Volume 05, Number 4, 2014

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https://hdl.handle.net/11299/170653

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Evaluation of an Initiative for Fostering Provider-Pharmacist Team Management of Hypertension in Communities
(University of Minnesota, College of Pharmacy, 2014) Doucette, William R.; Lickteig, Cailin; Veach, Stevie; Carter, Barry; Levy, Barcey
Objectives: 1) Conduct team building activities for provider-community pharmacist teams in small communities and 2) Determine the impact of the team approach on practitioner-reported consequences and 3) Identify obstacles to the team approach and ways to overcome them. Methods: Eleven provider-pharmacist teams were recruited in rural/micropolitan communities in Iowa. The teams participated in team building sessions facilitated by the project leaders, to discuss the team approach. Decisions included patient identification, practitioner roles, and communications. Most pharmacists conducted blood pressure (BP) checks in the pharmacy and assessed the anti-hypertensive medications. If the BP was not at goal, the pharmacist worked with the patient and provider to make improvements. Teams followed their strategies for 3-5 months. Data were collected from pharmacy logs and on-line surveys of team members before and after the team period. Results: Using a multi-case approach, 4 cases were classified as Worked-Well, 5 as Limited-Success, and 2 as No-Team-Care. The Worked-Well teams provided an average of 26.5 BP visits per team, while the Limited-Success teams averaged 6.8 BP visits. The Worked-Well teams established and used a system to support the team approach. The Limited-Success teams either didn’t fully establish their team system, or used it sparingly. The No-Team-Care cases did not provide any team care. Conclusions: Factors supporting success were: positive provider-pharmacist relations, established team system, commitment to team care, and patient willingness to participate. While this program had some success, potential improvements were identified: more follow-up after the team building session, additional patient materials, and guidance for practice changes.
Are We Treating The Patient or the Disease?
(University of Minnesota, College of Pharmacy, 2014) Vogt, Eleanor; Shane, Patricia; Kahn, Henry
The evidence abounds. A compelling body of research estimates that psychosocial stressors play a role in a significant number of patient complaints seen in primary care. In addition to the challenges faced by primary care clinicians who must consider their patients' psychosocial stressors, these factors can also affect pharmacists’ care. Patient stress, through a number of mechanisms, can limit the efficacy of medicine as well as our efforts to achieve optimal medication management, and adds a poorly examined complexity to patient care practices. A landmark Institute of Medicine report calls for “whole patient “care, addressing psychosocial health needs, not as an embellishment, but as part of routine care. Whole patient care requires a fundamental shift, with patient needs at the center of healthcare delivery, and psychosocial-linked distress considered as integral to that model. These considerations place this topic squarely within the pharmacists’ scope of practice and urgently call for an expanded approach to patient care and an opportunity for pharmacists to address that need. To parallel this discussion, the contributing role of practitioner stress is briefly reviewed.
Student pharmacists’ and recent graduates’ perception of and interest in independent pharmacy ownership
(University of Minnesota, College of Pharmacy, 2014) Sweaney, Ashley M.; Casper, Kristin A; Hoyt, Cara D.; Wehr, Allison M.
Objectives: To assess student pharmacists’ and recent graduates’ interest in independent community pharmacy ownership and compare perceptions of pharmacy ownership among students and recent graduates. Methods: An anonymous online survey was administered to student pharmacists currently licensed as interns and pharmacists licensed by examination from January 2010 to October 2012 within the state of Ohio. Results: 355 surveys were completed during the study period, with 200 (56.3%) completed by student pharmacists. Student pharmacists were significantly more interested in pharmacy ownership (p < 0.001) and had significantly higher self-reported likelihood of ownership (p = 0.03) compared to recent graduates. Top ranked advantages to ownership for both groups included professional autonomy, development of innovative services, and amount of time spent in patient care activities. The majority of respondents had been exposed to pharmacy ownership within a course, student organization, or experiential rotation, but felt they needed more training in financial, legal, and regulatory issues. Conclusion: Many student pharmacists and recent graduates are interested in pharmacy ownership. However, the majority of respondents feel it is unlikely they will own a pharmacy in the future. Resources need to be expanded for those interested in this career path.
Validity of Electronic Prescription Claims Records: A Comparison of Commercial Insurance Claims with Pharmacy Provider Derived Records
(University of Minnesota, College of Pharmacy, 2014) Martin, Bradley C.; Shewale, Anand
Objectives: To determine if and to what extent records obtained from PBM pharmacy claims differ from source documents obtained directly from pharmacy providers. This study also sought to explore possible associations between patient, pharmacy benefits, and pharmacy provider characteristics and the likelihood a patient would have missing prescription claims. Methods: This study used a cross-sectional design which included a sample of 1,484 patients residing in a single state with a common pharmacy benefit. Profiles describing all prescriptions filled in a pharmacy between January 1, 2002 through June 30, 2002 of these patients were requested directly from their pharmacy providers. Logistic regression was used to explore the factors associated with a person receiving a prescription that did not appear on the PBM claims. Results: Of the 1,484 eligible recipients sampled, profiles were obtained for 323 (22%) persons and there were analyzable profiles for 315 (21%) persons. There were a total of 2,977 prescriptions filled for the 315 subjects. Of those 2,977 prescriptions, 207 (7.0%) were missing from the claims files indicating that 93% were captured. Only prescription volume consistently influenced the likelihood a patient would have a missing prescription from the PBM claims (OR =1.08; 95%CI:1.05-1.12). Conclusion: Claims obtained from pharmacy benefit companies capture approximately 93% of prescription records when verified with records obtained from pharmacy providers. The rate of missing records from PBM claims does not appear to be meaningfully influenced by most finance based pharmacy benefit design features. However, certain classes of drugs such as iron products, digoxins, diuretics, sulfonylureas, and antigout may have incomplete claims records compared to other classes of drugs. Higher prescription utilizers are more likely to have prescription records filled that are not captured by PBMs. These conclusions should be interpreted in light of the modest usable response rate from pharmacy providers of 22% and the unknown generalizability of these patients utilizing one particular PBM from 2002 in the state of Georgia.
