Impact of Pharmacist-Physician Collaboration on Osteoporosis Treatment Rates

Background: The vast majority of women at high risk for osteoporotic fractures are not treated, despite known significant clinical and economic consequences of this prevalent condition. To date, this is the first study of this size and duration to examine the role of pharmacists in management of osteoporosis in a family medicine clinic. Objective: To compare the initiation or continuation of prescription antifracture therapy in high-risk patients with collaborative pharmacist-physician to physician-only management; secondarily, to evaluate recommendation rates for antifracture therapy and calcium and vitamin D. Methods: This retrospective cohort analysis included women older than 65 years with a dual-energy X-ray absorptiometry (DXA) scan ordered by a family medicine physician. High risk was defined as T-scores ≤−2.5 at the lumbar spine, femoral neck, or 33% radius, or a FRAX 10-year fracture risk score ≥20% for major osteoporosis-related or ≥3% for hip fractures. Results: There were 466 (311 high-risk) pharmacist-physician and 549 (237 high-risk) physician-managed DXAs included. For high-risk DXAs, collaborative management resulted in increased rates of receiving antifracture therapy prescriptions over physician-only management (66% vs 34%, P < 0.001), advisement for antifracture therapy (87% vs 32%, P < 0.001), and calcium and vitamin D (97% vs 45%, P < 0.001). Collaborative management also improved calcium and vitamin D advisement among all DXAs (96% vs 46%, P < 0.01). There was no difference in adverse events documented in the pharmacist-physician compared with physician-only management (7.2% vs 3.7%, P = 0.32). Conclusion and Relevance: Pharmacist-physician collaboration is associated with higher treatment rates of osteoporosis. This study supports the pharmacist-physician partnership as one method of improving osteoporosis management.

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Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

Journal of Opioid Management ◽

10.5055/jom.2021.0621 ◽

2021 ◽

Vol 17 (2) ◽

pp. 109-113

Author(s):

Julienne K. Kirk, PharmD, CDE, BCPS ◽

Matthew Q. Tran, PharmD ◽

Samantha Pelc, PharmD ◽

Katherine G. Moore, PharmD, BCPS, BCACP

Keyword(s):

Primary Care ◽

High Risk ◽

Family Medicine ◽

Quality Improvement Intervention ◽

Opioid Overdose ◽

Naloxone Administration ◽

Support Person ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

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HIV Preexposure Prophylaxis Training in Family Medicine Residencies: A National Survey

Family Medicine ◽

10.22454/fammed.2022.740210 ◽

2022 ◽

Vol 54 (1) ◽

pp. 24-29

Author(s):

Byron K. Jasper ◽

James N. Becker ◽

Allison Myers ◽

Peter F. Cronholm

Keyword(s):

High Risk ◽

Rural Communities ◽

Family Medicine ◽

Hiv Transmission ◽

Program Directors ◽

Preexposure Prophylaxis ◽

Primary Care Workforce ◽

Rural Residency ◽

Risk Patients ◽

Research Alliance

Background and Objectives: Preexposure prophylaxis (PrEP) reduces HIV transmission among high-risk individuals. Yet, the HIV epidemic continues to expand among marginalized populations and America’s Southeastern states. Various barriers remain to PrEP uptake, namely provider knowledge and education. We sought to investigate residency training, competency, and prescribing of PrEP among population size. Additionally, we asked program directors to identify barriers to PrEP. Methods: We surveyed family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. Results: Our survey questions had a 52.9% (276/522) response rate. No programs in rural communities less than 30,000 population (0/27) reported significant PrEP training for their residents; those in nonrural communities of at least 30,000 reported this training more frequently (41/246, 16.7%). Compared to Fischer expected values, the finding was statistically significant (P=.019); using a 75,000 population demarcation lowered significance (P=.192). We found programs that identify significant PrEP training also cite more PrEP prescribing within their practice (OR 7.27, P<.001). Programs with significant training also report their residents graduate with greater PrEP competency (OR 18.33, P<.001). The largest barriers identified were faculty expertise, not having enough high-risk patients, inadequate screening, and resident knowledge/training. Conclusions: We identified natural associations between increased training in PrEP and perceived PrEP competencies. We identified a lack of significant PrEP training and associated PrEP competencies in rural residency programs. Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk.

