scholarly journals Exploring the perspectives and strategies of Ontario community pharmacists to improve routine follow-up for patients with diabetes: A qualitative study

2021 ◽  
pp. 171516352110184
Author(s):  
Natali Surkic ◽  
Annalise Mathers ◽  
Jamie Kellar ◽  
Lori MacCallum ◽  
Lisa Dolovich
Keyword(s):  
Community Pharmacy ◽  
Diabetes Education ◽  
Community Pharmacists ◽  
Future Research ◽  
Convenience Sample ◽  
Routine Monitoring ◽  
Semistructured Interviews ◽  
Patients With Diabetes ◽  
Medication Reviews

Background: Medication reviews are a fundamental activity carried out as part of comprehensive care delivered by pharmacists. Varying programs that reimburse pharmacists for conduct of medication reviews are in place in different jurisdictions in Canada and other countries around the world. The MedsCheck Diabetes (MCD) program is a publicly funded service in Ontario, Canada, offered to patients with type 1 or type 2 diabetes. Through this service, pharmacists can complete a focused medication review with advice, training, monitoring and follow-up diabetes education. Although pharmacists can be reimbursed for patient follow-up activities, a low number of follow-up medication reviews are billed through this program. Methods: The study explores the barriers and facilitators that community pharmacists in Ontario experience in conducting routine monitoring and follow-up of patients with diabetes. Using a descriptive content analysis approach study, semistructured interviews were conducted with a convenience sample of 8 community pharmacists working in Ontario. Results: Three main themes emerged: the design of the MCD program, the state of community pharmacy and collaboration and relationships. These themes demonstrate challenges and potential strategies recognized by community pharmacists to conduct routine diabetes follow-up through the MCD program. Conclusion: Future research should more closely examine and implement strategies to optimize routine follow-up in community pharmacy for patients with diabetes, taking into consideration the themes and examples identified in this study. Can Pharm J (Ott) 2021;154:xx-xx.

scholarly journals Community Pharmacy Response in the Aftermath of Natural Disasters: Time-Sensitive Opportunity for Research and Evaluation

2018 ◽  
Vol 9 ◽  
pp. 215013271881349 ◽  
Author(s):  
Kyle Melin ◽  
Carlos E. Rodríguez-Díaz
Keyword(s):  
Health Care ◽  
Puerto Rico ◽  
Community Pharmacy ◽  
Natural Disaster ◽  
Community Pharmacists ◽  
Evidence Base ◽  
Third Party ◽  
Future Research ◽  
Prescription Medications ◽  
Collaborative Practice Agreement

One year ago, Hurricane Maria passed over the archipelago of Puerto Rico, leaving widespread disruption of nearly all human services, including the health care sector. In the aftermath of the hurricane, limited access to medical care and prescription medications presented a serious challenge to maintaining control of preexisting chronic diseases. Many patients did not have access to refrigeration for heat-sensitive medications. Significant dietary changes due to the limited availability of shelf-stable foods further exacerbated chronic conditions such as heart failure and diabetes. The role of community pharmacists following a natural disaster has previously been documented, and may include the triage of evacuees, assessment of immunization needs, and provision of prescription medications under a collaborative practice agreement. However, our experience in Puerto Rico demonstrated a variety of barriers limited pharmacists’ ability to adequately respond to the magnitude of this disaster. These included medication shortages, extended loss of power, and limited telecommunications for contacting prescribers, disaster relief agencies, and third-party payers. Ultimately, the lack of preexisting emergency protocols made overcoming such barriers difficult. As the first and sometimes only accessible health care provider to many patients following a natural disaster, we must build a solid evidence base and better understanding of the individual, interpersonal, and environmental factors that contribute to the community pharmacist response. To date, however, a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster. Future research must focus on these multi-level factors to better inform public policy and effective disaster planning. Ultimately, such research and planning will lead to increased resiliency in our primary health care systems in the face of future disasters.

Abstract NS5: Use of a Multidisciplinary Approach to Successfully Improve Inpatient Diabetes Self-Management Education and Diabetes Medication Reconciliation at Discharge for Persons With Diabetes and Stroke at a Major Academic Medical Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Suzanne Stone ◽  
Nancy Drobycki ◽  
Mark Johnson
Keyword(s):  
Medication Reconciliation ◽  
Medical Center ◽  
Diabetes Education ◽  
Academic Medical Center ◽  
Blood Pressure Reduction ◽  
Diabetes Medication ◽  
Effective Discharge ◽  
Inpatient Diabetes ◽  
Patients With Diabetes

