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1.
J Manag Care Spec Pharm ; 25(5): 538-543, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039066

RESUMO

Managed care organizations are growing more sophisticated in their ability to analyze data. There are increasing numbers of data analysts at managed care organizations, as well as more types of real-time, or "live," data available. These data range from pharmacy claims and enrollment files to medical claims, medical records, and linkages to external data. Moreover, the data are often curated in a way that allows for easier data analysis. Using these data, managed care residents are often required to perform a project to evaluate a utilization management policy or clinical program. Yet, there is a lack of guidance specific to managed care organizations on how to conduct such a research study using "live" claims data. This Viewpoint article provides a primer for managed care residents and other managed care professionals who are seeking to use data to help inform decisions on how to manage their beneficiaries' health and costs. DISCLOSURES: There was no funding source for this manuscript. Hung reports a grant from the Agency for Healthcare Research and Quality and personal fees from Blue Cross Blue Shield Association, outside the submitted work. Gedey, Groeneweg, and Jay have nothing to disclose.


Assuntos
Revisão da Utilização de Seguros/normas , Programas de Assistência Gerenciada/organização & administração , Assistência Farmacêutica/organização & administração , Pesquisa em Farmácia/métodos , Projetos de Pesquisa , Interpretação Estatística de Dados , Humanos , Internato e Residência , Programas de Assistência Gerenciada/economia , Assistência Farmacêutica/economia , Pesquisa em Farmácia/normas , Estados Unidos
2.
J Manag Care Spec Pharm ; 25(5): 526-531, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039067

RESUMO

Health care payment models that reward value over volume have the potential to improve patient care and control rising costs. These payment models are increasingly being implemented by a range of care delivery providers in the United States. Integrated delivery networks (IDNs)-systems of providers and sites (e.g., group practices and hospitals) that care for and provide health care services and health insurance plans to patients in a specific region or market-present special opportunities and challenges for value-based care and represent an important sector for the advancement of value-based models. Successful implementation of value-based agreements in IDNs requires a range of complex capabilities, including advanced data analytics, population health management solutions, comprehensive care management, and successful patient engagement. To address these and other operational issues, the Academy of Managed Care Pharmacy convened a stakeholder forum on November 13-14, 2018, in Baltimore, MD. Forum attendees addressed topics including (a) the current delivery of value-based care in IDNs; (b) opportunities and barriers to implementing pharmaceutical value-based agreements; (c) recommendations for IDNs to reach the full potential of value-based agreements; and (d) opportunities for collaborations among managed care organizations, accountable care organizations, and IDNs to improve health care outcomes. Thought leaders with a wide range of backgrounds attended the forum, including those representing patients, payers, providers, government, and biopharmaceutical companies. The forum was sponsored by Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Lilly, MedImpact, Merck, National Pharmaceutical Council, Novo Nordisk, Pharmaceutical Research and Manufacturers of America, Takeda, and Xcenda. This proceedings document presents common themes and comments from individual participants at the forum, which are not necessarily endorsed by all attendees, nor should they be construed to reflect group consensus. DISCLOSURES: This AMCP Partnership Forum and the development of this proceedings document were supported by Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Lilly, MedImpact, Merck, National Pharmaceutical Council, Novo Nordisk, Pharmaceutical Research and Manufacturers of America, Takeda, and Xcenda.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Assistência Farmacêutica/organização & administração , Seguro de Saúde Baseado em Valor/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Custos de Cuidados de Saúde , Humanos , Assistência Farmacêutica/economia , Estados Unidos , Seguro de Saúde Baseado em Valor/economia
3.
Yakugaku Zasshi ; 139(3): 405-410, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30828019

