scholarly journals A Qualitative Dual-Site Analysis of The Pharmacist Discharge Care (PHARM-DC) Intervention Using The CFIR Framework

2021 ◽  
Author(s):  
Logan Thomas Murry ◽  
Korey Kennelty ◽  
Michelle Keller ◽  
Joshua Pevnick ◽  
Jeffrey Schnipper
Keyword(s):  
Focus Group ◽  
Qualitative Analysis ◽  
Hospital Readmissions ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Structured Interviews ◽  
Administrative Roles ◽  
Team Members ◽  
Discharge Care ◽  
Study Team

Abstract Introduction: Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention.Methods: Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding.Results: In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention.Conclusion: The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability.

scholarly journals ADVANCED FORENSIC METHODS TO DETECT FRAUD

2021 ◽  
pp. 66-73
Author(s):  
Julija Liodorova ◽  
Irina Voronova ◽  
Ruta Shneidere
Keyword(s):  
Focus Group ◽  
Qualitative Analysis ◽  
Mathematical Models ◽  
Fraud Detection ◽  
Financial Statements ◽  
Structured Interviews ◽  
Forensic Accounting ◽  
Fraudulent Financial Statements

The aim of the article is to study forensic accounting methods to detect fraud in financial statements. A taxonomy of forensic analytics methods is proposed and a generalization of seven mathematical models for detecting fraud recommended by forensic accounting experts and practitioners is provided, allowing for the detection of fraudulent financial statements before it is too late. The authors’ qualitative analysis of evaluating fraud detection models is based on data from semi-structured interviews conducted in the focus group of forensic accountants, investigators, and prosecutors.

scholarly journals Addressing COVID-19 Barriers to Clinical Trial Enrollment and Implementation in the PHARM-DC Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 104-104
Author(s):  
Joshua Pevnick ◽  
Michelle Keller ◽  
Korey Kennelty ◽  
Michelle Ko ◽  
Logan Murry ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Controlled Trial ◽  
Hospital Readmissions ◽  
Phone Call ◽  
Patient Counseling ◽  
Structured Interviews ◽  
Post Discharge ◽  
Discharge Care ◽  
Study Participants

Abstract Recent hospitalization puts older adults at higher risk of experiencing adverse drug events (ADEs) that are a common cause of hospital readmission. Yet, most ADEs are preventable. The PHARMacist Discharge Care (PHARM-DC) study is a multi-site randomized controlled trial that seeks to evaluate the effect of pharmacist-led peri- and post-discharge interventions on 30-day hospital readmissions among older adults taking ≥10 medications or ≥3 high-risk medications. The PHARM-DC intervention includes pharmacist-led patient counseling, medication reconciliation at discharge, and a follow-up phone call post-discharge. We will highlight study protocol adaptations undertaken during the COVID-19 pandemic to address challenges to enrollment and to minimize risk of COVID-19 exposure for study participants and research personnel. Additionally, we will share insights from focus groups and semi-structured interviews with pharmacist interventionists and pharmacy leaders on barriers and facilitators to implementation due to the pandemic and strategies for future clinical trials to overcome barriers.

Impact of discharge medication bedside delivery service on hospital reutilization

2019 ◽  
Vol 76 (23) ◽  
pp. 1951-1957 ◽  
Author(s):  
Avni Patel ◽  
Melanie A Dodd ◽  
Richard D'Angio ◽  
Robert Hellinga ◽  
Ali Ahmed ◽  
...  
Keyword(s):  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Group Versus ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Group ◽  
Day Hospital ◽  
Index Visit ◽  
Significant Difference ◽  
The Impact

Abstract Purpose To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. Methods A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. Results A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45–1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. Conclusion There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.

scholarly journals Implementing post-discharge care following acute kidney injury in England: a single-centre qualitative evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036077 ◽  
Author(s):  
Rebecca Elvey ◽  
Susan J Howard ◽  
Anne-Marie Martindale ◽  
Thomas Blakeman
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Transitions Of Care ◽  
Clinical Expertise ◽  
Structured Interviews ◽  
Post Discharge ◽  
Factors Influencing ◽  
Discharge Care ◽  
Discharge Summaries

ObjectivesWe sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI).DesignQualitative study using semi-structured interviews and thematic analysis.SettingGeneral practices in one Clinical Commissioning Group area in England.ParticipantsA total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention.ResultsWe identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists’ roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care.ConclusionsThe research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations.