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Intensive Case Management of High-Risk Patients in a Family Medicine Residency Setting

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.12.4.264 ◽

1999 ◽

Vol 12 (4) ◽

pp. 264-269 ◽

Cited By ~ 1

Author(s):

S. G. Friedhoff

Keyword(s):

High Risk ◽

Family Medicine ◽

Case Management ◽

Intensive Case Management ◽

High Risk Patients ◽

Family Medicine Residency ◽

Risk Patients

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Bone mineral density status in urolithiasis patients with vitamin D inadequacy followed at a tertiary stone centre

Canadian Urological Association Journal ◽

10.5489/cuaj.2055 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 323 ◽

Cited By ~ 1

Author(s):

Mohamed Aly Elkoushy ◽

Mazen Jundi ◽

Terence T.N. Lee ◽

Sero Andonian

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

High Risk ◽

Osteoporotic Fractures ◽

Mineral Density ◽

Stone Formers ◽

Major Osteoporotic Fractures ◽

Recurrent Stone ◽

Dxa Scans ◽

Recurrent Stone Formers

Introduction: We assessed abnormalities in bone mineral density (BMD) and the risk of hip and major osteoporotic fractures in urolithiasis patients with vitamin D inadequacy (VDI) followed at a tertiary stone centre.Methods: Stone-free patients with VDI were invited to undergo dual-energy x-ray absorptiometry (DXA) scans to assess for BMD abnormalities at the femoral neck and lumbar spine. The World Health Organization’s validated Fracture Risk Assessment Tool (FRAX) was used to calculate the risk of hip and major osteoporotic fractures within 10 years. Patients with primary hyperparathyroidism or hypercalcemia were excluded.Results: In total, 50 consecutive patients were included between June 2011 and August 2012, including 26 (52%) males. The median age was 51 years and the median 25-hydroxyl vitamin D (25[OH]D) was 18.8 ng/mL. Thirty patients (60%) had abnormal T-scores on DXA studies. This decreased to 22 (44%) when age-matched Z-scores were used; 36% had osteopenia and 8% had osteoporosis. Femoral neck and lumbar spines were affected in 24% and 32% of patients, respectively. Recurrent stone-formers had significantly lower BMD when compared with first-time stone-formers. Median serum 25(OH)D was comparable between patients with normal and abnormal DXA scans (18.6 vs. 18.8 ng/mL; p = 0.91). Five patients (10%) were at high risk (≥3%) of hip fractures within 10 years.Conclusion: A high prevalence of abnormal DXA scans was found in urolithiasis patients with VDI, including 5 patients (10%) at high risk of hip fractures. Future studies need to assess the economic impact of obtaining DXA scans on urolithiasis patients with VDI, especially in recurrent stone-formers.

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Implementing STEADI in Academic Primary Care to Address Older Adult Fall Risk

Innovation in Aging ◽

10.1093/geroni/igx028 ◽

2017 ◽

Vol 1 (2) ◽

Cited By ~ 12

Author(s):

Elizabeth Eckstrom ◽

Erin M Parker ◽

Gwendolyn H Lambert ◽

Gray Winkler ◽

David Dowler ◽

...

Keyword(s):

Primary Care ◽

Vitamin D ◽

High Risk ◽

Fall Risk ◽

Primary Care Providers ◽

Care Providers ◽

High Risk Patients ◽

Risk Patients ◽

Fall Screening ◽

Key Questions

Abstract Background and Objectives Falls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. Design and Methods We systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions). Results Eighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients. Discussion and Implications We successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.

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Vaccination Rates in Patients With Medical Indications for the Pneumococcal Polysaccharide Vaccine in a Family Medicine Clinic

Journal of Pharmacy Practice ◽

10.1177/0897190017745411 ◽

2017 ◽

Vol 32 (2) ◽

pp. 154-157 ◽

Cited By ~ 2

Author(s):

Anthony Trovato ◽

Karen Gunning ◽

Karly Pippitt

Keyword(s):

High Risk ◽

Family Medicine ◽

Pneumococcal Vaccination ◽

Low Risk ◽

Vaccination Rates ◽

Medical Indication ◽

High Risk Patients ◽

Patients With Diabetes ◽

Risk Patients ◽

Patient Refusal

Background: Pneumococcal vaccination rates among high-risk patients (eg, diabetes, asthma, smoking) seen in 2 family medicine clinics are unknown. Objectives: To assess differences in pneumococcal polysaccharide vaccination rates and reasons for nonvaccination among patients with diabetes and asthma and patients who smoke. Methods: A chart review at 2 family medicine residency training clinics showed 425 patients with a medical indication for PPSV23 were seen between April 1, 2015, and April 30, 2015. One reviewer searched the electronic health records to assess reasons for nonvaccination. Results: Rates of nonvaccination were 29.8% in patients with diabetes, 58.7% in patients with asthma, and 62.5% in patients who smoke cigarettes. Patients were classified into 3 groups based on the reasons for nonvaccination: documented patient refusal, not being addressed by a provider, and being documented as low risk despite the presence of a medical indication. Conclusion: The 3 reasons for nonvaccination were vaccination not being addressed, misclassification of high-risk patients as low-risk patients for infection, and documented patient refusal. Providers overlooked vaccination more often in patients with asthma and cigarette use than in patients with diabetes. Patients seeing pharmacists were most likely to be vaccinated, whereas patients seeing physician assistants were least likely to be vaccinated. Pharmacists see patients to provide medication management and preventive care, whereas other providers treat more urgent conditions. Because indications are often overlooked and not addressed, pharmacists can play a larger role in identifying and vaccinating high-risk patients.

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