RESUMO

The 6-year education system for pharmacists was introduced in Japanese schools of pharmacy in 2006, after which a 4-year doctoral course system was established for advancing clinical pharmaceutical research. The roles of hospital pharmacists and community pharmacists have been expanded from drug dispensing to patient care. Clinical pharmacists practice patient care daily using evidence-based medicine and shared decision making. Clinical pharmacists also carry out research proactively for resolving clinical questions encountered in practice. The Japanese Society of Pharmaceutical Health Care and Sciences (JSPHCS) was established in June 1990, and its membership has expanded significantly. The society has over 12000 members including clinical pharmacists and those in pharmacies who participate in practice, research, and education. The JSPHCS functions as the main platform for pharmacy professionals. It holds annual meetings, publishes an academic journal, supports overseas study, and confers awards on exceptional individuals. It also authorizes JSPHCS-Certified Clinical Pharmacists, Board-Certified Oncology Pharmacists, and Board-Certified Pharmacotherapy Specialists. Recently, clinical pharmacy educational seminars and conferences for newly qualified pharmacists have been held to improve the quality of clinical research performed. Several subcommittees under the JSPHCS were newly established for promoting clinical pharmacy research. The mission of the JSPHCS is to promote clinical pharmacy research and systematize the evidence and information, thereby contributing to the healthcare of all.


Assuntos
Serviços Comunitários de Farmácia , Assistência Farmacêutica/organização & administração , Farmacêuticos , Serviço de Farmácia Hospitalar , Sociedades Farmacêuticas/organização & administração , Educação em Farmácia , Humanos , Japão , Papel Profissional , Pesquisa
4.
Farm Hosp ; 43(1): 1-5, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30624166

RESUMO

OBJECTIVE: Describe the phases of implementation, scaling and integration of a  pharmacy teleconsultation model in electronic history, to coordinate the care  transition of patients. METHOD: Descriptive and retrospective study in a health area of 500,000 inhabitants (3 years). In the first phase, a working group was created,  a communication platform was designed and a continuity program was piloted between a hospital pharmacist and the 13 primary care pharmacists. The objective was to solve problems related to medications (especially those of  sanitary approval) in polymedicated patients hospitalized in the Short Stay Unit- Emergency. In a second phase, the program included all the patients in any unit  and all the pharmacists in the hospital. In the third phase, the program was  extended to the teleconsultation format within the corporate information  systems of the Health Service. Quantitative descriptive variables were recorded (number, motives and resolution of the teleconsultations). RESULTS: In total, more than 470 consultations were registered (118 in the first  phase, 158 in the second and 194 in the third), which were resolved  in 90% of  the cases. The main reasons were discrepancies in type approval drugs,  prescribed in the care transition and nutritional assessment. CONCLUSIONS: Teleconsultation allows the coordination of pharmaceutical care  between levels, quickly and easily. Increase the visibility and access of  professionals. Problems are resolved without displacements or time delays for  patients.


Assuntos
Registros Eletrônicos de Saúde , Assistência Farmacêutica/organização & administração , Consulta Remota/organização & administração , Serviços Médicos de Emergência , Humanos , Erros de Medicação/prevenção & controle , Farmacêuticos , Serviço de Farmácia Hospitalar , Atenção Primária à Saúde , Estudos Retrospectivos , Espanha
5.
Geriatr Gerontol Int ; 19(1): 35-43, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30556238

RESUMO

AIM: In Japan, home pharmaceutical care (HPC) has recently been provided to home-bound older adults who have difficulties in accessing a community pharmacy, for regular medicine supplies and medication management. Although the number of HPC services provided has increased, HPC is not always carried out by clinically well-trained pharmacists, causing differences in the quality of HPC provided. The aim of the present study was to establish the quality dimensions of HPC (i.e. components that impact the quality of HPC) from the perspectives of home healthcare professionals. METHODS: Semistructured interviews and focus groups were carried out with nine home healthcare teams, comprising 61 multidisciplinary professionals including pharmacists, doctors, nurses, care managers, home helpers, medical social workers and other relevant stakeholders involved in home healthcare. Participants' responses were analyzed using thematic analysis. Identified themes were then categorized using Donabedian's framework (structure, process and outcome). RESULTS: Nine themes and 27 subthemes emerged, including: structure (pharmacist factors, pharmacy factors and external factors), process (before HPC, during HPC, after HPC and outside of HPC) and outcome (impact on patients and impact on other healthcare professionals). CONCLUSION: This study has identified quality dimensions of HPC from multidisciplinary home healthcare professionals' perspectives. These findings might be used to inform aspects of HPC that require improvement. In order to evaluate the quality of HPC, a set of indicators based on the identified quality dimensions could be developed. Geriatr Gerontol Int 2019; 19: 35-43.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Assistência Farmacêutica/organização & administração , Qualidade da Assistência à Saúde , Idoso , Feminino , Grupos Focais , Humanos , Japão , Masculino
6.
Interface (Botucatu, Online) ; 23: e180297, 2019. tab
Artigo em Português | LILACS | ID: biblio-1002339

