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1.
Sr Care Pharm ; 35(2): 75-80, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32019642

RESUMO

This report describes a case of hypertensive crisis identified by two pharmacists conducting a patient home visit. A 72-year-old woman living in a rural town in Eastern Washington state was referred for a pharmacist home visit by her care coordinator, who had concerns of possible medication-related issues. The patient had a history of type 2 diabetes mellitus, hypertension, ischemic stroke, heart failure with preserved ejection fraction, hypothyroidism, and unspecified back pain. This patient also experienced additional challenges resulting from living in a rural and medically underserved community. During the home visit, the patient's chief complaint was recurrent, painful migraine headaches that she self-treated with nonsteroidal anti-inflammatory medication. Upon examination, the pharmacists found the patient's blood pressure to be 223/132 mm Hg and her self-monitoring log consistently showed blood pressure readings greater than 180/110 mm Hg with a pulse between 75 bpm to 80 bpm. The patient was referred to the emergency department after determining her blood pressure met criteria for hypertensive crisis despite her adherence to her current antihypertensive regimen. She was hospitalized for three days. After her hospitalization, she was referred to her primary care providers and her pharmacist for follow up. The pharmacist reconciled her current medication regimen and made guideline-directed adjustments to her antihypertensive medications. Six months after her hospitalization her blood pressure was within goal and associated headaches had resolved.


Assuntos
Diabetes Mellitus Tipo 2 , Visita Domiciliar , Idoso , Anti-Hipertensivos , Feminino , Humanos , Farmacêuticos , Washington
2.
Sr Care Pharm ; 35(2): 93-106, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32019644

RESUMO

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.
DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.
SETTING: Two primary care physician-based practices.
INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.
MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.
RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.
Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.
CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.


Assuntos
Medicare , Farmacêuticos , Idoso , Estudos Transversais , Exercício , Grupos Focais , Humanos , Estados Unidos
3.
Am J Health Syst Pharm ; 77(4): 254-258, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-31907520
5.
Oral Dis ; 26(1): 89-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596995

RESUMO

OBJECTIVES: To investigate the clinical advices pharmacists would give to patients who present with various oral mucosal lesions. SUBJECTS AND METHODS: One hundred and twenty pharmacists in three major cities in the United Arab Emirates (UAE) were approached by senior dental students acting as mystery shoppers. Pharmacists were shown an image of one of four oral mucosal lesions representing candidosis, aphthous ulcer, erosive lichen planus and squamous cell carcinoma (SCC). Pharmacists' referral pattern and choices of medications were recorded and assessed against demographic variables. RESULTS: Eighty-eight per cent (88%) of pharmacists dispensed a non-prescription medication to treat the oral lesions, including SCC, while only 12% recommended that the lesion shown to them be assessed by a clinician. Among all referral recommendations, 32% were for SCC (p = .006). Geographical proximity of a clinic to the pharmacy was a significant factor in determining pharmacists' referral recommendation (p = .036). CONCLUSION: Most pharmacists dispensed a medication for oral mucosal lesions, including potentially malignant and malignant ones, without referring patients to a medical or dental practitioner. Pharmacists should be aware of the serious nature of some oral mucosal lesions and the necessity to refer those cases to a qualified practitioner for proper clinical assessment.


Assuntos
Competência Clínica , Serviços Comunitários de Farmácia , Doenças da Boca/diagnóstico , Doenças da Boca/terapia , Candidíase/diagnóstico , Candidíase/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Líquen Plano/diagnóstico , Líquen Plano/terapia , Mucosa Bucal/patologia , Farmacêuticos , Encaminhamento e Consulta/estatística & dados numéricos , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/terapia , Emirados Árabes Unidos
7.
J Oncol Pharm Pract ; 26(1): 13-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30832554

RESUMO

PURPOSE: To describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting. METHODS: Patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature. RESULTS: The mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively). CONCLUSIONS: Findings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.


