scholarly journals The New Era of Pharmacists in Ambulatory Patient Care

2019 ◽  
Vol 10 (1) ◽  
pp. 4
Author(s):  
AK Mohiuddin

Ambulatory care pharmacy practice is defined as the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management. The ambulatory care pharmacists may work in both an institutional and community-based clinic involved in direct care of a diverse patient population. A variety of specialty clinics are available for allergy and immunology, pulmonology, endocrinology, cardiology, nephrology, neurology, behavioral health, and infectious disease. Such services for this population may exist as a primary care clinic or an independent specialty clinic, typically in a PCMH, which is instrumental in coordinating care between various providers. Once a practice site is identified, it is important to establish a strong, trusting, and mutually beneficial relationship with the various decision-makers (e.g., administrators, providers) involved with the clinic. If pharmacy services are currently in existence, the pharmacy director may be able to identify and initially contact the appropriate person. If another pharmacist is providing clinical services, this person would be a resource to help determine areas for expansion of patient care and to whom to direct the proposed business plan. Additional individuals to consider as an initial point of contact include the clinic manager, clinic medical director, or administrative assistant to either of these persons. If the clinic setting is affiliated with a medical school, it may be necessary to contact the Department of Family Medicine head.   Article Type: Commentary  

2020 ◽  
Vol 42 (6) ◽  
pp. 1480-1489
Author(s):  
Elaine Nguyen ◽  
John T. Holmes ◽  
Radhika Narsinghani ◽  
Shanna O’Connor ◽  
Matthew W. Fuit ◽  
...  

Medical Care ◽  
1980 ◽  
Vol 18 (10) ◽  
pp. 1001-1012 ◽  
Author(s):  
Howard S. Zuckerman ◽  
Jo Anne Huntley ◽  
Keith J. Waterbrook

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 179
Author(s):  
Nicholas Cox ◽  
Bryce Ashby ◽  
Bradly Winter ◽  
Gregory Stoddard ◽  
Joanne LaFleur ◽  
...  

This study assesses the level of agreement on medication therapy problem (MTP) identification and classification between primary care, ambulatory care pharmacists within a health-system that recently implemented system-wide pharmacist provision of comprehensive medication management (CMM) services. Twenty standardized case vignettes were created and distributed to pharmacists who reviewed each case and identified and categorized MTPs. Outcomes include the number of MTPs identified, identification (yes/no) of specific MTPs within each case (e.g., need for a statin), and Pharmacy Quality Alliance (PQA) category used when classifying MTPs. The level of agreement on MTP identification/categorization was measured using intraclass correlation coefficient (ICC) and interpreted using the Landis and Koch interpretation scale. “Moderate agreement” was observed for the number of MTPs identified by pharmacists (ICC equal to 0.45; 95% confidence interval [CI]: 0.31 to 0.65). In approximately one-half of opportunities, the pharmacists agreed perfectly on the number of MTPs; in approximately one-third of opportunities, the number of MTPs identified varied by 1; and approximately one-tenth of the time, the number of MTPs varied by 2. In regard to the MTP identification (yes/no) and categorization, percent agreement was ≥73% across all MTPs. The results support the need for further training and education and provide the information necessary to target specific disease states.


Author(s):  
Katherine T. Mills ◽  
Erin Peacock ◽  
Jing Chen ◽  
Amanda Zimmerman ◽  
Hua He ◽  
...  

Abstract Background The coronavirus disease 2019 (COVID‐19) pandemic disproportionately affects individuals with hypertension and health disparities. Methods and Results We assessed experiences and beliefs of low‐income and minority patients with hypertension during the COVID‐19 pandemic. Participants (N=587) from the Implementation of Multifaceted Patient‐Centered Treatment Strategies for Intensive Blood Pressure Control (IMPACTS‐BP) study completed a telephone survey in May and June of 2020. Participants were 65.1% Black, 59.7% female, and 57.7% reported an income below the federal poverty level. Overall, 2.7% tested positive and 15.3% lost a family member or friend to COVID‐19. These experiences were significantly more common in Black (3.9% and 19.4%, respectively) than in non‐Black participants (0.5% and 7.8%, respectively). Further, 14.5% lost a job and 15.9% reported food shortages during the pandemic. Most participants complied with stay‐at‐home orders (98.3%), social distancing (97.8%), and always wearing a mask outside their home (74.6%). Participants also reported high access to needed healthcare (94.7%) and prescription medications (97.6%). Further, 95.7% of respondents reported that they continued to take their regular dosage of antihypertensive medications. Among the 44.5% of participants receiving a healthcare appointment by telehealth, 96.6% got the help they needed, and 80.8% reported that the appointment quality was as good as or better than in‐person visits. Finally, 88.9% were willing to return to their primary care clinic. Conclusions These data suggest that low‐income patients, especially Black patients, were negatively impacted by COVID‐19. However, most patients were able to access needed healthcare services and were willing to return to their primary care clinic for hypertension management.