Background: Persons with diabetes are 1.5 times more likely to have a stroke. Research shows that there is a correlation between increasing diabetes and stroke. Education for stroke patients, however, continues to focus on medication management and blood pressure reduction. American Diabetes Association indicates, “There should be a structured discharge plan tailored to the individual patient with diabetes.” Transitioning from the acute care is risky for diabetics, recommendations now include individualized education for diabetics with stroke. 40% of the stroke population at our institution showed risk factors for diabetes, yet 11% received diabetes education, and only 59% had diabetes medication pre-prescribed at discharge. The stroke team initiated an inpatient diabetes education to increase patient awareness and medication adherence. Purpose: The purpose of this project was to identify and address barriers related to the provision of individualized inpatient diabetes education and outpatient diabetes medication reconciliation for persons with diabetes and stroke. Method: The Endocrinology team was consulted for patients with diabetes and stroke with an A1c level of 7%. These team worked collaboratively to establish a consult process. Endocrinology APPs provided diabetic education and advised the Neurology team on the appropriate discharge medication regimen and follow-up. The stroke coordinator provided reminders during rounds to assure that consults were ordered for patients with diabetes having A1c 7% or greater. Results: Inpatient diabetes education improved from 11% in 2017 to 96% in 2019. Diabetes medication reconciliation, with listing of diabetes medications on the after visit summary at discharge increased from 59% in 2017 to 93% in 2019. Conclusions: Both metrics reflect improvement over a 2-year period, showing that collaboration between the Endocrinology and Neurology teams is key to effective discharge planning, diabetes medication reconciliation and outpatient follow-up.

scholarly journals Abdominal pain: a survey of clinically important outcomes for future research

CJEM ◽  
2010 ◽  
Vol 12 (06) ◽  
pp. 485-490 ◽  
Author(s):  
Angela M. Mills ◽  
Anthony J. Dean ◽  
Judd E. Hollander ◽  
Esther H. Chen
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Future Research ◽  
Original Research ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Clinically Significant

ABSTRACT Objective: We aimed to use the consensus opinion of a group of expert emergency physicians to derive a set of emergency diagnoses for acute abdominal pain that might be used as clinically significant outcomes for future research. Methods: We conducted a cross-sectional survey of a convenience sample of emergency physicians with expertise in abdominal pain. These experts were authors of textbook chapters, peer-reviewed original research with a focus on abdominal pain or widely published clinical guidelines. Respondents were asked to categorize 50 possible diagnoses of acute abdominal pain into 1 of 3 categories: 1) unacceptable not to diagnose on the first emergency department (ED) visit; 2) although optimal to diagnose on first visit, failure to diagnose would not be expected to have serious adverse consequences provided the patient had follow-up within the next 2–7 days; 3) if not diagnosed during the first visit, unlikely to cause long-term risk to the patient provided the patient had follow-up within the next 1–2 months. Standard descriptive statistical analysis was used to summarize survey data. Results: Thirty emergency physicians completed the survey. Of 50 total diagnoses, 16 were categorized as “unacceptable not to diagnose in the ED” with greater than 85% agreement, and 12 were categorized as “acceptable not to diagnose in the ED” with greater than 85% agreement. Conclusion: Our study identifies a set of abdominal pain conditions considered by expert emergency physicians to be clinically important to diagnose during the initial ED visit. These diseases may be used as “clinically significant” outcomes for future research on abdominal pain.

An evaluation of the CARES® Dementia Basics Program among caregivers

2016 ◽  
Vol 29 (1) ◽  
pp. 45-56 ◽  
Author(s):  
Michelle L. Pleasant ◽  
Victor Molinari ◽  
John V. Hobday ◽  
Sam Fazio ◽  
Nancy Cullen ◽  
...  
Keyword(s):  
Educational Interventions ◽  
Future Research ◽  
Correct Identification ◽  
Dementia Caregivers ◽  
Convenience Sample ◽  
Formal Caregivers ◽  
Care Partners ◽  
Post Test ◽  
Centered Care

ABSTRACTBackground:In 2014, the state of Oregon established Oregon Care Partners to provide high quality, free training to all dementia caregivers. This study evaluated participants’ changes in knowledge, sense of competency in dementia caregiving, and ability to identify person-centered caregiving techniques after completing CARES® Dementia Basics online program, one of the educational resources available through this initiative.Methods:A convenience sample of informal and formal caregivers (N = 51) provided data at three points in time; pre-test, post-test, and a follow-up test after an additional 30-day period to determine sustained changes in knowledge, sense of competency, and person-centered care.Results:From pre-test to post-test, modest improvements were detected in sense of competence in performing dementia care (ps < 0.01) and dementia-based knowledge, F(2, 150) = 7.71, p < 0.001, a multivariate effect size of w2 = 0.09. Even though improvements in sense of competency were not universal, three out of five individual items demonstrated positive growth from pre-test to post-test as well as four out of the five items from pre-test to follow-up test. Importantly, gains observed in dementia-based knowledge from pre-test to post-test were largely maintained at the 30-day follow-up. No significant changes were found in the correct identification of person-centered techniques after the training F(5, 150) = 1.63, p = 0.19.Conclusions:Future research should investigate how best to maintain educational interventions within the caregiving environment and to assess subsequent skill change.

