Evaluation of the potential impact of pharmacy technician performance of anticoagulation clinic tasks on operational efficiency

Abstract Purpose Results of a study to determine the proportion of anticoagulation clinic workload that could be performed by clinical pharmacy technicians (CPTs) and the potential impact on operational efficiency of pharmacist-managed anticoagulation clinics (ACCs) are reported. Methods In a quality improvement project involving 11 Veterans Affairs (VA) medical centers, investigators conducted a 3-day time study in pharmacist-managed ACCs followed by scoring of task appropriateness for CPTs via the RAND/UCLA appropriateness method by the VA Anticoagulation Subject Matter Expert (SME) Workgroup. The primary outcome was the percentage of tasks deemed appropriate for a CPT to perform. Results The Anticoagulation SME Workgroup determined that a wide variety of mainly administrative ACC tasks could be completed by a CPT. At the 11 VA ACCs, an average of 53.4% (range, 39.9–76.1%) of tasks being performed by pharmacists were deemed appropriate for CPTs. The average percentage of total clinic time associated with performing tasks appropriate for a CPT equated to an estimated 1,111 hours per year. Shifting that portion of the annual work hours to a CPT could potentially result in cost avoidance of $55,302. Conclusion At the ACCs evaluated, a significant proportion of tasks (53.4% on average) may be appropriate to assign to CPTs to improve the operational efficiency of these clinics. This finding supports development of business plans for the addition of CPTs in ACCs along with elements to inform crafting of an effective template for ACC structure, including clearly defined CPT roles.

Download Full-text

Economic Burden of Diabetes in Urban Indians

The Open Ophthalmology Journal ◽

10.2174/1874364101408010091 ◽

2014 ◽

Vol 8 (1) ◽

pp. 91-94 ◽

Cited By ~ 10

Author(s):

Pablo Chandra ◽

Bageshri Gogate ◽

Parikshit Gogate ◽

Nilesh Thite ◽

Abhay Mutha ◽

...

Keyword(s):

Indirect Cost ◽

Direct Cost ◽

Economic Burden ◽

Significant Proportion ◽

Class Iii ◽

Lower Middle Class ◽

Average Percentage ◽

Diet Control ◽

The Cost ◽

Class Iv

Purpose : To find out the average economic burden of medical care on a patient with diabetes in Pune, India Methods : A semi-open ended questionnaire followed by interview was conducted with patients attending diabetes and ophthalmic out-patient departments. They were asked regarding the duration of diabetes, methods undertaken for blood sugar control and the amount they spend on consultations, laboratory tests, medicines and procedures if any within past year. Expenditure was classified as direct cost (cost of medicines, doctor’s fees, investigations, lasers and surgery) and indirect cost (travel, diet control, health classes and loss of wages). Data was collected regarding the socioeconomic status according to Kuppaswamy classification. Results : 219 patients participated of whom 129 were males (58.9%). Average annual direct cost of diabetes treatment was Rs 8,822 of which 52.1% was spend on medicines, 3.2% was spend on lasers, 12.6% was spend on surgical procedures, 11.6% spent on investigations and 10.4% was spend on clinician fees. Average annual indirect cost was Rs. 3949 of which 3.4% was spend on travelling purpose, 0.4% was spent on health classes, 4.9% was spent on diet control and 91.3% was loss of wages. Average expenditure done by lower middle class was 23.7% of their income. Average percentage of income for direct and indirect cost was 3.6% and 1.4% respectively. The cost of the treatment formed1.3% of the annual income for those in Socio-economic class I, 1.7% in class II, 3.7% in class III and 23.7% in class IV. Conclusion : The cost of managing diabetes was a significant proportion of the patients’ income, especially for those on lower socio-economic scale (class IV).

Download Full-text

Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2018-000427 ◽

2019 ◽

Vol 8 (2) ◽

pp. e000427 ◽

Cited By ~ 3

Author(s):

Udaya Prabhakar Udayaraj ◽

Oliver Watson ◽

Yoav Ben-Shlomo ◽

Maria Langdon ◽

Karen Anderson ◽

...

