Identifying key roles of the pharmacy technician in primary care settings

2021 ◽  
Author(s):  
Shannon Gadd ◽  
Conrad E Lopez ◽  
Cory A Nelson ◽  
Trung Q Le ◽  
Cynthia S Valle-Oseguera ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Professional Judgment ◽  
Free Text ◽  
Pharmacy Technician ◽  
Pharmacy Technicians ◽  
Patient Outreach

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose As the pharmacist’s role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist’s professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature. Methods The duties of primary care pharmacist technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians. Results Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects. Conclusion Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

scholarly journals Exploring the Type 2 Diabetes Management in the Primary Care Setting in Ratchaburi Province, Thailand

2019 ◽  
Vol 12 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Phenchamat Khamthana ◽  
Yaowaluck Meebunmak ◽  
Issara Siramaneerat
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Body Mass Index ◽  
Body Mass ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diabetes Management ◽  
Care Practice ◽  
District Health

Purpose:We aimed to describe the outcomes of primary care setting of type 2 diabetes patient at Sub-District Health Promoting Hospital (SDHPH).Methods:This study was a cross-sectional study on 1,890 patients with type 2 diabetes who were participating in the primary care research networks in the Ratchaburi Province of Thailand. Data was obtained through a self-administered questionnaire about the state of health and care. Patient medical records were used to examine the condition of complications, treatment and several indicators of DM care. The data was processed by using logistic regression to analyse the effect of independent variables on the dependent variable. The hypothesis-null was rejected at p-values <0.05.Results:The participants in this study were of age 57.56 years (SD=12.10), and most (55.58%) were female. Most respondents (36.20%) completed a Bachelor’s degree and were working as employees (28.35%). Regarding duration of diabetes, the majority (28.35%) had 11-20 years. In terms of body mass index, 29.67% had body mass index between 25.0-29.9 (overweight). Regarding complications and comorbidities, the common complication and comorbidity was nephropathy (33.63%) while Ischemic heart disease was the major of other comorbid health problems (48.3%). Furthermore, patients were mostly taking Antihypertensive (67.80%) and ACE Inhibitor or ARB (59.00%). The majority of HbA1c level (42.74%) was lower than 7.0%. Regarding the logistic analysis, it showed that education and treatment significantly influenced Hemoglobin A1c level at significant levels of 0.05.Conclusion:Only modest numbers of patients achieved established targets of diabetes control. Reengineering primary care practice may be necessary to substantially improve health care.

scholarly journals SEXUAL DYSFUNCTION AMONG WOMEN AT FOUR TO SIX MONTHS POSTPARTUM: A STUDY IN A PRIMARY CARE SETTING

2020 ◽  
Vol 20 (1) ◽  
pp. 235-243
Author(s):  
Norafini Salamon ◽  
Syahnaz Mohd Hashim ◽  
Norfazilah Ahmad ◽  
Suzaily Wahab
Keyword(s):  
Primary Care ◽  
Sexual Dysfunction ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Cross Sectional ◽  
Maternal Characteristics ◽  
Local Setting ◽  
Arousal Disorder

Sexual dysfunction in women is a significant health problem that harms marriage stability. Women in the Western countries were reportedly being affected by this condition after childbirth but the magnitude of the problem in our local setting is still unknown. The aim of this cross-sectional study was to determine the prevalence of women with sexual dysfunction at four to six months postpartum and its possible risk factors in an urban primary care setting. The participants were given a set of questionnaire, consisting of three parts; i) sociodemographic and maternal characteristics ii) Malay version of Female Sexual Function Index and iii) Malay DASS-21 questionnaire. Responses from 249 women were analyzed. More than half (57.0%,n=142) were found to have sexual dysfunction. The most prevalent types of sexual dysfunction reported by the affected women were sexual satisfaction disorder (98.6%), followed by arousal disorder (58.5%) and lubrication disorder (28.9%). Three factors were found to be significantly associated with sexual dysfunction; household income of less than RM2000 (adj OR = 0.31, 95% CI 0.14, 0.70), Malay ethnic group (adj OR = 1.93,95% CI 1.02, 3.66) and breastfeeding (adj OR = 2.24,95% CI 1.03, 4.85). In conclusion, the prevalence of sexual dysfunction in the postpartum period was considerably high. Efforts should be made to incorporate sexual health as part of the routine postnatal assessment in primary care practice.

scholarly journals The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods

2020 ◽  
Author(s):  
Richard Whaddon Parsons ◽  
Danny Liew ◽  
A Munro Neville ◽  
Ralph G Audehm ◽  
Deepak Haikerwal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Medical Records ◽  
Care Setting ◽  
Primary Care Setting ◽  
Venous Pressure ◽  
Community Setting ◽  
Annual Incidence ◽  
Free Text ◽  
Australian Community