RESUMO

Este artigo, fundamentado na Teoria da Estruturação de Giddens, buscou analisar a organização e as práticas da assistência farmacêutica em oncologia em cinco municípios brasileiros por meio de um estudo de casos múltiplos, tendo o câncer de mama como condição marcadora. A subunidade de análise foram as unidades habilitadas de atenção oncológica. Foram entrevistados dez gestores e quinze profissionais de saúde. Complementarmente, foram considerados documentos e dados da observação direta da ação dos profissionais. Os resultados foram analisados segundo quatro eixos: estrutura organizacional, financiamento, tecnologias e processos de trabalho. Destacaram-se: a baixa articulação das ações de assistência farmacêutica realizadas entre os níveis de atenção à saúde, problemas estruturais nos serviços, insuficiência de financiamento, atrasos nos processos de avaliação e incorporação de tecnologias, e falhas nos processos de trabalho. Os aspectos destacados contribuem para a precariedade do funcionamento do sistema.


Este artículo, fundamentado en la Teoría de la Estructuración de Giddens, buscó analizar la organización y las prácticas de la asistencia farmacéutica en oncología en cinco municipios brasileños, por medio de un estudio de casos múltiples, teniendo el cáncer de mama como condición marcadora. La subunidad de análisis fueron las unidades habilitadas de atención oncológica. Se entrevistaron diez gestores y quince profesionales de salud. Complementariamente, se consideraron documentos y datos de observación directa de la acción de los profesionales. Los resultados se analizaron de acuerdo con cuatro ejes: estructura organizacional, financiación, tecnologías y procesos de trabajo. Se destacó la baja articulación de las acciones de asistencia farmacéutica realizadas entre los niveles de atención de la salud, problemas estructurales en los servicios, insuficiencia de financiación, atrasos en los procesos de evaluación e incorporación de tecnologías y fallas en los procesos de trabajo. Los aspectos destacados contribuyen para la precariedad del funcionamiento del sistema.


This study, based on the Giddens' Structuration Theory, aimed to analyze organization and pharmaceutical services practices for oncology care in five brazilian municipalities by a multiple-case study design, having breast cancer as a marker condition. Oncology care-certified facilities were established as analysis sub-units. In-depth interviews were conducted with ten managers and fifteen health professionals. Research strategy also involved document analysis and direct observation of practices. Results were analyzed according to four main themes: organizational structure, financing, technologies and work process. We found little interaction of pharmaceutical services with levels of care, structural problems within facilities, insufficient funding, belated technology assessment and technology adoption, and shortfalls in work processes. These aspects contribute to precarious functioning of the cancer-care system.


Assuntos
Humanos , Masculino , Feminino , Assistência Farmacêutica/organização & administração , Sistema Único de Saúde/organização & administração , Assistência à Saúde/organização & administração , Oncologia
7.
J Oncol Pharm Pract ; 25(1): 85-93, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29592766

