Care Pharmacy Services Research Articles

Position paper on critical care pharmacy services (executive summary): 2020 update

AbstractObjectivesTo provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice.DesignThe Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health‐Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross‐section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development.Main resultsThere are 82 recommendation statements: forty‐four original recommendations and 38 new recommendation statements. Thirty‐four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development.ConclusionsThe statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.

Structural and operational redesigning of patient-centered ambulatory care pharmacy services and its effectiveness during the COVID-19 pandemic.

BackgroundThe newly emerged coronavirus pandemic (COVID-19) has collapsed the entire global health care system. Due to these settings, a lot of strategic changes are adopted by healthcare facilities to ensure continuity in patient-centered services.ObjectiveThis study aims to evaluate the effectiveness of structural and operational changes made in ambulatory care pharmacy services during the COVID-19 pandemic.MethodsA retrospective comparative study was conducted to evaluate the impact and effectiveness of patient-centered interventions and consequent access to medication management care within Johns Hopkins Aramco Health Care ambulatory care pharmacy services during the COVID-19 pandemic by comparing patient-centered key performance indicators before and during COVID-19 pandemic for a total of 4 months.ResultsAs a result of the structural and operational changes made in patient-centered ambulatory care pharmacy services during the COVID-19 pandemic, a 48% prescriptions requests and 90% prescriptions fills are increased through online health portal application. A three-fold increase in the pharmacy call center utilization resulted in around 10% abandoned calls. In the number of physical visits to ambulatory care pharmacies, a 37% reduction was also noted. The decrease in staff schedule efficiency and an increase in average prescription waiting time were also noticed. The prescription collection through remote area pick up locations, and medication home delivery services were successful during COVID-19 pandemic as supported by statistical data.ConclusionThe access to ambulatory care pharmacy services during COVID-19 pandemic has been successfully maintained via medication home delivery, remote area pickup locations, pharmacy call-center consultations and refill requests, online health portal application services, and other measures, while reducing the number of physical visits to the JHAH hospital/clinic to ensure compliance with infection control and prevention measures.

Pharmacy, employee health lead health system's exposure response.

At Baystate Health in Western Massachusetts, the pharmacy department and Employee Health Services (EHS) work together to provide a consistent response whenever there is an occupational exposure to pertussis, bacterial meningitis, or other infectious diseases. Erin Taylor, assistant director of acute care pharmacy services at Baystate Medical Center (BMC) in Springfield, said in early February that the response protocol was developed after the 5-hospital system performed a gap analysis to review recent exposure incidents. Before then, she said, “there just was no standard process.” “We were all scrambling at the last minute and really not providing a valuable service to our employees,” she said. The new process includes well-defined procedures and documentation to track the health status of employees who are involved in exposure events. Taylor said the intent was to meet the needs of BMC and the health system’s smaller regional hospitals. She said one of the problems the group had to address was how to bill for medications used in the exposure response.

Pharmacy Patronage: Identifying the Roles of Nepalese Pharmacists in Tacking COVID-19

Coronavirus disease (COVID-19) pandemic is one of the dire issues currently worldwide. With increasing death tolls every day and with new information regarding disease every minute, it is very important to disseminate the updated and reliable information to the public. Along with other health care professionals, the pharmacists’ role is crucial in preventing the spread and management of the disease. The involvement of pharmacists from clinical trials, drug evaluation to providing pharmaceutical care and other basic pharmacy services in the frontline in this health emergency is undeniable. This commentary focuses on the role of pharmacists in different settings of the health care system and the degree of recognition of the work in Nepal.

