Outcomes of Aural Rehabilitation Provided in Person or by Telehealth Among Deaf/Hard of Hearing Young Children with Cochlear Implants or Hearing Aids.

Background: Cochlear implants and hearing aids may facilitate the development of listening and spoken language (LSL) in deaf/hard of hearing young children, but they require aural rehabilitation therapy-often unavailable outside urban areas-for optimal outcomes. This trial assessed the relative effectiveness of LSL therapy delivered either in person or by interactive video. The hypothesis was that telehealth service delivery would be noninferior to in-person therapy. Methods: Most parents refused randomization of their children to telehealth or in-person conditions; therefore, randomization was impossible. In consultation with the funder (NIDCD), the study design was modified. Parents were allowed to select their preferred study condition, and the study team was blinded to group membership. Forty-two families were in the in-person group and 35 in telehealth (40 and 30, respectively, after attrition). Primary endpoints were total score, auditory comprehension, and expressive communication on the Preschool Language Scale, 5th edition. There were several secondary speech, hearing, and language outcome measures. Assessments occurred at baseline and at follow-up after 6 months of LSL therapy. Results: Propensity scores were used to create two matched groups. At baseline, groups did not differ on PLS-5 scores. Change from baseline to F/U on age-equivalents for all three scores was nearly identical for both groups, although the telehealth group was younger, on average, than the in-person group. Discussion: Telehealth was noninferior to in-person services for all primary endpoints. For secondary outcomes, neither group demonstrated a significant advantage. Magnitudes of estimated group differences were small, suggesting nonsignificant differences not predominantly because of sample size. The telehealth group showed greater improvement on 15/24 of secondary language outcome measures. The findings provide evidence that telehealth is equivalent to in-person care for providing LSL therapy to young children with cochlear implants and hearing aids.

Impact of pharmacist participation in the patient care team on value-based health measures.

PURPOSE: To evaluate whether pharmacist engagement on the interdisciplinary team leads to improved performance on diabetes-related quality measures. METHODS: This was a retrospective observational study of patients seen in primary care and specialty clinics from October 2014 to October 2020. Patients were included if they had a visit with a physician, nurse practitioner, physician's assistant, or clinical pharmacist practitioner (CPP) within the study period and had a diagnosis of diabetes. The intervention group included patients with at least one visit with a CPP, while the control group consisted of patients who were exclusively managed by non-CPP providers. The primary outcome of this study was the median change in glycosylated hemoglobin (HbA1c) from baseline to follow-up at 3, 6, and 12 months. The secondary outcome was the probability of achieving the HbA1c targets of <7% and <8% at 3, 6, and 12 months. RESULTS: Patients referred to a CPP had higher HbA1c levels at baseline and were more likely to have concomitant hypertension (P < 0.01). Patients seen by a CPP had 0.31%, 0.41%, and 0.44% greater reductions in HbA1c compared to patients in the control group at 3, 6, and 12 months, respectively (P < 0.01). Patients managed by a CPP were also more likely to achieve the identified HbA1c targets of <7% and <8%. CONCLUSION: Patients referred to a CPP were more complex, but had greater reductions in HbA1c and were more likely to achieve HbA1c goals included in the organization's quality measures. This study demonstrates the value of pharmacists in improving patient care and their role in supporting an organization's achievement of value-based quality measures.

Advancing Pharmacy Practice through an Innovative Ambulatory Care Transitions Program at an Academic Medical Center.

Hospital readmissions are common and often preventable, leading to unnecessary burden on patients, families, and the health care system. The purpose of this descriptive communication is to share the impact of an interdisciplinary, outpatient clinic-based care transition intervention on clinical, organizational, and financial outcomes. Compared to usual care, the care transition intervention decreased the median time to Internal Medicine Clinic (IMC) or any clinic follow-up visit by 5 and 4 days, respectively. By including a pharmacist in the hospital follow-up visit, the program significantly reduced all-cause 30-day hospital readmission rates (9% versus 26% in usual care) and the composite endpoint of 30-day health care utilization, which is defined as readmission and emergency department (ED) rates (19% versus 44% usual care). Over the course of one year, this program can prevent 102 30-day hospital readmissions with an estimated cost reduction of $1,113,000 per year. The pharmacist at the IMC collaborated with the Family Medicine Clinic (FMC) pharmacist to standardize practices. In the FMC, the hospital readmission rate was 6.5% for patients seen by a clinic-based pharmacist within 30 days of discharge compared to 20% for those not seen by a pharmacist. This transitions intervention demonstrated a consistent and recognizable contribution from pharmacists providing direct patient care and practicing in the ambulatory care primary care settings that has been replicated across clinics at our academic medical center.

Frontline perspective on credentialing and privileging of ambulatory care pharmacists.