RESUMO

PURPOSE: The primary aim was to determine if dispensing of cyclophosphamide tablets resulted in accumulated residue on pharmacy counting tools during a simulated outpatient dispensing process. Secondary objectives included determining if cyclophosphamide contamination exceeded a defined threshold level of 1 ng/cm2 and if a larger number of prescriptions dispensed resulted in increased contamination. METHODS: Mock prescriptions of 40 cyclophosphamide 50 mg tablets were counted on clean trays in three scenarios using a simulated outpatient pharmacy after assaying five cleaned trays as controls. The three scenarios consisted of five simulated dispensings of one, three, or six prescriptions dispensed per scenario. Wipe samples of trays and spatulas were collected and assayed for all trays, including the five clean trays used as controls. Contamination was defined as an assayed cyclophosphamide level at or above 0.001 ng/cm2 and levels above 1 ng/cm2 were considered sufficient to cause risk of human uptake. Mean contamination for each scenario was calculated and compared using one-way analysis of variance. P-values of < 0.05 implied significance. RESULTS: Mean cyclophosphamide contamination on trays used to count one, three, and six cyclophosphamide prescriptions was 0.51 ± 0.10 (p=0.0003), 1.02 ± 0.10 (p < 0.0001), and 1.82 ± 0.10 ng/cm2 (p < 0.0001), respectively. Control trays did not show detectable cyclophosphamide contamination. Increasing the number of prescriptions dispensed from 1 to 3, 1 to 6, and 3 to 6 counts increased contamination by 0.51 ± 0.15 (p = 0.0140), 1.31 + 0.15 (p < 0.0001), and 0.80 ± 0.15 ng/cm2 (p = 0.0004), respectively. CONCLUSION: Dispensing one or more prescriptions of 40 cyclophosphamide 50 mg tablets contaminates pharmacy counting tools, and an increased number of prescriptions dispensed correlates with increased level of contamination. Counting out three or more prescriptions leads to trays having contamination that surpasses the threshold at which worker exposure may be increased. Pharmacies should consider devoting a separate tray to cyclophosphamide tablets, as cross-contamination could occur with other drugs and the efficacy of decontamination methods is unclear. Employee exposure could be minimized with the use of personal protective equipment, environmental controls, and cleaning trays between uses. Future investigation should assess the extent of drug powder dispersion, the effects of various cleaning methods, and the potential extent of contamination with different oral cytotoxic drugs.


Assuntos
Ciclofosfamida , Contaminação de Medicamentos/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Exposição Ocupacional , Farmácias/normas , Ciclofosfamida/efeitos adversos , Ciclofosfamida/análise , Descontaminação/métodos , Descontaminação/normas , Monitoramento Ambiental/métodos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Assistência Farmacêutica/organização & administração , Melhoria de Qualidade
8.
BMC Geriatr ; 18(1): 316, 2018 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-30567496

RESUMO

BACKGROUND: To introduce and manage a Pharmaceutical care programs in geriatric care institutions presents difficulties such as reduced pharmacy service staff, complexity of the patients or lack of integration of the pharmacist in the health care team. This work describes the evolution of the implementations of a program of pharmaceutical care centered in drug related problems (DRP) in a group of geriatric institutions of different levels of complexity. METHODS: Setting: Long-term and subacute care hospitals (HSS) and Health care teams attending nursing homes (EARs). PARTICIPANTS: Patients attended in HSS and EARs during different periods between 2010 and 2016. INTERVENTIONS: The program was developed in different stages, in which pharmacists made interventions of increasing complexity. RESULTS: Between 2010 and 2013, the approach was only to improve the prescription of non-appropriate drugs for the elderly, which was reduced from 19 to 14.5%. Subsequent steps included detection of drug-related problems (DRP), systematization of treatment revisions, recording of pharmacist interventions, improvements in the classification of interventions and the creation of a web-based database for recording in a more efficient way. During these years, there was an increase in the number of patients included in pharmaceutical care activities and thus the number of pharmacist interventions (3872 in 2014 vs 5903 in 2016). In 2016, mean age in 2016: 83.2 years old. Mean number of medicines/patient: 8.4 ± 3.3, and mean interventions/patient: 1.62. Degree of acceptance of the interventions by physicians improved (68.6% in 2016 vs 45.5% in 2012), even though there is still much work to do. The Medication Appropriateness Index (MAI) showed that when the interventions were accepted, there was an important improvement. HSS mean MAI values pre-intervention: 2.52, post-intervention 0.80. In EARs: 5 pre and 1.39 post. In both cases p < 0.0001. CONCLUSIONS: Approaching the deployment of activities in a progressive way has made us more efficient and able to confront and solve the problems that have arisen. Even though there has been a very restricted increase in the staff and budget, we are able to implement a DRP detection programme with guaranties of quality.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Casas de Saúde , Equipe de Assistência ao Paciente/organização & administração , Assistência Farmacêutica/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desenvolvimento de Programas
9.
Pharm. pract. (Granada, Internet) ; 16(3): 0-0, jul.-sept. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174796

RESUMO

Objectives: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen's behavioural model. Methods: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher's exact test and multinomial logistic regression models were used to establish association between variables. Results: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95%CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant's source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants' source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one's source of medicine information. Conclusions: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants' source of medicine and medicine information was influenced by both predisposing and enabling factors