Designing a Clinical Pharmacy Primary Care Intervention for Myocardial Infarction Patients Using a Patient and Public Involvement Discussion

Objective: to conduct a Patient and Public Involvement (PPI) focus group session. To help inform the design of a clinical pharmacy intervention in primary care for patients after a coronary event. Methods: this study followed a public involvement method. Community members of the public and community engaged research patients who had experienced myocardial infarction where invited to actively take part in a focus group discussion. This is to share past experiences and provide input and advice into the design of a potential research proposal. The session took place at a cardiac rehabilitation centre. Results: four key themes were identified from the focus group these included: experiences with pharmacy and primary care services, medicines knowledge, the pharmacist role and building rapport with healthcare professionals. Nine participants and three researchers attended the PPI discussion session. Seven of the participants were patients who had experienced a cardiac event in the last three months and two were carers. Primary care pharmacy services both clinical and public health were not very familiar to the participants. Different experiences with clinical pharmacy services were reported by participants, while one experience was reported to be helpful others perceived community pharmacists to be to be busy and isolated behind a counter. A general practice GP based specialist nurse was a familiar model of care unlike a specialist clinical pharmacist GP based care role. Participants reported limited time in GP consultations and the need to book double appointments. Participants stressed the need to receive consistent information about their disease and medication from different professionals involved in their care. Different views were expressed regarding the ability to build rapport with a clinical pharmacist when compared to a GP. Input on study outcomes and design was provided by participants. Conclusion: participants in this session mentioned that a clinical pharmacy intervention after hospital discharge would be useful for their continuity of care. Plans are in place to continue to involve patients and the public in the write up, ethics and dissemination of the potential clinical pharmacy proposal.

Implementation of pharmaceutical care for older adults in the brazilian public health system: a case study and realistic evaluation

BackgroundPharmaceutical care services have been recognized as the most highly regarded professional pharmacy practice model that allows the identification, intervention, and resolution of drug related problems. This practice provides significant clinical outcomes and can reduce direct and indirect costs for health systems. However, its implementation can be complex and challenging, needing study experiences that aims at overcoming obstacles, especially in free and universal healthcare systems. The objective of this study is to evaluate the implementation of Ambulatory Care Pharmacy services for older adults at Paulista Institute of Geriatrics and Gerontology (IPGG), which is recognized in the city of São Paulo for offering pharmaceutical care services for over 10 years continuously. This initiative and process is independent of external academic interventions or educational institutions. It is hoped that the results may also contribute to advancing the implementation of pharmaceutical care service in similar health systems.DesignThis is a case study using multiple sources of data. Qualitative and quantitative data were collected from institutional documents, by participant observation and interviews. Initial themes were identified by content analysis and analyzed under the context-mechanism-outcome configurations (CMO Configurations) in realistic evaluation.SettingGeriatrics and Gerontology Institute of São Paulo (known as IPGG).ParticipantsEleven health professionals and three pharmaceutical care service users.ResultsThree CMO configurations were identified and accepted: “Scenario Construction mediated by educational processes”, “Contribution to complex needs resolution”, and “Organizational Visibility”. The CMO (Context-Mechanism-Outcomes) configuration “Logistic activities discourage clinical pharmaceutical services implantation” was denied due to the influence of accepted CMOs.ConclusionsEducational processes which value transdisciplinary knowledge exchanges provide resources required to overcome important obstacles present during pharmaceutical care implementation. Thus, providing and seeking knowledge to build and offer context-consistent clinical health services as well as fulfilling organizational environment requirements can be the key to implement pharmaceutical care service.

