Evaluation of Provider Acceptance of Pharmacist Recommendations in a High User Patient Population

OBJECTIVE: To compare the acceptance rate of pharmacist recommendations in an interdisciplinary team for patients interviewed by the pharmacist versus those assessed by chart review. DESIGN: Retrospective chart review. SETTING: Interdisciplinary consultative team in an outpatient setting as part of a large academic health system provided care for "high utilizer" patients. PARTICIPANTS: Sixty-five patients at moderate to high risk of hospitalization who completed their first appointment with the team between March 1, 2019, and December 30, 2019. Most patients were 65 years of age or older and all had Medicare insurance. INTERVENTIONS: A pharmacist completed a chart review for all patients. A cohort of patients were also interviewed. Recommendations were recorded in the electronic medical record, discussed with the team, and forwarded to the patient's primary care provider. RESULTS: A total of 253 recommendations were made by pharmacists, with a significantly higher acceptance rate for patients who completed an interview with the pharmacist (40.7% vs. 28.4%; P = 0.046). Patientspecific factors resulting in higher acceptance rates in the interview group included age younger than 65 years (P = 0.013), 10 to 19 medications (P = 0.004), and mental health diagnosis (P = 0.02). CONCLUSION: The addition of an interview to chart review allowed pharmacists to make recommendations that were more likely to be accepted and therefore more clinically impactful.

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Exploring Pharmacy Trainee Experiential Learning in a Full Scope Collaborative Rural Primary Care Practice: A Retrospective Chart Review

Pharmacy ◽

10.3390/pharmacy9030155 ◽

2021 ◽

Vol 9 (3) ◽

pp. 155

Author(s):

Sara Robinson ◽

Feng Chang

Keyword(s):

Primary Care ◽

Chart Review ◽

Retrospective Chart Review ◽

Drug Level ◽

Care Practice ◽

Patient Transfers ◽

Rural Primary Care ◽

Time Basis ◽

Acceptance Rates ◽

The Impact

Despite reported benefits of pharmacy trainees (e.g., pharmacy students, pharmacy residents) in hospital settings, limited research on the impact of these trainees has been conducted in rural primary care. To explore the potential benefits and impact of pharmacy trainees practicing in a supervised collaborative rural primary care setting, a retrospective chart review was conducted. Drug therapy problems (DTPs) were classified using the Pharmaceutical Care Network Europe (PCNE V9) system. Valuation was measured using a validated tool developed by Overhage and Lukes (1999). Over 16 weeks on a part-time basis, pharmacy trainees (n = 3) identified 366 DTPs during 153 patient encounters. The most common causes for DTPs were related to patient transfers and the need for education. Drug level interventions carried out directly by trainees under supervision accounted for 13.1% of total interventions. Interventions that required prescriber authorization had an acceptance rate of 83.25% higher than previous acceptance rates found in urban primary care settings. About half (51%) of the interventions proposed and made by pharmacy trainees were classified as significant or very significant, suggesting these trainees added significant value to the pharmacy service provided to rural community residents. This study suggests that pharmacy trainees can be effective resources and contribute meaningfully to patient care in a collaborative rural primary care team setting.

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Diagnostic conversions from major depressive disorder into bipolar disorder in an outpatient setting: Results of a retrospective chart review

Journal of Affective Disorders ◽

10.1016/j.jad.2012.06.014 ◽

2013 ◽

Vol 144 (1-2) ◽

pp. 112-115 ◽

Cited By ~ 38

Author(s):

Dominika Dudek ◽

Marcin Siwek ◽

Daria Zielińska ◽

Rafał Jaeschke ◽

Janusz Rybakowski

Keyword(s):

Bipolar Disorder ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Chart Review ◽

Retrospective Chart Review ◽

Outpatient Setting ◽

Major Depressive

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1085. Comparison of the Incidence of AKI in Vancomycin AUC Based Goal Trough Dosing vs. Traditional Trough Dosing in the Outpatient Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1279 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S634-S634

Author(s):

Marissa Rees ◽

Derek N Bremmer ◽

Dustin R Carr ◽

Tamara Trienski ◽

Carley Buchanan ◽

...