OBJECTIVES: To present the current state of, and frontline advice on, the implementation of successful credentialing and privileging processes for practicing pharmacists in the United States. METHODS: The American Society of Health-System Pharmacists (ASHP) Section Advisory Group on Compensation and Practice Sustainability surveyed ambulatory care pharmacists via ASHP Connect about the status, structure and oversight of their ambulatory care clinical practice sites with credentialed and privileged (C&P) pharmacists. KEY FINDINGS: Over 80% of survey respondents identified themselves as a C&P pharmacist, and over 90% indicated it is 'Important' or 'Very Important' for pharmacists to be C&P. Qualitative survey responses indicated the most important considerations for establishing or expanding a credentialing and privileging process for ambulatory care pharmacists were 'don't re-create the wheel', 'establish a physician champion and/or obtain leadership buy-in', 'be persistent and patient', 'develop a guidance document' and 'work within existing processes'. CONCLUSIONS: Starting a credentialing and privileging process is critical in preparation for, or response to, provider status recognition of pharmacists in the United States. When used with existing guidance documents on credentialing and privileging, 'front line' advice from practicing pharmacists can help promote expanded roles for pharmacists within healthcare systems.

Community Pharmacist Preferences in Transition of Care Communications.

OBJECTIVE: To determine community pharmacist preferences in transition of care (TOC) communications. METHODS: In this cross-sectional study, data were gathered via electronic survey of community pharmacists regarding their preferences for TOC communications. The survey was distributed via email by the North Carolina Board of Pharmacy. Results were analyzed using descriptive statistics. RESULTS: Survey responses were received from 343 community pharmacists (response rate = 6.1%). Responders most commonly worked in an independent, single store (29.2%, n = 100) or national chain (29.2%, n = 100) pharmacy setting. Preferred method for a TOC communication was via electronic health record (63.0%, n = 184). Preferred TOC communication content are mentioned as follows: active (93.2%, n = 274) and discontinued (86.4%, n = 254) medications and reason for hospitalization (85.0%, n = 250). The top 3 self-identified barriers to utilizing a TOC communication: lack of care coordination with community pharmacy (35.0%, n = 14), lack of support from other health-care providers (22.5%, n = 9), and absence of compensation for providing the service (17.5%, n = 7). When asked if TOC communications were available, 97.5% (n = 278) indicated it would be useful. CONCLUSION: Community pharmacists acknowledged a need for TOC communications and shared their preferences in the content and method of communication. Future research is warranted to implement TOC communications between a health system and community pharmacy.

Patient Satisfaction with Medicare Annual Wellness Visits Administered by a Clinical Pharmacist Practitioner.

BACKGROUND: In accordance with the Patient Protection and Affordable Care Act, Medicare provides coverage for annual wellness visits (AWVs) to eligible beneficiaries, which focus on preventative services, furnish personalized preventative health plans, and direct appropriate referrals. These visits may be conducted by a physician or another licensed practitioner working under the direct supervision of a physician. In North Carolina, pharmacists licensed as clinical pharmacist practitioners (CPPs) may perform and bill for AWVs, but there are limited data on patient satisfaction with pharmacists serving in this advanced role. OBJECTIVES: To (a) investigate patient satisfaction with and perception of an initial Medicare AWV administered by a CPP in an academic internal medicine clinic and (b) examine the relationship between patient satisfaction and the number of interventions or referrals made during an AWV. METHODS: All established patients of an academic internal medicine clinic aged 66 years and older were eligible for AWVs with a CPP, and those completing an AWV with a CPP were eligible for inclusion in this study. Patient satisfaction with the CPP and AWV was assessed by a telephone satisfaction questionnaire administered after the visit by a pharmacy student not affiliated with the clinic. RESULTS: Forty-six patients were included in this study. Patients rated their satisfaction with the CPP at a mean of 4.7 and with the visit at a mean of 4.6 on a Likert scale ranging from 1 to 5, where 1 was "very dissatisfied" and 5 was "very satisfied." Using a Likert scale of 1 to 5, where 1 was "strongly disagree" and 5 was "strongly agree," patients responded with a mean of 4.4 that they were comfortable discussing their health information with a CPP and a mean of 4.1 that they were just as comfortable discussing their health information for this visit with a CPP as with their primary care physician. CONCLUSIONS: Overall, patients were very satisfied with the CPP and AWVs and felt comfortable with CPPs as the providers of this service. As such, this study demonstrates that through Medicare AWVs, pharmacists can provide direct patient care and contribute to team-based initiatives. DISCLOSURES: No outside funding supported this study, and the authors have no conflicts of interest to declare. Study concept and design were contributed by Cavanaugh and Shilliday, along with Sherrill. The data were collected by Sherrill and Shilliday and interpreted by Sherrill, Cavanaugh, and Shilliday. The manuscript was written and revised by Sherrill, Cavanaugh, and Shilliday. This work was presented at the ASHP Annual Meeting in Las Vegas, Nevada, on December 3, 2012.

Comparing ownership and use of bed nets at two sites with differential malaria transmission in western Kenya.