Critical care pharmacy services in the Western Region of Saudi Arabia

Background: The value of critical care pharmacists (CCPs) in intensive care units (ICUs) has been well documented, and various studies have demonstrated the positive impacts of CCPs. Despite growing evidence supporting the contributions of clinical pharmacists in general and CCPs in particular in improving patient outcomes, many hospitals in the Kingdom of Saudi Arabia (KSA) still lack clinical pharmacy services. Most studies that have measured the impacts of CCPs in ICU settings have been conducted outside Saudi Arabia, with a significant gap in the literature related to CCP-related impacts, needs and obstacles in Saudi Arabia. Objective: To evaluate the current status of CCP services and the CCP services that are needed in Saudi Arabia as well as the barriers to establishing these services. Setting: Governmental and non-governmental hospitals in the western region of the KSA. Method: This was a cross-sectional survey-based study conducted in the western region of the KSA. The questionnaire included questions investigating current CCP services, which include clinical, educational, administrative and research services. Additional questions assessed the obstacles, needs and limitations related to the development of CCP services. Main Outcome Measures: The primary outcome is to describe the current status of ICU pharmacists in the KSA. Secondary outcomes of interest are the evaluation of the need for CCP services and the identification of the main barriers to establishing these services. Results: Of the 130 hospitals with ICUs to which surveys were emailed, 94 (72%) responded. Forty-three percent of responding hospitals had an ICU multidisciplinary team structure that included a pharmacist who visited the unit during medical rounds. Up to 54% of the hospitals with CCP services had one dedicated pharmacist present at bedside and during medical rounds. Approximately 78% of the ICU pharmacists performed one or more clinical activities. Training pharmacy interns was one of the major educational activities provided by ICU pharmacists. Clinical services (42%) were the most needed services, followed by educational (14%) activities. Limited job availability was the main barriers to having CCP services among hospitals. Conclusion: Critical care pharmacists in the western region of the KSA mainly provide fundamental clinical services, with limited engagement in desirable and optimal services such as research activities. The limited CCP services in the KSA are due to several barriers that warrant national efforts from the Ministry of Health (MOH) and the Saudi Commission for Health Specialists (SCFHS).

Patient's Satisfaction of Pharmacy Ambulatory Cares at the Emergency Hospital in Riyadh City, Saudi Arabia

International Journal of Pharmacology and Clinical Sciences,2019,8,3,199-203.DOI:10.5530/ijphs.2019.8.34Published:September 2019Type:Research ArticleAuthors:Yousef Ahmed Alomi, Nahith Alotaibi, Hawazen Abdullah Al-Kammash, Aroub Alhamidi, Walaa Aboziad, Kairat Imad Al-Hennawi, and Mohanad Imad Al-Hennawi Author(s) affiliations:Yousef Ahmed Alomi*, The Former General Manager of General Administration of Pharmaceutical Care, The Former Head, National Clinical pharmacy and pharmacy practice, The Former Head, Pharmacy R&D Administration, Ministry of Health, Riyadh, SAUDI ARABIA. Nahith Alotaibi, Head, Pharmacy Services, Aleman Hopsital, Ministry of Health, Riyadh, SAUDI ARABIA. Hawazen Abdullah Al-Kammash, Clinical Pharmacist Staff, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, SAUDI ARABIA. Aroub Alhamidi, Clinical Pharmacist Staff, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, SAUDI ARABIA. Walaa Aboziad, Clinical Pharmacist Staff, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, SAUDI ARABIA. Kairat Imad Al-Hennawi, Clinical Pharmacist Staff, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, SAUDI ARABIA. Mohanad Imad Al-Hennawi, Clinical Pharmacist Staff, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, SAUDI ARABIA. Abstract:Purpose: To explore the patient satisfaction of pharmacy ambulatory care services at the Emergency Hospital in Riyadh city, Saudi Arabia. Methods: This is a 4-month cross-sectional survey of patients’ satisfaction of ambulatory care pharmacy services at the Emergency Hospital, Saudi Arabia. The survey consisted of 48 questions divided into two parts: the first part collects demographic information and the second part contains questions on 11 domains: (1) medication availability (2) patient counseling (3) pharmacist and patient relationship (4) medication reconciliation (5) medication aberrance (6) pharmacy location (7) pharmacy-waiting area (8) pharmacy communications (9) pharmacy-waiting time (10) pharmacy recommends to others (11) overall patient satisfaction of pharmacy services. The survey was distributed to the Emergency Hospital in Riyadh city, included public, pediatrics and emergency hospitals ambulatory care patient. The study was in an electronic format and it analyze through the survey monkey system. Results: A total of 202 patients responded to the survey. Of those, 144 (71.6%) was Saudi and 57 (28.4%) was non-Saudi. The gender distribution 105 (52%) were females and 97 (48%) were males. The majority of them were in age group of 18-44 years (62%), while more than 44 years old was 68 (33.7%). The highest level of education was high school 81 (40.3%) followed by the Bachelor’s degree 51 (25.4%) and an intermediate school 44 (21.9%). The mean [±standard deviation (SD)] waiting time to get the medications was 19.36±11.02 (minute). The average scores of domains medication availability was 3.71, patient counseling was 3.48, pharmacist and patient relationship were 4.1 and medication reconciliation was 1.99. The medication adherence was 1.88, pharmacy location was 4.13, the pharmacy-waiting area was 3.31, pharmacy communications was 2.18, pharmacy-waiting time was 3.74 and pharmacy recommends to others was 3.69. The General evaluation of pharmacy services was found to be very good to excellent with 155 (76.7%) of responders, while 186 (92.1%) responders recommend the pharmacy to their family or friends and 176 (88.44%) responders prefer to revisit pharmacy. Conclusion: More than half of the patients were satisfied with ambulatory care pharmacy services at Riyadh, Saudi Arabia. Medication reconciliation, medication adherence and pharmacy communication domains were not found to be satisfied. Refining ambulatory care pharmacy services will avoid drug misadventures, avoid extra cost and surge patient satisfaction with pharmacy services. Keywords:Ambulatory care, Emergency, Ministry of Health, Patient, Pharmacy, Satisfaction, Saudi ArabiaView:PDF (195.57 KB) PDFClick here to download the PDF file. Images Overall, satisfied or dissatisfied with your last visit to our pharmacy

