scholarly journals Implementation of a Pharmacist-Led Transitions of Care Program within a Primary Care Practice: A Two-Phase Pilot Study

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 4 ◽  
Author(s):  
Erin Slazak ◽  
Amy Shaver ◽  
Collin M. Clark ◽  
Courtney Cardinal ◽  
Merin Panthapattu ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Primary Care Practice ◽  
Phase 1 ◽  
Transitions Of Care ◽  
Care Practice ◽  
Control Group ◽  
Phase 2 ◽  
Two Phase ◽  
Effective Manner

Pharmacists in primary care settings have unique opportunities to address the causes of ineffective care transitions. The objective of this study is to describe the implementation of a multifaceted pharmacist transitions of care (TOC) intervention integrated into a primary care practice and evaluate the effectiveness of the program. This was a two-phase pilot study describing the development, testing, and evaluation of the TOC program. In Phase 1, the TOC intervention was implemented in a general patient population, while Phase 2 focused the intervention on high-risk patients. The two pilot phases were compared to each other (Phase 1 vs. Phase 2) and to a historical control group of patients who received usual care prior to the intervention (Phase 1 and Phase 2 vs. control). The study included 138 patients in the intervention group (Phase 1: 101 and Phase 2: 37) and 118 controls. At baseline, controls had a significantly lower LACE index, shorter length of stay, and a lower number of medications at discharge, indicating less medical complexity. A total of 344 recommendations were provided over both phases, approximately 80% of which were accepted. In adjusted models, there were no significant differences in 30-day all-cause readmissions between Phase 2 and controls (aOR 0.78; 95% CI 0.21–2.89; p = 0.71) or Phase 1 (aOR 0.99; 95% CI 0.30–3.37; p = 0.99). This study successfully implemented a pharmacist-led TOC intervention within a primary care setting using a two-phase pilot design. More robust studies are needed in order to identify TOC interventions that reduce healthcare utilization in a cost-effective manner.

scholarly journals Development and pilot study of the Primary Care Practice Improvement Tool (PC‐PIT): an innovative approach

2014 ◽  
Vol 201 (S3) ◽  
Author(s):  
Lisa Crossland ◽  
Tina Janamian ◽  
Mary Sheehan ◽  
Victor Siskind ◽  
Julie Hepworth ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Primary Care Practice ◽  
Innovative Approach ◽  
Care Practice ◽  
Practice Improvement

The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics

2020 ◽  
Author(s):  
Vivienne A Rose ◽  
Elena N Klyushnenkova ◽  
Min Zhang ◽  
Verlyn O Warrington
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Care Setting ◽  
Primary Care Practice ◽  
Primary Care Setting ◽  
Weight Loss Program ◽  
Care Practice ◽  
Control Group ◽  
Baseline Weight ◽  
Medical Weight Loss

Abstract Background Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice. Objective To determine whether participation in the MWLP within a general primary care setting can result in weight loss. Methods A retrospective medical chart review of patients treated in MWLP and a control group of patients with obesity receiving regular care in the general primary care setting. From the practice database (1 April 2015–31 March 2016), 209 patients (≥18 years old) who participated in the MWLP were identified; 265 controls were selected from the remaining population based on the presence of the obesity-related diagnoses. Results MWLP patients lost on average 2.35 ± 5.88 kg in 6 months compared to their baseline weight (P < 0.0001). In contrast, the control group demonstrated a trend of gaining on average 0.37 ± 6.03 kg. Having three or more visits with the MWLP provider within 6 months after program initiation was the most important factor associated with successful loss of at least 5% of the baseline weight. Weight loss also correlated with a decrease in abdominal girth. Conclusion MWLP integrated into the general primary care practice may potentially be an effective model for managing obesity and related morbidities.

