Description of Pharmacist Recommendations in the Caring for Older Adults and Caregivers at Home (COACH) Program

2020 ◽  
Vol 35 (1) ◽  
pp. 38-46 ◽  
Author(s):  
Brittany Loy Melville ◽  
Janine Bailey ◽  
Jason Moss ◽  
William Bryan ◽  
Judith Davagnino ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Program Assessment ◽  
Potentially Inappropriate Medications ◽  
Care Model ◽  
Clinical Pharmacists ◽  
Coach Program ◽  
At Home

OBJECTIVE: To describe recommendations made by geriatric clinical pharmacists within an innovative care model focusing on patients with dementia living at home. DESIGN: Retrospective chart review. SETTING: Outpatients in a tertiary care Veterans Affairs health care system. PARTICIPANTS: Veterans who underwent a Caring for Older Adults and Caregivers at Home (COACH) Program assessment and had at least one medicationrelated recommendation made by a geriatric clinical pharmacist. MAIN OUTCOME MEASURES: The primary endpoint was the number and category of medication-related recommendations made by a geriatric clinical pharmacist at the initial COACH program assessment. Secondary endpoints were recommendation acceptance rates and change in potentially inappropriate medications (PIMs) at six months. RESULTS: There were 104 patients included. The mean age was 81 years and the majority of patients were male and Caucasian. At baseline, patients were receiving a mean of 12 medications/person, and 59% of patients were receiving at least one PIM. There were 248 total medication recommendations made, with a mean of 2.4 recommendations/person (range 1-5). The three most common recommendation categories were to discontinue a drug, decrease the dose, and switch to a potentially safer alternative. Providers accepted 110 (44%) recommendations within six months. Patients were receiving a mean of one PIM/person at baseline, and no change was observed at six months.CONCLUSION: This study describes recommendations made through medication reviews by geriatric clinical pharmacists within an innovative care model for patients with dementia living at home. These data may provide information to other clinical pharmacists implementing consult services in similar settings.

scholarly journals Older adult females hospitalized with cardiovascular disease outweigh male older adults in receiving Potentially Inappropriate Medication

2021 ◽  
Author(s):  
rishabh Sharma ◽  
Parveen Bansal ◽  
Manik Chhabra ◽  
Malika Arora
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Logistic Regression ◽  
Older Adult ◽  
Tertiary Care ◽  
Binary Logistic Regression ◽  
Adult Patients ◽  
Potentially Inappropriate Medications ◽  
Care Hospital ◽  
Very High

Introduction: There are a lack of potentially inappropriate medications (PIMs) predictors among the geriatric population with cardiovascular disease (CVD). Objective: This study was focussed on finding out the predictors and prevalence of PIMs use in the older adult patients hospitalized with cardiovascular disease. Methods: This prospective cross-sectional study included 250 older adult patients (mean age 69.03± 5.76 years) with the CVD having age 65 years or more, admitted in the cardiology/medicine department of a tertiary care hospital. PIMs were identified as per Beers criteria 2019. Binary Logistic regression analysis was used to determine the predictors of PIMs use in older adult patients. Results: Results indicate a very high PIM prescription rate of more than 62.4% (n= 156) with Proton pump inhibitor, short acting insulin according to sliding scale, Enoxaparin <30ml/min as the most commonly prescribed PIMs. On Binary logistic regression, important predictors for PIMs use were found to be females (odds ratio [OR] 2.36, 95% confidence interval (CI) 1.36- 4.09, P= 0.002), three diagnosis (OR 4.29, 95% CI 1.31- 14.0, P= 0.016), ≥4 diagnosis (OR 4.8, 95% CI 1.49- 15.44, P= 0.009), 7-9 days of hospital stay (OR 4.74, 95% CI 1.07- 20.96, P= 0.04), ≥ 9 medications per day (OR 0.09, 95% CI 0.01- 0.50, P= 0.006). Conclusion: The prevalence of PIMs in older adults with cardiovascular disease is very high, and females with CVD have emerged as a potential PIM indicator. The study also indicates a lack of awareness towards Beer criteria in health care workers (physicians/pharmacists/nursing staff) leading to PIM.