Pharmacist implementation of a transitions of care electronic referral process to provide hand-off between inpatient and outpatient settings

ObjectiveTo describe the implementation of an electronic transitions of care referral process within a large, academic medical center. Practice setting and descriptionTo improve communication between the inpatient and ambulatory care pharmacists, the pharmacy department created an electronic referral (e-referral) order, which becomes part of the patient’s electronic medical record. Data were collected to describe use of the electronic order and to discuss the role of the referrals in supporting a newly developed ambulatory care pharmacy service. Practice innovationThe e-referral was built to enhance the efficiency of direct patient care and prioritize patient care activities. This electronic order was built to collect specific details focused on medication-related concerns and provide hand-off to ambulatory care pharmacists for outpatient follow-up. EvaluationA retrospective, cohort analysis of patients was conducted from August 1, 2014, to July 31, 2015. Patients were included in the project if they were 18 years of age or older and received an e-referral order upon transition from the inpatient to the outpatient setting. Patients were excluded if the e-referral was sent from an outpatient setting or if they were younger than 18 years of age. Data were collected to describe the e-referral process and discuss how these referrals supported a new outpatient pulmonary clinic. ResultsA total of 268 inpatient referral orders were included for analysis. Common indications for the referrals included education (49%), follow-up from inpatient consult (46%), adherence (45%), and therapy optimization (42%). A total of 241 (90%) e-referrals were sent from an inpatient pharmacist to an ambulatory care pharmacist; the other 27 (10%) referrals were sent by a physician or mid-level provider. Of the 241 pharmacist referrals, 46 (19%) were placed by pharmacy residents. The majority of inpatient e-referrals (63.4%) were for chronic obstructive pulmonary disease and sent to the outpatient pulmonary clinical pharmacist for follow-up after discharge. The pulmonary clinic ambulatory care pharmacist completed 110 discharge calls (95.7%). ConclusionAn e-referral from inpatient to ambulatory care pharmacists provides pharmacist-to-pharmacist hand-off for medication-related needs after discharge.

Patient Satisfaction of Ambulatory Care Pharmacy Services in Pediatric and Maternity Hospital in Riyadh City, Saudi Arabia

Patient Satisfaction of Ambulatory Care Pharmacy Services in Pediatric and Maternity Hospital in Riyadh City, Saudi Arabia

Patient Satisfaction of Ambulatory Care Pharmacy Services in Riyadh City, Saudi Arabia

Patient Satisfaction of Ambulatory Care Pharmacy Services in Riyadh City, Saudi Arabia

