The Impact of Face-to-Face Pharmacist Transitional Care Management Visits on Medication-Related Problems

2020 ◽  
Vol 36 (3) ◽  
pp. 95-101
Author(s):  
Bianca Mayzel ◽  
Sandra Axtell ◽  
Carolyn Richardson ◽  
Nicholas Link
Keyword(s):  
Readmission Rate ◽  
Medication Reconciliation ◽  
Transitional Care ◽  
Retrospective Chart Review ◽  
Optimization Methods ◽  
Related Factor ◽  
Prospective Group ◽  
The Difference ◽  
Internal Medicine Clinic ◽  
The Impact

Background: Studies are needed to evaluate medication-related problems (MRPs) to assess the effect of a pharmacist on managing medications postdischarge. Objective: To assess the ability of pharmacist-led medication review and reconciliation to reduce the number of MRPs found in transitional care medicine (TCM) visits, leading to medication optimization. Methods: This study involved a retrospective chart review of standard TCM procedure at a family/internal medicine clinic and a prospective, team-based TCM visit in the same clinic. Inclusion criteria included patients discharged from any hospital within our institution and seen in the clinic. The primary outcome was the difference in the proportion of MRPs found between the prospective and retrospective groups. Secondary outcomes included the number and specific type of MRPs found, classified by the Pharmaceutical Care Network Europe tool, and further subdivided by patient aware or unaware of MRP, only in the prospective group, as well as 30-day readmission rate. Results: Patients in the prospective group (n = 50) had an average age of 67.9 years versus 65.5 years in the retrospective group (n = 50). Four times as many patients in the prospective group were found to have MRPs than the retrospective group. The most common MRP was due to a patient-related factor, meaning the cause is related to a patient’s behavior. Patients were unaware of the MRP in a majority of these cases. Thirty-day readmission rate did not differ between the groups. Conclusion: Team-based TCM visits that included a pharmacist-led medication reconciliation uncovered more MRPs than patients who did not have a pharmacist perform a medication reconciliation.

scholarly journals Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

2010 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Sarah M. Westberg ◽  
Kathrine Beeksma
Keyword(s):  
Internal Medicine ◽  
Nursing Staff ◽  
Medication Reconciliation ◽  
Future Research ◽  
Original Research ◽  
Educational Initiative ◽  
Medicine Clinic ◽  
Internal Medicine Clinic ◽  
The Impact ◽  
Competency Assessments

Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic. Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation. Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting. Type: Original Research

Impact of weight and creatinine measurements in carboplatin dosing.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13027-e13027 ◽  
Author(s):  
Feriel Boumedien ◽  
Youri Arsenault ◽  
Nathalie LeTarte
Keyword(s):  
Body Weight ◽  
Serum Creatinine ◽  
Actual Body ◽  
Retrospective Chart Review ◽  
Actual Body Weight ◽  
Calculated Dose ◽  
The Difference ◽  
The Impact ◽  
Carboplatin Dose ◽  
Creatinine Measurement

e13027 Background: Controversy surrounding weight in Carboplatin dosing is still current. Also, new methods of measuring serum creatinine have raised more questions regarding the precision of Carboplatin dose calculations. The two objectives of this study were to evaluate the impact of alternative weight indicators (actual and adjusted body weight) in the Cockcroft–Gault equation and the use of different creatinine measurements (standard and IDMS) in order to accurately predict Carboplatin dose. Methods: We performed a retrospective chart review on all patients who received at least one dose of Carboplatin between March 7th and May 8th 2010. The patients were divided into two groups according to their body mass index (BMI): 20 < BMI < 27 and BMI ≥ 27. The differential creatinine clearance and Carboplatin dose were assessed in each group using the actual body weight and the adjusted body weight with IDMS creatinine. Moreover, for patients who had their creatinine measurement at the CHUM hospital, we calculate the difference in Carboplatin dose by using the standard creatinine (SC) measurement and IDMS creatinine with the same weight. Results: A total of 95 patients, representing 119 Carboplatin doses, were included in the analysis. 82% were women and median age was 63. The average BMI was 26,6. The Carboplatin expected AUC was 5 for 89% of patients and Carboplatin was associated to Paclitaxel in 78% of patients. In patients with a 20<BMI< 27 (44%), the average difference between the calculated dose using their actual body weight and adjusted body weight was +6.03% (95% CI, 5.2 to 6.9%). For patients with a BMI ≥ 27 (43%), the mean dose difference was +20.6% (95% CI, 18.8 to 22.5%). The use of SC or IDMS creatinine led to a discrepancy in doses of 5.2% (95% CI, 4.7 to 5.7%) for patients with BMI <27 (35 patients) and 5.5% (95% CI, 4.9 to 6.2%) for those with BMI ≥ 27 (23 patients). Conclusions: Based on these findings, we decide in our clinic, to use the actual body weight for patients with a BMI between 20 and 27, and the adjusted body weight for those with a BMI ≥ 27. We also chose not to modify our doses based on the type of the serum creatinine measurement.