No disponible


Assuntos
Humanos , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Assistência Farmacêutica/organização & administração , Zona Rural , Serviços de Informação sobre Medicamentos , Informação de Saúde ao Consumidor , Diabetes Mellitus/tratamento farmacológico , Hipertensão/tratamento farmacológico , Estudos Transversais , Autorrelato , Prescrições de Medicamentos/estatística & dados numéricos , Inquéritos e Questionários , Análise Multivariada , Gana/epidemiologia
10.
Pharm. pract. (Granada, Internet) ; 16(3): 0-0, jul.-sept. 2018. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-174803

RESUMO

Objectives: To evaluate a prompt card (i.e., a post-card sized tool that lists counselling prompt information) with 5 key elements and 3 open key questions to ask patients in community pharmacies. Methods: Community pharmacists practicing in England and accredited to perform consultations used the prompt card during a formal consultation with emphasis on patients receiving oral anticoagulation. Main outcome measure was the number of performed consultations with pharmacists' thoughts and feedbacks in writing. Results: During 8 weeks, 19 pharmacists (mean age: 36.6 (SD=9) years; 7 women; accredited an average of 12.9 (SD=9.8) years) performed 1,034 consultations and used the prompt card 104 times during anticoagulation consultations. Overall the prompt card was judged practical and relevant by the 16 pharmacists who used it (100%), especially because it outlines what a good consultation should comprise. The key elements offered a logical framework to guide the overall approach when undertaking a consultation. The two questions, "Why do you want to use this medicine?" and "Why would you not want to use this medicine?" generated negative responses from the patient and pharmacists, respectively. Conclusions: Our prompt card with key questions summarizing all the points that should be addressed in a consultation supported effective communication during patient-pharmacist interaction. Two questions need rephrasing and a further question is needed to determine how patients are using their medicines


No disponible


Assuntos
Humanos , Assistência Farmacêutica/organização & administração , Anticoagulantes/administração & dosagem , Informação de Saúde ao Consumidor/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Reino Unido/epidemiologia , Folhetos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
11.
Pharm. pract. (Granada, Internet) ; 16(3): 0-0, jul.-sept. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174804

RESUMO

Background: Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance. Objectives: To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge. Methods: Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted. Results: Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received'long-term' benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents. Conclusions: One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous long-term treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Transtornos Mentais/tratamento farmacológico , Hipnóticos e Sedativos/administração & dosagem , Benzodiazepinas/administração & dosagem , Assistência Farmacêutica/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Estudos Retrospectivos , Ansiolíticos/uso terapêutico , Sumários de Alta do Paciente Hospitalar
13.
J Manag Care Spec Pharm ; 24(8): 795-799, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30058987

RESUMO

BACKGROUND: Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (PCMH) and accountable care organization (ACO) environment. PROGRAM DESCRIPTION: In 2008, the year before PCMH implementation, 36% of patients who were hospitalized at Advocate Trinity Hospital for a heart failure exacerbation were readmitted within 30 days of their hospital stay for heart failure exacerbation. This high rate of heart failure hospital readmissions, compared with national standards, drove the implementation of the PCMH at Advocate Medical Group - Southeast Center (AMG-SE), the adjoining outpatient medical clinic. A clinical pharmacist was added to the health care team to help achieve the collective goal of improving patient outcomes and decreasing hospitalizations. OBSERVATIONS: From November 1, 2009, through August 30, 2010, the clinical pharmacist conducted visits and intervened in the care of 111 chronic heart failure patients. A pre/post analysis of those 111 patients during the 10 months before and after the integration of the clinical pharmacist showed that those patients were hospitalized 63 times in the 10 months before having regularly scheduled visits with the clinical pharmacist and 30 times in the 10 months after establishing care. This reduction from 63 to 30 visits translated to an approximate 50% decrease in heart failure hospitalizations in patients being followed by the clinical pharmacist within the first 10 months. Once the clinical pharmacist became better integrated into the workflow through development of rapport with the medical team, the outcomes improved further. In an 18-month analysis from May 1, 2010, through November 30, 2011, only 2% of patients (3 of 153) designated as high-risk patients managed by the clinical pharmacist had a 30-day readmission for heart failure exacerbation. IMPLICATIONS: Outcomes-based models have expanded opportunities for clinical pharmacist involvement and can provide unique reimbursement options. Demonstration of cost savings and an improvement in quality measures are paramount to establishing and justifying the clinical pharmacist's role in a team-based model of care. DISCLOSURES: No outside funding supported this research. The authors have no conflicts of interest to disclose.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Readmissão do Paciente/estatística & dados numéricos , Assistência Farmacêutica/organização & administração , Farmacêuticos/organização & administração , Papel Profissional , Organizações de Assistência Responsáveis/economia , Organizações de Assistência Responsáveis/organização & administração , Organizações de Assistência Responsáveis/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Redução de Custos , Humanos , Conduta do Tratamento Medicamentoso/economia , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Readmissão do Paciente/tendências , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/organização & administração , Assistência Centrada no Paciente/estatística & dados numéricos , Assistência Farmacêutica/economia , Assistência Farmacêutica/estatística & dados numéricos , Farmacêuticos/economia , Farmacêuticos/estatística & dados numéricos , Planos de Incentivos Médicos/organização & administração , Planos de Incentivos Médicos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Reembolso de Incentivo/organização & administração , Reembolso de Incentivo/estatística & dados numéricos
14.
J Manag Care Spec Pharm ; 24(8): 819-833, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30058988