Keyword(s):

Serum Creatinine ◽

Treatment Failure ◽

Chart Review ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Outpatient Setting ◽

Primary Objective ◽

Patient Specific ◽

Health Record ◽

The Mean

Abstract Background Recent changes to vancomycin guidelines recommend dosing by targeting an AUC of 400-600 in most patients, due to similar effectiveness and reduced rates of acute kidney injury (AKI). AKI was defined as an increase in serum creatinine of ≥ 0.5 mg/dl, a 50% increase in serum creatinine from baseline on two consecutive readings, or a decrease in creatinine clearance from 50% from baseline on two consecutive readings. The purpose of this study was to assess the incidence of AKI in patients receiving vancomycin dosed by AUC based trough goals and vancomycin dosed by traditional trough goals (15-20 mcg/mL) in the outpatient setting. Methods This study was performed by retrospective chart review using the electronic health record. Patients receiving vancomycin outpatient as continuation of therapy after discharge from December 1, 2018 through March 24, 2021 were reviewed. The primary objective was incidence of AKI in patients receiving vancomycin outpatient with trough goals derived from patient specific AUC calculations compared to patients receiving vancomycin by traditional goal troughs. Secondary objectives included rate of treatment failure, average AUC estimated trough range, and number of regimen changes required. Results There were a total of 65 patients in the traditional trough dosing group and 53 patients in the AUC trough dosing group. The incidence of AKI was higher in the traditional trough dosing group compared to the AUC trough group (23.1% vs 5.7%; p=0.01). There were no differences in incidence of treatment failure. The mean AUC estimated trough range was 11.4-16.9 mcg/mL. There were significantly less average regimen changes required in the AUC dosing group (1.64 vs 1.13; p=0.006). Patients receiving AUC trough dosing were 78% less likely to develop AKI as patients receiving traditional trough dosing (HR 0.221, 95%CI 0.051 – 0.968). Conclusion There was a significantly lower incidence of AKI in patients receiving vancomycin dosed by AUC based troughs compared to traditional trough dosing. Continuing AUC trough based dosing for vancomycin in the outpatient setting is convenient and may lead to reduced rates of AKI. Disclosures Dustin R. Carr, PharmD, BCPS, BCIDP, AAHIVP, Merck (Speaker’s Bureau)

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A single-center, retrospective chart review evaluating outpatient code status documentation in the EPIC electronic medical record for patients with advanced solid tumor cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.242 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 242-242 ◽

Cited By ~ 3

Author(s):

John M. Horton ◽

Michael Hwang ◽

Joseph D. Ma ◽

Eric Roeland

Keyword(s):

Cancer Patients ◽

Advance Care Planning ◽

Solid Tumor ◽

Chart Review ◽

Retrospective Chart Review ◽

Outpatient Setting ◽

Care Planning ◽

Advanced Solid Tumor ◽

Code Status ◽

Advance Care

242 Background: A desired code status is a critical element of advance care planning ideally outlined in an advance directive. Preferably, advance care planning occurs in the non-emergent, outpatient setting. In the absence of a documented code status, full resuscitation is the default, which is not desired by all patients. Currently, unlike the inpatient setting, there is no single, convenient location for code status documentation in the outpatient EPIC electronic medical record (EMR). In order to propose a system-wide solution, a retrospective chart review was completed to assess the scope of the problem. Methods: 160 charts were randomly selected of advanced solid tumor cancer patients (stage III-IV) who received care by a medical oncologist at the UCSD Moores Cancer Center from 2008-2011. The primary objective was to determine the incidence of code status documentation. Secondary objectives included determining the clinical role of the documenter and the code status documentation location within the EMR. Results: 57 advanced cancer patients (36%) had code status documented in 9 different locations in the EMR. Of the 57 patients, only 4 (7%) had a code status documented in the outpatient setting. When documented, code status was located in the progress note (5%), demographics tab (26%), problem list (2%), and scanned media section (14%). Out of the 160 charts, the outpatient oncologist documented the code status in 1 chart. Inpatient EMR locations of the code status included the discharge summary (33%), history and physical (11%), and progress note (9%). Conclusions: In the absence of a standard EPIC outpatient code status documentation procedure, code status was infrequently and inconsistently documented. Consequently, a readily available and accurate code status is not present for emergencies in the outpatient setting. With this information, we will focus future efforts on a clearly defined, standard, and convenient location for outpatient code status documentation in the EPIC EMR.

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