Integration and compensation of pharmacists into primary care medical groups

ObjectiveTo demonstrate the expansion of an outpatient pharmacy program within a health system via annual wellness visits (AWVs) and disease state management patient encounters at outpatient medical groups. SettingA referral-based pharmacist-managed ambulatory care center, a department of a hospital, and 4 primary care medical groups of a community practice hospital health system in Savannah and Pooler, Georgia, and Bluffton, South Carolina. Practice descriptionSt. Joseph’s/Candler is a 714 bed, 2 hospital community practice heath care system located in Savannah, Georgia. The St. Joseph’s/Candler Center for Medication Management (CMM) is a pharmacist-managed ambulatory care clinic that provides referral-based ambulatory care services in anticoagulation, diabetes, heart failure, tobacco cessation, transitional care, vaccinations, and wellness contracts for self-insured organizations, and has 147 referring physicians. Nurse Practitioners and Pharmacists evaluate and manage patients under their scope of practice and supervising medical director for the CMM. Pharmacists and Nurse Practitioners educate patients and collaborate with referring physicians for disease state management but do not carry prescriptive authority at CMM. CMM bills for services as a provider-based department of the hospital. CMM is recognized as an Anticoagulation Center of Excellence by the Anticoagulation Forum and is interventional with ambulatory care quality initiatives of the health system. Pharmacists in CMM are board-certified in ambulatory care provided by Board of Pharmacy Specialties and have completed a minimum of a 1-year post-graduate training program accredited by the American Society of Health-System Pharmacists. CMM has 4 off-campus satellite locations providing ambulatory care referral-based services. Since 2007, the CMM has primarily provided anticoagulation services via laboratory monitoring and management of warfarin. Practice innovationPharmacists transitioned from provider-based departments of a hospital to outpatient primary care medical groups. This transition changed their job description and the model for reimbursement of the pharmacists’ salaries. Four pharmacists were present 60 hours per week from January 2018 to August 2018, and 80 hours per week (2 full-time clinical pharmacist positions) from September 2018 to December 2018, to conduct AWVs and disease state management patient encounters. These pharmacists divided their time between a department of a hospital and a traditional medical group of the same health system. EvaluationFor calendar year 2018, 1770 AWVs and 468 disease state management patient care visits were provided exclusively by pharmacists to patients of the 4 primary care medical groups of this community practice health system. Patient visits for disease state management included diabetes, hypertension, hyperlipidemia, anticoagulation, and tobacco cessation. ResultsFor the calendar year 2018, 1770 AWVs and 468 disease state management patient visits were provided exclusively by pharmacists, under the direct supervision of physician, to patients of primary care medical groups. ConclusionThis is an example of expanding direct patient care pharmacy services, within a health system, to primary care medical groups, without direct grant or university funding.

Measuring the impact of integrating post-graduate year two ambulatory care pharmacy residents into specialty clinics

Background: It is well established that integration of a pharmacist into specialty clinics increases access to medication, improves patient adherence and decreases financial burden on patients. As specialty clinics and the prescribing of specialty medications continues to exponentially grow, it is critical for pharmacy residents to be provided learning opportunities within these settings to maximize pharmacy services as well as to educate future pharmacists in this field. The University of Louisville Hospital is an academic medical center that currently trains two post-graduate year two (PGY-2) ambulatory care pharmacy residents annually. Aims: To measure the impact of utilizing PGY-2 ambulatory care pharmacy residents on increasing coverage and provider satisfaction in specialty clinics. Additionally, to evaluate the ability of the learning experience in meeting the residents’ educational objectives. Methods: PGY-2 residents were trained to provide ambulatory care pharmacy services in the Hepatitis C and Multiple Sclerosis (MS) Clinics. They then provided those services with peripheral support from a preceptor over a 6 month period. Outcomes collected to determine the impact of PGY-2 residents included hours of clinic coverage provided, number of patients served, number of patients that discontinued treatment and provider satisfaction with pharmacy services. To demonstrate the meaningfulness of this learning experience, the educational objectives met as defined by the American Society of Health System Pharmacists (ASHP) residency standards will be reported. Results: Over 6 months, pharmacist coverage was expanded by 104 hours in the Hepatitis C Clinic and 84 hours in the MS Clinic through utilization of PGY-2 residents. The total number of patients served during those hours was 114 in Hepatitis C and 102 in MS. During this 6 month period, only three patients discontinued hepatitis C treatment before completing therapy and two patients discontinued therapy in the MS clinic due to medication related issues. Of the providers surveyed, 100% were satisfied with the pharmacy services provided and agreed that the pharmacist took prompt action to resolve their needs and/or concerns. ASHP educational objectives met through this learning experience include R1.1.3, R1.1.4, R1.1.6, R1.1.7, R2.1.2, R3.3.1 and R3.3.2. Conclusions: These results and observations show that patients, providers and PGY-2 ambulatory care residents all benefit from integration of PGY-2 residents into the specialty clinic setting.

