Comprehensive Medication Management Research Articles

Potential benefits of incorporating social determinants of health screening on comprehensive medication management effectiveness.

Increasingly, pharmacists are asked to incorporate social determinants of health (SDoH) identification and referral into clinical practice. However, to date, no studies have evaluated clinical changes from embedding SDoH screening into the delivery of comprehensive medication management (CMM) in patients with chronic conditions. To examine the clinical effectiveness of implementing a clinical pharmacist-led SDoH screening and referral process as part of CMM encounters across a network of 7 Federally Qualified Health Centers (FQHCs). We used a retrospective cohort design to evaluate the effectiveness of integrating SDoH screening into CMM across a network of 7 FQHCs. A difference-in-difference approach was used to compare the effectiveness of CMM between patients with and without SDoH needs on the probability of achieving clinical control for blood pressure (<140 systolic/90 diastolic mm Hg) and diabetes (<9% hemoglobin A1c). Among 807 patients receiving CMM in 2023, 595 (74%) were screened for SDoH. 55.1% of patients screened had 1 or more SDoH, most commonly facing barriers related to insurance (22.0%), language (11.3%), transportation (9.1%), health behaviors (7.1%), income/employment (5.9%), and food insecurity (5.6%). Comparing patients with SDoH needs with those without, the proportion of patients controlled at baseline was 66.3% vs 72.3% for hypertension and 39.0% vs 75.4% for diabetes, respectively. Following a CMM encounter, the proportion of patients who achieved blood pressure control increased 7.6% more (P = 0.225) among patients with SDoH needs than in those without SDoH, whereas diabetes control rates increased 13.3% more (P = 0.143). Although not statistically significant, the results of this pilot evaluation suggest the potential for meaningful clinical improvements from screening and referral of SDoH needs as a part of CMM encounters. These results should be corroborated using a larger, more robust study design.

EXaminaTion of cRitical cAre PHArmacist pRoductivity MetricS (EXTRA‐PHARMS): The clinical pharmacist's perspective

AbstractBackgroundCritical care pharmacists are well‐established, valuable members of the intensive care unit interprofessional team with unique skills to perform comprehensive medication management in complex critically ill patients. However, standardized and consequential productivity metrics for critical care pharmacists have not been established.ObjectiveTo characterize the utilization and perception of contemporary critical care pharmacy productivity metrics utilized among individual institutions.Design, Setting, and ParticipantsAn electronic survey was distributed to critical care pharmacist members of the Society of Critical Care Medicine Clinical Pharmacy and Pharmacology Section and the American College of Clinical Pharmacy Critical Care Practice and Research Network.Main Outcomes and MeasuresThe survey included 23 questions to assess institution demographics, individual respondent demographics, institution practices, and individual respondent perceptions about the value of critical care pharmacist productivity metrics.ResultsA total of 204 critical care pharmacists, largely from the United States, responded to the survey between July and November 2022. Institutional metrics captured by more than 50% of the respondents' institutions included order verification rate/number of orders verified (60%), number of clinical interventions (57%), and intravenous to enteral product interchanges (52%). Of these metrics, critical care pharmacists only agreed with the value of the number of clinical interventions, were indifferent to the value of intravenous to oral product interchanges, and disagreed with the value of order verification rate/number of orders verified.ConclusionsSignificant discrepancies exist between institutional productivity metric practices and their perceived value and utility among critical care pharmacists.

Validation of an algorithm to prioritize patients for comprehensive medication management in primary care settings.

Comprehensive medication management (CMM) programs optimize the effectiveness and safety of patients' medication regimens, but CMM may be underutilized. Whether healthcare claims data can identify patients appropriate for CMM is not well-studied. Determine the face validity of a claims-based algorithm to prioritize patients who likely need CMM. We used claims data to construct patient-level markers of "regimen complexity" and "high-risk for adverse effects," which were combined to define four categories of claims-based CMM-need (very likely, likely, unlikely, very unlikely) among 180 patient records. Three clinicians independently reviewed each record to assess CMM need. We assessed concordance between the claims-based and clinician-review CMM need by calculating percent agreement as well as kappa statistic. Most records identified as 'very likely' (90%) by claims-based markers were identified by clinician-reviewers as needing CMM. Few records within the 'very unlikely' group (5%) were identified by clinician-reviewers as needing CMM. Interrater agreement between CMM-based algorithm and clinician review was moderate in strength (kappa = 0.6, p < 0.001). Claims-based pharmacy measures may offer a valid approach to prioritize patients into CMM-need groups. Further testing of this algorithm is needed prior to implementation in clinic settings.

Complexity of patient encounters within a clinically integrated community pharmacy network Medicaid payer program

BackgroundCommunity pharmacists frequently care for patients with complex medical and social needs; however, specific evidence on pharmacist perceptions of what makes a patient encounter complex has not been clearly characterized. There is a need to better understand specific factors that contribute to patient encounter complexity and demonstrate how pharmacists in community settings care for these individuals. ObjectivesThe objectives of this programmatic case study were to: (1) elucidate factors that contributed to patient encounter complexity as a part of a Medicaid Managed Care Organization comprehensive medication management payer program in community pharmacies and (2) curate a series of patient case vignettes that provide evidence of pharmacists care for patients with complex medical and social needs within community pharmacies. MethodsThis qualitative programmatic case study utilized data from semistructured interviews with community pharmacists who provided comprehensive medication management services to Medicaid patients in Pennsylvania. Pharmacists described their most complex patient encounter. Interviews were transcribed and independently coded by 2 investigators. The coded texts were grouped into categories, and a cross-case inductive thematic analysis was performed to identify complexity factors. ResultsThirty pharmacists provided 48 patient case vignettes and 3 complexity factors emerged: (1) care coordination, (2) behavioral health support, and (3) social determinants of health. Representative patient case vignettes were selected to illustrate these factors. ConclusionPharmacists, who participated in a community pharmacy Medicaid Managed Care Organization payer program, provided care to patients with complex health needs. In addition to medication-related problems, specific factors that increased pharmacist perception of encounter complexity were care coordination with other health care providers, behavioral health support, and addressing social determinants of health.