Introducing the Health Coach at a Primary Care Practice: A Pilot Study (Part 2)

2011 ◽  
Vol 89 (2) ◽  
pp. 37-42 ◽  
Author(s):  
Bethany Sneed Lanese ◽  
Asoke Dey ◽  
Prashant Srivastava ◽  
Robert Figler
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Primary Care Practice ◽  
Care Practice ◽  
Health Coach

Abstract 226: Integration of Traditional and Alternate Chronic Care Models within a Primary Care Setting for Diabetes Management and Cardiovascular Disease Prevention

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mohan Thanikachalam ◽  
G Shanmugasundar ◽  
Muthuswamy Ravikiran ◽  
Vijaykumar Harivanzan ◽  
Sripriya Ravi
Keyword(s):  
Primary Care ◽  
Blood Sugar ◽  
Care Setting ◽  
Primary Care Practice ◽  
Diabetes Management ◽  
Self Management ◽  
Care Practice ◽  
Control Group ◽  
Management Support ◽  
Care Models

Background: Several chronic care models (CCMs) for diabetes management and cardiovascular disease prevention have been implemented, but outcomes have been marginal. Traditionally, CCMs have been offered within the trusted primary care practice environment, but self-management support is episodic, cost ineffective and difficult to scale. Alternate CCMs that offer self-management support mostly through telephone coaching or virtual (web/mobile platforms) interventions, enable easy access, scalability and cost effectiveness, yet are impaired by the limits of isolated self-management support when provided outside the context of the trusted, therapeutic relationship of a primary care practice. We hypothesize that an integrated model taking advantage of positive aspects of traditional and alternate CCMs will lead to positive behavioral change (empowerment), sustained patient participation and better outcomes. Methods: To test this hypothesis, we implemented the Empowerment and Participatory Care Model (EPCM) in a study center in Chennai, India by integrating face-to-face support with customized telephone, Internet and mobile phone enabled interventions within a primary care setting. Patients who participated in the traditional CCM formed the control group. Results: In the participents in traditional CCM (n=422), there was an average reduction of 0.57% in HbA1c, 16 mg/dl in fasting blood sugar, 30 mg/dl in post prandial blood sugar and 16 mg/dl of LDL at the end of year-one. In comparison, among the patients (66% men; mean age 52 yrs) who participated in the EPCM and had completed one-year in the program (n=112) there was average reduction of 1.6% in HbA1c, 57 mg/dl in fasting blood sugar, 80 mg/dl in post prandial blood sugar and 18 mg/dl of LDL (p<0.01). Figure 1 shows the difference in percent reduction of the various biochemical parameters between the EPCM and the control group. The total cost of care (other than medication) per patient per year in the EPCM, after taking into consideration purchasing power parity between USA and India, was 900 USD. Conclusion: The persons with diabetes who participated in the EPCM had better quality of metabolic control, but long-term follow up is required to assess overall reduction in the risk of cardiovascular complications and cost effectiveness.

scholarly journals Feasibility of a Clinical Decision Support Tool to Manage Resistant Hypertension: Team-HTN, a Single-arm Pilot Study

2020 ◽  
Author(s):  
Leilani A Siaki ◽  
Victor LIN ◽  
Robert Marshall ◽  
Robert Highley
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Pilot Study ◽  
Phase 1 ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Phase 2 ◽  
Support Tool ◽  
Sequencing Algorithm ◽  
Clinical Decision Support Tool