Students’ Perceptions on a Business Plan Assignment for an Ambulatory Care Pharmacy Elective

Objective. To evaluate a business-centered assignment implemented in a pharmacy elective course at two different institutions and analyze student perceptions of the delivery platforms used and the value and utility of the assignment. Methods. The ambulatory care electives at Butler University and Samford University introduce students to the expanding role of the ambulatory care pharmacist, emphasizing business plan development for new ambulatory care pharmacy services. As part of the elective, students are asked to work in groups to complete a business plan for a new ambulatory care service of their choosing. A survey was conducted to assess student perceptions on the assignment. Results. Of the 58 students who completed the business plan assignment, 49 completed the survey and were included in the data analysis. Overall, 100% of Samford students and 97% of Butler students either strongly agreed or agreed that the business plan was an innovative assignment unlike others completed in the curriculum. Samford students strongly agreed (100%) that if asked by a future employer to develop a new pharmacy service, concepts learned from this assignment would be useful, compared to 59% of Butler students who felt this way. While both the web and written delivery platforms had identical learning outcomes, the written business plan was the approach that the majority of students were more comfortable using. Conclusion. The business plan assignment was used as a method to familiarize students with the process of developing new ambulatory care pharmacy services. Based on survey results, the students perceived this to be an innovative assignment that allowed them to feel confident in developing and communicating ambulatory care business plans. As the practice of ambulatory care pharmacy expands, assignments such as this can be included in the pharmacy curriculum to meet the need for teaching effective business strategies to future pharmacists.

EFFECT OF EDUCATION HOME PHARMACY CARE ON HYPERTENSION PATIENTS ‘LIVING QUALITY IN PUSKESMAS

Hypertension is one of ten degenerative diseases that decline the patient’s quality of life. Controlling hypertension through the role of pharmacists as a care giver in home pharmacy care activities can reduce the morbidity of the disease. The purpose of this study was to examine the effect of home pharmacy care education on the quality of life of hypertensive patients hospitalized at the Gamping II Public Health Center. This research design was quasi-experimental with a pre post control group. Respondents of this study were 28 hypertensive patients of the Gamping II Public Health Center. They were taken by simple random sampling and then divided into 2 groups, control and intervention. In the intervention group, respondents were given a pre-test and then educated with Home Pharmacy Care as many as 4 times. Data on blood pressure changes were measured using tensimeter, while quality of life assessment was SF-36 questionnaires. Data were analyzed by using student t-test. The results of this study showed that hypertensive patients are home pharmacy care services at Gamping II Public Health Center had significantly decreased blood pressures both systolic and diastolic (p <0.05), while the quality of life showed a significant increase (p <0.05). It was concluded that the application of home pharmacy care education to hypertensive patients in GampingPublic Health Center could reduce blood pressure and can statistically improve quality of life.