2019 ◽  
Vol 72 (5) ◽  
Author(s):  
Richard S Slavik ◽  
Manish Khullar ◽  
Sean K Gorman ◽  
Nicole Bruchet ◽  
Sarah Murray ◽  
...  

ABSTRACTBackground: Canadian pharmacy practice residency programs promote development of key competencies for direct patient care resulting in resolution of drug therapy problems (DTPs), which is 1 of 8 national clinical pharmacy key performance indicators. There are no Canadian data on the contribution of residents to resolution of DTPs, including DTPs for priority diseases covered in disease-state education modules (PD-DTPs) or quality indicator DTPs (QI-DPTs), as assessed through application of evidence-based interventions proven to reduce morbidity, mortality, or health resource utilization. Objective: To describe the contribution of pharmacy practice residents to direct patient care using 3 process-of-care measures: resident-resolved DTPs, PD-DTPs, and QI-DTPs. Methods: This prospective, observational single-group study was conducted across 5 rotation sites within the authors’ health authority from September 2, 2013, to June 13, 2014. The primary outcome was number of DTPs resolved. The secondary outcomes were number of PD-DTPs resolved; number of QI-DTPs resolved; numbers of DTPs, PD-DTPs, and QI-DTPs resolved over time; and residents’ satisfaction with electronic tracking of resolved DTPs (in terms of training, usability, efficiency, and time requirements). Results: Four residents completed a total of twenty-one 4-week rotations and resolved a total of 1201 DTPs. Of these, 620 (52%) were PD-DTPs and 479 (40%) were QI-DTPs. Overall, the number of interventions increased for rotations 1–3, decreased for rotations 4 and 5, and increased again for rotation 6. The median score for all questions in all domains of the satisfaction survey was 4 out of 5 (“agree”). Conclusions: Pharmacy practice residents were resolving DTPs, PD-DTPs, and QI-DTPs for patients and were contributing significantly to direct patient care. On the basis of literature evidence, the number and type of interventions observed in this study would be expected to improve clinical and health economic outcomes for patients.RÉSUMÉContexte : Les programmes de résidence canadiens en pratique pharma-ceutique encouragent le développement de compétences clés relatives aux soins directs offerts aux patients. Ces compétences entraîneront la résolu-tion des problèmes de pharmacothérapie (DTP), l’un des huit indicateurs clés nationaux de rendement relatifs à la pharmacie clinique. Il n’existe pas de données canadiennes portant sur la contribution des résidents à la résolution des problèmes de pharmacothérapie, notamment ceux relatifs aux maladies prioritaires (PD-DTP) couverts dans les modules d’éducation sur les problèmes de santé, ou les indicateurs de qualité des DTP (QI-DPT), évalués au moyen d’interventions fondées sur des données scientifiques dont il a été prouvé qu’elles réduisaient la morbidité, la mortalité ou l’utilisation des ressources sanitaires. Dans une étude, les intervenants avaient des opinions divergentes concernant la contribution des résidents à la résolution des DTP, des PD-DTP et des QI-DTP.Objectif : Décrire la contribution des résidents dans le cadre de la pratique pharmaceutique des soins directs offerts aux patients à l’aide de trois mesures spécifiques du processus des soins : DTP, PD-DTP et QI-DTP résolus par les résidents. Méthodes : Cette étude prospective par observation portant sur un seul groupe a été menée dans cinq sites de rotation compris dans la sphère d’autorité sanitaire des auteurs, du 2 septembre 2013 au 13 juin 2014. Le résultat principal était le nombre de DTP résolus. Les résultats sec-ondaires étaient les suivants : nombre de PD-DTP résolus; nombre de QI-DTP résolus; nombre de DTP, de PD-DTP et de QI-DTP résolus avec le temps; et la satisfaction des résidents à l’égard du suivi électronique de leurs DTP résolus (en termes de formation, de facilité d’utilisation, d’efficacité et d’exigences en matière de temps). Résultats : Quatre résidents ont effectué un total de 21 rotations de quatre semaines et ont résolu 1201 DTP. De ceux-ci, 620 (52 %) étaient des PD-DTP et 479 (40 %), des QI-DTP. Les interventions générales ont augmenté de la 1re à la 3e rotation; elles ont diminué à la 4e et à la 5e rotation; elles ont à nouveau augmenté à la 6e rotation. Le score moyen de toutes les questions posées dans l’enquête de satisfaction, tous domaines confondus, était de 4 sur 5 (ou « d’accord »).Conclusions : Les résidents en pratique pharmaceutique résolvaient les DTP, les PD-DTP et les QI-DTP des patients et contribuaient de manière significative aux soins directs aux patients. Sur base de la documentation, on pourrait s’attendre à ce que le nombre et le type d’interventions observées dans cette étude améliorent les résultats cliniques et sanitaires des patients.  