Abstract There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF. Methods : We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals. Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were aged 18 years and above. Of these patients 16,930 were classified as having ‘definite HF’, 4873 as having ‘probable HF’ and 36,517 as having ‘possible HF’. A further 40,992 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify ‘definite’ HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify ‘probable HF’ patients. The majority of ‘possible’ HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign. Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.

scholarly journals The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods

2019 ◽  
Author(s):  
Richard Whaddon Parsons ◽  
Danny Liew ◽  
A Munro Neville ◽  
Ralph G Audehm ◽  
Deepak Haikerwal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Medical Records ◽  
Care Setting ◽  
Primary Care Setting ◽  
Community Setting ◽  
Annual Incidence ◽  
Free Text ◽  
Novel Approach ◽  
Australian Community

Abstract Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF. Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals. Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were aged 18 years and above. Of these patients 16,930 were classified as having ‘definite HF’, 4873 as having ‘probable HF’ and 36,517 as having ‘possible HF’. A further 40,992 were identified as having an aetiological condition associated with HF. These estimates accord with findings in similar populations from other countries. Among ‘active patients’ (regular attenders of a practice), the crude prevalence of HF was 1.813% (95%CI:1.79–1.84%), and the age-standardised prevalence was 2.199% (95%CI:2.168-2.23%). The annual incidence was 0.291% (95%CI:0.286–0.296%), and the age-standardised annual incidence was 0.348% (95%CI:0.342–0.354%). The estimates of prevalence and incidence suggest that almost 420,000 people were living with HF in Australia in 2017, and over 66,000 new cases of HF occurred that year. Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.

scholarly journals The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods

2020 ◽  
Author(s):  
Richard Whaddon Parsons ◽  
Danny Liew ◽  
A Munro Neville ◽  
Ralph G Audehm ◽  
Deepak Haikerwal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Medical Records ◽  
Care Setting ◽  
Primary Care Setting ◽  
Venous Pressure ◽  
Community Setting ◽  
Annual Incidence ◽  
Free Text ◽  
Australian Community

Abstract Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF.Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals.Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were aged 18 years and above. Of these patients 16,930 were classified as having ‘definite HF’, 4873 as having ‘probable HF’ and 36,517 as having ‘possible HF’. A further 40,992 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify ‘definite’ HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify ‘probable HF’ patients. The majority of ‘possible’ HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign.Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.

The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics

2020 ◽  
Author(s):  
Vivienne A Rose ◽  
Elena N Klyushnenkova ◽  
Min Zhang ◽  
Verlyn O Warrington
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Care Setting ◽  
Primary Care Practice ◽  
Primary Care Setting ◽  
Weight Loss Program ◽  
Care Practice ◽  
Control Group ◽  
Baseline Weight ◽  
Medical Weight Loss

Abstract Background Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice. Objective To determine whether participation in the MWLP within a general primary care setting can result in weight loss. Methods A retrospective medical chart review of patients treated in MWLP and a control group of patients with obesity receiving regular care in the general primary care setting. From the practice database (1 April 2015–31 March 2016), 209 patients (≥18 years old) who participated in the MWLP were identified; 265 controls were selected from the remaining population based on the presence of the obesity-related diagnoses. Results MWLP patients lost on average 2.35 ± 5.88 kg in 6 months compared to their baseline weight (P &lt; 0.0001). In contrast, the control group demonstrated a trend of gaining on average 0.37 ± 6.03 kg. Having three or more visits with the MWLP provider within 6 months after program initiation was the most important factor associated with successful loss of at least 5% of the baseline weight. Weight loss also correlated with a decrease in abdominal girth. Conclusion MWLP integrated into the general primary care practice may potentially be an effective model for managing obesity and related morbidities.

scholarly journals Impact on an integrated psychiatric pharmacy service in a primary care clinic

2019 ◽  
Vol 9 (4) ◽  
pp. 269-274
Author(s):  
Benjamin Chavez ◽  
Emily Kosirog
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pharmacy Service ◽  
Psychiatric Disease ◽  
Care Practice ◽  
Psychiatric Medication ◽  
State Management ◽  
Disease States

Abstract Introduction Traditionally, clinical pharmacists have been employed in the primary care setting to help manage chronic disease states, such as diabetes and hypertension. Although the benefits of pharmacists managing chronic conditions have been extensively published, published data for clinical pharmacist mental health services in primary care is limited to Veterans Affairs populations. This article describes a practice model in which pharmacists are providing psychiatric medication management and consultation in a federally qualified health center. Methods A period of 1 year from the psychiatric pharmacy service was analyzed from April 1, 2017, to March 31, 2018. Reports were generated that included information about psychiatric pharmacy consults, 1-on-1 psychiatric pharmacy visits, and psychotropic medication prescribing/dispensing trends. Each consult was further reviewed for additional details, including patient characteristics, medications prescribed, psychiatric diagnoses involved, and actions taken. Results A review of this pharmacy service showed significant pharmacist involvement in psychiatric medication consults and 1-on-1 visits. Common disease states consulted on were depressive disorders, anxiety disorders, and neurologic disorders, which reflects psychiatric disease states commonly seen in primary care practice. Provider satisfaction survey results showed that the service was valued and that providers felt their comfort in prescribing psychotropic medications improved due to the service. Discussion The service described here exemplifies the potential for pharmacists in the ambulatory care setting to expand beyond the traditional chronic disease state management. It also speaks to a potential role for psychiatric pharmacists in the primary care setting.