Differences in career paths and attributes of pharmacists completing a community pharmacy residency program (CPRP)
(University of Minnesota, College of Pharmacy, 2014) Ulbrich, Timothy R.; Adams, Alex; Bright, David R.; Sullivan, Donald L.; Schnur, Evan; Bess, D. Todd; Owen, James; Bradley-Baker, Lynette
Objective: To determine any differences in career paths and career attributes of pharmacists who have completed a PGY1 community pharmacy residency program (CPRP) as compared to those that have not completed a PGY1 CPRP. Methods: A web-based survey evaluating various aspects of community pharmacists’ careers was distributed to 274 CPRP graduates in addition to a random sample of 7,376 community pharmacists. The survey contained 32 questions evaluating various career attributes. Questions that assessed level of agreement were on a 6-point Likert-type Scale (1=strongly disagree; 6=strongly agree). Results: A total of 353 participants completed the survey, with 224 indicating that they had not completed a CPRP. Pharmacists who completed a CPRP responded that they spend significantly more time on patient care services, teaching, and research, and spend less time dispensing medications compared to those that have not completed a CPRP. Compared to those that did not complete a CPRP, CPRP graduates were less likely to agree that current level of workload negatively impacts job performance, motivation to work, job satisfaction, mental/emotional health, and physical health. Conclusion: Pharmacists completing a CPRP noted significant differences in their current employment and job responsibilities. Additional expansion and education regarding the importance of CPRPs should be considered.
A pilot project to assess community pharmacists’ knowledge and caring behaviors for recurrent headache sufferers after a migraine-focused educational intervention
(University of Minnesota, College of Pharmacy, 2014) Murray, Kelly A.; Skomo, Monica L.; Carter, Sandra M.
Objectives: (1) Compare pharmacists’ self-assessed knowledge of migraine before and after an educational intervention; (2) Compare pharmacists’ self-reported care behaviors following an educational intervention with a control group of pharmacists; (3) Identify interactions between the educational intervention results and individual independent variables. Design: Quasi-experimental, parallel design. Setting: Twenty community pharmacies in northeastern Oklahoma from March to May 2010. Participants: 49 pharmacists at one of twenty community pharmacies, with active and in-good-standing Oklahoma pharmacy licenses. Intervention: Two-hour educational session on migraine identification and current treatment. Main outcome measures: Compare pharmacists’ self-assessed knowledge of migraine before and after an educational intervention and compare self-reported care behaviors of these same pharmacists with a control group of pharmacists. Results: Pharmacists’ self-assessed knowledge mean scores were significantly higher post-intervention compared to pre-intervention (p<0.0001). Self-assessed knowledge was higher in the intervention group post-questionnaire scores compared to the control group of pharmacists (p=0.004). Intervention group pharmacists were more confident in their ability to maintain knowledge of migraine (p=0.04). No difference was seen regarding difficulty in providing care for a migraineur (p=0.16) or in how the pharmacists perceived employer culture (p=0.79). No significant interactions were found between the educational intervention and demographic variables collected. Conclusion: Attending an educational program on migraine improved pharmacists’ knowledge and confidence when providing care to migraineurs.
Evaluation of provider documentation of medication management in a Patient-Centered Medical Home (PCMH)
(University of Minnesota, College of Pharmacy, 2014) Nguyen, Trang T.; Mehta, Bella H.; Rodis, Jennifer L.; Casper, Kristin A; Wexler, Randell K.
Purpose: The National Committee for Quality Assurance (NCQA) has standards for recognizing Patient-Centered Medical Homes (PCMH) including one for medication management. Study objectives were to identify if and how providers within a PCMH recognized under the 2008 guidelines were documenting components of medication management to meet NCQA’s 2011 requirements including: 1) providing information about new prescriptions to >80% of patients; 2) assessing understanding of medications for >50% of patients; and 3) assessing response and barriers to medication adherence for >50% of patients. Methods: Physician and pharmacist-led patient visits from a family medicine office, from February 1 to August 1, 2012 were assessed. Patients over 18 years old taking at least one medication were included. A retrospective chart review was performed to assess documented components of medication management. Descriptive statistics were used to analyze data. Results: A systematic sampling of 450 physician-led and 195 pharmacist-led patient visits, demonstrated providers did not meet documentation goals for providing patients information on new prescriptions (65% pharmacist, 24% physician, 36% of total provider notes) or for assessment of patients’ understanding of medications (9% pharmacist 12% physician, 11% of total provider notes). Individually each type of provider did not meet the goal of assessing patient response and barriers to adherence to medication, but with combined intervention by the pharmacists and the physicians, the site was able to surpass NCQA’s percentage goal (57% and 58%). Conclusions: No components of medication management are well documented. Using the electronic medical record, pharmacists may be able to develop documentation tools and assist sites to meet NCQA’s goals for medication management.