Assuntos
Afatinib/efeitos adversos , Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Educação de Pacientes como Assunto/tendências , Farmacêuticos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Serviços Comunitários de Farmácia/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Receptores ErbB/genética , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Estudos Retrospectivos
8.
J Oncol Pharm Pract ; 26(1): 29-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30832556

RESUMO

OBJECTIVES: This study aimed to investigate the effectiveness of pharmacist intervention in reducing and preventing prescribing errors of investigational drugs for cancer patients. MATERIALS AND METHODS: A retrospective study was conducted during two periods: a baseline period from December 2015 to June 2016 and an intervention period from July 2016 to February 2017. The investigational drug service (IDS) pharmacists performed active interventions during the intervention period. RESULTS: Among 12,387 investigational drug orders, 395 (6.1%) prescribing errors were detected in 6477 orders at the baseline period, and 278 errors (4.7%) were detected in 5,910 orders at the intervention period. To identify factors that affect prescribing errors, three models were constructed for the multivariate analysis. Among factors affecting prescribing errors, sponsor initiated trial (SIT) was the strongest factor (AOR: 4.16, 95% CI: 3.31-5.23). Pharmacist intervention reduced prescribing errors by at least 25% in all constructed models after adjusting for confounding variables. Prescribing errors were 1.3 times higher when dealing with intravenous medications than when dealing with oral medications. There were 60% fewer prescribing errors in the blinded study than in the open study. SIT and multi-center/multi-nation studies had 4.2 and 2.4 times more frequent prescribing errors than in investigator-initiated trials (IIT) and single-center/single-nation studies, respectively. Fewer errors occurred in phase 2 and trials covering both phase 1 and phase 2 (phase 1/2) than in phase 3 trials. CONCLUSIONS: The IDS pharmacist intervention in cancer clinical trials was associated with significant reductions in prescribing errors and may lead to increased medication safety.


Assuntos
Drogas em Investigação/efeitos adversos , Erros de Medicação/prevenção & controle , Neoplasias/tratamento farmacológico , Farmacêuticos , Serviço de Farmácia Hospitalar/métodos , Papel Profissional , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , República da Coreia/epidemiologia , Estudos Retrospectivos
9.
J Oncol Pharm Pract ; 26(1): 116-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31096855

RESUMO

PURPOSE: Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. METHODS: An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. RESULTS: Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. CONCLUSION: The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.


Assuntos
Centros Médicos Acadêmicos/normas , Prática Avançada de Enfermagem/normas , Oncologia/normas , Profissionais de Enfermagem/normas , Farmacêuticos/normas , Assistentes Médicos/normas , Centros Médicos Acadêmicos/métodos , Prática Avançada de Enfermagem/métodos , Antineoplásicos/administração & dosagem , Feminino , Humanos , Masculino , Oncologia/métodos , Inquéritos e Questionários
10.
J Oncol Pharm Pract ; 26(1): 156-174, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31354102

RESUMO

The development of BCR-ABL-targeting tyrosine kinase inhibitors has transformed chronic phase chronic myeloid leukemia (CP CML) from a disease with a terminal prognosis to a treatable chronic illness. Long-term treatment with tyrosine kinase inhibitors means that patients have to be clinically managed and monitored over extended periods of time, thus a patient-centered, medically integrated, and multidisciplinary oncology healthcare team is required to support patients through their journey. Pharmacists work with patients, physicians, and the wider support team to select the optimum therapy plan for a given patient. These decisions are based on risk factors, comorbidities, concomitant medications, and personal circumstances and pharmacists advise on the efficacy and safety of different treatment options. Additionally, pharmacists are a key point-of-contact and resource for monitoring patient response to treatment, identifying and managing adverse events and drug-drug interactions, any subsequent therapy plan modifications, and, potentially, treatment-free remission. Pharmacists also assist with patient education, medication adherence, and financial discussions with patients throughout the long course of the disease. This review provides an overview of BCR-ABL tyrosine kinase inhibitors, discusses the role of the medically integrated pharmacy team, and suggests strategies that pharmacists can use in patient management and clinical decision-making to optimize the treatment of CP CML.


Assuntos
Antineoplásicos/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Adesão à Medicação , Farmacêuticos/tendências , Inibidores de Proteínas Quinases/uso terapêutico , Interações de Medicamentos/fisiologia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Oncologia/métodos , Oncologia/tendências , Proteínas Tirosina Quinases/antagonistas & inibidores
11.
J Oncol Pharm Pract ; 26(1): 175-186, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31554471

RESUMO

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.