Moving Diabetes Management From Clinic to Community: Development of a Prototype Based on Automated Voice Messaging

1997 ◽  
Vol 23 (6) ◽  
pp. 672-680 ◽  
Author(s):  
John D. Piette
Keyword(s):  
Patient Monitoring ◽  
Diabetes Management ◽  
Diabetes Education ◽  
Public Healthcare ◽  
Management Service ◽  
Randomized Controlled ◽  
Voice Messaging ◽  
Patients With Diabetes

The purpose of this study is twofold. First, it provides a review of the literature supporting the development of a new service to help patients with diabetes and their providers manage their care. This service, automated voice messaging (A VM) with nurse follow-up, allows for systematic and intensive patient monitoring and diabetes education as well as a means of focusing clinical resources where they are most needed. Second, it provides a description of a prototype AVM-based diabetes management service that has been developed as part of two ongoing, randomized, controlled trials to test the efficacy of AVM care for patients with Type 2 diabetes. Preliminary findings from implementing this service in two large public healthcare systems suggest that AVM-supported care is feasible, desirable by clinicians and patients with diabetes, and may identify serious health problems that otherwise would go unnoted through standard means of clinic-based patient care.

scholarly journals Community Pharmacist Telephonic Medication Reviews with Uncontrolled Asthma Patients: A Pilot Study

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 25
Author(s):  
Kathryn A. Hartley ◽  
Kendall D. Guthrie ◽  
Steven C. Stoner ◽  
Justin R. May ◽  
D. Matthew Hartwig ◽  
...  
Keyword(s):  
Symptom Control ◽  
Persistent Asthma ◽  
Community Pharmacists ◽  
Primary Care Providers ◽  
Care Providers ◽  
Uncontrolled Asthma ◽  
Exact Test ◽  
National Quality ◽  
Medication Reviews

This study reports the process of telephonic medication reviews conducted by community pharmacists for patients with asthma. The study occurred at an independent community chain in association with a Missouri Medicaid consulting group. Participants were identified utilizing claims data and met the National Quality Forum criteria for uncontrolled moderate-to-severe persistent asthma. A pharmacist performed the initial encounter via telephone which included a knowledge questionnaire, symptom control assessment, and medication review. Pharmacists identified drug-related problems (DRPs) and faxed recommendations to patients’ primary care providers (PCPs). Thirty days later, pharmacists called to follow up with the patients and faxed PCPs to resolve any outstanding DRPs, new DRPs, or recommendations. Questionnaire scores and symptom control assessments were compared and analyzed utilizing a paired t-test, Chi-squared test, or Fisher’s exact test. The number and categories of DRPs, recommendations made by pharmacists, and intervention time were reported. Fourteen participants completed initial encounters with twelve completing follow-up. The majority answered ‘yes’ to at least one symptom control assessment question indicating partially controlled to uncontrolled asthma. The average knowledge assessment score was 5.17 out of 7 initially and 5.42 for the follow-up. Pharmacists identified 43 DRPs and made 41 recommendations with a mean intervention time of 65 min.

scholarly journals Community pharmacist perceptions of clinical medication reviews

2010 ◽  
Vol 2 (3) ◽  
pp. 234 ◽  
Author(s):  
Linda Bryant ◽  
Gregor Coster ◽  
Ross McCormick
Keyword(s):  
Community Pharmacy ◽  
Community Pharmacist ◽  
Health Care Services ◽  
Community Pharmacists ◽  
Utilization Review ◽  
Routine Practice ◽  
Structured Interviews ◽  
Traditional Role ◽  
Plan Implementation ◽  
Medication Reviews

INTRODUCTION: Changes in delivery of health care services has led to pressure for community pharmacists to extend their traditional role and become more involved with patient-focussed services such as medication reviews, in collaboration with general practitioners (GPs). This has not been generally implemented into routine practice, and many barriers have been suggested that inhibit community pharmacists extending their role. These have often focussed on physical or functional barriers. This study explores possible attitudinal factors that prevent increased participation of community pharmacists in medication reviews undertaken in collaboration with GPs. METHODS: Twenty community pharmacist participants who participated in the General Practitioner– Pharmacist Collaboration (GPPC) study were interviewed. The GPPC study investigated the outcomes of community pharmacists undertaking a clinical medication review in collaboration with GPs, and the potential barriers. Semi-structured interviews were analysed using a general inductive thematic approach. FINDINGS: Emerging themes were that community pharmacists perceived that they were not mandated to undertake this role, it was not a legitimate role, particularly from the business perceptive, and pharmacists were concerned that they lacked the skills and confidence to provide this level of input. CONCLUSION: While there is concern that community pharmacists’ skills are underutilised, there are probable attitudinal barriers inhibiting pharmacists from increasing their role in clinical medication reviews. Perceived legitimacy of the service was a dominant theme, which appeared to be related to issues in the business model. Further investigation should consider the use of a clinical pharmacist working within a general practice independent of a community pharmacy. KEYWORDS: Community pharmacy services; drug utilization review; primary healthcare; health plan implementation

