Evolution, Current Structure, and Role of a Primary Care Clinical Pharmacy Service in an Integrated Managed Care Organization

2013 ◽  
Vol 47 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Rachel MF Heilmann ◽  
Stephanie M Campbell ◽  
Beverly A Kroner ◽  
Jenel R Proksel ◽  
Sarah J Billups ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Pharmacy ◽  
Primary Care Physicians ◽  
Vital Role ◽  
Clinical Pharmacy Service ◽  
Care Organization ◽  
Full Time ◽  
Current Structure ◽  
The Impact

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

scholarly journals The Role of Primary Care in a Pandemic: Reflections During the COVID-19 Pandemic in Canada

2020 ◽  
Vol 11 ◽  
pp. 215013272096287
Author(s):  
Joanne Kearon ◽  
Cathy Risdon
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Vital Role ◽  
Surge Capacity ◽  
Hospital System ◽  
Effective Implementation ◽  
Health Measures ◽  
Second Wave ◽  
Specific Barriers

As COVID-19 cases began to rise in Ontario, Canada, in March 2020, increasing surge capacity in hospitals and intensive care units became a large focus of preparations. As part of these preparations, primary care physicians were ready to be redeployed to the hospitals. However, due to the effective implementation of community-wide public health measures, the hospital system was not overwhelmed. As Ontario prepares now for a potential second wave of COVID-19, primary care physicians have an opportunity to consider the full breadth and depth of scope for primary care during a pandemic. From planning to surveillance to vaccination, primary care physicians are positioned to play a unique and vital role in a pandemic. Nevertheless, there are specific barriers that will need to be overcome.

The Role of Clinical Pharmacy in Preventing Prescribing Errors in the Emergency Department of a Governmental Hospital in Jordan: A Pre-Post Study

2020 ◽  
pp. 001857872094223 ◽  
Author(s):  
Derar H. Abdel-Qader ◽  
Najlaa Saadi Ismael ◽  
Ahmad Z. Al Meslamani ◽  
Abdullah Albassam ◽  
Asma’ A. El-Shara’ ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Pharmacy ◽  
Active Phase ◽  
Vital Role ◽  
Prescribing Errors ◽  
Clinical Pharmacists ◽  
Spss Software ◽  
The Impact ◽  
Error Types

Background: Clinical pharmacists have a vital role in intercepting prescribing errors (PEs) but their impact within a Jordanian hospital emergency department (ED) has never been studied. Objective: To evaluate the impact of clinical pharmacy services on PEs and assess predictors of physicians’ acceptance of clinical pharmacists’ interventions. Setting: This study was conducted in the ED of the largest governmental hospital in Jordan. Method: This was a pre-post study conducted in October and November 2019 using a disguised observational method. There were 2 phases: control phase (P0) with no clinical interventions, and active phase (P1) where clinical pharmacists prospectively intervened upon errors. The clinical significance of errors was determined by a multidisciplinary committee. The SPSS software version 24 was used for data analysis. Main Outcome Measure: PEs incidence, type, severity, and predictors for physicians’ acceptance. Results: Of 18003 patients, 8732 were included in P0 and 9271 in P1. PEs incidence decreased from 24.6% to 5.4%. Contraindication, drug selection, and dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0) to 12.6%, 0.0%, and 0.0% (P1), respectively. Albeit not statistically significant, drug-drug interaction, drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively. Significant and serious errors were significantly reduced from 68.7% and 3.0% (P0) to 8.9% and 1.8% (P1), respectively. During P1, most errors were minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians’ acceptance were: significant errors (OR 3.1; 95% CI 2.6-4.3; P = 0.03) and non-busy physicians (OR 2.1; 95% CI 1.6-2.7; P = 0.04). Conclusion: Clinical pharmacists significantly reduced PEs in the ED by 76%; most of interventions were significant. Policymakers are advised to implement active clinical pharmacy in the ED.

Understanding the Role of Primary Care Physicians in Managing ADHD

2007 ◽  
Author(s):  
Thomas J. Power ◽  
Nathan J. Blum ◽  
Jennifer A. Mautone ◽  
Patricia H. Manz ◽  
Leslee Frye
Keyword(s):  
Primary Care ◽  
Primary Care Physicians

Corporal Punishment

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 792-793
Author(s):  
Den A. Trumbull ◽  
DuBose Ravenel ◽  
David Larson
Keyword(s):  
United States ◽  
Primary Care ◽  
Social Policy ◽  
Violence Prevention ◽  
Corporal Punishment ◽  
Primary Care Physicians ◽  
Scientific Evidence ◽  
The United States

The supplement to Pediatrics entitled "The Role of the Pediatrician in Violence Prevention" is timely, given the increasingly serious violence problem in the United States.1 Many of the supplement's recommendations are well-conceived and developed. However, the recommendation to "work toward the ultimate goal of ending corporal punishment in homes" (page 580)2 is unwarranted and counterproductive. Before one advises against a practice approved by 88% of American parents3 and supported by 67% of primary care physicians,4 there should be sufficient scientific evidence to support the proposed change in social policy.

The impact of a program to enhance the competencies of primary care physicians in caring for patients with AIDS

1986 ◽  
Vol 1 (5) ◽  
pp. 287-294 ◽  
Author(s):  
Charles E. Lewis ◽  
Howard E. Freeman ◽  
Sherrie H. Kaplan ◽  
Christopher R. Corey
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
The Impact

scholarly journals The Role of the Primary-Care Physician in Treating Relapses in Multiple Sclerosis Patients

2009 ◽  
Vol 11 (3) ◽  
pp. 122-126 ◽  
Author(s):  
Sarah A. Morrow ◽  
Marcelo Kremenchutzky
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Tertiary Care ◽  
Care Physician ◽  
Diagnosis And Treatment ◽  
High Prevalence ◽  
Tertiary Care Centers ◽  
Multiple Sclerosis Patients

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.

scholarly journals Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan

2020 ◽  
Vol 52 (6) ◽  
pp. 417-421
Author(s):  
Ian Nelligan ◽  
Tamara Montacute ◽  
Michael-Anne Browne ◽  
Steven Lin
Keyword(s):  
Family Medicine ◽  
Health Plan ◽  
Average Cost ◽  
Primary Care Physicians ◽  
Health Spending ◽  
Cost Of Care ◽  
Care Organization ◽  
Data Set ◽  
The Impact ◽  
Minor Procedure

Background and Objectives: Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians. Methods: We examined claims data for procedures performed on patients insured under our AMC’s home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI). Results: Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33. Conclusion: A family medicine minor procedure service significantly lowered health spending at our AMC.

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