scholarly journals Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care

2021 ◽  
Author(s):  
Ankie Hazen ◽  
Vivianne Sloeserwij ◽  
Bart Pouls ◽  
Anne Leendertse ◽  
Han de Gier ◽  
...  
Keyword(s):  
General Practice ◽  
Professional Identity ◽  
Training Program ◽  
Integrated Care ◽  
Clinical Pharmacist ◽  
Care Model ◽  
Clinical Pharmacists ◽  
General Practices ◽  
Related Harm ◽  
Qualitative Analyses

AbstractBackground Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication. Aim To prevent medication-related harm by integrating a clinical pharmacist in the general practice team. This best practice paper provides an overview of 1. the development of this function and the integration process and 2. its impact, measured with quantitative and qualitative analyses. Setting Ten general practices in the Netherlands. Development and implementation of the (pragmatic) experiment We designed a 15-month workplace-based post-graduate learning program to train pharmacists to become clinical pharmacists integrated in general practice teams. In close collaboration with general practitioners, clinical pharmacists conduct clinical medication reviews (CMRs), hold patient consultations for medication-related problems, carry out quality improvement projects and educate the practice staff. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety. Evaluation The integrated care model improved medication safety: less medication-related hospitalisations occurred compared to usual care (rate ratio 0.68 (95% CI: 0.57–0.82)). Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist. This new caregiver proved to align well with the general practitioner. Conclusion A clinical pharmacist in general practice proves a feasible integrated care model to improve the quality of drug therapy.

scholarly journals PRESCRIPTION ANALYSIS AND PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATION USE IN OLDER ADULTS; AN OBSERVATIONAL STUDY

2020 ◽  
pp. 108-112
Author(s):  
N. SENTHIL KUMAR ◽  
GEENA K. REJI ◽  
REEMA K. A. ◽  
VIJAYARANGAN S. ◽  
RAMYA A.
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Adverse Drug Reactions ◽  
Inappropriate Medication ◽  
Tertiary Care ◽  
Potentially Inappropriate Medications ◽  
Drug Reactions ◽  
Geriatric Population ◽  
Institutional Ethics ◽  
Inappropriate Medications

Objective: The objectives of the present study were to determine the prevalence of Potentially Inappropriate Medications and Adverse Drug Reactions in older adults and to collect doctors’ responses regarding the PIM list or any other criteria to treat older adults in India. Methods: This was an observational study conducted in different tertiary care hospitals of two districts, Erode and Salem after obtaining approval of the Institutional Ethics Committee. A sample of 250 older adults (60 y and above) and 97 doctors were included during the study period of 6 mo from February 2019 to July 2019. Inappropriate medications were identified by using 2019 updated Beer’s criteria. The causality of the adverse events was assessed by Naranjo Adverse Drug Reaction Probability Scale. Results: Out of the 250 prescriptions, only 86(34.4%) of the prescriptions were appropriate and 164(65.6%) were inappropriate. The most commonly inappropriate prescribed medications were diuretics, ranitidine, and tramadol. A total of 74 ADRs was observed in 74 patients. Of these, 57(22.8%) ADRs were due to inappropriate medications listed in Beers criteria. There was a significant association between the occurrence of ADRs and the use of PIMs listed in 2019 updated Beer’s criteria [χ2 = 6.08, P = 0.013 (df = 1)]. Conclusion: The study shows that there is a high prevalence of inappropriate medications and adverse drug reactions in hospitalized older adults. Beer’s criteria can be used as a guideline by the physicians while prescribing the drugs to the geriatric population.

Review of a Home-Based Palliative Care Program for Children with Malignant and Non-Malignant Diseases

1997 ◽  
Vol 13 (4) ◽  
pp. 28-33 ◽  
Author(s):  
Ernest A. Kopecky ◽  
Sheila Jacobson ◽  
Prashant Joshi ◽  
Maria Martin ◽  
Gideon Koren
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Patient Characteristics ◽  
Palliative Care Program ◽  
Tertiary Care Facility ◽  
Home Based ◽  
At Home