scholarly journals Impact of Clinical Decision Support on Time to Order Resolution for Patients with Documented Allergies

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 80 ◽  
Author(s):  
Tenielle Watkins ◽  
Sandra Aguero ◽  
Michael Jaecks
Keyword(s):  
Median Time ◽  
Medical Information ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Second Shift ◽  
The Difference ◽  
Verification Process ◽  
The Impact ◽  
Third Shift

Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was –21 min (95% CI (confidence interval), –39 to –2.9; p = 0.02). The difference in median time to order resolution for orders, based on pharmacist work shift was, –21 min for the first shift (95% CI, –41.2 to –0.8; p = 0.04), –50 min for the second shift (95% CI, –109.8 to 9.8; p = 0.10), and +3 min for the third shift (95% CI, –36.1 to 30.1; p = 0.85). Orders with an allergy intervention by a pharmacist were 2.75 times more likely (adjusted odds ratio = 2.75; 95% CI, 0.98 to 7.7; p = 0.06) to have a therapy change than orders without allergy interventions. Based on the results, when information about antibiotic allergies lacks details, it takes more time for pharmacists to resolve alerted orders.

scholarly journals Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis

2021 ◽  
Vol 22 (5) ◽  
pp. 1086-1094
Author(s):  
J. Priyanka Vakkalanka ◽  
Ryan` Neuhaus ◽  
Karisa Harland ◽  
Lance Clemsen ◽  
Elaine Himadi ◽  
...  
Keyword(s):  
Social Support ◽  
Emergency Department ◽  
Propensity Score ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Emergency Department Utilization ◽  
Lengths Of Stay ◽  
Mobile Crisis ◽  
The Difference ◽  
The Impact

Introduction: Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization. Methods: We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015–2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score–matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit. Results: The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6–93 days) for the MCO patients and 88 days (IQR: 20–164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27). Conclusion: The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization.

Abstract WP390: Closing the Gap: Integrating Community Paramedics in Stroke Patients Transition to Home

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Susan J Ashcraft ◽  
Laura Post ◽  
Camron Young
Keyword(s):  
Readmission Rate ◽  
Transitional Care ◽  
Care Delivery ◽  
Care Program ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Population ◽  
The Impact

Background and Issues: The transition of stroke patients home is complex. Assessment of functional status and coordination of healthcare and support services while engaging patient and family to be active participants in secondary prevention is essential in preventing stroke recurrence. Readmission rates for stroke patients are also high. Reductions in stroke readmissions must target unresolved problems at discharge and the quality of immediate post-hospital care. Purpose: The purpose of the Community Paramedic program is to reduce stroke readmissions. An additional goal is to identify key areas which may contribute to poor patient outcomes or readmission and develop and implement action plans for their prevention. Methods: Use of a community paramedic transitional care model is an innovative approach to reduce readmissions in the stroke population. Using the Model for Improvement, an interprofessional team developed a transitional care program focusing on patient-centered care delivery, and on reducing readmissions and adverse outcomes. Use of The National Transitions of Care Coalition’s essential interventions categories, the program addressed: medication management, transitional planning, shared accountability, provider engagement, patient and family engagement and education, follow-up care, and information transfer. Results: Despite a 13% increase in stroke patient volume from 2014 to 2015, the program realized a statistically significant reduction in readmission rate (10.7% to 8.51%; p = .045, α =.05) in 2015 and has sustained the reduction through 2016. This reduction represents 21 avoided readmissions in the stroke population with cost avoidance of at least $210,000.00. The decrease in readmission rate is well below both the goal and stretch goals of 5% and 10% reduction in stroke readmissions. Conclusion: The impact of integrating Community Paramedics into a transitional care program coordinated through Stroke Navigators shows a significant impact on reducing 30-day readmissions. Replication in other patient populations and other counties may have a significant impact for both patients and hospitals focused on improving similar outcomes.

