Assessment of the Impact of Pharmacist-led Transitions of Care Services in a Primary Health Center

2019 ◽  
pp. 001857871988380
Author(s):  
Gaelle Njonkou ◽  
Kikelola Gbadamosi ◽  
Sheheryar Muhammad ◽  
Imran Chughtai ◽  
Giang Le ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Drug Therapy ◽  
Primary Health Center ◽  
Therapy Management ◽  
Care Services ◽  
Drug Therapy Management ◽  
Primary Health ◽  
Insured Patients ◽  
The Impact

Background: The impact of pharmacist-led transition of care services with collaborative drug therapy management has shown to improve patients’ outcomes and decrease health costs. Compelling statistics show higher readmission rates for under-insured patients compared with insured patients at primary health care clinics. Methods: This is a single center, prospective, cohort study designed to examine team-based collaborative drug therapy management and its effect on therapeutic outcomes of under-insured patients with target chronic diseases managed in a primary health center. Targeted chronic diseases included dyslipidemia, diabetes, hypertension, anticoagulation disorders, chronic obstructive pulmonary disease, and heart failure. The primary outcome measures included percentage of time in therapeutic international normalized ratio (INR) and percentage of patients at targeted goals of blood pressure, lipids, and hemoglobin A1c (HbA1c). Secondary outcomes included reduced emergency department visits, number of patient encounters, hospital readmissions within 30 days of discharge, and disease exacerbation rates. Results: Patients were at INR goal 58% of the time compared with 52% at baseline ( P = .66). There was a 9% improvement in mean HbA1c in the intervention group when compared with baseline (9.6% vs 10.9%, P = .03). With pharmacist intervention, 73.8% of the patients had their blood pressure at goal compared with 50% at baseline ( P = .14). A limited number of patients were readmitted for different reasons, including uncontrolled disease states. Conclusions: The pharmacist-physician collaborative drug therapy management led to improved blood pressure control, average HbA1c, and time in therapeutic INR range. A decrease in health care utilization was also identified.

scholarly journals MUSCLE ADVERSE EVENTS AMONG USERS OF SIMVASTATIN IN PRIMARY HEALTH CARE: COLLABORATIVE DRUG THERAPY MANAGEMENT

2018 ◽  
Vol 11 (1) ◽  
pp. 99
Author(s):  
Marcos Francisco Pereira Lobrigatte ◽  
Glauco de Mello Nogueira ◽  
Vinícius João Navarini ◽  
Márcia Terezinha Lonardoni Crozatti ◽  
Jorge Juarez Vieira Teixeira
Keyword(s):  
Health Care ◽  
Creatine Kinase ◽  
Primary Health Care ◽  
Drug Therapy ◽  
Adverse Events ◽  
Thyroid Stimulating Hormone ◽  
Therapy Management ◽  
Drug Therapy Management ◽  
Primary Health ◽  
One Year

Collaborative drug therapy management in primary health care involves communication among the physician, pharmacist and user of simvastatin and can result in safer results regarding patient wellbeing. The aim of the study was to investigate muscle adverse events and risk factors related to simvastatin. For patients who developed muscle adverse events, collaborative drug therapy management was performed in an attempt to resolve the symptoms. A non-randomized case study was conducted at the single basic health unit in the city of Peabiru, Parana, Brazil, for a period of one year. Patients were interviewed using a structured form. To confirm muscle adverse events, the patient was referred to a physician and submitted to the suspension and return to treatment. Thyroid-stimulating hormone, creatine kinase and alanine aminotransferase exams were performed. A sample of 148 users of simvastatin was selected. Eleven patients had some type of simvastatin-associated muscle adverse event (myopathy), among whom seven had muscle symptoms (myalgia) and four had elevated creatine kinase, but were asymptomatic (asymptomatic myopathy). Collaborative drug therapy management focused on simvastatin for five patients with myalgia led to improvements in the quality of life of two patients. EVENTOS ADVERSOS MUSCULARES ENTRE USUÁRIOS DE SINVASTATINA NA ATENÇÃO PRIMÁRIA EM SAÚDE: MANEJO COLABORATIVO DE TERAPIA MEDICAMENTOSA Resumo: O manejo colaborativo de tratamento medicamentoso em atenção primária envolve a comunicação entre o médico, farmacêutico e o usuário de sinvastatina e pode levar a resultados mais seguros, favorecendo o bem-estar do paciente. O objetivo do estudo foi investigar eventos adversos musculares e fatores de risco para tais eventos, relacionados à sinvastatina. Para os pacientes que desenvolveram eventos adversos musculares, o manejo colaborativo foi realizada de forma a resolver os sintomas. Um estudo de caso não randomizado foi realizado na única unidade básica de saúde na cidade de Peabiru, Paraná, Brasil, por um período de um ano. Os pacientes foram entrevistados por meio de um formulário estruturado. Para confirmar os eventos adversos musculares, o paciente era encaminhado ao médico, sendo submetido à suspensão e retorno da sinvastatina. Foram realizadas dosagens do hormônio tireoestimulante, creatina quinase e alanina aminotransferase. Uma amostra de 148 usuários de simvastatina foi selecionada. Do grupo estudado, 11 pacientes tiveram algum tipo de evento adverso muscular (miopatia) associada à sinvastatina, entre os quais sete tiveram sintomas musculares (mialgia) e quatro apresentaram elevação da creatina quinase, mas eram assintomáticos (miopatia assintomática). O manejo colaborativo de terapia medicamentosa focada na sinvastatina para cinco pacientes com mialgia levou a melhoria na qualidade de vida de dois pacientes. Palavras-chave: Evento adverso; Manejo da terapia medicamentosa; Doença muscular; Atenção primária em saúde; Sinvastatina.

