Assessing the Quality of Pharmaceutical Care II. Application of Concepts of Quality Assessment from Medical Care

1993 ◽  
Vol 27 (2) ◽  
pp. 215-223 ◽  
Author(s):  
Karen B. Farris ◽  
Duane M. Kirking

Objective To present a framework that facilitates quality assessment of pharmaceutical care (PC) so that the profession and the public may identify pharmacists in ambulatory settings who provide quality care in all aspects of their practices. Data Sources A MEDLINE search augmented by a review of International Pharmacy Abstracts was used to identify pertinent quality assessment and pharmacy practice literature; indexing terms included quality assurance, healthcare, pharmacists, community pharmacy services, ambulatory, pharmacy, and process and outcome assessment. Study Selection All identified quality assessments of community pharmacy practice were considered. Studies that documented the effectiveness of specific pharmacist activities and patient satisfaction were also included. Data Extraction The literature was independently reviewed by the primary author. Data Synthesis The structure–process–outcome paradigm is presented as a framework for quality assessment of PC. Structure should be assessed at periodic intervals because it identifies the potential for the provision of quality care. Process, the care that pharmacists provide, must be documented and linked to outcomes before either structure or process can be used to make inferences about the quality of PC. Technical and interpersonal processes should be examined. Outcomes require an interdisciplinary approach that not only considers other medical care inputs but also recognizes the psychologic, economic, and social factors that affect health status and quality of life. Process and outcome must both be assessed to distinguish the contribution of pharmacists from that of other healthcare providers. Examples of criteria are provided and a model to integrate PC within the healthcare system is discussed. Conclusions It is pharmacists’ duty to ensure that patients receive an acceptable level of PC. The structure-process-outcome paradigm provides a framework to identify and link pharmacists’ processes with patients’ outcomes.

2020 ◽  
Author(s):  
Agustin Lara-Esqueda ◽  
Sergio A Zaizar-Fregoso ◽  
Violeta M Madrigal-Perez ◽  
Mario Ramirez-Flores ◽  
Daniel A Montes-Galindo ◽  
...  

BACKGROUND Diabetes Mellitus is a worldwide health problem and the leading cause of premature death with increasing prevalence over time. Usually, along with it, Hypertension presents and acts as another risk factor that increases mortality risk. Both diseases impact the country's health while also producing an economic burden for society, causing billions of dollars to be invested in their management. OBJECTIVE The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico, according to the official Mexican standard for each pathology. METHODS 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical records database, exported as anonymized data for research purposes. Each patient record was compared against the standard to test the quality of medical care. RESULTS Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease of diabetes or hypertension. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination in the whole population. Specialty referral reached 1% in angiology or cardiology in the whole population. CONCLUSIONS Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards. While patients with DM and HBP do not have a current standard to evaluate their own needs.


2021 ◽  
Vol 10 (11) ◽  
pp. 2311
Author(s):  
Eleonora Gaetani ◽  
Fabiana Agostini ◽  
Luigi Di Martino ◽  
Denis Occhipinti ◽  
Giulio Cesare Passali ◽  
...  

Background: Hereditary hemorrhagic telangiectasia (HHT) needs high-quality care and multidisciplinary management. During the COVID-19 pandemic, most non-urgent clinical activities for HHT outpatients were suspended. We conducted an analytical observational cohort study to evaluate whether medical and psychological support, provided through remote consultation during the COVID-19 pandemic, could reduce the complications of HHT. Methods: A structured regimen of remote consultations, conducted by either video-calls, telephone calls, or e-mails, was provided by a multidisciplinary group of physicians to a set of patients of our HHT center. The outcomes considered were: number of emergency room visits/hospitalizations, need of blood transfusions, need of iron supplementation, worsening of epistaxis, and psychological status. Results: The study included 45 patients who received remote assistance for a total of eight months. During this period, 9 patients required emergency room visits, 6 needed blood transfusions, and 24 needed iron supplementation. This was not different from what was registered among the same 45 patients in the same period of the previous year. Remote care also resulted in better management of epistaxis and improved quality of life, with the mean epistaxis severity score and the Euro-Quality of Life-Visual Analogue Scale that were significantly better at the end than at the beginning of the study. Discussion: Remote medical care might be a valid support for HHT subjects during periods of suspended outpatient surveillance, like the COVID-19 pandemic.


