A "Sense"-ational HPV Vaccination Quality Improvement Project in a Family Medicine Residency Practice.

BACKGROUND: Human papillomavirus (HPV) vaccination uptake for adolescents and young adults in the United States remains far from national goals. Using a multi-component intervention aligned with community-wide efforts, we implemented a quality improvement project to increase HPV vaccinations among 9-26 year-old male and female patients in an urban, low income, minority population family medicine residency practice. METHODS: The pre-intervention year was November 2, 2014 to October 31, 2015 and the intervention year was November 1, 2015 to October 31, 2016. Based on community input and published literature, the interventions were creative, practice-specific provider-, patient-, and system-level strategies. To compare pre- and post-intervention vaccinations, HPV vaccination data were extracted from an electronic medical record request for age-eligible patients seen in the practice during the intervention year. Chi-square, McNemar's and 2-tailed, 2-sample Z tests were used to test differences in vaccination initiation (≥1 dose) and completion (3 doses) across groups and over time. RESULTS: Despite high pre-intervention rates (58% and 75%), HPV vaccine initiation significantly increased 12.8 percentage points (PP) for males and 10.6 PP for females from pre- to post-intervention (P < 0.001). HPV vaccine completion also significantly increased 16 PP for males and 10.9 PP for females (P < 0.001). Young adult patients (18-26 years-old) had significant increases in completion rates (9.9 PP; P < 0.001), not observed among adolescents (20 PP; ns). CONCLUSIONS: Consistent and abundant positive HPV vaccination messaging, low-cost sensory rewards, process change, and community, clinician, and nonclinical staff engagement were associated with higher HPV vaccine initiation and completion, especially among young adults.

Key factors for sustainable integration of pharmacists in team-based primary care physician practices.

OBJECTIVES: To (1) identify strategies for financial justification of pharmacists integrated into team-based primary care, (2) describe the payment models currently used for integration of pharmacists into team-based primary care, and (3) elicit key factors facilitating sustainable pharmacist-provided patient care services in the primary care setting. DESIGN: Qualitative analysis using semistructured interviews. SETTING: Nonacademic outpatient primary care physician practices throughout the United States from January to April 2014. PARTICIPANTS: Pharmacists responsible for leadership of clinical pharmacists in primary care practices whose positions are supported through nondispensing patient care services. MAIN OUTCOME MEASURES: Current payment model, infrastructure, documentation strategies, and methods of quality assessment. RESULTS: Twelve interviews were conducted. Practices included a combination of single- and mixed-payer models in integrated and nonintegrated health systems. Various billing strategies were used, particularly in nonintegrated models, to sustain pharmacists in primary care practices utilizing both fee-for-service (FFS) and value-based incentives payments. Five main themes were elicited: (1) Pharmacists are integrated and valuable members of health care teams; (2) pharmacists are documenting in an accessible electronic health record; (3) data tracking is a facilitator for justifying and adapting practice; (4) systematized processes for pharmacist integration exist in each practice; and (5) pharmacists' responsibilities on the team have grown and evolved over time. CONCLUSION: Pharmacists' contributions to improving patients' medication-related care are the same regardless of payment model. Financially sustainable integration of pharmacists on the team involves using a combination of FFS and value-based incentive payments, consistent documentation, meaningful collection of pharmacists' contributions to improve the quality of care, and a firm understanding of the practice's needs and financial structure. These themes can be used as a guide for pharmacists as they establish themselves in an FFS environment and adapt to a future in value-based care.

Pharmacist-Delivered Comprehensive Medication Management Within Family Medicine Practices An Evaluation of the SCRIPT Project.

BACKGROUND AND OBJECTIVES: Pharmacist inclusion in patient-centered medical home (PCMH) teams has been shown to benefit both patients and practices. However, pharmacists' inclusion on these teams is not widespread, partly because the work they do is not well known. The Successful Collaborative Relationships to Improve PatienT care (SCRIPT) project was started in August 2009 to understand the clinical and economic impact of pharmacists providing direct patient care. The objective of this study was to describe the work of pharmacists practicing as integrated members of the patient care team within PCMHs through retrospective analysis of their patient care documentation over a 4-year time frame. Two pharmacists were placed into four suburban medical home practices in Pittsburgh, Pennsylvania to perform comprehensive medication management (CMM). These pharmacists documented their CMM encounters in an electronic health record and a database for reporting purposes. METHODS: This study is a retrospective, descriptive analysis of pharmacist-documented CMM encounters from February 2010 through February 2014. Pharmacists' work-including patient demographics, disease states, and medication therapy problems-was recorded in a Microsoft Access database and tabulated. RESULTS: The pharmacists conducted 11,206 CMM encounters with 3,777 unique patients during the study period. The pharmacists identified 9,375 medication therapy problems (MTPs) and performed 14,092 interventions. Pharmacists most commonly worked with patients with diabetes, hypertension, pain, and hyperlipidemia. Physician and patient acceptance of the pharmacists' work was high. CONCLUSIONS: Pharmacists working in family medicine offices contribute to patient care through identification and resolution of MTPs and also by collaborating with PCMH teams.

Pharmacist-Led Drug Therapy Problem Management in an Interprofessional Geriatric Care Continuum: A Subset of the PIVOTS Group.