Importance of community engagement in primary health care: the case of Afghan refugees

2015 ◽  
Vol 21 (3) ◽  
pp. 262 ◽  
Author(s):  
I-Hao Cheng ◽  
Sayed Wahidi ◽  
Shiva Vasi ◽  
Sophia Samuel
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Engagement ◽  
Health Care Services ◽  
Local Community ◽  
Health Workers ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
The Impact

Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia.

scholarly journals Assessing the impact of the 2008 health reform in Ecuador on the performance of primary health care services: an interrupted time series analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sergio E Flores Jimenez ◽  
Miguel San Sebastián
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Reform ◽  
Health Care Services ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
The Impact

Abstract Background In 2008, Ecuador started a national health reform based on the principles of Alma Ata to achieve Universal Health Coverage. While coverage indicators have increased, a systematic assessment of the impact of the reform on the delivery of health services at primary level is lacking. The aim of this study was to assess the impact of the 2008 health reform on the performance of primary health care services in Ecuador. Methods Ambulatory Care Sensitive Conditions (ACSC) are a subset of diseases where hospital admission is potentially avoidable by high quality well-functioning primary care. Thus, observing the behaviour of ACSC hospitalizations can serve as an indicator of how the primary health care level is performing. Crude and adjusted rates, stratified by sex, were calculated from ten selected ACSC hospitalization discharges during 22 years of data representing 11 years before and after the health reform. An interrupted time series analysis was then conducted by applying a negative binomial regression and adjusting for overdispersion and autocorrelation. Results Overall higher crude and adjusted rates for ACSC hospitalizations were observed in women compared to men; both increased gradually since the start of the observation, reaching a peak around 2010, and then started a downwards trend. In men, the incidence rate ratio increased significantly by 3 % per year during the period before the intervention. During the first year after intervention, an increase (13 %) was detected, and then a statistically significant 1 % decrease (IRR = 0.99; 95 % CI: 0.98, 0.99) was observed in the ACSC rate ratio per year in the period after the intervention. Similar trends and effect sizes were found for women. Conclusions The study revealed significant decreasing trends of the ACSC hospitalization rates in both sexes, indicating an improvement of the performance of the primary health care services following the 2008 national health reform. A continuous strengthening of the primary care model as well as a regular monitoring of ACSC hospitalization rates in the country is recommended. A health economic evaluation considering hospitalizations avoided and associated costs is also advisable.

Impact of Pharmacist-Led Drug Therapy Management Services on HbA1c Values in a Predominantly Hispanic Population Visiting an Outpatient Endocrinology Clinic

2020 ◽  
pp. 089719002092786
Author(s):  
José J. Hernández-Muñoz ◽  
Annette C. De Santiago ◽  
Stephanie Z. Cedrone ◽  
Rene A. Verduzco ◽  
Daniela Z. Bazan
Keyword(s):  
Drug Therapy ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Absolute Change ◽  
Therapy Management ◽  
Predominantly Hispanic ◽  
Drug Therapy Management ◽  
The Mean ◽  
The Impact ◽  
Endocrinology Clinic