BACKGROUND: Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use. METHODS: Community forums and a household, cross-sectional survey were used to collect information on factors related to bed net ownership and use in western Kenya. Sites with disparate levels of transmission were selected, including an endemic lowland area, Miwani, and a highland epidemic-prone area, Kapkangani. Analysis of ownership was stratified by site. A combined site analysis was conducted to examine factors associated with use of all available bed nets. Logistic regression modelling was used to determine factors associated with ownership and use of owned bed nets. RESULTS: Access to bed nets as the leading barrier to their use was identified in community forums and cross-sectional surveys. While disuse of available bed nets was discussed in the forums, it was a relatively rare occurrence in both sites. Factors associated with ownership varied by site. Education, perceived risk of malaria and knowledge of individuals who had died of malaria were associated with higher bed net ownership in the highlands, while in the lowlands individuals reporting it was easy to get a bed net were more likely to own one. A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria. In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season. CONCLUSION: Variations in factors associated with ownership should be acknowledged when constructing messaging and distribution campaigns. Despite reports of bed nets being used for other purposes, those in the home were rarely unused in these communities. Disuse seemed to be related to beliefs that can be addressed through education programmes. As mass distributions continue to take place, additional research is needed to determine if factors associated with LLIN ownership and use change with increasing availability of LLIN.

Post Outbreak Review: Dengue Preparedness and Response in Key West, Florida.

Dengue is the most prevalent mosquito-borne viral infection. Recent outbreaks in the southern United States illustrate the risk of reemergence. The first autochthonous cases since 1934 in Key West, FL, occurred in 2009-2010. We conducted a survey in 2012 with decision makers instrumental to the control of the outbreak to 1) determine their awareness of the multiple strategies used to control the outbreak and 2) assess their perceptions of the relative effectiveness of these strategies. An online survey was delivered to a predefined list of decision makers from multiple sectors to better understand dengue preparedness and response. Thirty-six out of 45 surveys were returned for an 80% response rate. Results indicate the need to focus prevention strategies on educational campaigns designed to increase population awareness of transmission risk. Respondents remain concerned about future dengue transmission risk in Key West and lack of resources to respond.

Pharmacist-coordinated multidisciplinary hospital follow-up visits improve patient outcomes.

BACKGROUND: The Affordable Care Act of 2010 allows for the adjustment of reimbursement to health care centers based on 30-day readmission rates. High readmission rates may be explained by multiple events at discharge, including medication errors that occur during the transition of care from inpatient to outpatient. Pharmacist involvement at discharge has been shown to improve health outcomes in patients with chronic disease; however, there is limited knowledge regarding the benefits of a clinic appointment with a pharmacist postdischarge. OBJECTIVE: To compare hospital readmission rates and interventions in a multidisciplinary team visit coordinated by a clinical pharmacist practitioner with those conducted by a physician-only team within an internal medicine hospital follow-up program. METHODS: A retrospective observational study was completed. Patients seen between May 2012 and January 2013 in 1 of the 2 hospital follow-up program models (multidisciplinary team or physician-only team) were included. RESULTS: A total of 140 patient visits were included for 124 patients. Patients seen by the multidisciplinary team had a 30-day readmission rate of 14.3% compared with 34.3% by the physician-only team (P=0.010). Interventions completed during the visits, including addressing nonadherence, initiating a new medication, and discontinuing a medication were also statistically different between the groups, with the multidisciplinary team completing these interventions more frequently. CONCLUSIONS: Hospital follow-up visits coordinated by the multidisciplinary team decreased 30-day hospital readmission rates compared with follow-up visits by a physician-only team.

Medicare annual wellness visits conducted by a pharmacist in an internal medicine clinic.

PURPOSE: The clinical and financial outcomes of an initial Medicare annual wellness visit (AWV) administered by a clinical pharmacist practitioner (CPP) in an academic internal medicine clinic are described. SUMMARY: As a result of the Patient Protection and Affordable Care Act, Medicare Part B allows for coverage of an AWV at no cost to eligible beneficiaries. The AWV is directed at health prevention, disease detection, and coordination of screening available to beneficiaries. CPPs are pharmacists who are recognized as advanced practice providers in the state of North Carolina and are authorized to administer AWVs. Eligible Medicare beneficiaries at least 65 years of age in an academic internal medicine clinic were mailed invitations to schedule an AWV. Patients who scheduled an AWV were mailed a packet to complete before the visit. During the visit, the packet was reviewed and interventions were made based on prespecified criteria derived from evidence-based medicine recommendations. After completion of the AWV, patients were provided with a detailed and individualized prevention plan. Between August 2011 and May 2012, 98 patients attended an AWV, all performed by the same CPP. The average time from check in to checkout for all patients was 73 minutes. The CPP made 441 interventions during these 98 visits, averaging 4.5 interventions per AWV completed. All initial AWVs were reimbursable up to a maximum of $159.38 per visit. CONCLUSION: A Medicare AMV administered by a CPP resulted in a wide variety of patient interventions and reimbursement for services provided.