A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana

2020 ◽  
pp. 105566562095999
Author(s):  
Chelsea L. Sommer ◽  
Ali P. Wankier ◽  
Solomon Obiri-Yeboah ◽  
Seth Gyamfi ◽  
Barbara Amponsah Frimpong ◽  
...  
Keyword(s):  
Focus Group ◽  
Qualitative Analysis ◽  
Qualitative Methods ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cultural Beliefs ◽  
Barriers And Facilitators ◽  
Medical Professionals ◽  
Team Members ◽  
Semistructured Interviews

Objective: The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa. Design: Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members. Setting: A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital. Participants: Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana. Interventions: Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care. Results: Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2. Conclusions: Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.

Navigating medically complex patients through system barriers: Patients’ perspectives on care coordination

2018 ◽  
Vol 21 (4) ◽  
pp. 160-169 ◽  
Author(s):  
Monica Siañez ◽  
Cara Pennel ◽  
Loida Tamayo ◽  
Rebecca Wells
Keyword(s):  
Social Support ◽  
Focus Group ◽  
Care Coordination ◽  
Structured Interviews ◽  
Case Study Methodology ◽  
Program Administrators ◽  
Medical Needs ◽  
Study Team ◽  
Health Related ◽  
Care Coordinators

Introduction Care coordination can improve healthcare quality and reduce costs. The objective of this study was to provide a qualitative understanding of the most helpful coordination services as experienced by patients receiving these services to reduce emergent hospital use. Methods Using case study methodology, we conducted focus group conversations with 51 care coordination patients and semi-structured interviews with 29 care coordinators at nine sites throughout Texas. The study team performed constant comparative analysis, beginning with start codes based on prior research. Results On average, focus group participants were 47 years old. The majority of participants reported a high school or General Equivalency Diploma level of education or less (84%), an annual income less than $14,999 (87%), and living with multiple chronic health conditions (60%). The majority (85%) of care coordinators reported backgrounds in nursing or social work. In our analysis, themes of what patients found most helpful fell under a broad social support framework (instrumental, informational, emotional, and advocacy) that care coordinators were uniquely situated to provide. Discussion Our paper adds to existing evidence by providing perspectives of patients with complex medical and non-medical needs about which care coordination services are most helpful. In this sample, patients with high needs describe reliance on professional sources, rather than their own social networks, to address several aspects of social support and to help meet non-health-related, as well as health-related needs. This can inform providers’ approaches to treatment as well as program administrators’ decisions about addressing and prioritizing services in care coordination programs.

A design contribution to the entrepreneurial experience

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Juan David ROLDAN ACEVEDO ◽  
Ida TELALBASIC
Keyword(s):  
Product Development ◽  
Qualitative Analysis ◽  
Design Research ◽  
Recent Literature ◽  
Early Stage ◽  
Entrepreneurial Activity ◽  
Value Proposition ◽  
Structured Interviews ◽  
User Centric ◽  
Constant Growth

In recent history, different design approaches have been entering fields like management and strategy to improve product development and service delivery. Specifically, entrepreneurship has adopted a user-centric mindset in methodologies like the business canvas model and the value proposition canvas which increases the awareness of the users’ needs when developing solutions. What happens when a service design approach is used to understand the entrepreneurs’ experience through the creation of their startups? Recent literature suggests that entrepreneurial activity and success is conditioned by their local entrepreneurship ecosystem. This study investigates the Entrepreneurship Ecosystem of Medellín, Colombia - an ecosystem in constant growth but that lacks qualitative analysis. The sample consists of 12 entrepreneurs in early-stage phase. The data was gathered with two design research methods: Cultural Probes and Semi-structured interviews. The analysis of the information collected facilitated the development of 4 insights about the entrepreneurs and an experience map to visualise and interpret their journey to create a startup. The results of this study reflected the implications of the ecosystem, the explanation of the users’ perceptions and awareness and propose a set of ideas to the local government to improve the experience of undertaking a startup in Medellín.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

Prescription in Locker Box (PILBOX): Remodeling of the Medication Collection Process (Preprint)

2020 ◽  
Author(s):  
Lim Jit Fan Christina ◽  
Goh Boon Kwang ◽  
Chee Wing Ling Vivian ◽  
Tang Woh Peng ◽  
Goh Qiuling Bandy
Keyword(s):  
Cross Sectional Study ◽  
Ease Of Use ◽  
Prescription Medications ◽  
Pharmacy Staff ◽  
Cross Sectional ◽  
Team Members ◽  
Face To Face ◽  
Ranking Score ◽  
Study Team ◽  
Willingness To Use