ABSTRACT Introduction Based on defining criteria, hypertension (HTN) affects 31% to 46% of the adult U.S. population and almost 20% of service members. Resistant HTN (rHTN) consumes significant resources, carries substantial morbidity and mortality risk and costs over $350 billion dollars annually. For multiple reasons, only 48.3% of people with HTN are controlled, e.g., undiagnosed secondary HTN, therapeutic or diagnostic inertia, and patient adherence. Our purpose was to determine the feasibility of a web-based clinical decision support tool (CDST) using a renin-aldosterone system (RAS) classification matrix and drug sequencing algorithm to assist providers with the diagnosis and management of uncontrolled HTN (rHTN). Outcomes were blood pressure (BP) rates of control, provider management time, and end-user satisfaction. Methods This two-phase, prospective, non-randomized, single-arm, six-month pilot study was conducted in primary care clinics at a tertiary military medical center. Patients with uncontrolled HTN and primary care providers were recruited. Phase 1 patients checked their BP twice daily (AM and PM), three times weekly using a standardized arm cuff. Patients with rHTN were enrolled in phase 2. Phase 2 patients were managed virtually by providers using the CDST, the RAS classification matrix, and the drug sequencing algorithm which incorporated age, ethnicity, comorbidities, and renin/aldosterone levels. Medications were adjusted every 10 days until BP was at target, using virtual visits. Results In total, 54 patients and 16 providers were consented. One transplant patient was disqualified, 29 met phase 2 criteria for rHTN, and 6 providers completed the study. In phase 1, 45% (n = 24) of patients were identified as having apparent uncontrolled HTN using peak diurnal blood pressure (pdBP) home readings. In phase 2 (n = 29), previously undetected RAS abnormalities were identified in 69% (n = 20) of patients. Blood pressure control rates improved from 0% to 23%, 47%, and 58% at 2, 4, and 6 months, respectively. Provider management time was reduced by 17%. Using home pdBP readings identified masked HTN in almost 20% of patients that would have been missed by a single daily AM or PM home BP measurement. Feasibility and satisfaction trends were favorable. Conclusions Despite significant morbidity, mortality, and existing guidelines, over half of hypertensive patients are uncontrolled. Our results suggest that this CDST used with pdBP monitoring is a feasible option to facilitate improved rates of control in rHTN, aid in overcoming therapeutic/diagnostic inertia, improve identification of secondary HTN, and potentially, access. Further research with this tool in a larger population is recommended.

scholarly journals Pilot study evaluating the monitoring of canine diabetes mellitus in primary care practice

2019 ◽  
Vol 6 (1) ◽  
pp. e000250
Author(s):  
Jennifer Ann Cartwright ◽  
Malcolm Cobb ◽  
Mark D Dunning
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Blood Glucose ◽  
Pilot Study ◽  
Primary Care Practice ◽  
Secondary Outcome ◽  
Care Practice ◽  
Case Review ◽  
Retrospective Case ◽  
Canine Diabetes Mellitus

ObjectivesThis study aimed to describe how canine diabetes mellitus (CDM) is monitored in primary care practice (PCP) and to report outcomes.DesignRetrospective case review.SettingPCP.Participants40 dogs of 22 different pedigrees and five crossbreeds. Median age at diagnosis was nine years and six months (eight years six months to 10 years five months). Dogs were diagnosed with CDM between January 1, 2008 and December 30, 2012 and remained with the practice to the study end or until death.Primary and secondary outcome measuresStability achievement and death or euthanasia. Consultations for each dog were identified and recorded through records collected from the PCP (January 1, 2008 to December 30, 2012).ResultsA median of three consultations per dog occurred in the first month, subsequently falling to a median of one consultation every 19 days thereafter. After the first month postdiagnosis, weight and single blood glucose concentrations were most frequently recorded at 66.8 and 42 per cent of consultations respectively and a blood glucose curve was performed infrequently (17.4 per cent). Serum biochemistry was measured at 8 per cent of consultations and urine culture at only 0.8 per cent. Median survival time (MST) for all dogs was eight months (2–21 months). Eighteen dogs stabilised within three months of diagnosis and their MST was 20.5 months, (10.25–25.75 months), significantly longer than the 22 dogs not achieving stability within three months (MST 2.5 months, 0–5.5 months) (P<0.001). Those dogs not surviving beyond the first month had significantly fewer consultations than those still alive (P<0.005).ConclusionsThis pilot study indicates dogs with CDM managed solely in PCP experience limited monitoring tests and have lower MST than reported in the literature. Recruitment of a larger cohort of CDM cases from a larger number of PCP will help determine whether these results accurately represent this demographic and verify if infrequent testing is associated with a poor outcome. Importantly, prospective evaluation of decision-making around monitoring CDM in PCP is required, to help determine the effectiveness and feasibility of more frequent monitoring strategies, such as those recommended by the American Animal Hospital Association, particularly to influence MST.

Sign in / Sign up

Export Citation Format

Share Document