Dental Age Difference in Children with ADHD

2018 ◽  
Vol 42 (3) ◽  
pp. 208-211
Author(s):  
Puneet Wadhwa ◽  
Qingzhao Yu ◽  
Han Zhu ◽  
Janice A. Townsend
Keyword(s):  
Retrospective Chart Review ◽  
Control Group ◽  
Age Difference ◽  
Adhd Group ◽  
Dental Age ◽  
Children With Adhd ◽  
Hyperactivity Disorder ◽  
Significant Difference ◽  
The Difference ◽  
The Impact

Objective: The purpose of this study was to determine if changes in dental development are associated with Attention Deficit Hyperactivity Disorder (ADHD) or ADHD medications. Study Design: This retrospective chart review evaluated the dental age of 128 patients between 6 and 16 years of age using the Demirjian method from the following two groups a) children with ADHD b) unaffected children. The ADHD group was further stratified into four groups according to the medication type. The impact of ADHD on dental age difference (the difference between dental age and chronologic age) was analyzed using T-test and the association between medication type and dental age difference was analyzed through one way ANOVA. Results: The mean difference between estimated dental age and chronologic age (dental age difference) for all subjects was 0.80 years. There was no significant dental age difference in subjects with ADHD and the control group (0.78±1.28vs. 0.84 ±1.09 years respectively; P=0.75) and there was no significant difference in dental age difference and type of medication (P=0.84). Conclusion: No significant difference was found between children with ADHD and unaffected children with respect to dental age difference. No significant differences were found in dental age difference in the four medication groups.

scholarly journals 774. A New Outpatient Parenteral Antimicrobial Therapy (OPAT) Management Program Reduces Excess Antimicrobial Days of Therapy and Expedites Timely Central Line Removal

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S344-S344
Author(s):  
Catherine Kidd ◽  
Joshua C Eby ◽  
Tania Thomas ◽  
Megan Shah ◽  
Zachary Elliott ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Management Program ◽  
Close Attention ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Days Of Therapy ◽  
The Difference ◽  
The Impact

Abstract Background Patients discharged on parenteral antimicrobials often require in-person follow-up to determine antimicrobial discontinuation and coordination of central line (CL) removal at the end of therapy. Without close attention to timing of follow-up, antimicrobial courses may be extended beyond a planned end date until scheduled follow-up, leading to excess antimicrobial days of therapy (DOT) and CL retention. Excess DOT can result in increased cost of medication and CL supplies, antimicrobial exposure, and risk of CL-associated bloodstream infections or thrombosis. We sought to assess the impact of the University of Virginia (UVA) OPAT program on excess antimicrobial DOT and excess CL days. Methods This was a retrospective chart review of patients enrolled in the OPAT program at UVA between August 2018 and April 2019. The UVA OPAT program was started in August 2018. Quality improvement (QI) practice changes were implemented in February 2019 for improving follow-up and stopping antimicrobials at the projected end date. Patients were therefore divided into 2 cohorts – August through January 2018 and February through April 2019. Data collected included projected end date of therapy (EOT), actual EOT, actual removal date of CL, and follow-up date. Excess antimicrobial DOT and excess CL days were calculated by the difference in projected vs. actual dates. For continuous data, Student t-test was used. Results 248 patients enrolled in OPAT from August 2018 through April 2019. After implementation of QI efforts, mean time from projected EOT to follow-up appointment decreased from 10.0 days to 4.3 days for those with appointments after projected EOT. Mean excess antimicrobial DOT decreased from 2.8 ± 4.53 SD days to 1.6 ± 2.75 SD days (P = 0.026), and mean excess CL days decreased from 3.2 ± 4.63 SD days to 2.0 ± 2.89 SD days (P = 0.035). Conclusion The involvement of an OPAT program with close attention to outpatient follow-up and cessation of antimicrobials decreased the excess antimicrobial DOT and CL days and reduced variability in care. Reduction in antimicrobial overuse and CL overuse is expected to reduce cost and decrease the risk of medication- and CL-related collateral damage. Disclosures All authors: No reported disclosures.