RESUMO

BACKGROUND: Sales of medical foods (MFs) and convenience packages (CPs) are projected to exceed $2 billion in the United States, with an annual growth rate of 10%. Several studies have highlighted the rapid growth of MF use within the California Workers' Compensation System (CAWCS). To curb this growth, California implemented Assembly Bill 378 (AB 378) in 2012 to regulate physicians' incentives to dispense MFs and CPs. AB 378's regulation on only physician-dispensed MFs and CPs and not pharmacy-dispensed MFs and CPs generated a setting for evaluating the differential effect of the bill on MF and CP use and cost. OBJECTIVES: To (a) examine the use and cost of MFs and CPs in the CAWCS that are not for inborn errors of metabolism and (b) evaluate the regulatory effect of AB 378. METHODS: This study adopted a quantitative approach and employed descriptive statistics and t-tests. The analyses used the most recent complete annual claims data from the Workers' Compensation Information System dataset to evaluate MF and CP claims frequencies and dollar amounts reimbursed from 2011 to 2013 and to compare the difference between physician-dispensed and pharmacy-dispensed products. RESULTS: Of 151,107 MFs and CPs billed, 95,528 (63.2%) prescriptions were reimbursed. The reimbursed MFs and CPs accounted for approximately $19 million paid to pharmacies and physicians over 3 years. Physician-dispensed MFs, which were regulated by AB 378 in January 2012, experienced a reduction in mean amount reimbursed by $9.95 (P < 0.001)-from $195.64 to $185.68-compared with the mean amount reimbursed in 2011. Conversely, physician-dispensed CPs, as well as pharmacy-dispensed MFs and CPs, did not experience a decrease in mean amount reimbursed. CONCLUSIONS: The results indicated that AB 378 was associated with a statistically significant reduction in physician-dispensed MFs. Concomitantly, the results from t-tests showed no statistically significant difference in mean amount reimbursed for MFs and CPs to pharmacies before and after AB 378. The finding was expected and as hypothesized because AB 378 did not regulate pharmacy-dispensed MFs and CPs. Legislative measures, such as AB 378 in California, may influence rising costs and use of MFs and CPs in general. Other workers' compensation systems could adopt similar legislation to affect the behavior of physician prescribing of non-inborn errors of metabolism MFs and further test these findings. DISCLOSURES: Funding for this study was contributed by the California Workers' Compensation System. The authors have nothing to disclose.