Keyword(s):

Quality Improvement ◽

Kidney Transplant ◽

Blood Test ◽

Significant Proportion ◽

Kidney Transplant Recipients ◽

Test Quality ◽

Improvement Project ◽

Face To Face ◽

Transplant Patients ◽

Kidney Transplant Patients

Kidney transplant patients in our regional centre travel long distances to attend routine hospital follow-up appointments. Patients incur travel costs and productivity losses as well as adverse environmental impacts. A significant proportion of these patients, who may not require physical examination, could potentially be managed through telephone consultations (tele-clinic). We adopted a Quality Improvement approach with iterative Plan–Do–Study–Act (PDSA) cycles to test the introduction of a tele-clinic service. We codesigned the service with patients and developed a prototype delivery model that we then tested over two PDSA improvement ramps containing multiple PDSA cycles to embed the model into routine service delivery. Nineteen tele-clinics were held involving 168 kidney transplant patients (202 tele-consultations). 2.9% of tele-clinic patients did not attend compared with 6.9% for face-to-face appointments. Improving both blood test quality and availability for the tele-clinic was a major focus of activity during the project. Blood test quality for tele-clinics improved from 25% to 90.9%. 97.9% of survey respondents were satisfied overall with their tele-clinic, and 96.9% of the patients would recommend this to other patients. The tele-clinic saved 3527 miles of motorised travel in total. This equates to a saving of 1035 kgCO2. There were no unplanned admissions within 30 days of the tele-clinic appointment. The service provided an immediate saving of £6060 for commissioners due to reduced tele-clinic tariff negotiated locally (£30 less than face-to-face tariff). The project has shown that tele-clinics for kidney transplant patients are deliverable and well received by patients with a positive environmental impact and modest financial savings. It has the potential to be rolled out to other renal centres if a national tele-clinic tariff can be negotiated, and an integrated, appropriately reimbursed community phlebotomy system can be developed to facilitate remote monitoring of patients.

Download Full-text

Beyond Just Bacteria: Functional Biomes in the Gut Ecosystem Including Virome, Mycobiome, Archaeome and Helminths

Microorganisms ◽

10.3390/microorganisms8040483 ◽

2020 ◽

Vol 8 (4) ◽

pp. 483 ◽

Cited By ~ 12

Author(s):

Ravichandra Vemuri ◽

Esaki M. Shankar ◽

Marcello Chieppa ◽

Rajaraman Eri ◽

Kylie Kavanagh

Keyword(s):

Significant Proportion ◽

Genetic Material ◽

Clinical Applications ◽

Health It ◽

Human Gut ◽

Marked Influence ◽

Microbiome Composition ◽

Bacterial Microbiota ◽

Potential Impact

Gut microbiota refers to a complex network of microbes, which exerts a marked influence on the host’s health. It is composed of bacteria, fungi, viruses, and helminths. Bacteria, or collectively, the bacteriome, comprises a significant proportion of the well-characterized microbiome. However, the other communities referred to as ‘dark matter’ of microbiomes such as viruses (virome), fungi (mycobiome), archaea (archaeome), and helminths have not been completely elucidated. Development of new and improved metagenomics methods has allowed the identification of complete genomes from the genetic material in the human gut, opening new perspectives on the understanding of the gut microbiome composition, their importance, and potential clinical applications. Here, we review the recent evidence on the viruses, fungi, archaea, and helminths found in the mammalian gut, detailing their interactions with the resident bacterial microbiota and the host, to explore the potential impact of the microbiome on host’s health. The role of fecal virome transplantations, pre-, pro-, and syn-biotic interventions in modulating the microbiome and their related concerns are also discussed.

Download Full-text

Pharmacy Technician Review of Oral Nutritional Supplements (ONS) within Care Homes

Pharmacy ◽

10.3390/pharmacy7010028 ◽

2019 ◽

Vol 7 (1) ◽

pp. 28

Author(s):

Clare Collins ◽

Catherine Tucker ◽

Carol Walton ◽

Sian Podbur ◽

Steven Barrett

Keyword(s):

