organisations.


Asunto(s)
Conciliación de Medicamentos/métodos , Servicio de Farmacia en Hospital/organización & administración , Técnicos de Farmacia , Actitud del Personal de Salud , Francia , Humanos , Organización y Administración , Farmacéuticos , Técnicos de Farmacia/educación
11.
Am J Health Syst Pharm ; 76(Supplement_1): S28-S33, 2019 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-30689695

RESUMEN

Purpose: The implementation of a commercially available, Web-based, barcode-enabled workflow management system for filling and checking patient-specific oral syringes at the Cleveland Clinic is described. Summary: Historically, the process for preparing oral syringes has been a manual, repetitive procedure at Cleveland Clinic. Within this process, paper logs are the sole source of information. These logs can be difficult to locate or interpret. It remains a rote process with numerous manual steps offering opportunity for human error. Traditionally, automation, such as barcode scanning, has not been available during oral syringe preparation and checking. Based on increasing regulatory demands and documentation gaps identified, solutions were explored in the pharmacy's nonsterile compounding environment. An electronic verification workflow system was developed, implemented, and evaluated with a focused assessment of throughput and patient safety relative to oral syringe preparation. This was a retrospective study conducted in an academic, tertiary, acute care medical center. Analysis was completed at 3 months to evaluate efficiencies. Data regarding experiences at the Cleveland Clinic shows promising benefits with regards to United States Pharmacopeia chapter 795 compliance, the pursuit of incorporating advanced informatics and automation in manual processes, and standardization of workflow within an enterprise setting. Conclusion: Implementation of an electronic workflow verification system that integrates barcode verification and image-capture capabilities has maintained regulatory compliance in the nonsterile compounding environment including preparation of oral syringe doses without impacting throughput.


Asunto(s)
Servicio de Farmacia en Hospital/organización & administración , Jeringas , Flujo de Trabajo , Administración Oral , Humanos , Sistemas de Entrada de Órdenes Médicas/organización & administración
12.
Ann Pharm Fr ; 77(2): 159-167, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30683487

RESUMEN

BACKGROUND: In French hospitals, the supply and management of drugs are missions of pharmacists. The aim of this study is to assess the use of efficacy and economics opinions of the Haute Autorite de santé (HAS) in hospital referencing of drugs in France in 2017. METHODS: A questionnaire for hospital pharmacists was developed to establish their knowledge and their uses of Transparency Commission and Economic and Public Health Evaluation Committee opinions. This survey was distributed by the ADIPH association in July 2017. This questionnaire included 35 questions. RESULTS: Despite the health professional are more and more interesting by economics analysis, only 30 % of hospitals pharmacists of this panel declared to use HAS economic opinions (versus 80% for Transparency Commission opinions). Among these pharmacists, 86% used this report in the hospital referencing of drugs. CONCLUSION: Through this analysis, some prospects for improvement can be seen in the health professional formation, cost-effectiveness report publication and the use of cost-effectiveness analysis. This study is an overview of the use of opinions provided by the HAS. This thesis established a basis to reflection on the use of economics reports and models in the hospital decisions.


Asunto(s)
Economía Hospitalaria , Farmacéuticos , Servicio de Farmacia en Hospital/economía , Servicio de Farmacia en Hospital/organización & administración , Análisis Costo-Beneficio , Francia , Humanos , Salud Pública , Encuestas y Cuestionarios
13.
Clin Transl Oncol ; 21(4): 467-478, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30298467

RESUMEN

AIM: To define recommendations that permit safe management of antineoplastic medication, minimise medication errors and improve the safety of cancer patients undergoing treatment. METHODS: By reviewing the literature and consulting the websites of various health organisations and agencies, an expert committee from the Spanish Society of Hospital Pharmacy and the Spanish Society of Medical Oncology defined a set of safe practices covering all stages of providing cancer therapy to patients. The Spanish Society of Oncology Nursing revised and endorsed the final list. RESULTS: In total, 68 recommendations arranged in five sections were defined. They include issues concerning the training of health professionals, the technological resources needed, treatment planning, informing the patient and his/her family, the processes of prescribing, preparing, dispensing and administering cancer therapy (orally, parenterally or intrathecally), assessing patient adherence and treatment toxicity. CONCLUSIONS: It is essential for healthcare establishments to implement specific measures designed to prevent medication errors, in order to ensure the safety of cancer patients treated with antineoplastic medication.