Assuntos
Alimentos Formulados/estatística & dados numéricos , Doenças Metabólicas/terapia , Assistência Farmacêutica/organização & administração , Medicamentos sob Prescrição/uso terapêutico , Indenização aos Trabalhadores/organização & administração , California , Prescrições de Medicamentos/estatística & dados numéricos , Alimentos Formulados/economia , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/economia , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Doenças Metabólicas/economia , Assistência Farmacêutica/economia , Assistência Farmacêutica/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Estados Unidos , Indenização aos Trabalhadores/economia , Indenização aos Trabalhadores/estatística & dados numéricos
15.
Ned Tijdschr Geneeskd ; 1622018 May 14.
Artigo em Holandês | MEDLINE | ID: mdl-30040324

RESUMO

Almost half of medication-related hospital admissions are preventable. In the primary care setting structured medication reviews (SMRs) are an effective tool to detect and prevent medication errors that may cause harm to patients. Increasingly, SMRs are also being carried out in the clinical setting. SMRs are usually carried out by pharmacists who are well trained in pharmacology and in detecting medication errors. However, the implementation rate of the pharmaceutical interventions that result from SMRs is too low. We have introduced a multidisciplinary pharmacotherapy team of pharmacists and medical doctors into the clinic to carry out Medication review 2.0. The team performs SMRs to detect and prevent medication errors in hospital patients, improves the implementation rate of pharmaceutical interventions by enhancing transmural communication, and gives training and support to clinical prescribers in doing an SMR.


Assuntos
Erros de Medicação/prevenção & controle , Assistência Farmacêutica/organização & administração , Farmacêuticos/normas , Humanos , Equipe de Assistência ao Paciente/organização & administração , Garantia da Qualidade dos Cuidados de Saúde
16.
Cien Saude Colet ; 23(6): 1937-1949, 2018 Jun.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29972501

RESUMO

This article examines pharmaceutical services and access to essential medicines in Brazil during the 30 years since the advent of Brazil's Unified Health System from a comprehensiveness perspective. The following topics are addressed: the "realignment" of pharmaceutical services; human resources in pharmaceutical services; the essential medicines concept; the rational use of medicines; technological advances and drug manufacturing; and ethical regulation. With a strong regulatory focus and a structural framework centered on the National Medicines Policy, the past three decades represent a mixture of progress and setbacks, considering the national complexities of the healthcare system and the political, economic and social changes that have influenced policy and access to medicines, which is a key concern even in the world's richest countries, as the forums of discussion on global health have demonstrated. We show that major steps forward have been taken, highlighting that the recent fiscal austerity measures imposed by the government threaten to seriously undermine social progress.


Assuntos
Indústria Farmacêutica/tendências , Acesso aos Serviços de Saúde/tendências , Programas Nacionais de Saúde/organização & administração , Assistência Farmacêutica/organização & administração , Brasil , Assistência Integral à Saúde/organização & administração , Assistência Integral à Saúde/tendências , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Medicamentos Essenciais/provisão & distribução , Saúde Global , Política de Saúde , Humanos , Programas Nacionais de Saúde/tendências , Assistência Farmacêutica/tendências , Política
17.
Pharm. pract. (Granada, Internet) ; 16(2): 0-0, abr.-jun. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174785

RESUMO

Objective: This study aims to assess the views and attitudes of the general public towards the current role of pharmacists in Jordan. Methods: This study is a cross-sectional quantitative questionnaire-based study. After a thorough literature review on public perspectives of pharmaceutical care services, a draft questionnaire was designed. This questionnaire was examined and discussed in a focus group of invited public members and was amended accordingly to reach the final draft. The questionnaire was administered using a structured interview technique in which members of the public were asked a series of questions by a trained pharmacist. The study took a place over a period of six months, from January to June 2013. Individuals were recruited from urban and rural areas of Jordan. Results: A total of 1214 respondents were interviewed during the study. Of the respondents, 67.8% were female. Most of the respondent were married (64%) and had a university degree (88.5%). Approximately half of the respondents (55.1%) had no previous knowledge of pharmaceutical care. A relative majority of respondents considered the most important activity performed by pharmacists to be dispensing medications (46.2%), followed by patient counseling (34.6%). The majority of respondents (86.4%) believed that pharmacists have a role in providing healthcare services, and 68% of respondents reported that in order to serve their needs, a pharmacist must consider the patient's needs and engage patients in determining medication timing and options. Conclusions: The plurality of respondents believed in the importance of pharmacists in providing pharmaceutical care services. However, respondents expected much from pharmacists and felt that their current role was unsatisfying


No disponible


Assuntos
Humanos , Masculino , Feminino , Assistência Farmacêutica/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Jordânia/epidemiologia , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Demografia , Papel Profissional
18.
Consult Pharm ; 33(3): 152-158, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29720300