This retrospective chart review presents the patient characteristics and utilization of the home-based palliative care program at The Hospital for Sick Children in Toronto. A total of 126 children dying from a broad spectrum of diseases was admitted during the period 1986–1994, referred from neurosurgery, genetic/metabolic, neurology, neonatology, nephrology, cardiology, general pediatrics, general surgery, and pulmonology. At the time of review, 15 patients remained alive and 18 had been discharged from the program. Mean age at the time of referral was 4.8 ± 0.51 years and mean age at death was 5.3 ± 0.55 years. The mean number of days in hospital was 26.5 ± 14.6 while days spent at home averaged 98.4 ± 15.2; thus 80% of the children's remaining time was spent at home. The average number of parent-team contacts was 3.5 ± 0.9 by pager and 24.0 ± 2.9 by telephone. Of the 93 patients who died in the program, 53% died at home, 18% died in community hospitals, and 29% died in a tertiary care facility. Analgesic medications were administered to 54% of the patients; 56% of these then required opioid analgesia for pain and symptom management. Home-based palliative care appeared to be an effective program for many children with a variety of terminal illnesses after adequate supports for the child and family had been established.

Quantifying Clinical Pharmacist Activities in a Tertiary Care Hospital Using Key Performance Indicators

2020 ◽  
pp. 001857871989707
Author(s):  
Abdulrazaq S. Al-Jazairi ◽  
Adel O. Alnakhli
Keyword(s):  
Patient Care ◽  
Clinical Pharmacy ◽  
Clinical Pharmacist ◽  
Performance Indicators ◽  
Tertiary Care Hospital ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Key Performance Indicators ◽  
Care Hospital ◽  
Clinical Pharmacists

Background: Key performance indicators (KPIs) are a set of measures used to help an organization in assessing and achieving goals critical to success. The aim of this study was to quantify the clinical pharmacists’ contribution to patient care in a tertiary care hospital using predefined clinical pharmacy KPIs. Method: This study was a prospective, observational study conducted by the Pharmaceutical Care Division of a tertiary care hospital. Clinical pharmacy KPIs were submitted by each clinical pharmacist on a monthly basis for 12 months during 2017. All clinical pharmacists up to the managerial level were included in the study. Data were analyzed, stratified, and correlated using Microsoft Excel, JMP statistical software, and Spearman correlation. The study was approved by the hospital’s Office of Research Affairs, RAC number 2171-080. Results: A total of 42 clinical pharmacists reviewed 104 728 patient encounters. They performed an adjusted average of 1221 interventions with an acceptance rate of 91.5%, 273 medication reconciliations, 325 discharge consultations, 332 pharmacokinetic consultations, 700 total parenteral nutrition consultations and follow-ups, and 12 688 electronic order verifications per clinical pharmacist per year. These interventions collectively resulted in a cost saving of $316 087.65 per clinical pharmacist per year. Statistical significance with positive correlation was noted for a number of precepted residents/students and clinical pharmacists’ experience ( R = 0.382, P = .013) and board certification ( R = 0.428, P = .0047). Conclusion: Clinical pharmacy KPIs were able to quantify the clinical pharmacists’ contributions to patient care and cost savings, which may lead to improve, standardize, and benchmark clinical pharmacy activities in the region.

Utilization and Cost Effects of the VHA Caring for Older Adults and Caregivers at Home (COACH) Program

2020 ◽  
pp. 107755872092959
Author(s):  
Wei Song ◽  
Orna Intrator ◽  
Jack Twersky ◽  
Judith Davagnino ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Emergency Services ◽  
Average Treatment Effect ◽  
Community Dwelling ◽  
Care Utilization ◽  
Veterans Health ◽  
Health Administration ◽  
Coach Program ◽  
At Home

Since 2010, the Veterans Health Administration has initiated a home-based Caring for Older Adults and Caregivers at Home (COACH) program to provide clinical support to dementia patients and family caregivers. But its impact on health care utilization and costs is unknown. We compared 354 COACH care recipients with a propensity score weighted comparison group of 9,857 community-dwelling Veterans during fiscal years 2010-2015. In 1-year follow-up, COACH program was associated with a lower rate of long-term nursing home placement (average treatment effect on the treated [ATT] –3%; p = .01). The program increased utilization of emergency services (ATT 6%; p = .01), hospitals (ATT 10%; p < .001), and personal care services (ATT 31%; p < .001). Health care costs were also significantly increased. Improved access to services may have enabled COACH Veterans to stay at home longer. As one of Veterans Health Administration’s top priorities to expand caregiver assistance programs, COACH seems to be a promising model for a nationwide implementation.