2018 ◽  
Vol 33 (3) ◽  
pp. 321-325
Author(s):  
Jasmine Peterson ◽  
April Hinds ◽  
Aida Garza ◽  
Jamie Barner ◽  
Lucas Hill ◽  
...  

Purpose: A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician–pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician–pharmacist covisits. Objective: To evaluate the impact of physician–pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. Methodology: This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. Results: A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (−1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. Conclusion: The results suggest that physician–pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.


2019 ◽  
Vol 76 (8) ◽  
pp. 521-529 ◽  
Author(s):  
John Valgus ◽  
Kristin W Weitzel ◽  
Josh F Peterson ◽  
Daniel J Crona ◽  
Christine M Formea

AbstractPurposeThis report examines and evaluates pharmacogenomics as an emerging science as it relates to the Practice Advancement Initiative and its predecessor the Pharmacy Practice Model Initiative’s consensus statements for optimal pharmacy practice models.SummaryPharmacogenomics is one of many emerging sciences to impact medication management and delivery of patient care. Increasingly, biomarkers are included in drug labeling and can assist pharmacists with personalizing medicine to optimize patient therapies and avoid adverse effects. The 2011 ASHP Pharmacy Practice Model Summit generated a list of 147 consensus statements for optimal pharmacy practice. Of these, 1 statement explicitly describes adjustment of drug regimens based on genetic factors as an essential activity of pharmacist-provided drug regimens, and 9 other statements provide additional support for incorporation of this emerging science into all aspects of patient care provided by pharmacists. We describe 4 institutions that have made significant inroads to implementing pharmacogenomics, to provide a framework and serve as resources for other institutions initiating their own pharmacogenomics implementation journeys.ConclusionThrough prioritized efforts of the pharmacy profession and health care institutions, pharmacogenomics will be disseminated and implemented, and the goal of the Pharmacy Practice Model Initiative’s consensus statements of improving health care using patients’ genetic characteristics will be realized.


2018 ◽  
Vol 23 (1) ◽  
pp. 4-17 ◽  
Author(s):  
Stacie J. Lampkin ◽  
Brooke Gildon ◽  
Sandra Benavides ◽  
Kelly Walls ◽  
Leslie Briars

Pediatric clinical pharmacists are an integral part of the health care team. By practicing in an ambulatory care clinic, they can reduce the risk of medication errors, improve health outcomes, and enhance patient care. Unfortunately, because of limited data, misconceptions surrounding the role of pharmacists, and reimbursement challenges, there may be difficulty in establishing or expanding pediatric clinical pharmacy services to an ambulatory care setting. The purpose of this paper is to provide an overview of considerations for establishing or expanding pharmacy services in a pediatric ambulatory care clinic. The primer will discuss general and pediatric-specific pharmacy practice information, as well as potential barriers, and recommendations for identifying a practice site, creating a business plan, and integrating these services into a clinic setting.


2020 ◽  
Vol 43 (1) ◽  
pp. 5-12
Author(s):  
Chelsea Howland ◽  
Laurel Despins ◽  
Jeri Sindt ◽  
Bonnie Wakefield ◽  
David R. Mehr

The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients who used a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those who assumed usual care. Data were extracted from electronic medical records from individuals who participated in a randomized controlled trial comparing in-home monitoring and usual care in patients with Type 2 diabetes and hypertension being treated in a primary care clinic. Data about nursing activities initiated by primary care clinic nurses were compared between groups using descriptive statistics and independent t-tests. Significant differences between groups were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up. This study provides evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.


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