Care Home ◽

Nutritional Supplements ◽

Cost Effective ◽

Care Homes ◽

Improvement Project ◽

Oral Nutritional Supplements ◽

Collaborative Working ◽

Pharmacy Technicians ◽

Effective Use ◽

The Cost

Up to 42% of patients admitted to care homes are at risk of malnutrition. Oral nutritional supplements (ONS) can be prescribed to increase nutritional intake when diet alone is insufficient to meet daily nutritional requirements. Where ONS are inappropriately initiated or continued beyond treatment goals this can contribute to significant waste and unnecessary costs. This study reviewed whether pharmacy technicians working in care home settings can support the cost-effective use of ONS. A quality improvement project using Plan-Do-Study-Act (PDSA) methodology was undertaken by pharmacy technicians working in care homes to review the prescribing and monitoring of ONS. A sample of 330 residents were reviewed across 5 care homes. 45 residents were prescribed ONS, 16 of whom were unknown to dietitians. In collaboration with the dietetic service an oral nutritional support flow chart was developed and tested. Thirteen of the 16 residents unknown to the dietetic team did not require ONS and could be considered for alternative dietary options. Through collaborative working with dietetic services, pharmacy technicians can support effective use and review of ONS for care home residents, reduce unnecessary prescribing, and ensure appropriate referral to dietitians where indicated.

Download Full-text

P002 Real-world experiences of biologic tapering

Rheumatology ◽

10.1093/rheumatology/keab247.001 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Zoe Rutter-locher ◽

Yik Long Man ◽

Lydia Marsh ◽

Scott Mercer ◽

Bina Menon ◽

...

Keyword(s):

Real World ◽

Biologic Therapy ◽

Small Sample Size ◽

Significant Proportion ◽

Small Sample ◽

Patient Choice ◽

Treat To Target ◽

Improvement Project ◽

Real World Setting

Abstract Background/Aims Biologic therapy and treat to target have significantly improved patient outcomes and we now have a proportion of patients on biologic therapy who remain in clinical remission. NICE guidance suggests “cautiously reducing drug doses or stopping drugs in those who have maintained the treatment target”. Despite this guidance, little is known about current clinical practice of biologic tapering in UK rheumatology centres. We aimed to illustrate current practice and success rates in biologic tapering in a real-world setting in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS). Methods We identified patients who were potentially suitable for biologic tapering 1 week prior to their follow up appointment using the following criteria - any anti-TNFα biologic ≥ 1 year, RA patients (DAS28 CRP<3.2, CRP normal), PSA patients (no swollen joints, CRP normal, no extra-articular manifestations), AS patients (BASDAI<4, CRP normal). We then analysed how many patients were successfully tapered at one year. Tapering schedule was decided by the supervising rheumatologist. Results From December 2018 to February 2019, 66 patients were identified as being suitable for biologic tapering. 3 patients did not attend and were excluded from further analysis. Tapered group: 20 (32%) patients were tapered. Based on the retrospective review of clinic letters, the “tapering schedule” was inconsistent and the information provided to patients if they flared was also inconsistent - 9 (45%) patients were advised to return to their normal dose and only 1 (5%) patient was advised to contact the helpline. After 12 months of follow up, 11 (55%) patients remained on the tapered dose, 7 (35%) patients returned to their prior dose and 2 (10%) patients were lost to follow up. Non-tapered group: 43 (68%) patients were not tapered. The reasons for not tapering were divided into 6 broad categories: active disease (n = 15, 35%), patient choice (n = 5, 12%), DMARD was tapered instead (n = 5, 12%), discuss at next visit (n = 3, 7%), reason not mentioned (n = 12, 28%), other (n = 3, 7%) Conclusion This Quality Improvement Project has highlighted the inconsistencies in biologic tapering in a UK real-world setting. In response to this inconsistency, we have developed a departmental guideline which provides stringent criteria to identify patients at lowest risk of flaring and standardises a tapering schedule and clinical pathway. We also created a patient information leaflet that could be distributed. Only half of the patients remained on the tapered dose after 1 year, suggesting a significant proportion of patients flare following dose reduction. However, our findings may be limited by small sample size. National guidance and a thorough audit based on this guidance is welcomed. Disclosure Z. Rutter-locher: None. Y. Long Man: None. L. Marsh: None. S. Mercer: None. B. Menon: None. A. Cope: None.

Download Full-text

Decoration of Ceramic Tile by Outsible Materials, as a Universal Method of Treating Children under the Conditions of Hospital

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i4.36.25044 ◽

2018 ◽

Vol 7 (4.36) ◽

pp. 1108

Author(s):

Yu. A. Boyko ◽

E. P. Dragunova

Keyword(s):

Ceramic Tile ◽

Social Life ◽

Age Groups ◽

Significant Proportion ◽

Visual Images ◽

Universal Method ◽

Ceramic Tiles ◽

Medical Centers ◽

The Social

A modern person, being subjected to ever-increasing loads, is forced to constantly think about the preservation of health and efficiency. Consultative and treatment centers have gradually become important objects of maintaining health, in which people spend quite a large part of their time, starting from the first days of life. Unfortunately, in recent years, a significant proportion of patients at medical centers and clinics have been composed of children of different age groups, as the most vulnerable part of society carrying the burden of the social life of a metropolis. This article analyzes the possibility of using overglaze painting to create visual images of any degree of complexity on the surface of ceramic tiles when designing medical centers for treating children.