BACKGROUND: Drug therapy problems, which are adverse events involving medications that can ultimately interfere with a patient's therapeutic goals, occur frequently in older adults. If not identified, resolved, and prevented through clinical decision-making, drug therapy problems may negatively affect patient health outcomes. OBJECTIVE: To quantify the impact of pharmacist interventions on the care of older adults by identifying the most common drug therapy problems, the medications most often involved in these problems, and the actions taken by pharmacists to resolve these problems. METHODS: This retrospective chart review included individuals seen by a geriatric pharmacist in one geriatric practice, where 4 pharmacists provide continuous, comprehensive medication management across 2 outpatient geriatric clinics, skilled-nursing facilities, and assisted-living facilities. The individuals were seen between August 2014 and November 2015. For all patient care encounters during this time frame, pharmacists used the Assurance System to document each drug therapy problem, the medications involved, the patient's care setting (ie, outpatient clinic, assisted-living facility, skilled-nursing facility), the actions taken to resolve any drug therapy problems, and the estimated 90-day impact on the patient and the healthcare system. RESULTS: A total of 3100 drug therapy problems were identified during 3309 patient-pharmacist encounters for 452 patients (mean age, 81.4 years), 48.7% of whom were seen in the skilled-nursing facility. The most common drug therapy problem was dose too low, followed by dose too high, and warfarin was the most common drug associated with drug therapy problems. Pharmacists provided 4921 interventions, often more than 1 intervention per drug therapy problem, for 275 different medications. Laboratory monitoring and dose change were the most common interventions, with an estimated annual financial savings between $268,690 and $270,591. CONCLUSION: Older patients are a vulnerable patient population who often receive unsafe medication regimens, which can result in adverse drug reactions and other critical problems. When integrated into interprofessional geriatric care teams, pharmacists' interventions provide an invaluable qualitative and monetary resource to the medication-based management of patients with well-recognized, high-risk geriatric syndromes as they transition to and through various levels of care.

The SMARxT Media Literacy Program: Improving Evidence-Based Prescribing among Medical Students.

Media literacy may help medical trainees optimize evidence-based decision-making. Many prescriptions written are not evidence-based, resulting in unnecessary morbidity and mortality. In this study, we aimed to assess feasibility, acceptability, and initial efficacy of a media literacy prescribing program. We recruited 30 medical students, who completed animated video modules about pharmaceutical marketing and prescribing. We used a process evaluation and open-ended items to assess feasibility and acceptability, and knowledge tests before and after the intervention to assess efficacy. The program was feasible to implement and well-accepted by participants. After the educational intervention, knowledge and attitude targets around evidence-based prescribing and drug marketing improved.

An innovative, residency-based, interprofessional faculty development program.

PURPOSE: The impact of an interprofessional faculty development fellowship (FDF) on pharmacy graduates' careers is described. SUMMARY: The FDF instructional approach is a longitudinal acquisition and application of knowledge, skills, and attitudes fostered by clinical care delivery, teaching experiences, structured reflection, the giving and receiving of feedback, research and scholarly projects, and leadership development and exercises. Interprofessional FDF fellows teach, learn, and provide care together in both inpatient and outpatient clinical settings as a part of the evidence-based medicine curriculum, providing educational sessions for medical students, pharmacy students, medical residents, attending family medicine physicians, and clinical pharmacy faculty throughout the year. Twenty-seven of the 30 pharmacist graduates of the fellowship (90% response rate) responded to an electronic survey about the influence of the FDF on their careers. Overall, pharmacy graduates were very satisfied with the fellowship. The fellowship fostered a clear pattern of continued, collaborative learning. While additional training beyond a pharmacy residency program is not necessary for a successful clinical career, 41% of graduates pursued additional training after completing the fellowship. Open-ended responses for motivations for completing the FDF and influences the FDF had on their careers fell unforced into the FDF curriculum domains, which reinforced the belief that these are the right areas to target for development. CONCLUSION: Pharmacy residents participated in a broad, interprofessional faculty development curriculum, which fostered teaching, scholarship, leadership, professional development, and clinical skills. Pharmacist graduates indicated that the experience significantly influenced their careers and professional development.

Pharmacist integration into the medical home: qualitative analysis.

OBJECTIVE: To determine the acceptance and attitudes of family medicine physicians, clinical and nonclinical office staff, pharmacists, and patients during pharmacist integration into a medical home. DESIGN: Qualitative study. SETTING: Pittsburgh, PA, area from August 2009 to June 2010. PARTICIPANTS: Physicians, staff, pharmacists, and patients at four single-specialty family medicine office practices functioning as medical homes. MAIN OUTCOME MEASURES: Attitudes, acceptance, barriers, and problems identified by participants. RESULTS: A total of 84 interviews were conducted: 21 interviews with family medicine physicians, 26 with patient care staff, 9 with nonclinical staff, 13 with patients, 6 with pharmacists, and 8 with office managers. Five main themes emerged from each group regarding the integration of a pharmacist, including positive overall feeling; clinical, educational, and time-saving benefits to the various groups; challenges understanding the role of the pharmacist; improved workflow and integration resulting from pharmacist flexibility and motivation; and suggestions to increase the pharmacists' time in each office. Pharmacists felt that they were accepted within 6 months of the integration process and that time management was a challenge. CONCLUSION: Participants felt that inclusion of a pharmacist into their practice improves the quality of patient care, provides a valuable resource for all providers and staff, and empowers patients. The initial concerns of the clinical and nonclinical staff disappeared within the first months of pharmacist integration. These results provide guidance to clinicians and insight into strategies for building a pharmacist-integrated medical home team.