Community Pharmacist Preferences in Transition of Care Communications

2018 ◽  
Vol 32 (5) ◽  
pp. 524-528 ◽  
Author(s):  
Mackenzie A. Dolan ◽  
Chelsea P. Renfro ◽  
Stefanie P. Ferreri ◽  
Betsy B. Shilliday ◽  
Timothy J. Ives ◽  
...  
Keyword(s):  
Community Pharmacy ◽  
Health Care Providers ◽  
Community Pharmacist ◽  
Community Pharmacists ◽  
Cross Sectional Study ◽  
Study Data ◽  
Future Research ◽  
Transition Of Care ◽  
Care Providers ◽  
Cross Sectional

Objective: To determine community pharmacist preferences in transition of care (TOC) communications. Methods: In this cross-sectional study, data were gathered via electronic survey of community pharmacists regarding their preferences for TOC communications. The survey was distributed via email by the North Carolina Board of Pharmacy. Results were analyzed using descriptive statistics. Results: Survey responses were received from 343 community pharmacists (response rate = 6.1%). Responders most commonly worked in an independent, single store (29.2%, n = 100) or national chain (29.2%, n = 100) pharmacy setting. Preferred method for a TOC communication was via electronic health record (63.0%, n = 184). Preferred TOC communication content are mentioned as follows: active (93.2%, n = 274) and discontinued (86.4%, n = 254) medications and reason for hospitalization (85.0%, n = 250). The top 3 self-identified barriers to utilizing a TOC communication: lack of care coordination with community pharmacy (35.0%, n = 14), lack of support from other health-care providers (22.5%, n = 9), and absence of compensation for providing the service (17.5%, n = 7). When asked if TOC communications were available, 97.5% (n = 278) indicated it would be useful. Conclusion: Community pharmacists acknowledged a need for TOC communications and shared their preferences in the content and method of communication. Future research is warranted to implement TOC communications between a health system and community pharmacy.

scholarly journals 861. Impact of COVID-19 Mitigation Measures on PrEP Care at a Safety Net Health System in Atlanta

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S522-S522
Author(s):  
Valeria D Cantos ◽  
Kate Ferencsik ◽  
Jennifer Prevot ◽  
Kelly Reyna ◽  
Gabriela Georgial ◽  
...  
Keyword(s):  
Health System ◽  
Laboratory Testing ◽  
Safety Net ◽  
Mitigation Measures ◽  
Future Research ◽  
Cross Sectional ◽  
Convenience Sample ◽  
The Impact ◽  
Urban Clinic

Abstract Background The Grady Health System pre-exposure prophylaxis (PrEP) program modified its care practices to accommodate COVID-19 mitigation measures. Changes enacted included: transition to telemedicine visits, medication mail delivery, and flexible timing of quarterly laboratory testing. These were implemented in March 2020 and remain in place presently. This study aimed to evaluate patients’ long-term acceptability of these modifications and to assess their impact on PrEP care. Methods This was a cross-sectional study in a convenience sample of PrEP patients, ages 18 and older, at an urban clinic in Atlanta. They were invited to complete a survey between December 2020 and April 2021. The survey assessed the impact of mitigation measures on overall PrEP care, follow up visits, medication access, and ability to complete laboratory testing. It also evaluated the usability, quality, satisfaction, and concerns with telemedicine. Data were examined using median and interquartile ranges, and proportions. Results Of 145 patients contacted, 61 completed the survey (median age 33 years, 72% Black, 75% cisgender men, 15% transgender women). Most participants did not report interruptions in their PrEP care (72%) or follow up visits (74%). Most found it easy to access medications (82%), as participants’ report of medication mail delivery usage increased from 57% (pre-pandemic) to 73% (in-pandemic period). Interruptions in completing quarterly labs were more frequently reported, as only 62% found this to be easy. Overall, 89% reported using telemedicine; telephone call was the most used method (78%). Telemedicine users’ ratings for quality, usability, and satisfaction of telemedicine was high (median score: 6/7) and nearly all users (97%) reported no concerns about its continued use for PrEP care. A few participants (5%) raised concerns about loss of telephone services due to financial issues, impacting their ability to complete telemedicine visits. Conclusion PrEP care at an urban clinic was well- maintained despite COVID-19 mitigation measures. Telemedicine was found to be acceptable and usable by surveyed participants. Future research on widescale implementation of telemedicine for PrEP care is needed Disclosures All Authors: No reported disclosures

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