In Memoriam: Fernand Labrie, June 28, 1937 – January 16, 2019

In the UK, the customary method of obtaining special low protein (LP) foods was by dispensing through a pharmacist (until 2010) for patients with inherited metabolic disorders (IMD) requiring LP diets. Recently, different home delivery services have been introduced to support patient access of low protein foods, but the effectiveness of these services is unclear.A prospective, longitudinal, observational study to examine the effectiveness and safety of patient home delivery services for LP foods over 12 months in IMD patients requiring a LP diet.IMD patients/caregivers had the choice of 2 home delivery services (Homeward® and Vitaflo at Home®) as well as access to primary care pharmacy services. Both home delivery services provided a limited range of LP foods. Over a 12-month period, a member of the IMD dietetic team conducted 4 home visits to IMD patients on LP diets using home delivery services for low protein foods. At each visit, caregivers completed a questionnaire consisting of 20 multiple choice and open questions about their prescription experience with special LP foods. The researchers also completed stock checks, assessed ‘use by dates’ and adequacy of home storage for LP foods.In total, 58 patients participated in this study. Over 12 months, 95% (n = 55/58) of caregivers used their local pharmacy, 93% (n = 54/58) Homeward® and 78% (n = 45/58) Vitaflo at Home® to access LP foods. Two home delivery services were used by 41 (71%) caregivers and the remaining 17 (29%) only used one of the home delivery service companies. Each patient only stored a median of 6 (range 0–22) different LP foods at home. Overall, 45% (n = 26/58) of caregivers reported problems with their GP prescriptions. 30% (n = 16/53) of caregivers received at least one incorrect prescription when using their pharmacy (e.g. gluten-free foods instead of LP, incorrect product or incorrect product amount), 6% errors (n = 3/53) with Homeward® and 2% (n = 1/48) with Vitaflo at Home®. 49% (n = 26/53) of caregivers said they experienced delayed receipt of LP foods from their pharmacy, compared with 11% (n = 6/55) from Homeward® and 8% (n = 4/48) Vitaflo at Home®.Although home delivery services for special LP foods are associated with less errors and delay compared with pharmacies, inaccuracies and inefficiencies still occur and the overall system is complex. We suggest a new, simpler, less fragmented system whereby metabolic dietitians prescribe LP foods. This is likely to result in less burden on NHS resources and ensure a better treatment delivered to IMD patients.

Home delivery service of low protein foods in inherited metabolic disorders: Does it help?

BackgroundIn the UK, the customary method of obtaining special low protein (LP) foods was by dispensing through a pharmacist (until 2010) for patients with inherited metabolic disorders (IMD) requiring LP diets. Recently, different home delivery services have been introduced to support patient access of low protein foods, but the effectiveness of these services is unclear. AimA prospective, longitudinal, observational study to examine the effectiveness and safety of patient home delivery services for LP foods over 12 months in IMD patients requiring a LP diet. MethodsIMD patients/caregivers had the choice of 2 home delivery services (Homeward® and Vitaflo at Home®) as well as access to primary care pharmacy services. Both home delivery services provided a limited range of LP foods. Over a 12-month period, a member of the IMD dietetic team conducted 4 home visits to IMD patients on LP diets using home delivery services for low protein foods. At each visit, caregivers completed a questionnaire consisting of 20 multiple choice and open questions about their prescription experience with special LP foods. The researchers also completed stock checks, assessed ‘use by dates’ and adequacy of home storage for LP foods. ResultsIn total, 58 patients participated in this study. Over 12 months, 95% (n = 55/58) of caregivers used their local pharmacy, 93% (n = 54/58) Homeward® and 78% (n = 45/58) Vitaflo at Home® to access LP foods. Two home delivery services were used by 41 (71%) caregivers and the remaining 17 (29%) only used one of the home delivery service companies. Each patient only stored a median of 6 (range 0–22) different LP foods at home. Overall, 45% (n = 26/58) of caregivers reported problems with their GP prescriptions. 30% (n = 16/53) of caregivers received at least one incorrect prescription when using their pharmacy (e.g. gluten-free foods instead of LP, incorrect product or incorrect product amount), 6% errors (n = 3/53) with Homeward® and 2% (n = 1/48) with Vitaflo at Home®. 49% (n = 26/53) of caregivers said they experienced delayed receipt of LP foods from their pharmacy, compared with 11% (n = 6/55) from Homeward® and 8% (n = 4/48) Vitaflo at Home®. ConclusionsAlthough home delivery services for special LP foods are associated with less errors and delay compared with pharmacies, inaccuracies and inefficiencies still occur and the overall system is complex. We suggest a new, simpler, less fragmented system whereby metabolic dietitians prescribe LP foods. This is likely to result in less burden on NHS resources and ensure a better treatment delivered to IMD patients.