Purpose To assess the impact pharmacists have on improving glycemic control among predominantly Hispanic diabetic patients visiting an endocrinology clinic in South Texas. Pharmacists were recently integrated into this clinic to be part of a collaborative team. Methods This study follows a retrospective cohort design. All patients received diabetic care from endocrinologists, and some received pharmacist-led drug therapy management (PDTM). Patients with ≥1 PDTM were categorized as the intervention group and those without PDTM as the standard of care (SOC) group. The outcome variables were the mean absolute change in glycosylated hemoglobin (HbA1c) from baseline and the proportion of patients at goal HbA1c (<7%) postintervention. Results Data were collected from 222 patients (n = 120 SOC patients, n = 102 PDTM patients). The mean age was 61 ± 14 years, 136 (61%) were female, and 197 (89%) were Hispanic. The mean absolute change in HbA1c was −1.3%. In the adjusted model, the mean absolute change in HbA1c in the PDTM compared to the SOC group was not significant (−0.1% ± 0.2%; P < .74), and concurrent interventions from registered dieticians (RDs) and licensed professional counselors (LPC) were identified as effect modifiers of the association. The stratum specific analysis identified the greatest decrease in HbA1c when the three interventions (ie, PDTM, RD, and LPC) coincided (−1.0% ± 0.3%; P < .01). Postintervention, 25% of those who received PDTM achieved an HbA1c<7% as compared to 19% in the SOC group. Conclusion The clinical importance of pharmacists is enhanced when integrated with behavioral modifying programs to achieve additional improvement in HbA1c.

Continuation of Drug Therapy

2000 ◽  
Vol 35 (3) ◽  
pp. 242-245
Author(s):  
Holly Vance
Keyword(s):  
Health Care ◽  
Drug Therapy ◽  
Patient Care ◽  
Health Care Providers ◽  
Washington State ◽  
Care Providers ◽  
Patient Centered ◽  
Therapy Management ◽  
Drug Therapy Management

Collaborative drug therapy management (CDTM) is a method for developing a patient-centered practice in which the pharmacist's activities are integrated with those of other health care providers. The goals of this continuing feature are to refine the concept of CDTM and provide patient-care applications from the authors' experience in Washington state. Questions or suggestions should be addressed to Timothy S. Fuller, FASHP, Fuller and Associates, 1948 Boyer Avenue East, Seattle, WA 98112-2924 (tel. 206-860-8308).

scholarly journals The Impact of Primary Health Care Services on Under-Five Mortality in Rural Niger

1996 ◽  
Vol 25 (3) ◽  
pp. 568-577 ◽  
Author(s):  
ROBERT J MAGNANI ◽  
JANET C RICE ◽  
NANCY B MOCK ◽  
AHMED A ABDOH ◽  
DAVID M MERCER ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Services ◽  
Under Five ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
Rural Niger ◽  
The Impact

The Impact of War on Population Health

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Turkan Ahmet
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Services ◽  
Negative Effects ◽  
The Past ◽  
Care Services ◽  
Physical Environments ◽  
The Social ◽  
Personal Experiences ◽  
The Impact

The past few decades of ongoing war in Iraq has had a dramatic impact on the health of Iraq’s population. Wars are known to have negative effects on the social and physical environments of individuals, as well as limit their access to the available health care services. This paper explores the personal experiences of my family members, who were exposed to war, as well as includes information that has been reviewed form many academic sources. The data aided in providing recommendations and developing strategies, on both local and international levels, to improve the health status of the populations exposed to war.

A Study on the Impact of Demonetization on Utilisation of Private Health Care Services in a South Indian City

2020 ◽  
Vol 11 (2) ◽  
pp. 485
Author(s):  
Vijay K. Yalanchmanchili ◽  
N. Partha Sarathy ◽  
U. Vijaya Kumar ◽  
M. Ravi Kiran ◽  
Kalapala Abhilash
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Private Health Care ◽  
Care Services ◽  
South Indian ◽  
Indian City ◽  
The Impact

The Roots of Global Health Inequity

2017 ◽  
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Care ◽  
World War Ii ◽  
Primary Health Care ◽  
Economic Policies ◽  
World War ◽  
The Public ◽  
The World Bank ◽  
Primary Health ◽  
The Cold War ◽  
The Impact

This chapter outlines the historical roots of health inequities. It focuses on the African continent, where life expectancy is the shortest and health systems are weakest. The chapter describes the impoverishment of countries by colonial powers, the development of the global human rights framework in the post-World War II era, the impact of the Cold War on African liberation struggles, and the challenges faced by newly liberated African governments to deliver health care through the public sector. The influence of the World Bank and the International Monetary Fund’s neoliberal economic policies is also discussed. The chapter highlights the shift from the aspiration of “health for all” voiced at the Alma Ata Conference on Primary Health Care in 1978, to the more narrowly defined “selective primary health care.” Finally, the chapter explains the challenges inherent in financing health in impoverished countries and how user fees became standard practice.

Sign in / Sign up

Export Citation Format

Share Document