Assuntos
Liderança , Neoplasias/tratamento farmacológico , Farmacêuticos/tendências , Farmácia/tendências , Sexismo/tendências , Feminino , Humanos , Assistência Farmacêutica/tendências , Farmácia/métodos , Sexismo/prevenção & controle
13.
Sr Care Pharm ; 35(1): 3-12, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883540

RESUMO

The term "elder orphan" is an emerging description of an individual older than 65 years of age who lacks dependents or close family members on whom to rely for assistance, particularly in dealing with health problems. As the number of elder orphans continues to grow, this population is increasingly at risk. Some social determinants of health affect the elder-orphan population disproportionately, including financial security, housing, and transportation. Medication nonadherence may be a sign of increasing isolation and unaddressed problems. Elder orphans may have difficulty managing their health care, and pharmacists can help by identifying patients without support systems may be able to act as valuable assets to these patients. Brown-bag medication reviews, medication therapy management, and thorough medication reconciliation are excellent interventions to prevent medication misadventure. Identifying other medical professionals and services that can support the elder orphan is also prudent.


Assuntos
Reconciliação de Medicamentos , Farmacêuticos , Idoso , Humanos , Adesão à Medicação , Conduta do Tratamento Medicamentoso
14.
Sr Care Pharm ; 35(1): 34-37, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883543

RESUMO

The objective of this manuscript is to review an ambulatory care pharmacist service that evolved into a pharmacotherapy, polypharmacy service with multiple submodels. The practice is located in a multispecialty, tertiary care, destination medical clinic in Florida. Ambulatory care pharmacist services have evolved to demand expertise in multiple, specialized areas to address the more complex medical issues of the polypharmacy patient. Many of these patients are older than 65 years of age, with broad medical care needs. A number of changes have led to the need for these expanded services: the growth and diversification of pharmacists' ambulatory care services, the multitude of sophisticated medications, the continued direct-to-consumer commercialization, the growth of dietary supplements, and the implementation of pharmacogenomic testing, In addition, new advances in clinical and laboratory technologies make polypharmacy a viable pharmacist clinical specialty. With the broad knowledge base needed for these patients, a polypharmacy pharmacist may function as a pharmacology troubleshooter expert.


Assuntos
Farmacêuticos , Polimedicação , Idoso , Assistência Ambulatorial , Florida , Humanos
15.
Sr Care Pharm ; 35(1): 38-46, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31883544

RESUMO

OBJECTIVE: To describe recommendations made by geriatric clinical pharmacists within an innovative care model focusing on patients with dementia living at home. DESIGN: Retrospective chart review. SETTING: Outpatients in a tertiary care Veterans Affairs health care system. PARTICIPANTS: Veterans who underwent a Caring for Older Adults and Caregivers at Home (COACH) Program assessment and had at least one medicationrelated recommendation made by a geriatric clinical pharmacist. MAIN OUTCOME MEASURES: The primary endpoint was the number and category of medication-related recommendations made by a geriatric clinical pharmacist at the initial COACH program assessment. Secondary endpoints were recommendation acceptance rates and change in potentially inappropriate medications (PIMs) at six months. RESULTS: There were 104 patients included. The mean age was 81 years and the majority of patients were male and Caucasian. At baseline, patients were receiving a mean of 12 medications/person, and 59% of patients were receiving at least one PIM. There were 248 total medication recommendations made, with a mean of 2.4 recommendations/person (range 1-5). The three most common recommendation categories were to discontinue a drug, decrease the dose, and switch to a potentially safer alternative. Providers accepted 110 (44%) recommendations within six months. Patients were receiving a mean of one PIM/person at baseline, and no change was observed at six months.CONCLUSION: This study describes recommendations made through medication reviews by geriatric clinical pharmacists within an innovative care model for patients with dementia living at home. These data may provide information to other clinical pharmacists implementing consult services in similar settings.