1996 ◽  
Vol 12 (suppl 2) ◽  
pp. S85-S93 ◽  
Author(s):  
Luiz Antonio Bastos Camacho ◽  
Haya Rahel Rubin

Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6), depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.


Author(s):  
Sangita Timsina ◽  
Bhuvan K.C. ◽  
Dristi Adhikari ◽  
Alian A. Alrasheedy ◽  
Mohamed Izham Mohamed Ibrahim ◽  
...  

Community pharmacies in Nepal and other South Asian countries are in a mediocre state due to poor regulation and the fact that many pharmacies are run by people with insufficient training in dispensing. This has led to the inappropriate use of medicines. The problems due to poor regulation and the mediocre state of community pharmacies in South Asia encompass both academia and clinical practice. In this paper, a 2-week community pharmacy internship programme completed by 2 graduating pharmacy students of Pokhara University (a Nepalese public university) at Sankalpa Pharmacy, Pokhara, Nepal is illustrated. During the internship, they were systematically trained on store management, pharmaceutical care, counselling skills, the use of medical devices, pharmaceutical business plans, medicine information sources, and adverse drug reaction reporting. An orientation, observations and hands-on training, case presentation, discussion, and feedback from 2 senior pharmacists were used as the training method. A proper community pharmacy internship format, good pharmacy practice standards, and a better work environment for pharmacists may improve the quality of community pharmacies.


1997 ◽  
Vol 31 (6) ◽  
pp. 713-719 ◽  
Author(s):  
Michelle CH Shibley ◽  
Carol B Pugh

OBJECTIVE: To implement and evaluate pharmaceutical care services for patients with hyperlipidemias in the community pharmacy setting, to evaluate the results of a pharmaceutical care training process for pharmacists by using an assessment quiz, and to measure patient outcomes resulting from provision of pharmaceutical care to patients with hyperlipidemia. DESIGN: A prospective study was conducted over a 1 -year period. Patients served as their own controls. SETTING: Two independent community pharmacies in Richmond, Virginia. PARTICIPANTS: Twenty-five adult patients with confirmed dyslipidemias completed the study. INTERVENTIONS: Study pharmacists assessed each patient and assisted in setting therapeutic goals; patients also completed a visit with a registered dietitian. Drug therapy recommendations were made to physicians by the pharmacist when appropriate. Follow-up was scheduled with the pharmacist to ensure positive outcomes and reduce adverse effects. MAIN OUTCOME MEASURES: Fasting lipoprotein profiles were measured initially and at 6 and 12 months. The SF-36 survey, the MacKeigan-Larson satisfaction survey, and a patient opinion survey were administered initially and at the conclusion of the study. RESULTS: Total cholesterol and low-density lipoprotein cholesterol values were significantly decreased at 12 months compared with either the baseline or 6-month values (p < 0.02). Significant improvement was found in several domains of the surveys; quality of life, patient satisfaction with pharmacy services, and patient opinions on the role of the pharmacist improved after the intervention. CONCLUSIONS: Pharmaceutical care may positively affect lipid values, quality of life, and patient satisfaction.


2005 ◽  
Vol 39 (9) ◽  
pp. 1539-1541 ◽  
Author(s):  
Karen B Farris ◽  
Fernando Fernandez-Llimos ◽  
SI (Charlie) Benrimoj

Pharmaceutical care models and practices differ in various countries. Reimbursement for cognitive services, for example, varies across countries in Europe, Asia, and the Americas. Practice-based research has blossomed in many countries, with different emphases and challenges. This international series will describe the organization of community pharmacy within the healthcare system and report the status of practice-based research. Each paper will focus on one country. The series will conclude with a summary by the series editors describing the key themes across the papers, outlining milestones yet to be achieved, and proposing a research agenda for community pharmacy practice.


