TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate.

OBJECTIVES: To determine if a community pharmacy-based transition of care (TOC) program that included the full scope of medication therapy management (MTM) services (TransitionRx) decreased hospital readmissions, resolved medication-related problems, and increased patient satisfaction. DESIGN: Prospective, quasi-experimental study. SETTING: Nine Kroger Pharmacies located in Western Cincinnati. PATIENTS: Patients older than 18 years of age and discharged from two local hospitals with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease, or pneumonia. Patients were recruited from two local hospitals and referred to the community pharmacy for MTM services with the pharmacist within 1 week of discharge. MAIN OUTCOME MEASURES: Pharmacists reconciled the patients' medications, identified drug therapy problems, recommended changes to therapy, and provided self-management education. At 30 days after discharge, research personnel conducted telephone surveys, using a previously validated survey instrument, to assess hospital readmissions and patient satisfaction. Pharmacist interventions and medication-related problems were documented. RESULTS: A total of 90 patients completed the study. Of these, 20% of patients in the usual care group were admitted to the hospital within 30 days compared with 6.9% of patients in the intervention group (P = 0.019). In the 30 patients who received MTM services from the pharmacist, 210 interventions were made. The overall mean patient satisfaction with the TOC process was not significantly different between patients who were seen by the pharmacist and those who were not seen by the pharmacist. CONCLUSION: Community pharmacies successfully collaborated with hospitals to develop a referral process for TOC interventions. Patients who received MTM services from the pharmacist experienced significantly fewer readmissions than patients who received usual care.

Development, implementation, and evaluation of a pharmacist-conducted screening program for depression.

OBJECTIVE: To develop, implement, and evaluate a depression screening program performed by pharmacists in the community setting; to determine the ability of this screening to identify and refer patients with symptoms of depression; and to determine whether physician referral results in initiation or modification of treatment. DESIGN: Prospective study. SETTING: 32 locations of a large grocery chain pharmacy in the Cincinnati and Dayton, OH, area from February 8, 2010, to March 30, 2011. PATIENTS: 3,726 patients 18 years or older. INTERVENTION: Patients were screened for depression using the Patient Health Questionnaire (PHQ). Patients who screened positive on the two-item PHQ (PHQ-2) then were given the nine-item PHQ (PHQ-9). Patients who screened positive on the PHQ-9 were referred to their physician. Pharmacists followed up with these patients to determine the action that was taken following the screening. MAIN OUTCOME MEASURES: Number of patients with a positive PHQ-9, number of patients referred to their physician, and number of patients for whom treatment was initiated or modified as a result of screening. RESULTS: 3,726 patients were screened for depression by pharmacists during the study period. A total of 67 (1.8%) patients screened positive on the PHQ-2. Of the patients who completed the PHQ-9, approximately 25% met the criteria for consideration of diagnosis and were referred to their physician. Five patients presented with suicidal thoughts and were referred for urgent treatment. Approximately 60% of patients with a positive PHQ-9 had initiated or modified treatment at the time of follow-up. CONCLUSION: A screening program for depression was successfully developed and implemented in the community pharmacy setting. Using the PHQ, pharmacists were able to quickly identify undiagnosed patients with symptoms of depression. The majority of patients with a positive screening had initiated or modified treatment at the time of follow-up.

Pharmacist-managed chronic obstructive pulmonary disease screening in a community setting.

OBJECTIVES: To implement a spirometry-based chronic obstructive pulmonary disease (COPD) screening in a community pharmacy chain, determine whether pharmacists can accurately perform spirometry screenings and interpret results, and determine whether performing screenings improved enrollment in smoking cessation programs. DESIGN: Prospective study. SETTING: Kroger pharmacies in the Cincinnati-Dayton Kroger Marketing Area and off-site screening events in Cincinnati, OH, from March to December 2010. PATIENTS: Consenting individuals older than 35 years who met inclusion and exclusion criteria. INTERVENTION: Specially trained community pharmacists administered a validated COPD screening questionnaire and performed spirometry. The results were interpreted, given to the patient, and faxed to the primary care physician. Any patient who was currently smoking was offered smoking cessation counseling. MAIN OUTCOME MEASURES: Spirometry technical quality and interpretation accuracy, screening questionnaire scores in relationship to spirometry results, number of patients enrolled in smoking cessation programs. RESULTS: Of the 185 patients, 10 were excluded due to inability to perform spirometry. After review, 174 (99%) of the spirometries were judged acceptable and 157 (90%) demonstrated reproducible results. The mean (+/-SD) score on the COPD Population Screener questionnaire was 2.3 ± 1.6 (range 0-8). Airflow limitation (defined as forced expiratory volume in 1 second/forced vital capacity < lower limit of normal) was detected in 16 (9%) of the patients. Although 12 (75%) of these patients were former or current smokers, only 3 (19%) were at increased risk for COPD based on their screening questionnaire scores. Of the nine current smokers who participated in a follow-up interview, two had successfully abstained from smoking for 6 months after the screening and five others had made an attempt to quit. CONCLUSION: This study demonstrated that pharmacists are able to perform accurate and reproducible spirometry in a community pharmacy setting.

Pharmacist-initiated peripheral arterial disease screening program in a community pharmacy setting.

OBJECTIVES: To evaluate the feasibility of implementing a pharmacist-initiated peripheral arterial disease (PAD) screening program in the community setting and to determine the ability of this screening to increase the number of patients identified with PAD. DESIGN: Prospective study. SETTING: Three locations of a large pharmacy grocery chain in the Cincinnati and Dayton, OH, area, from February 3, 2009, to May 31, 2009. PATIENTS: 39 patients 50 years or older with a diagnosis of hypertension, dyslipidemia, and/or diabetes. INTERVENTION: PAD screening, including an assessment of PAD symptoms and an ankle-brachial index (ABI) calculation using a handheld Doppler. Patients who screened positive were provided with appropriate counseling on possible treatments, medications, and lifestyle modifications and referred to their primary care physician for further evaluation. MAIN OUTCOME MEASURES: Successful implementation of program, number of patients referred to their physician for follow-up, and number of patients with ABI scores indicating PAD. RESULTS: 17 of the 39 patients screened (44%) were referred to their physician for follow-up because they had ABI scores indicating PAD, symptoms indicating PAD, or noncompressible vessels. Using ABI scores, PAD was detected in nine patients (23.1%). Pharmacists implemented the program successfully. CONCLUSION: This study successfully demonstrated the feasibility of implementing a pharmacist-initiated PAD screening program in the community setting. The implementation of this screening program included the acquisition of affordable equipment, training of pharmacists, and access to the appropriate patient population. This study also was effective in increasing the recognition of PAD in patients screened in the community setting.

A structured approach for teaching students to counsel self-care patients.

OBJECTIVES: To determine whether the use of a structured interviewing framework improved students' ability to treat self-care patients. DESIGN: First-professional year pharmacy students (P1) in their first quarter of Pharmacy Practice Skills Development were taught self-care through a series of 4 modules. In each module students' content knowledge and application were assessed using quizzes and role-play scenarios, respectively. During the second module, a structured interview model (QuEST process) was presented by the instructor and students were tested on the same content and role-play used in module 1. ASSESSMENT: Sixty-four students completed the 4 self-care modules. Quiz scores improved from the first to the second module (75.8% vs. 88.4%, p < 0.001). Mean role-play scores also significantly improved after learning the QuEST process. CONCLUSION: The QuEST process is an effective tool to teach students how to counsel patients with self-care issues.