Download Full-text

Abstract 253: Out of Range INR Results Lead to Increased Health Care Utilization in Four Large Anticoagulation Clinics

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.253 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Geoffrey D Barnes ◽

Xiaokui Gu ◽

Eva Kline-Rogers ◽

Chris Graves ◽

Eric Puroll ◽

...

Keyword(s):

Venous Thromboembolism ◽

Thromboembolic Complication ◽

Anticoagulation Clinic ◽

Target Range ◽

Control Group ◽

Phone Calls ◽

Adjusted Means ◽

Anticoagulation Clinics ◽

Lab Test ◽

The Impact

Background: The impact on healthcare utilization of a single out of range (OOR) INR value not associated with any bleeding or thromboembolic complication among chronic warfarin-treated patients is not well described. Methods: At four large phone-based anticoagulation clinics in Michigan, warfarin-treated patients with atrial fibrillation (AF) or venous thromboembolism (VTE) were identified and data collected via medical chart abstraction. Propensity score matching was used to identify two groups closely matched on patient characteristics: the OOR INR group (INR value < 1.8 or > 3.2 if target range was 2-3) and the control group (INR value between 1.8 and 3.2). Data for each anticoagulation clinic interaction and INR lab test were abstracted until the patient had 2 subsequent and sequential in-range INR values. Methods and frequency of interactions between the anticoagulation clinic and patient were recorded, described as median and interquartile ranges (IQR) and compared using Poisson regression with adjusted means. Results: Demographics were similar for the 116 OOR INR patients and the 58 control patients studied (mean±SD age 72.1±13.0 and 74.3±11.3 years, respectively). Indications for warfarin were more commonly venous thromboembolism in the OOR versus in-range patients (42.2% vs. 27.6%, p=0.06). OOR and in-range INR patients experienced a median of 3 (IQR 3-5) and 3 (IQR 3-3) with adjusted means of 4.2 and 3.2 (p<0.001) INR lab draws until two sequential tests were in-range. OOR INR patients required a median 5 (IQR 3-6) with adjusted means of 5.3 and 3.7 interactions with the anticoagulation clinic versus 3 (IQR 3-4) for in-range INR patients (p<0.001). OOR INR patients more often required phone calls (adjusted means 2.9 versus 0.9, p<0.001) but fewer mailed letters (adjusted means 1.3 versus 2.3, p<0.001) than in-range INR patients. OOR INR patients more often required multiple types of contact than in-range INR patients (83.6% versus 55.2%, p<0.001). Contact was most frequently performed by registered nurses (adjusted means 3.4 versus 2.9, p=0.059) and administrative assistants (adjusted means 1.3 versus 0.5, p<0.001) for both OOR and in-range INR patients. Blood count and renal function lab test were similarly rare for both groups (mean 0.4, median 0, p=0.74 for each). Conclusions: Warfarin-treated patients who experience OOR INR values without any bleeding or thromboembolic complication require more frequent interactions with the anticoagulation clinic, including more telephone calls and multiple types of contact.

Download Full-text

Value of Preoperative Clinic Visits in Identifying Issues with Potential Impact on Operating Room Efficiency

Anesthesiology ◽

10.1097/00000542-200612000-00026 ◽

2006 ◽

Vol 105 (6) ◽

pp. 1254-1259 ◽

Cited By ~ 86

Author(s):

Darin J. Correll ◽

Angela M. Bader ◽

Melissa W. Hull ◽

Cindy Hsu ◽

Lawrence C. Tsen ◽

...