2018 ◽  
Vol 71 (3) ◽  
Author(s):  
Apolline Adé ◽  
Denis Lebel ◽  
Jean-François Bussières

<p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>La littérature scientifique portant sur l’application des connaissances (AC) est vaste et complexe et les publications sur les interventions dans le domaine de la santé concernent surtout les médecins et les infirmières. Pour autant que les auteurs sachent, il n’existe pas de revue documentaire s’intéressant à l’AC et à ses retombées en pharmacie.</p><p><strong>Objectif : </strong>Décrire le profil des interventions visant l’AC en pratique pharmaceutique.</p><p><strong>Source des données : </strong>La plateforme Knowledge Translation+ (KT+) a été utilisée pour en extraire des articles publiés entre janvier 2010 et décembre 2016 à l’aide du terme « pharmacist ».</p><p><strong>Sélection des études et extraction des données : </strong>Les principales variables retenues pour établir le profil des interventions visant l’AC en pratique pharmaceutique étaient le protocole de recherche de l’étude, le lieu de l’intervention, les rôles du pharmacien, les types de connaissances transférées et les retombées. Le codage de la nature des interventions pharmaceutiques reposait sur la classification du site Impact Pharmacie.</p><p><strong>Synthèse des données : </strong>Au total, 114 articles ont été sélectionnés : revues systématiques (<em>n </em>= 25, 22 %), études contrôlées à répartition aléatoire (<em>n </em>= 45, 40 %) études rétrospectives (<em>n </em>= 21, 18 %), études prospectives (<em>n </em>= 13, 11 %), études pré-post intervention (<em>n </em>= 10, 9 %). Les études se déroulaient surtout en établissement de santé (74 %). La majorité des interventions ciblaient des étapes de soins pharmaceutiques et la realization de séances d’éducation thérapeutique et de conseils prodigués aux patients. Il existait un manque de rigueur méthodologique lors de la conception des interventions et quant à leur description.</p><p><strong>Conclusion : </strong>Le pharmacien est le principal producteur de connaissances et oriente les interventions visant leur application vers les patients ou les professionnels de santé. Celles-ci concernaient principalement la démarche de soins pharmaceutiques et le travail en interdisciplinarité. La mise en place d’une formation initiale et continue, la gestion de l’information et la désignation d’un pharmacien responsable de l’AC au sein de chaque département de pharmacie pourraient encourager le développement de cette mise en application des connaissances. Ce concept peut être utile pour soutenir la création d’un modèle de pratique pharmaceutique cohérent.</p><p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>The scientific literature on knowledge translation (KT) is vast and complex, and most publications concerning health care interventions involve physicians and nurses. To the authors’ knowledge, there have been no literature reviews on KT and its impact on pharmacy practice.</p><p><strong>Objective: </strong>To determine the profile of interventions relating to KT in pharmacy practice.</p><p><strong>Data Sources: </strong>The term “pharmacist” was used to search the web platform Knowledge Translation+ (KT+) to identify pertinent articles published between January 2010 and December 2016.</p><p><strong>Study Selection and Data Extraction: </strong>The main variables analyzed to determine the profile of KT interventions in pharmacy practice were the study’s research protocol, the geographic location of the intervention, pharmacist roles, the types of knowledge transferred, and impacts of the interventions. The nature of pharmacy interventions was coded according to the classification on the Impact Pharmacie website.</p><p><strong>Data Synthesis: </strong>A total of 114 articles were selected: systematic reviews (<em>n </em>= 25, 22%), randomized controlled trials (<em>n </em>= 45, 40%), retrospective studies (<em>n </em>= 21, 18%), prospective studies (<em>n </em>= 13, 11%), and pre-post intervention studies (<em>n </em>= 10, 9%). Most of the studies (74%) were conducted in a health care institution. The majority of interventions targeted pharmaceutical care steps, therapeutic educational sessions, and patient education. There was a lack of methodological rigour during the development of interventions and in their description.</p><p><strong>Conclusion: </strong>Pharmacists are key generators of knowledge, and their interventions related to KT are directed toward patients or other health care professionals. These interventions have mainly addressed the pharmaceutical care process and interdisciplinary work. The implementation of initial and continuing education, the management of information, and the designation of a pharmacist responsible for KT in each pharmacy department might promote the development of such KT. This concept might in turn support the design of a coherent pharmacy practice model.</p>


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