Assuntos
Cuidadores , Farmacêuticos , Idoso de 80 Anos ou mais , Empatia , Feminino , Humanos , Masculino , Lista de Medicamentos Potencialmente Inapropriados , Estudos Retrospectivos
16.
Sr Care Pharm ; 34(10): 636-643, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818349

RESUMO

Laboratory tests play an essential role in diagnosing disease and in determining and monitoring medication therapy. Laboratory interference-inaccuracies resulting from other properties in the sample-from both endogenous and exogeneous sources, can potentially lead to erroneous diagnosis and changes in medications. Some types of laboratory interference are particularly common for elderly individuals. Pharmacists and other practitioners need to be aware of various common sources of interference with laboratory results so they can better assess the validity of laboratory values for their patients.


Assuntos
Serviços de Laboratório Clínico , Idoso , Humanos , Laboratórios , Farmacêuticos
17.
Sr Care Pharm ; 34(10): 660-668, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818351

RESUMO

OBJECTIVE: To describe an established, pharmacist-managed, fee-for-service, office-based pharmacogenomics (PGx) practice.
SETTING: Multi-specialty, academic, tertiary care medical clinic and hospital.
PRACTICE DESCRIPTION: Physician office-based PGx fee-for-service (FFS) pharmacist practice. Patients seen are complex and most are older adults.
INNOVATION: Established service in a new area of ambulatory practice that is financially self-sustaining. Patients who received PGx testing were seen within the medication therapy management polypharmacy practice since 2015, with the PGx practice becoming official in 2018.
MAIN OUTCOME MEASUREMENTS: Growth of practice, evaluated by referred patient consults ordered per month by providers.
RESULTS: Because of insufficient third-party payment for PGx services, the practice was developed as a selfpay, FFS practice and growing because of patient and provider demand.
CONCLUSION: It is quite possible pharmacists in greater numbers can expand PGx services into ambulatory and inpatient areas they may have never otherwise entered now that PGx has grown in use and relevance. PGx presents additional opportunities and service lines for pharmacists to practice how they were trained and assist them in collaborative integration onto the medical team.


Assuntos
Farmacêuticos , Farmacogenética , Planos de Pagamento por Serviço Prestado , Humanos , Conduta do Tratamento Medicamentoso , Polimedicação
18.
Sr Care Pharm ; 34(10): 678-686, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818354

RESUMO

OBJECTIVE: Assess the impact of a pharmacist-driven deprescribing procedure on reduction of target medications at discharge among geriatric patients receiving care in a hospital-based transitional care unit.
DESIGN: Retrospective, single-center chart review.
SETTING: Transitional care unit located within a hospital.
PARTICIPANTS: Patients 65 years of age and older were included if they were admitted to the transitional care unit between June 1, 2017, and December 15, 2017, on one or more of the following target medication classes: antihistamines, benzodiazepines, hypnotic sleep aids, proton-pump inhibitors, and skeletal muscle relaxants.
INTERVENTIONS: Pharmacists performed a structured review of patient's medications upon admission and utilized the deprescribing procedure developed by our institution to identify and deprescribe target medications in an attempt to optimize the patient's medication regimen prior to discharge.
RESULTS: Overall, 129 patients on 198 target medications were included in the study. Patients were on an average of 1.5 ± 0.78 target medications at admission, which was reduced to 0.78 ± 0.73 at discharge (P < 0.001). Overall, a 50% reduction of target medications was achieved.
CONCLUSION: A pharmacist-driven deprescribing procedure significantly reduced the quantity of target medications that older patients were discharged on.


Assuntos
Desprescrições , Idoso , Humanos , Farmacêuticos , Estudos Retrospectivos , Cuidado Transicional
20.
Soins ; 64(841): 50-51, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31864514

RESUMO

Beyond the checking of a prescription, the pathophysiological characteristics of the patient and the other prescribed medicines, pharmacists contribute to the field of oncology in their other missions. The benefits in terms of the reduction of risks for caregivers have been favoured by the centralisation of preparations combined with the application of other methods derived from industry. Research is continuing in order to dispense safe medicines which comply with the prescription and control the risks linked to the use of these highly active medicines.


Assuntos
Cuidadores/psicologia , Relações Interprofissionais , Neoplasias/tratamento farmacológico , Farmacêuticos/psicologia , Humanos
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