Identification of critical factors for forming collaborative relationships between physicians and pharmacists

2019 ◽  
Vol 76 (16) ◽  
pp. 1238-1247
Author(s):  
Kyle M Turner ◽  
Cory A Nelson ◽  
Deborah L Pestka ◽  
Todd D Sorensen
Keyword(s):  
Phase Ii ◽  
Medication Management ◽  
Primary Care Clinic ◽  
Advisory Group ◽  
Structured Interviews ◽  
Collaborative Relationships ◽  
Relative Level ◽  
Care Clinic ◽  
Building Relationships ◽  
Minimum Criteria

Abstract Purpose The purpose of this study was to identify and describe strategies that have successfully achieved collaboration among physicians and pharmacists providing comprehensive medication management (CMM) to support development of CMM services. Methods A 2-phase, mixed-methods approach was employed to identify successful strategies for building pharmacist–physician relationships in primary care clinic settings. Phase I used a qualitative approach to identify strategies deemed successful in building relationships with physicians. An advisory group of pharmacists with experience building CMM practices assisted in the development of minimum criteria characterizing pharmacists as having strong collaborative relationships. Semi-structured interviews were conducted with 10 interviewees meeting established criteria. Researchers coded interview transcripts and identified the resulting strategies. Phase II employed a survey instrument to determine how frequently identified strategies are used and evaluate the relative level of perceived impact of each strategy, which was distributed to a national audience of pharmacists practicing in ambulatory care settings. Responses from pharmacists meeting prespecified criteria were included in the analysis. Results Thirty-three strategies were identified and grouped into 8 themes. In phase II, 104 survey respondents met defined criteria and were eligible to endorse use of identified strategies and rate their relative influence. Conclusions Thirty-three strategies were identified and grouped into 8 themes to aid pharmacists practicing CMM in developing stronger collaborative relationships with physician colleagues. A national sampling found many of these strategies were employed by a majority of pharmacists, who had found them to be influential in creating collaborative relationships.

scholarly journals Precision of Medication Therapy Problem Identification and Classification amongst Primary Care Clinic Pharmacists

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 179
Author(s):  
Nicholas Cox ◽  
Bryce Ashby ◽  
Bradly Winter ◽  
Gregory Stoddard ◽  
Joanne LaFleur ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Intraclass Correlation ◽  
Primary Care Clinic ◽  
Care Clinic ◽  
Medication Therapy ◽  
Disease States ◽  
Case Vignettes ◽  
Pharmacy Quality ◽  
Level Of Agreement

This study assesses the level of agreement on medication therapy problem (MTP) identification and classification between primary care, ambulatory care pharmacists within a health-system that recently implemented system-wide pharmacist provision of comprehensive medication management (CMM) services. Twenty standardized case vignettes were created and distributed to pharmacists who reviewed each case and identified and categorized MTPs. Outcomes include the number of MTPs identified, identification (yes/no) of specific MTPs within each case (e.g., need for a statin), and Pharmacy Quality Alliance (PQA) category used when classifying MTPs. The level of agreement on MTP identification/categorization was measured using intraclass correlation coefficient (ICC) and interpreted using the Landis and Koch interpretation scale. “Moderate agreement” was observed for the number of MTPs identified by pharmacists (ICC equal to 0.45; 95% confidence interval [CI]: 0.31 to 0.65). In approximately one-half of opportunities, the pharmacists agreed perfectly on the number of MTPs; in approximately one-third of opportunities, the number of MTPs identified varied by 1; and approximately one-tenth of the time, the number of MTPs varied by 2. In regard to the MTP identification (yes/no) and categorization, percent agreement was ≥73% across all MTPs. The results support the need for further training and education and provide the information necessary to target specific disease states.

Impact of Physician–Pharmacist Covisits at a Primary Care Clinic in Patients With Uncontrolled Diabetes

2018 ◽  
Vol 33 (3) ◽  
pp. 321-325
Author(s):  
Jasmine Peterson ◽  
April Hinds ◽  
Aida Garza ◽  
Jamie Barner ◽  
Lucas Hill ◽  
...  
Keyword(s):  
Care Delivery ◽  
Medication Management ◽  
Primary Care Clinic ◽  
Collaborative Management ◽  
Multicenter Cohort Study ◽  
Care Clinic ◽  
Uncontrolled Diabetes ◽  
Significant Difference ◽  
The Impact

Purpose: A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician–pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician–pharmacist covisits. Objective: To evaluate the impact of physician–pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. Methodology: This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. Results: A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (−1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. Conclusion: The results suggest that physician–pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.

scholarly journals Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views

2021 ◽  
Vol 12 ◽  
Author(s):  
Emma Kaminskiy ◽  
Yaara Zisman-Ilani ◽  
Shulamit Ramon
Keyword(s):  
Mental Health ◽  
Service User ◽  
Medication Management ◽  
Psychiatric Nurses ◽  
Advisory Group ◽  
Service Users ◽  
Psychiatric Medication ◽  
Structured Interviews ◽  
Community Psychiatric ◽  
Medication Decisions

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.

scholarly journals Cyberbullying Text-messages: Iterative Qualitative Methods for Intervention Design with Adolescents (Preprint)

2020 ◽  
Author(s):  
Megan L. Ranney ◽  
Sarah K. Pittman ◽  
Isabelle Moseley ◽  
Kristen E. Morgan ◽  
Alison Riese ◽  
...  
Keyword(s):  
Qualitative Methods ◽  
Text Messaging ◽  
Primary Care Clinic ◽  
Text Messages ◽  
Matrix Analysis ◽  
Pediatric Care ◽  
Structured Interviews ◽  
White Participant ◽  
Care Clinic ◽  
Cyber Harassment