Potentially Inappropriate Medications in Older Adults: Deprescribing with a Clinical Pharmacist

2018 ◽  
Vol 67 (1) ◽  
pp. 115-118 ◽  
Author(s):  
Catherine A. Ammerman ◽  
Brent A. Simpkins ◽  
Nora Warman ◽  
Tara N. Downs
Keyword(s):  
Older Adults ◽  
Clinical Pharmacist ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medications

scholarly journals Antimicrobial time-out for vancomycin by infectious disease physicians vs clinical pharmacists: a before-after crossover trial

2021 ◽  
Author(s):  
Shinya Hasegawa ◽  
Yasuaki Tagashira ◽  
Shutaro Murakami ◽  
Yasunori Urayama ◽  
Akane Takamatsu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Critical Care ◽  
Clinical Pharmacist ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Pharmacists ◽  
Time Out ◽  
Days Of Therapy ◽  
The Impact ◽  
Critical Care Patients

Abstract Background The present study assessed the impact of time-out on vancomycin use and compared the strategy’s efficacy when led by pharmacists versus infectious disease (ID) physicians at a tertiary care center. Methods Time-out consisting of a telephone call to inpatient providers and documentation of vancomycin use &gt; 72 hours was performed by ID physicians and clinical pharmacists in the Departments of Medicine and Surgery/Critical Care. Patients in the Department of Medicine were assigned to the ID physician-led arm, and patients in the Department of Surgery/Critical Care were assigned to the clinical pharmacist-led arm in the initial, six-month phase and were switched in the second, six-month phase. The primary outcome was the change in weekly days of therapy (DOT) per 1,000 patient-days (PD), and vancomycin use was compared using interrupted time-series analysis. Results Of 587 patients receiving vancomycin, 132 participated, with 79 and 53 enrolled in the first and second phases, respectively. Overall vancomycin use decreased although the difference was statistically non-significant (change in slope, −0.25 weekly DOT per 1,000 PD; 95% confidence interval, −0.68 to 0.18, p = 0.24). The weekly vancomycin DOT per 1,000 PD remained unchanged during phase 1 but decreased significantly in phase 2 (change in slope, −0.49; −0.84 to −0.14, p = 0.007). Antimicrobial use decreased significantly in the surgery/critical care patients in the pharmacist-led arm (change in slope, −0.77; −1.33 to −0.22, p = 0.007). Conclusions Vancomycin time-out was moderately effective, and clinical pharmacist-led time-out with surgery/critical care patients substantially reduced vancomycin use.

Side Effects of Chemotherapy and Cancer Treatment in Tertiary Care Teaching Hospital

2016 ◽  
Vol 2 (1) ◽  
pp. 62-78
Author(s):  
. Hemraj ◽  
Raj Kumar ◽  
Sourabh Kosey ◽  
Amit Sharma ◽  
Nalini Negi
Keyword(s):  
Side Effects ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Informational Needs ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Medical College ◽  
Related Information ◽  
The Common ◽  
Chemotherapy Patients

To determine the most common physical side effects experienced by local chemotherapy patients. Their perceptions of these side effects and informational needs from clinical pharmacists were also evaluated. This was a single center, observational cross-sectional study conducted at department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. A face to face interview was conducted. Information collected included chemotherapy related side effects after last chemotherapy experience, the most worrisome side effects, overlooked by healthcare professionals and the preferred method, amount and source of receiving related information. In this study, hundred patients were enrolled out of them 48 were male and 52 were female. When differential calculations was done, common side effects or adverse effects of chemotherapy in the patients of breast, lung cancer, Ovarian Cancer, Colon cancer, Prostate cancer, Lymphoma Cancer, Cervix cancer where there is much irregular medicine intake 57.4% may be due to common problem of joint pain reported by all the patients under study, with the consecutive problem of nausea and vomiting. The high prevalence of chemotherapy related side effects among local patients is a major concern and findings of their perceptions and informational needs may serve as a valuable guide for clinical pharmacists and physicians to help in side effect management. This study shows the common problems reported by the patients when they are suffering from cancer condition, according to their incidence perceptions as experienced by the patient, this will allow the physician and clinical pharmacist to effectively counsel and manage the common symptoms as reported prior to its occurrence in the patient, so that withdrawal can be checked.

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