BACKGROUND Traditionally, patients wishing to obtain their prescription medications have had to present themselves physically at pharmacy counters and collect their medications via face-to-face interactions with pharmacy staff. Prescription in Locker Box (PILBOX) is a new innovation which allows patients and their caregivers to collect their medication asynchronously, 24/7 at their convenience, from medication lockers instead of from pharmacy staff and at any time convenient to them instead of being restricted to pharmacy operating hours. OBJECTIVE This study aimed to determine the willingness by patients/caregivers to use this new innovation and factors that affect their willingness. METHODS This prospective cross-sectional study was conducted over 2 months at 2 public primary healthcare centres in Singapore. Patients or caregivers who were at least 21 yo and turned up at the pharmacies to collect medications were administered a self-developed 3-part questionnaire face-to-face by trained study team members, if they gave their consent to participate in the study. RESULTS A total of 222 participants completed the study. About 40% of them participants were willing to use the PILBOX to collect their medications. Amongst the participants who were keen to use the PILBOX service, slightly more than half (i.e. 52.8%) of them were willing to pay for the PILBOX service. The participants felt that the ease of use (3.46±1.21 i.e. mean of ranking score ± standard deviation) of the PILBOX was the most important factor that would affect their willingness to use the medication pick up service. This was followed by “waiting time” (3.37±1.33), cost of using the medication pick up service (2.96±1.44) and 24/7 accessibility (2.62±1.35). This study also found that age (p=0.006), language literacy (p=0.000), education level (p=0.000), working status (p=0.011) and personal monthly income (p=0.009) were factors that affected the willingness of the patients or caregivers to use the PILBOX. CONCLUSIONS Patients and caregivers are keen to use PILBOX to collect their medications for its convenience and the opportunity to save time, if it is easy to use and not costly.

scholarly journals 1326. Vancomycin Area Under the Concentration-Time Curve (AUC) Estimation Using a Bayesian Approach Versus First-Order Pharmacokinetic Equations: A Pilot Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S673-S673
Author(s):  
Jeffrey Pearson ◽  
Yazed S Alsowaida ◽  
B S Pharm ◽  
David W Kubiak ◽  
Mary P Kovacevic ◽  
...  
Keyword(s):  
Pilot Study ◽  
Median Time ◽  
Bayesian Modeling ◽  
Surgical Prophylaxis ◽  
Time Curve ◽  
Team Members ◽  
First Order ◽  
Concentration Time ◽  
Study Team ◽  
Auc Estimation

Abstract Background Current guidelines endorse area under the concentration-time curve (AUC)-based monitoring over trough-only monitoring for systemic vancomycin. Vancomycin AUC can be estimated using either Bayesian modeling software or first-order pharmacokinetic (PK) calculations. The objective of this pilot study was to evaluate and compare the efficiency and feasibility of these two approaches for calculating the estimated vancomycin AUC. Methods A single-center crossover study was conducted in four medical/surgical units at Brigham and Women’s Hospital over a 3-month time period. All adult patients who received vancomycin were included. Patients were excluded if they were receiving vancomycin for surgical prophylaxis, were on hemodialysis, if vancomycin was being dosed by level, or if vancomycin levels were never drawn. The primary endpoint was the amount of time study team members spent calculating the estimated AUC and determining regimen adjustments with Bayesian modeling compared to first-order PK calculations. Secondary endpoints included the number of vancomycin levels drawn and the percent of those drawn that were usable for AUC calculations. Results One hundred twenty-four patients received vancomycin during the study, of whom 47 met inclusion criteria. The most likely reasons for exclusion were receiving vancomycin for surgical prophylaxis (n=40) or never having vancomycin levels drawn (n=32). The median time taken to assess levels in the Bayesian arm was 9.3 minutes [interquartile range (IQR) 7.8-12.4] versus 6.8 minutes (IQR 4.8-8.0) in the 2-level PK arm (p=0.004). However, if Bayesian software is integrated into the electronic health record (EHR), the median time to assess levels was 3.8 minutes (IQR 2.3-6.8, p=0.019). In the Bayesian arm, 30 of 34 vancomycin levels (88.2%) were usable for AUC calculations, compared to 28 of 58 (48.3%) in the 2-level PK arm. Conclusion With EHR integration, the use of Bayesian software to calculate the AUC was more efficient than first-order PK calculations. Additionally, vancomycin levels were more likely to be usable in the Bayesian arm, thereby avoiding delays in estimating the vancomycin AUC. Disclosures All Authors: No reported disclosures

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