BACKGROUND Effective, acceptable programs to reduce consequences of cyberbullying are needed. OBJECTIVE This study used “Agile” qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyber-harassment and cyberbullying victimization. METHODS Adolescents were recruited from an urban primary care clinic to participate in three consecutive iterations of the program. All participants completed a brief in-clinic intervention followed by 8 weeks of daily, automated text messaging. After 2 weeks (iteration1 and iteration2) or 8 weeks (iteration3) of messaging, participants completed semi-structured interviews that sought feedback on intervention experiences. Framework matrix analysis expeditiously summarized participant feedback and guided changes in each iteration. Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. RESULTS Nineteen adolescents (age 13-17) reporting past-year cyber-victimization enrolled: 7 took part in iteration1, 4 in iteration2, and 8 in iteration3. Participants were an average age of 15 years, 58% were female, 63% Hispanic, and 21% White. Participant feedback was used to adjust intervention content and design. Participant satisfaction (from 0% excellent to 80% excellent) and engagement (from 60% of daily assessments completed to 80% completed) improved from the first to the third iteration. CONCLUSIONS This study shows the value of structured participant feedback gathered in an Agile intervention refinement methodology for development of a technology-based intervention targeting adolescents.

scholarly journals The New Era of Pharmacists in Ambulatory Patient Care

2019 ◽  
Vol 10 (1) ◽  
pp. 4
Author(s):  
AK Mohiuddin
Keyword(s):  
Patient Care ◽  
Ambulatory Care ◽  
Medication Management ◽  
Primary Care Clinic ◽  
Pharmacy Practice ◽  
Initial Point ◽  
Healthcare Services ◽  
Direct Care ◽  
Direct Patient Care ◽  
Care Clinic

Ambulatory care pharmacy practice is defined as the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management. The ambulatory care pharmacists may work in both an institutional and community-based clinic involved in direct care of a diverse patient population. A variety of specialty clinics are available for allergy and immunology, pulmonology, endocrinology, cardiology, nephrology, neurology, behavioral health, and infectious disease. Such services for this population may exist as a primary care clinic or an independent specialty clinic, typically in a PCMH, which is instrumental in coordinating care between various providers. Once a practice site is identified, it is important to establish a strong, trusting, and mutually beneficial relationship with the various decision-makers (e.g., administrators, providers) involved with the clinic. If pharmacy services are currently in existence, the pharmacy director may be able to identify and initially contact the appropriate person. If another pharmacist is providing clinical services, this person would be a resource to help determine areas for expansion of patient care and to whom to direct the proposed business plan. Additional individuals to consider as an initial point of contact include the clinic manager, clinic medical director, or administrative assistant to either of these persons. If the clinic setting is affiliated with a medical school, it may be necessary to contact the Department of Family Medicine head.   Article Type: Commentary  

Vision Screening Among Primary Care Clinic Patients

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 93A-93A
Author(s):  
Lwbba Chait ◽  
Angeliki Makri ◽  
Rawan Nahas ◽  
Gwen Raphan
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Vision Screening ◽  
Care Clinic

Association Between Potentially Inappropriate Medications and 30-Day Post–Hospital Discharge Outcomes in US Veterans

2021 ◽  
pp. 106002802110320
Author(s):  
Heather G. Allore ◽  
Danijela Gnjidic ◽  
Melissa Skanderson ◽  
Ling Han
Keyword(s):  
Hospital Discharge ◽  
Adverse Drug Events ◽  
Primary Care Clinic ◽  
Care Utilization ◽  
Potentially Inappropriate Medications ◽  
Care Hospital ◽  
Care Clinic ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Reduced Risk

Background Potentially inappropriate medication (PIMs) use is common in older inpatients and it may lead to increased risk of adverse drug events. Objectives To examine prevalence of PIMs at hospital discharge and its contribution to health care utilization and mortality within 30-days of hospital discharge. Methods This was a prospective cohort of 117 570 veterans aged ≥65 years and hospitalized in 2013. PIMs at discharge were categorized into central nervous system acting (CNS) and non-CNS. Outcomes within 30-days of hospital discharge were: (1) time to first acute care hospital readmission, and all-cause mortality, (2) an emergency room visit, and (3) ≥3 primary care clinic visits. Results The cohort’s mean age was 74.3 years (SD 8.1), with 51.3% exposed to CNS and 62.8% to non-CNS PIMs. Use of CNS and non-CNS PIMs, respectively, was associated with a reduced risk of readmission, with an adjusted hazard ratio (aHR) of 0.93 (95% CI = 0.89-0.96) for ≥2 (vs 0) CNS PIMs and an aHR of 0.85 (95% CI = 0.82-0.88) for ≥2 (vs 0) non-CNS PIMs. Use of CNS PIMs (≥2 vs 0) was associated with increased risk of mortality (aHR = 1.37 [95% CI = 1.25-1.51]), whereas non-CNS PIMs use was associated with a reduced risk of mortality (aHR = 0.75 [95% CI = 0.69-0.82]). Conclusion and Relevance PIMs were highly common in this veteran cohort, and the association with outcomes differed by PIMs. Thus, it is important to consider whether PIMs are CNS acting to optimize short-term posthospitalization outcomes.

scholarly journals Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications

2021 ◽  
Vol 12 ◽  
pp. 215013272110350
Author(s):  
Pasitpon Vatcharavongvan ◽  
Viwat Puttawanchai
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Study Data ◽  
Patient Specific ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Care Clinic ◽  
Inappropriate Medications

Background Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.

Sign in / Sign up

Export Citation Format

Share Document