scholarly journals Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care

2021 ◽  
Author(s):  
Ankie Hazen ◽  
Vivianne Sloeserwij ◽  
Bart Pouls ◽  
Anne Leendertse ◽  
Han de Gier ◽  
...  
Keyword(s):  
General Practice ◽  
Professional Identity ◽  
Training Program ◽  
Integrated Care ◽  
Clinical Pharmacist ◽  
Care Model ◽  
Clinical Pharmacists ◽  
General Practices ◽  
Related Harm ◽  
Qualitative Analyses

AbstractBackground Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication. Aim To prevent medication-related harm by integrating a clinical pharmacist in the general practice team. This best practice paper provides an overview of 1. the development of this function and the integration process and 2. its impact, measured with quantitative and qualitative analyses. Setting Ten general practices in the Netherlands. Development and implementation of the (pragmatic) experiment We designed a 15-month workplace-based post-graduate learning program to train pharmacists to become clinical pharmacists integrated in general practice teams. In close collaboration with general practitioners, clinical pharmacists conduct clinical medication reviews (CMRs), hold patient consultations for medication-related problems, carry out quality improvement projects and educate the practice staff. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety. Evaluation The integrated care model improved medication safety: less medication-related hospitalisations occurred compared to usual care (rate ratio 0.68 (95% CI: 0.57–0.82)). Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist. This new caregiver proved to align well with the general practitioner. Conclusion A clinical pharmacist in general practice proves a feasible integrated care model to improve the quality of drug therapy.

Description of Pharmacist Recommendations in the Caring for Older Adults and Caregivers at Home (COACH) Program

2020 ◽  
Vol 35 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Brittany Loy Melville ◽  
Janine Bailey ◽  
Jason Moss ◽  
William Bryan ◽  
Judith Davagnino ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Program Assessment ◽  
Potentially Inappropriate Medications ◽  
Care Model ◽  
Clinical Pharmacists ◽  
Coach Program ◽  
At Home

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.

Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management

2020 ◽  
Vol 44 (3) ◽  
pp. 451
Author(s):  
Victar Hsieh ◽  
Glenn Paull ◽  
Barbara Hawkshaw
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Integrated Care ◽  
Significant Proportion ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Model ◽  
Care Project ◽  
Effective Delivery

ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.

A chlamydia education and training program for general practice nurses: reporting the effect on chlamydia testing uptake

2021 ◽  
Vol 27 (1) ◽  
pp. 36
Author(s):  
Anna Wood ◽  
Sabine Braat ◽  
Meredith Temple-Smith ◽  
Rebecca Lorch ◽  
Alaina Vaisey ◽  
...  
Keyword(s):  
General Practice ◽  
Training Program ◽  
Treatment Effect ◽  
Controlled Trial ◽  
Education And Training ◽  
Practice Nurses ◽  
Chlamydia Testing ◽  
Increased Risk ◽  
General Practices ◽  
And Training

The long-term health consequences of untreated chlamydia are an increased risk of pelvic inflammatory disease, ectopic pregnancies and infertility among women. To support increased chlamydia testing, and as part of a randomised controlled trial of a chlamydia intervention in general practice, a chlamydia education and training program for general practice nurses (GPN) was developed. The training aimed to increase GPNs’ chlamydia knowledge and management skills. We compared the difference in chlamydia testing between general practices where GPNs received training to those who didn’t and evaluated acceptability. Testing rates increased in all general practices over time. Where GPNs had training, chlamydia testing rates increased (from 8.3% to 19.9% (difference=11.6%; 95% CI 9.4–13.8)) and where GPNs did not have training (from 7.4% to 18.0% (difference=10.6%; 95% CI 7.6–13.6)). By year 2, significantly higher testing rates were seen in practices where GPNs had training (treatment effect=4.9% (1.1 – 8.7)), but this difference was not maintained in year 3 (treatment effect=1.2% (−2.5 – 4.9)). Results suggest a GPN chlamydia education and training program can increase chlamydia testing up to 2 years; however, further training is required to sustain the increase beyond that time.

scholarly journals Clinical pharmacist facilitators in primary care: a descriptive study of their roles and services provided in general practices of southern New Zealand

2020 ◽  
Vol 12 (1) ◽  
pp. 88 ◽  
Author(s):  
Sivamanoj Yadav Boyina ◽  
Tim Stokes ◽  
Angela Renall ◽  
Rhiannon Braund
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Clinical Pharmacy ◽  
Clinical Pharmacist ◽  
Retrospective Case ◽  
Primary Health ◽  
General Practices ◽  
Pharmacist Services ◽  
Geographical Locations ◽  
Case Note Review

