Browsing by Subject "patient-centered care"

Now showing 1 - 3 of 3
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    Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population
    (University of Minnesota, College of Pharmacy, 2013) Kelling, Sarah E.; Bright, David R.; Ulbrich, Timothy R.; Sullivan, Donald L.; Gartner, James; Cornelius, Douglas C.
    Objective: To describe successes and barriers with the development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population. Setting: A single supermarket chain pharmacy Practice description: Community pharmacists provide dispensing and non-dispensing pharmacy services including medication therapy management, biometric wellness screenings, and immunizations. Practice innovation: Developed and implemented a community pharmacy medication therapy management-based transition of care program for patients with managed Medicaid Main outcome measures: Feasibility of developing and implementing a transition of care service in a community pharmacy Results: During the first six months, a total of 17 patients were seen as part of the program. Study pharmacists identified successes and potential strategies for overcoming barriers. Conclusion: Developing and implementing a community pharmacy transition of care program for patients with managed Medicaid was logistically feasible.
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    Minimally Disruptive Medicine: State of the Science and Plan for the Future
    (2018-04) Boehmer, Kasey
    Background Patients living with multiple chronic conditions, or multimorbidity, represent a growing portion of the adult population. One in four adult Americans, three in four over the age of 65, live with multimorbidity. This population experiences unique challenges, many of which are driven by the way healthcare is delivered. Specifically, patients must cope with the work of being a patient. For patients with a single condition to follow recommended guidelines, the work amounts to approximately two hours per day. However, with multiple chronic conditions, this can quickly become a part- or full-time job for patients and their families. The ability to cope with this work rests on patients’ capacity, which is a result of their interactions with their biography, resources, environment, patient and life work, and social network. When this capacity is overwhelmed by the work of being a patient, problems accessing and using healthcare and enacting self-care arise, which if unaddressed can have negative impacts on patients’ health outcomes and quality of life. Minimally Disruptive Medicine (MDM) is a philosophy of care, supported by a conceptual model and multiple theoretical frameworks, that seeks to address and remedy problems of patient workload-capacity imbalance. To date, chronic care remains unexamined in light of the principles of MDM, and MDM remains untested. Aims Therefore, the aims of this dissertation were to: 1) Conduct a systematic review and synthesis of recent interventions using the Chronic Care Model to examine the extent to which MDM had been adopted within those interventions; 2) Evaluate the implementation process of a six-month pilot of an MDM-driven intervention, Capacity Coaching, in primary care using focused ethnographic observations and in-depth interviews; and 3) Propose a detailed protocol to implement and test MDM using a proven culture-change curriculum. Methods We conducted a systematic review and qualitative thematic synthesis of reports of Chronic Care Model (CCM) implementations published from 2011 – 2016, a focused ethnographic study, which included the synthesis of written artifacts, nine hours of clinic observation, and nine interviews with ten key stakeholders, and propose a mixed-methods, cluster-randomized trial to test MDM using a culture-change approach. Results CCM implementations examined were mostly aligned with the healthcare system’s goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Capacity Coaching’s implementation, however, addressed most of these shortcomings of past chronic care interventions, including being available to patients living with any chronic condition(s), acknowledging and seeking to reduce patient work, and supporting patient capacity holistically across all constructs described in the Theory of Patient Capacity. Its implementation was successful in getting many individuals on the healthcare team to understand the purpose of the program and the ways in which it was distinguishable from other programs and in getting a small group of dedicated champions to drive implementation of the program forward. However, implementation struggled to get a broader group of individuals across the clinic involved in the program and to build in evaluation of the program’s success. These challenges are ones specifically addressed in the Leadership Saves Lives culture-change curriculum. Conclusion MDM offers a unique lens to meet the needs of the growing population living with multimorbidity. However, recent chronic care interventions have not implemented most MDM principles. Capacity Coaching is a novel intervention that uses MDM principles and when implemented showed promise in overcoming past chronic care shortcomings. Its pilot implementation highlighted challenges in enrolling the full healthcare team to drive MDM forward. The LSL program offers promise to overcome these challenges, but deserves large-scale testing.
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    Pharmacists’ social authority to transform community pharmacy practice
    (University of Minnesota, College of Pharmacy, 2011) McPherson, Timothy; Fontane, Patrick
    Leaders in the profession of pharmacy have articulated a vision of pharmacists as providers of patient-centered care (PCC) services and the Doctor of Pharmacy was established as the required practice degree to achieve this vision. Pharmacist-provided PCC services have been shown to reduce medication costs and improve patient compliance with therapies. While community pharmacists are capable of, and are ideally placed for, providing PCC services, in fact they devote most of their time to prescription dispensing rather than direct patient care. As professionals, community pharmacists are charged with protecting society by providing expert services to help consumers manage risks associated with drug therapies. Historically pharmacists fulfilled this responsibility by accurately dispensing prescription medications, verifying doses, and allergy checking. This limited view of pharmacy practice is insufficient in light of the modern view of pharmacists as providers of PCC. The consumers’ view of community pharmacy as a profession represents a barrier to transforming the basis of community pharmacy from product distribution to providing PCC services. Community pharmacists are conferred with social authority to dictate the manner in which their professional services are provided. Pharmacists can therefore facilitate the transition to PCC as the primary function of community pharmacy by exercising their social authority to engage consumers in their roles in the new patient-pharmacist relationship. Each pharmacist must decide to provide PCC services. Suggestions for initiating PCC services in community pharmacy are offered.