Asunto(s)
Antineoplásicos/uso terapéutico , Oncología Médica/normas , Administración del Tratamiento Farmacológico/normas , Seguridad del Paciente/normas , Antineoplásicos/efectos adversos , Humanos , Oncología Médica/organización & administración , Errores de Medicación/prevención & control , Neoplasias/tratamiento farmacológico , Enfermería Oncológica/organización & administración , Servicio de Farmacia en Hospital/organización & administración , España
14.
Pain Pract ; 19(3): 303-309, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30403432

RESUMEN

PURPOSE: To describe a model of clinical pharmacy services as part of a multidisciplinary specialty pain clinic by discussing (1) the role of a clinical pharmacist in a specialty setting, including clinical interventions implemented, and (2) how integration of a clinical pharmacist may translate into an improved patient care model for the management of chronic pain. METHODS: A retrospective chart review was conducted of pharmacist visits from October 1, 2013, to September 30, 2015, in a specialty pain clinic at an academic medical center in Los Angeles, California. Data were collected regarding medication-related problems (MRPs) identified by the pharmacist, interventions implemented to resolve the MRPs, and types of medication care coordination activities (MCCAs) performed by the pharmacist, such as responding to medication refill requests and insurance issues. Descriptive statistics were used. Institutional review board approval was obtained prior to initiating the study. RESULTS: At least 1 MRP was identified in 98.7% of the 380 visits. Problems identified by the clinical pharmacist were divided into 5 categories: medication refills needed (43%), medication appropriateness/effectiveness (18%), miscellaneous (17%), safety (16%), and nonadherence/patient variables (6%). Interventions focused on referral to appropriate providers, medication counseling, medication initiation, dose adjustment, and medication discontinuation. The most common MCCA was responding to refill requests. CONCLUSION: A clinical pharmacist can identify many MRPs and implement interventions in chronic pain management. Integration of clinical pharmacy services may improve practice management by facilitating the completion of MCCAs and increase access to patients' needs outside the clinic.


Asunto(s)
Clínicas de Dolor/organización & administración , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Centros Médicos Académicos , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención al Paciente , Cooperación del Paciente , Derivación y Consulta , Estudios Retrospectivos
15.
Int J Pharm Pract ; 27(2): 149-156, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30252175

RESUMEN

OBJECTIVES: To investigate the experiences of the participants in a study introducing a Pharmacy Accuracy Checking Technician (PACT) role, and specifically their perceptions of any advantages and disadvantages. METHODS: Self-administered surveys were distributed during the introduction of a checking technician role in eight community and four hospital pharmacy sites. Surveys were conducted at three time points; at baseline, at mid-point and a final data collection. Questions covered staff perceptions on; technicians' ability to take on this role, impact on workflow, impact on pharmacists' time spent with patients and any perceived advantages or disadvantages. KEY FINDINGS: Three hundred and fifty-five responses were received from participants. There was significant support for the introduction of this new role, and the greatest advantage identified was an increase in time available to pharmacists to increase potential clinical activities. Many staff felt that this role could easily fit into their current workplace and workflow with minor adjustments. There was a perception that this new role would increase safety and decrease errors as a result of the separation of clinical and checking tasks. Respondents identified a need for more technicians; however, conversely concern was expressed of a negative impact on the number of pharmacists' jobs. CONCLUSIONS: Despite the disruption caused by the training process, the respondents believed this new role to be beneficial to both staff and patients, and that the new model would allow for increased error identification and enhanced safety.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Técnicos de Farmacia/organización & administración , Femenino , Humanos , Masculino , Errores de Medicación/prevención & control , Nueva Zelanda , Proyectos Piloto , Rol Profesional , Encuestas y Cuestionarios
16.
J Oncol Pharm Pract ; 25(2): 423-433, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29890918