Abstract 187: Sex-related Differences in Discharge Disposition for STEMI Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
James R Langabeer ◽  
Timothy D Henry ◽  
Raymond Fowler ◽  
Tiffany Champagne-Langabeer ◽  
Alice Jacobs
Keyword(s):  
Transitional Care ◽  
Systems Of Care ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Post Discharge ◽  
Dietary Counseling ◽  
Discharge Disposition ◽  
Rehabilitation Programs ◽  
The Difference ◽  
The Impact

Background: It is known that women with ST-elevation myocardial infarction (STEMI) have higher mortality in comparison to men. While the reasons for this sex-based difference are not completely understood, older age, higher prevalence of risk factors and co-morbid disease and longer time to reperfusion have been implicated. To determine whether the difference in outcomes persist even with an increase in the regional breadth of STEMI systems of care, we evaluated discharge disposition patterns and medications in a mature, multi-hospital cardiovascular network. Methods and Results: Data were drawn from a regional subset of the National Cardiovascular Data Registry for 33 hospitals in and around Dallas County, Texas from 2010 to 2015 (8,725 STEMI patients). We explored the difference between men and women in discharge dispositions (to home or other facility), to cardiac rehabilitation programs, to dietary counseling, as well as prescribed discharge medications. After multivariate controls for confounding factors including age, we found that men were 1.277 times more likely be discharged home than women (92% versus 86%), while women were more likely to be sent to an additional transitional care unit, nursing facility, or other facility. Women were also less likely to be offered dietary modification counseling (71% vs. 67%). Importantly, women were also much less likely to be prescribed Class I medications at discharge, including aspirin, beta blockers, statins, GP IIb/IIA and ACE inhibitors (all p<.001). Conclusions: Women treated for STEMI have notable differences in discharge dispositions patterns following percutaneous coronary intervention discharge. The post-discharge medications and services that women are prescribed needs to be carefully considered to reduce the significant differences in discharge disposition, although more research is needed in order to fully understand the impact of these differences.

scholarly journals Implementing a Standardized Transition Care Plan in Skilled Nursing Facilities

2018 ◽  
Vol 39 (8) ◽  
pp. 855-862 ◽  
Author(s):  
Mark Toles ◽  
Jennifer Leeman ◽  
Cathleen Colón-Emeric ◽  
Laura C. Hanson
Keyword(s):  
Transitional Care ◽  
Retrospective Chart Review ◽  
Skilled Nursing Facilities ◽  
Care Plan ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Transition Care ◽  
Intervention Protocol ◽  
Implementation Tool ◽  
The Impact

Prior studies have not described strategies for implementing transitional care in skilled nursing facilities (SNFs). As part of the Connect-Home study, we pilot tested the Transition Plan of Care (TPOC) template, an implementation tool that SNF staff used to deliver transitional care. A retrospective chart review was used to describe the impact of the TPOC template on three implementation outcomes: reach to patients, staff adoption of the template, and staff fidelity to the intervention protocol for transition care planning. The template reached 100% of eligible patients ( N = 68). Adoption was high, with documentation by four disciplines in 90.6% of patient records ( N = 61). Fidelity to the intervention protocol was moderately high, with 73% of documentation that was concordant with the protocol. Our findings suggest an electronic medical record (EMR)-based implementation tool may increase the ability of staff to prepare older adults and their caregivers for self-care at home. Further research is needed to test the efficacy of the protocol on patient outcomes after transitions from SNF to home.

Evaluation of the impact of public investment programs on social and economic performance of territories

2019 ◽  
pp. 109-123
Author(s):  
I. E. Limonov ◽  
M. V. Nesena
Keyword(s):  
Bayesian Modeling ◽  
Positive Impact ◽  
Public Investment ◽  
Difference In Differences ◽  
The Public ◽  
Export Activity ◽  
Regional Investment ◽  
The Difference ◽  
The Impact ◽  
Development Institution

The purpose of this study is to evaluate the impact of public investment programs on the socio-economic development of territories. As a case, the federal target programs for the development of regions and investment programs of the financial development institution — Vnesheconombank, designed to solve the problems of regional development are considered. The impact of the public interventions were evaluated by the “difference in differences” method using Bayesian modeling. The results of the evaluation suggest the positive impact of federal target programs on the total factor productivity of regions and on innovation; and that regional investment programs of Vnesheconombank are improving the export activity. All of the investments considered are likely to have contributed to the reduction of unemployment, but their implementation has been accompanied by an increase in social inequality.

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