RESUMO

OBJECTIVE: To develop heart failure (HF) and chronic obstructive pulmonary disease (COPD) self-management kits in an accountable care organization (ACO) to facilitate patients' self-care and prevent hospital readmissions. SETTING: Pharmacists practice in an outpatient-based ACO. They participate in interprofessional office visits with providers and independently manage maintenance pharmacotherapies. PRACTICE DESCRIPTION: Pharmacists collaborate with an interprofessional team within the ACO including physicians, nurses, case managers, and paramedics. Two commonly encountered diseases are chronic COPD and HF. Reducing preventable readmissions for these conditions are important quality benchmarks and cost-saving strategies. PRACTICE INNOVATION: Pharmacists were responsible for developing HF and COPD self-management kits containing patient education materials and prescriptions to facilitate self-care. Prior to kit development, pharmacists performed a literature review to determine the presence of previously published findings on these topics. MAIN OUTCOME MEASUREMENTS: The interprofessional team continually evaluates the successes and limitations of this initiative. Pharmacists developed training and instructions for ACO allied health professionals in an effort to incorporate the self-management kits in clinical practice. RESULTS: The initial literature search revealed no studies describing the intervention of interest. Innovative programs designed to help reduce preventable readmissions are lacking in primary care. Implementation of the self-management kits was accepted by interprofessional ACO leadership and is currently being integrated into allied health workflow. CONCLUSION: Patients at risk for having an exacerbation of COPD or HF should receive self-management strategies. Prompt therapy prior to exacerbations reduces hospital admissions and readmissions, speeds recovery, and slows disease progression. Pharmacist-facilitated implementation of self-management kits may be developed by interprofessional health care teams.


Assuntos
Insuficiência Cardíaca/terapia , Transferência de Pacientes/organização & administração , Doença Pulmonar Obstrutiva Crônica/terapia , Autocuidado/métodos , Organizações de Assistência Responsáveis/organização & administração , Progressão da Doença , Humanos , Pacientes Ambulatoriais , Equipe de Assistência ao Paciente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Assistência Farmacêutica/organização & administração , Farmacêuticos/organização & administração , Atenção Primária à Saúde/organização & administração , Papel Profissional , Autogestão
20.
J Manag Care Spec Pharm ; 24(6): 572-578, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29799323

RESUMO

Cancer is one of the most costly medical conditions to treat in the United States due in part to increasingly innovative, but expensive, chemotherapeutic, immuno-oncologic, and biologic treatments. At the same time, health insurance in the United States is increasingly shifting a larger part of the costs to patients through higher premiums, deductibles, and coinsurance and copayment rates. These shifts are driving the need for quality measures and value measurements in oncology that assess the total effect on care and can be used to develop payment models. Measures that consider the patient's experience are emerging as important factors for evaluating value in cancer care. To address these issues, the Academy of Managed Care Pharmacy (AMCP) convened a stakeholder forum, Driving Value and Outcomes in Oncology, on November 14-15, 2017, in Arlington, Virginia. The goals of the forum were to (a) understand which oncology-specific quality measures are important for managed care decision makers; (b) prioritize the gaps related to the use of pharmaceuticals in measuring oncology outcomes; (c) develop a list of recommendations for how a collaboration of payers, providers, and AMCP may drive improvements in oncology care; and (d) define solutions for addressing causes of patient financial burdens for cancer care. More than 30 national and regional health care leaders representing health plans, integrated delivery systems, pharmacy benefit managers, pharmacists, employers, patient advocates, national professional associations, and biopharmaceutical companies participated in the forum. DISCLOSURES: This AMCP Partnership Forum and the development of this proceedings report were supported in collaboration with Abbvie, Amgen, AstraZeneca, Foundation Medicine, Genentech, Gilead, Eli Lilly, Merck, Sanofi, Takeda Oncology, and Xcenda.


Assuntos
Programas de Assistência Gerenciada/economia , Oncologia/economia , Neoplasias/terapia , Assistência Farmacêutica/economia , Congressos como Assunto , Humanos , Programas de Assistência Gerenciada/organização & administração , Oncologia/métodos , Oncologia/organização & administração , Neoplasias/economia , Assistência Farmacêutica/organização & administração , Indicadores de Qualidade em Assistência à Saúde/economia , Estados Unidos
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