ABSTRACT INTRODUCTIONInternationally, the inclusion of pharmacists into general practice as clinical pharmacy facilitators has improved patient outcomes. However, clinical pharmacists are relatively new to southern New Zealand general practices and their range of services has not been studied. AIMSTo describe the implementation of clinical pharmacist services in general practices in the Southern region; to examine the tasks conducted by clinical pharmacy facilitators; and to determine the characteristics of patients who access this service. METHODSThe establishment and development of the clinical pharmacy facilitator role was determined by documentation held within the local Primary Health Organisation. The activities performed by clinical pharmacy facilitators were collected from patient medical records for the period 31 March 2015 to 31 March 2018. To describe the characteristics of patients receiving these services, a retrospective case note review of patients seen by the facilitators was conducted. RESULTSThe clinical pharmacy facilitator role was initiated with three pharmacists in three geographical locations across the region. Within 18 months, the number of facilitators was increased to eight. As a result of collaboration with the general practice team, 42% of referrals came from general practitioners directly. Overall, 2621 medicine-related problems were identified in 2195 patients. Dosage adjustment was the most common recommendation made by pharmacy facilitators. They consulted mostly older patients and patients taking five or more medicines. DISCUSSIONWith effective collaboration, clinical pharmacy facilitators can play a key role in optimisation of medicines therapy.

scholarly journals Medication-related harm in New Zealand general practice: a retrospective records review

2021 ◽  
pp. BJGP.2020.1126
Author(s):  
Sharon Leitch ◽  
Susan Dovey ◽  
Wayne Cunningham ◽  
Alesha Smith ◽  
Jiaxu Zeng ◽  
...  
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Immunomodulatory Agents ◽  
Factors Associated ◽  
Increased Risk ◽  
Cardiovascular Medications ◽  
General Practices ◽  
Review Study ◽  
Inform Decision Making ◽  
Related Harm

Background: The extent of medication-related harm in general practice is unknown. Aim: To identify and describe all medication-related harm in electronic general practice records. Design and Setting: Retrospective cohort records review study in 44 randomly selected New Zealand general practices for the three years 2011-2013. Methods: Eight general practitioners reviewed 9076 randomly selected patient records. Medication-related harms were identified when the causal agent was prescribed in general practice. Harms were coded by type, preventability, and severity. The number and proportion of patients who experienced medication-related harm was calculated. Weighted logistic regression was used to identify factors associated with harm. Results 976/9076 study patients (10.8%) experienced 1,762 medication-related harms over three years. After weighting, the incidence rate of all medication-related harms was 73.9 harms per 1000 patient-years, and the incidence of preventable or potentially preventable medication-related harms was 15.6 per 1000 patient-years. Most harms were minor (1390/1762, 78.9%), but one in five harms were moderate or severe (373/1762, 21.1%); three patients died. Eighteen study patients were hospitalised; after weighting this correlates to a hospitalisation rate of 1.1 per 1000 patient-years. Increasing age, number of consultations, and number of medications were associated with increased risk of medication-related harm. Cardiovascular medications, antineoplastic and immunomodulatory agents, and anticoagulants caused most harm by frequency and severity. Conclusion Medication-related harm in general practice is common. This study adds to the evidence about the risk posed by medication in the real world. Findings can be used to inform decision-making in general practice.

scholarly journals Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study

2018 ◽  
Vol 68 (675) ◽  
pp. e735-e742 ◽  
Author(s):  
Margaret Maskrey ◽  
Chris F Johnson ◽  
Jason Cormack ◽  
Margaret Ryan ◽  
Hector Macdonald
Keyword(s):  
Cohort Study ◽  
Clinical Pharmacist ◽  
Support Staff ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Clinical Pharmacists ◽  
Health And Social Care ◽  
Observational Cohort ◽  
General Practices ◽  
The Impact

BackgroundGeneral practice in the UK is experiencing a workforce crisis. However, it is unknown what impact prescribing support teams may have on freeing up GP capacity and time for clinical activities.AimTo release GP time by providing additional prescribing resources to support general practices between April 2016 and March 2017.Design and settingProspective observational cohort study in 16 urban general practices that comprise Inverclyde Health and Social Care Partnership in Scotland.MethodGPs recorded the time they spent dealing with special requests, immediate discharges, outpatient requests, and other prescribing issues for 2 weeks prior to the study and for two equivalent periods during the study. Specialist clinical pharmacists performed these key prescribing activities to release GP time and Read coded their activities. GP and practice staff were surveyed to assess their expectations at baseline and their experiences during the final data-collection period. Prescribing support staff were also surveyed during the study period.ResultsGP time spent on key prescribing activities significantly reduced by 51% (79 hours, P<0.001) per week, equating to 4.9 hours (95% confidence interval = 3.4 to 6.4) per week per practice. The additional clinical pharmacist resource was well received and appreciated by GPs and practices. As well as freeing up GP capacity, practices and practitioners also identified improvements in patient safety, positive effects on staff morale, and reductions in stress. Prescribing support staff also indicated that the initiative had a positive impact on job satisfaction and was considered sustainable, although practice expectations and time constraints created new challenges.ConclusionSpecialist clinical pharmacists are safe and effective in supporting GPs and practices with key prescribing activities in order to directly free GP capacity. However, further work is required to assess the impact of such service developments on prescribing cost-efficiency and clinical pharmacist medication review work.

VA Researchers Test Integrated Care Model for Substance-Abusing Patients

2001 ◽  
Author(s):  
Andrew J. Saxon ◽  
Daniel R. Kivlahan ◽  
Donelle Howell
Keyword(s):  
Integrated Care ◽  
Substance Abusing ◽  
Care Model

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

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