Keyword(s):

Economic Impact ◽

Operating Room ◽

Resource Use ◽

Preoperative Evaluation ◽

Operating Room Efficiency ◽

Medical Problems ◽

Or Management ◽

Medical Centers ◽

Medical Issues ◽

Potential Impact

Background Preoperative clinics have been shown to decrease operating room delays and cancellations. One mechanism for this positive economic impact is that medical issues are appropriately identified and necessary information is obtained, so that knowledge of the patients' status is complete before the day of surgery. In this study, the authors describe the identification and management of medical issues in the preoperative clinic. Methods All patients coming to the Preoperative Clinic during a 3-month period from November 1, 2003, through January 31, 2004, at the Brigham and Women's Hospital, Boston, Massachusetts, were studied. Data were collected as to the type of issue, information needed to resolve the issue, time to retrieve the information, cancellation and delay rates, and the effect on management. Results A total of 5,083 patients were seen in the preoperative clinic over the three-month period. A total of 647 patients had a total of 680 medical issues requiring further information or management. Of these issues, 565 were thought to require further information regarding known medical problems, and 115 were new medical problems first identified in the clinic. Most of the new problems required that a new test or consultation be done, whereas most of the old problems required retrieval of information existing from outside medical centers. New problems had a far greater probability of delay (10.7%) or cancellation (6.8%) than old problems (0.6% and 1.8%, respectively). Conclusions The preoperative evaluation can identify and resolve a number of medical issues that can impact efficient operating room resource use.

Download Full-text

Deaf people: What every clinician needs to know

BJPsych Advances ◽

10.1192/apt.bp.116.016154 ◽

2017 ◽

Vol 23 (2) ◽

pp. 89-94 ◽

Cited By ~ 1

Author(s):

Margaret du Feu

Keyword(s):

Mental Health ◽

Adverse Effects ◽

Significant Proportion ◽

Learning Objectives ◽

Deaf People ◽

Physical And Mental Health ◽

Know How ◽

High Prevalence ◽

Potential Impact ◽

Mental And Physical Health

SummaryDeafness is a common and varied medical, social and psychological construct that affects a significant proportion of the population. Restricted communication and uninformed attitudes have adverse effects on the physical and mental health of deaf people. Clinicians need to know how to recognise and resolve these difficulties.Learning Objectives• Be aware of the high prevalence and diverse nature of deafness• Recognise the importance of effective communication and how to achieve this with deaf people• Understand the potential impact of deafness on mental and physical health

Download Full-text

Quality of Anticoagulation Control and Costs of Monitoring Warfarin Therapy among Patients with Atrial Fibrillation in Clinic Settings: A Multi-Site Managed-Care Study

Annals of Pharmacotherapy ◽

10.1345/aph.1e169 ◽

2005 ◽

Vol 39 (3) ◽

pp. 446-451 ◽

Cited By ~ 56

Author(s):

Joseph Menzin ◽

Luke Boulanger ◽

Ole Hauch ◽

Mark Friedman ◽

Cheryl Beadle Marple ◽

...

Keyword(s):

Atrial Fibrillation ◽

Warfarin Therapy ◽

Anticoagulation Clinic ◽

Health Plans ◽

Nonvalvular Atrial Fibrillation ◽

Quality Of Control ◽

Anticoagulation Clinics ◽

Anticoagulation Control

BACKGROUND: Warfarin is recommended for prevention of stroke in patients with atrial fibrillation who are at moderate or high risk, but requires intensive management to achieve safe and optimal anticoagulation control. Anticoagulation clinics are often used to administer warfarin therapy more effectively. OBJECTIVE: To collect data from multiple sites and assess the quality and costs associated with anticoagulation clinic services. METHODS: A random sample of 600 adults with chronic nonvalvular atrial fibrillation (CNVAF) receiving warfarin was selected from anticoagulation clinics affiliated with 3 health plans. Patients were identified between 1996 and 1998 and followed for up to one year. We assessed the proportion of time that international normalized ratio (INR) values were within the recommended range (2.0–3.0) and the costs of anticoagulation clinic care. RESULTS: Patients had an average of 18 clinic contacts over a mean duration of follow-up of 10.5 months. On average, patients were within the recommended INR range 62% of this time, with 25% of days below range and 13% above range. The mean per-patient cost of warfarin monitoring over the follow-up period averaged $261 at site A, $305 at site B, and $205 at site C (in 2003 US$). Mean costs for patients treated for one full year were $288, $339, and $216, respectively. CONCLUSIONS: In 3 geographically diverse health plans, anticoagulation clinics provided a generally higher quality of control than previously reported in other observational studies. This study highlights the costs of obtaining this level of control.

Download Full-text