scholarly journals Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study

2017 ◽  
Vol 18 (04) ◽  
pp. 333-343 ◽  
Author(s):  
Shelina Visram
Keyword(s):  
Primary Care ◽  
Mixed Method ◽  
Chronic Conditions ◽  
Care Setting ◽  
Primary Care Setting ◽  
Lifestyle Changes ◽  
Care Practice ◽  
Mixed Method Study ◽  
Lifestyle Interventions ◽  
One To One

AimTo evaluate the impact and acceptability of offering one-to-one lifestyle interventions delivered by lay health trainers in the primary care setting.BackgroundChronic conditions represent major causes of ill-health, avoidable disability, pain and anxiety, and tend to be more prevalent in less affluent groups. This is due, in part, to the link between unhealthy lifestyles and lower socio-economic status, although factors such as poverty, worklessness and social exclusion play a larger role. Lay health trainers were introduced in England with the aim of providing personalised lifestyle advice, support and access to services for people living in disadvantaged areas. There is a body of literature on the effectiveness of lay or community health workers in the management of chronic conditions. However, little is known about their potential to promote lifestyle changes in newly diagnosed patients. An innovative health trainer service was piloted in the primary care setting, to work with people diagnosed with a chronic condition or identified as potentially benefitting from one-to-one support.MethodsA mixed method study design was utilised. Semi-structured interviews and focus groups were conducted with practice staff (n=11) and patients (n=15) from one primary care practice in North East England, United Kingdom. Discussions were audio-recorded and analysed using a thematic content approach. Routinely collected pre-/post-intervention data (n=246 patients at baseline; sample sizes varied at end line) were analysed and appropriate descriptive and summary statistics produced.FindingsThe discussions highlighted a high level of satisfaction with the health trainer model in terms of supporting positive lifestyle changes. Locating the intervention within the practice removed access barriers, particularly for those with long-term conditions. Anecdotal evidence of health improvement was supported by the quantitative analyses, which revealed statistically significant improvements in body mass index, blood pressure, dietary habits, exercise levels, alcohol intake, self-rated health and self-efficacy amongst those who completed the intervention.

Patient Notification of Test Results in a Primary Care Setting

2013 ◽  
Vol 6 (2) ◽  
pp. 120-123
Author(s):  
Caroline Sulllivan ◽  
Janice Smolowitz
Keyword(s):  
Primary Care ◽  
Diagnostic Test ◽  
Care Setting ◽  
Primary Care Setting ◽  
Safety Issue ◽  
Care Practice ◽  
Test Results ◽  
Quality Health Care ◽  
Improvement Project

The ordering and management of diagnostic test results is an important aspect of the plan of care in the primary care setting. The process involves a series of steps beginning with ordering the test and appropriate communication to ensure patient follow-up. Patient–provider communication and documentation is essential to achieve high-quality health care outcomes. The failure to communicate diagnostic test results and develop follow-up plans is an important patient safety issue. This quality improvement project examined management of diagnostic tests in a primary care practice for the purpose of improving processes of care and outcomes. The project focused on current practices, patient satisfaction, and patients’ preference relating to laboratory result communication.

scholarly journals The epidemiology of heart failure in the general Australian community - Study of Heart failure in the Australian Primary carE setting (SHAPE): methods

2020 ◽  
Author(s):  
Richard Whaddon Parsons ◽  
Danny Liew ◽  
A Munro Neville ◽  
Ralph G Audehm ◽  
Deepak Haikerwal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Medical Records ◽  
Care Setting ◽  
Primary Care Setting ◽  
Venous Pressure ◽  
Community Setting ◽  
Annual Incidence ◽  
Free Text ◽  
Australian Community

Abstract Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF.Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals.Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were adults and 1.12 million were regular patients. Of these patients 15,468 were classified as having ‘definite HF’, 4751 as having ‘probable HF’ and 33,556 as having ‘possible HF’. A further 39,247 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify ‘definite’ HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify ‘probable HF’ patients. The majority of ‘possible’ HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign.Conclusions: This novel approach to undertaking retrospective research of primary care data successfully analysed a combination of coded and uncoded data from the electronic medical records of patients routinely managed in the GP setting. SHAPE is the first real-world study of the epidemiology of HF in the general Australian community setting.

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