Pharmacists in Critical Care.

The beginnings of caring for critically ill patients date back to Florence Nightingale's work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care.

PHP54 - A Time-Driven Activity-Based Cost Study of Primary Care Pharmacy Service of Chronic Diseases Among The Elderly at Community Health Center, Krabi Hospital and Sai Thai Contract Units Of Primary Care, Krabi Province, Thailand

This study aimed to describe a cost of primary care pharmacy service, including home health visit, provided by Thai pharmacist from Community Health Center of Krabi hospital, Sai Thai Contract Units of Primary Care, and community pharmacy. A Time-driven activity-based costing method was applied in calculating cost of service. Bootstrapping technique was adopted to demonstrate the variation of time spending on each activity. Patients with chronic diseases diagnosed with either hypertension, or diabetes, or dyslipidemia were sampled. The lengths of time of each activity per patient's visit were observed. Time-to-pharmacy activities were compared between a primary care unit and a community pharmacy. At the community pharmacy, pharmacist spent about 3.11 minutes per patient (95%CI=3.08-3.15) on pharmaceutical diagnosis and 8.64 minutes per patient (95%CI=8.49-8.79) on counseling and dispensing. At the community health centre, pharmacists spent about 3.75 minutes per patient (95%CI=3.63-3.86) on counseling and dispensing, while, family pharmacist spent about 4.37 minutes per home visit (95%CI=4.14-4.59) on pharmaceutical diagnosis and 21.38 minutes per home visit (95%CI=20.33-22.41) on counseling and dispensing.Total cost of primary care pharmacy activities at the primary care unit and community pharmacy were 11.6501 USD and 1.4729 USD, respectively. At the Primary Care Unit, however, none of total cost of service was calculated because there were not activities provided by pharmacist. Integrating primary care pharmacy services between the community health center and community pharmacy is a suggested model, which is to attract more patients with uncomplicated chronic diseases to use primary care service, as well as, to decrease total cost of pharmacy service regarding public health service provider's perspective. Ultimately, primary care pharmacy service should be more financially supported by Thai public health purchasers in order to improve the effective provisions of service. Key words: Time-driven activity-based costing, Primary care pharmacy service, Chronic diseases

Development and validation of an Ambulatory Care Patient Satisfaction Questionnaire to assess pharmacy services in Malaysia.

Background Assessing patient satisfaction regarding a pharmacy ambulatory care service is important as patient satisfaction is a determinant of the viability and sustainability of the service provided. Objective To develop and validate the Ambulatory Care Patient Satisfaction Questionnaire in Malaysia. Setting A public hospital in Malaysia with two outpatient pharmacies. The main outpatient pharmacy has an average waiting time of 1-2h; whilst PharmCARE (which prepares repeat prescriptions in advance) has an average waiting time of 5-15min. Method Our instrument was developed based on literature review, a theoretical framework and an expert panel. The initial version consisted of 20 Likert-type items (where a higher score indicates higher satisfaction) was administered to patients/carers who were ≥ 21years, from November 2015 to June 2016 at baseline and 2weeks later. Main outcome measure The psychometric properties of the instrument. Results A total of 200/220 participants agreed to participate (response rate = 90.9%): main outpatient pharmacy = 114, PharmCARE = 86. Flesch reading ease was 51.9. The final version consists of 17 items with five domains measuring information (4 items), accessibility (4 items), relationship (4 items), outcomes (2 items) and continuity of care (3 items). Participants who collected their medications from PharmCARE [78.0% (72.8-81.3)] were significantly more satisfied than participants from the main outpatient pharmacy [72.0% (68.0-76.0), p < 0.001]. The overall Cronbach's alpha value was 0.839. Kappa values ranged from 0.681 to 0.914. Conclusion Our instrument was found to be a valid and reliable instrument to assess satisfaction of patients towards an ambulatory care pharmacy service in Malaysia.