scholarly journals Opioid stewardship: implementing a proactive, pharmacist-led intervention for patients coprescribed opioids and benzodiazepines at an urban academic primary care centre

2020 ◽  
Vol 9 (2) ◽  
pp. e000635 ◽  
Author(s):  
Tiana Tilli ◽  
Jonathan Hunchuck ◽  
Norman Dewhurst ◽  
Tara Kiran
Keyword(s):  
Primary Care ◽  
Primary Care Centre ◽  
Care Centre ◽  
Opioid Dose ◽  
Fourfold Increase ◽  
Care Plans ◽  
Number Of Patients ◽  
Control Clinic ◽  
Academic Primary Care ◽  
Future Work

In 2017, almost 4000 Canadians died from opioid-related causes. Coadministration of opioids and benzodiazepines is a risk factor for overdose. Few studies have evaluated leveraging pharmacists to address opioid-benzodiazepine coprescribing. Our aim was to develop and test a role for pharmacists as opioid stewards, to reduce opioid and benzodiazepine doses in coprescribed patients. We conducted Plan-Do-Study-Act cycles between November 2017 and May 2018 across two primary care centre clinics. A third clinic acted as a control. Our intervention included a pharmacist: (1) identifying patients through medical record queries; (2) developing care plans; (3) discussing recommendations with physicians and (4) discussing implementing recommendations. We refined the intervention according to patient and physician feedback. At the intervention clinics, the number of patients with pharmacist developed care plans increased from less than 20% at baseline to over 60% postintervention. There was also a fourfold increase in the number of patients with an active opioid taper. At the control clinic, the number of patients with pharmacist developed care plans remained relatively stable at less than 20%. The number of patients with active opioid tapers remained zero. At the intervention clinics, mean daily opioid dose decreased 11% from 50.5 milligrams morphine equivalent (MME) to 44.7 MME. At the control clinic, it increased 15% from 62.3 MME to 71.4 MME. The number of patients with a benzodiazepine taper remained relatively stable at both the intervention and control clinics at less than 20%. At the intervention clinics, mean daily benzodiazepine dose decreased 8% from 9.9 milligrams diazepam equivalent (MDE) to 9.3 MDE. At the control clinic, it decreased 4% from 10.8 MDE to 10.4 MDE. A proactive, pharmacist-led intervention for coprescribed patients increased opioid tapers and decreased opioid and benzodiazepine doses. Future work will help us understand whether sustaining the intervention ultimately reduces rates of opioid-benzodiazepine coprescribing.

scholarly journals Are Care Plans Suitable for the Management of Multiple Conditions?

2016 ◽  
Vol 6 (2) ◽  
pp. 103-113 ◽  
Author(s):  
Charlotte E. Young ◽  
Frances M. Boyle ◽  
Allyson J. Mutch
Keyword(s):  
Primary Care ◽  
Patient Preferences ◽  
Care Plan ◽  
Care Practice ◽  
Multiple Chronic Conditions ◽  
Comorbid Conditions ◽  
Care Needs ◽  
Care Plans ◽  
Number Of Patients ◽  
Multiple Conditions

Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs.

scholarly journals 216 Integrated Day Hospital for Older Persons in a Primary Care Centre

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Fiona McGrath ◽  
Sarah Ronayne ◽  
Karen McHugh ◽  
Mary McDonnell ◽  
Elnsari Muataz ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Older Persons ◽  
Blood Pressure Monitoring ◽  
Rapid Assessment ◽  
Population Data ◽  
Shared Vision ◽  
Primary Care Centre ◽  
Day Hospital ◽  
Care Centre

Abstract Background To progress with integrated care, for older persons, it was proposed to establish a Day Hospital in a Primary Care Centre. Population data for Co Mayo shows the percentage of those over 65 years, (17.6%), to be significantly higher than the national average In 2018 there were 39,092 attendances to the Emergency Department and approximately 500, per month, were over 75 years. The aim was to develop a pathway from the Emergency Department to the Day Hospital for those 75 years and over who had experienced a fall. Additionally, this included an Early Supported Discharge for hip fracture patients. Methods The Day Hospital was operational 1 day per week with an allocation of funding for a Consultant, Occupational Therapist and assigned Project Manager. Holter and Blood pressure monitoring equipment was purchased. The Home First Team were reassigned to the front door of the hospital and worked with a cANP and a Medical Registrar. A weekly multi-disciplinary forum, inclusive of all stakeholders, developed working relationships, built a shared vision and standardised the approach for the patient cohort. Frailty training was provided specifically to Emergency Department staff. Results The Home First Team saw 541 patients (Jan-Apr 2019) and in collaboration with the Geriatrician streamed those suitable for management to primary care. The Integrated Day Hospital, 1 day per week (Jan-Apr 2019) delivered 55 new assessments plus follow-up appointments. Patient feedback is very positive and specifically highlights ease of access in primary care. Conclusion Establishing a Day Hospital in a Primary Care Centre is an innovative approach and shifts the focus of intervention from acute to primary care. The location is ideal due to a range of disciplines on site, PHN, Dietetics, Psychiatry This is the initial phase, with some pathways in place, and the overall aim is to provide GP access to rapid assessment in Primary Care and thus ensure hospital avoidance where possible.

scholarly journals Nursing Fundamentals: Light between the Shadows of Covid-19 Pandemic

2021 ◽  
Vol 8 (1) ◽  
pp. 1-4
Author(s):  
Mercedes De Dios Aguado ◽  
Keyword(s):  
Primary Care ◽  
Nursing Staff ◽  
Primary Care Centre ◽  
Care Centre ◽  
Florence Nightingale

The main objective of this article is to share the experienceof nursing staff during the COVID 19 pandemic in a Primary Care Centre of the Toledo province the care and attention given to population follow the foundations of the nursing theories Florence Nightingale, Concepción Arenal and Hildegard Peplau.

scholarly journals Vitamin D levels in a pediatric population of a primary care centre: a public health problem?

2018 ◽  
Vol 11 (1) ◽  
Author(s):  
J. M. Fernández Bustillo ◽  
A. Fernández Pombo ◽  
R. Gómez Bahamonde ◽  
E. Sanmartín López ◽  
O. Gualillo
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Vitamin D ◽  
Health Problem ◽  
Pediatric Population ◽  
Public Health Problem ◽  
Primary Care Centre ◽  
Care Centre ◽  
Vitamin D Levels
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