RESUMEN

AIMS: The goal of the present review was to identify studies that assess how pharmaceutical services contribute to hematopoietic stem cell transplantation (HSCT). METHODS: We conducted a systematic literature review of published studies describing results from clinical services provided by pharmacists working with HSCT, conducted according to PRISMA guidelines ( PROSPERO registration number CRD42017062391). A search strategy was applied within PubMed, CENTRAL, EMBASE, SCOPUS, and LILACS databases in April 2017. Inclusion criteria were observational or experimental studies that addressed the following research question: "What are a clinical pharmacist's main contributions to HSCT?" The quality of selected studies was evaluated using the Downs and Black checklist. RESULTS: We identified 1838 studies, and seven were included in the systematic review. The results indicated that clinical pharmacy is useful during HSCT treatment within both inpatient and outpatient settings. Pharmaceutical contributions identified included management of pharmacotherapy-related problems, participation in discussions with clinical teams, drug reconciliation, patient and team education regarding pharmacotherapy, preparation of guidelines and educational materials, and evaluation of medication adherence. These activities favored the control and prevention of pharmacotherapy-related problems, the maintenance of immunosuppressive serum levels, improvement in patients' clinical and nutritional status, facilitated medication adherence, and provided economic and humanistic gains. CONCLUSIONS: Despite the small number of articles discussing the topic under analysis, the results were unanimous in confirming the positive impact of pharmacists' contributions to clinical practice for HSCT.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Farmacéuticos , Servicio de Farmacia en Hospital , Humanos , Inmunosupresores/uso terapéutico , Cumplimiento de la Medicación , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración
17.
Res Social Adm Pharm ; 15(3): 267-278, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-29773308

RESUMEN

BACKGROUND: Hospital discharge poses a significant threat to the continuity of medication therapy and frequently results in drug-related problems post-discharge. Therefore, establishing continuity of care by realizing optimal collaboration between hospital and community pharmacists is of utmost importance. OBJECTIVE: To evaluate the collaboration between hospital and community pharmacists on addressing drug-related problems after hospital discharge. METHODS: A prospective follow-up study was conducted between November 2013-December 2014 in a general hospital and all affiliated community pharmacies. Adult patients, admitted for ≥48 h to the neurology or pulmonology ward were eligible if they used ≥3 chronic prescription drugs and lived in the community pharmacies' service area. The HomeCoMe intervention program was comprised of medication verification and counseling at admission, medication screening by the hospital pharmacist during admission, outpatient pharmacy discharge consultation and support, and a community pharmacist home visit within one week post-discharge. RESULTS: The mean age of the 152 included patients was 67.0 ±â€¯12.6 years and 56.6% were female. A total of 745 DRPs (4.9 ±â€¯2.2 DRPs per patient, range: 0-11) were identified with the need for additional "Education or information" (36.1%) and "Compliance" (16.4%) issues as most common DRP-types. This led to a total of 928 recommendations (6.1 ±â€¯3.0 per patient, range: 1-19) to solve the DRP. The majority of DRPs were identified (83.6%, n = 623) and solved (91.6%, n = 682) by the community pharmacist during the home visit. Furthermore, 52.5% (n = 64) of the DRPs identified during hospitalization were solved during the post-discharge home visit. CONCLUSIONS: Collaboration between hospital and community pharmacists from hospital admission to readmission to primary care is crucial to establish continuity of care. A post-discharge community pharmacist home visit is a valuable addition to in-hospital transitional care to identify and solve drug-related problems.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Errores de Medicación/prevención & control , Servicio de Farmacia en Hospital/organización & administración , Anciano , Continuidad de la Atención al Paciente , Conducta Cooperativa , Femenino , Hospitalización , Hospitales Generales , Visita Domiciliaria , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Farmacéuticos/organización & administración , Rol Profesional
18.
J Oncol Pharm Pract ; 25(3): 607-612, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29451420

RESUMEN

OBJECTIVES: To describe key activities performed by a newly deployed clinical pharmacist in an outpatient pediatric hematology, oncology, transplant clinic. To demonstrate how utilization of the pharmacist evolved, as indicated by changes in frequency of key activities, during the first four months of integration. DESIGN: Clinical pharmacists were made consistently available in an outpatient clinic serving hematology, oncology, transplant patients and their families. A list of key activities, based on provincial clinical pharmacist standards, was created to provide a framework for the role. Over a four-month period, the pharmacists recorded the number of times activities were performed. RESULTS: Over the data collection period, obtaining best possible medication histories (203), providing medication counseling (150), and creating adherence aids (144) were the most commonly performed activities. In comparison to the first month, key activities increased by 73% in the fourth month. Notably, providing recommendations for drug therapy (156%), assessments of adherence (122%), and best possible medication history collection (88%) increased considerably. CONCLUSIONS: The integration of a pharmacist into an outpatient pediatric hematology, oncology, transplant clinic resulted in the provision of several key clinical pharmacy services. As the role developed, activities were performed more frequently, demonstrating growth in utilization of the pharmacist.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Niño , Hematología/organización & administración , Humanos , Oncología Médica/organización & administración
19.
J Pharm Pract ; 32(1): 68-76, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29183253

RESUMEN

BACKGROUND:: Pharmacists may assist with reducing 30-day readmission rates for patients with heart failure (HF) exacerbation or acute myocardial infarction (AMI) by promoting medication adherence. OBJECTIVE:: To determine the change in 30-day readmission rates for patients with HF exacerbation or AMI after implementation of a "high-touch" standard of care. METHODS:: Patients admitted with HF exacerbation, non-ST-segment elevation AMI, or ST-segment elevation AMI from August 1, 2013, to June 30, 2015, were included in this prospective study. Patients were educated while in the inpatient setting and followed up in the outpatient setting through telephone contact and scheduling a medication therapy management (MTM) appointment with a pharmacist. Data were collected by pharmacy personnel involved in the implementation of the intervention. RESULTS:: Within the HF and AMI arms, 100 and 93 patients, respectively, were included in the study. The 30-day readmission rates were 24% and 17.2% for HF and AMI, respectively, which were not statistically significant when compared to historical institutional readmission rates prior to study initiation (18.2% for HF, P = .238; 11.4% for AMI, P = .252). CONCLUSION:: A "high-touch" pharmacist-driven transitions of care program may affect 30-day readmission rates for patients with HF exacerbation or AMI; potential processes for initiating transitions of care programs are provided.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Infarto del Miocardio sin Elevación del ST/tratamiento farmacológico , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/organización & administración , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Administración del Tratamiento Farmacológico/organización & administración , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Readmisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Proyectos Piloto , Rol Profesional , Estudios Prospectivos
20.
Acta Clin Belg ; 74(2): 75-81, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29708056

RESUMEN

Objectives The goal is to develop clinical pharmacy in the Belgian hospitals to improve drug efficacy and to reduce drug-related problems. Methods From 2007 to 2014, financial support was provided by the Belgian federal government for the development of clinical pharmacy in Belgian hospitals. This project was guided by a national Advisory Working Group. Each funded hospital was obliged to describe yearly its clinical pharmacy activities. Results In 2007, 20 pharmacists were funded in 28 pilot hospitals; this number was doubled in 2009 to 40 pharmacists over 54 institutions, representing more than half of all acute Belgian hospitals. Most projects (72%) considered patient-related activities, whereas some projects (28%) had a hospital-wide approach. The projects targeted patients at admission (30%), during hospital stay (52%) or at discharge (18%). During hospital stay, actions were mainly focused on geriatric patients (20%), surgical patients (15%), and oncology patients (9%). Experiences, methods, and tools were shared during meetings and workshops. Structure, process, and outcome indicators were reported and strengths, weaknesses, opportunities, and threats were described. The yearly reports revealed that the hospital board was engaged in the project in 87% of the cases, and developed a vision on clinical pharmacy in 75% of the hospitals. In 2014, the pilot phase was replaced by structural financing for clinical pharmacy in all acute Belgian hospitals. Conclusion The pilot projects in clinical pharmacy funded by the federal government provided a unique opportunity to launch clinical pharmacy activities on a broad scale in Belgium. The results of the pilot projects showed clear implementation through case reports, time registrations, and indicators. Tools for clinical pharmacy activities were developed to overcome identified barriers. The engagement of hospital boards and the results of clinical pharmacy activities persuaded the government to start structural financing of clinical pharmacy.


Asunto(s)
Servicio de Farmacia en Hospital/organización & administración , Bélgica , Financiación Gubernamental , Hospitales/estadística & datos numéricos , Proyectos Piloto
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