Clinical and economic outcomes of a pharmacogenomics-enriched comprehensive medication management program in a self-insured employee population

Clinical and economic outcomes from a pharmacogenomics-enriched comprehensive medication management program were evaluated over 26 months in a self-insured U.S. employee population (n = 452 participants; n = 1500 controls) using propensity matched pre-post design with adjusted negative binomial and linear regression models. After adjusting for baseline covariates, program participation was associated with 39% fewer inpatient (p = 0.05) and 39% fewer emergency department (p = 0.002) visits, and with 21% more outpatient visits (p < 0.001) in the follow-up period compared to the control group. Results show pharmacogenomics-enriched comprehensive medication management can favorably impact healthcare utilization in a self-insured employer population by reducing emergency department and inpatient visits and can offer the potential for cost savings. Self-insured employers may consider implementing pharmacogenomics-enriched comprehensive medication management to improve the healthcare of their employees.

Quality and access outcomes in 2 Veterans Health Administration facilities with fidelity to the comprehensive medication management framework

Quality and access outcomes in 2 Veterans Health Administration facilities with fidelity to the comprehensive medication management framework

Bridging the Gaps and Improving Care: Comprehensive Medication Management for Transgender Patients.

The consequences of mismanaged medications for the nearly 1.4 million adults in the United States who identify as transgender can be severe. Hormone therapy, pre- or post-gender affirming surgical therapies, and concurrent management of chronic conditions like diabetes or hypertension necessitate careful medication oversight. Without tailored care, these individuals are at risk for poor health outcomes and increased health care costs. Pharmacists are in a unique position to provide inclusive, gender-affirming health care to transgender individuals. Comprehensive Medication Management integrates pharmacists into the health care team to ensure medications are appropriate, effective, safe, and able to be taken as intended.

An international, multicenter post hoc analysis comparing in-person and virtual medication management strategies in post-ICU recovery clinics.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To compare the incidence of ICU pharmacist interventions in intensive care unit recovery center (ICU-RC) in-person and virtual clinic visits. This was a post hoc analysis of interventions implemented by ICU pharmacists among adult patients who were referred to 12 ICU-RCs across the United States and the United Kingdom between September 2019 and July 2021, as reported in a previously published study "An International, Multicenter Evaluation of Comprehensive Medication Management by Pharmacists in ICU Recovery Centers." That study included patients who received a comprehensive medication review by an ICU pharmacist. Medication-related interventions performed by an ICU pharmacist during ICU-RC in-person clinic visits were compared to those performed during virtual clinic visits. There were 507 patients referred to an ICU-RC, of whom 474 patients attended a clinic visit. Of those, 472 received a comprehensive medication review, with 313 patients attending in-person visits and 159 patients attending virtual visits. The incidence of medication-related interventions implemented was higher in the ICU-RC in-person clinic group compared to the virtual clinic group (86.5% vs 79.2%, P = 0.04). There was no difference in the median number of ICU pharmacist interventions per patient between the in-person and virtual clinic groups (2 vs 2, P = 0.13). An ICU admission diagnosis was an independent predictor of medication-related interventions among all patients. The incidence of ICU pharmacist interventions was higher at ICU-RC in-person clinic visits compared to virtual clinic visits. Pharmacists aid in meeting the complex pharmacologic challenges of post-intensive care syndrome in both settings.

Implementation of a practice model for inpatient psychiatric clinical pharmacist practitioners with prescriptive authority at a veterans health care facility.

Clinical pharmacists play a valuable role on collaborative health care teams, especially in the field of mental health. However, there is a need to explore innovative practice models that optimize their potential in providing comprehensive medication management in inpatient psychiatric settings. This report aims to describe the implementation of a practice model using an inpatient psychiatric clinical pharmacist practitioner performing comprehensive medication management. The implementation of a practice model using a psychiatric clinical pharmacist practitioner was a feasible way to deliver comprehensive medication management and other clinical services in an inpatient psychiatric setting amid staffing challenges. Whereas limitations such as resource constraints must be considered, the success of this model highlights the value of a versatile psychiatric clinical pharmacist practitioner. These findings might offer insight to other health care facilities considering a similar approach to provide mental health care through the use of a psychiatric clinical pharmacist practitioner.

Narrowing Cardiovascular Disease Health Disparities by Advancing the Role of Pharmacists Through a Multisector Consortium.

Demand for scaling and sustaining clinical services to improve health outcomes while minimizing costs is rising, particularly for patients dealing with major cardiovascular disease and stroke risk factors such as hypertension. Consequently, there is growing national and local interest in engaging pharmacists as part of the solution through the implementation of comprehensive medication management. To capitalize on this momentum, a team from the University of Southern California led the establishment of the California Right Meds Collaborative (CRMC) in 2019. CRMC aims to reduce the burden of uncontrolled chronic disease by advancing the role of pharmacists as team members in the health care system. This case study describes CRMC's structure and approach to developing value-based payment models and advancing the competency of pharmacists through training, continuous quality improvement, and technical assistance. In addition, this case study provides an overview of a CRMC pilot project wherein a local health plan tested a value-based payment model to deliver comprehensive medication management. The pilot underwent many iterative changes throughout its duration but ultimately was considered a success and adopted as part of standard practice. Lessons learned from this effort can help others leverage the availability of pharmacists to assist vulnerable populations in their communities.

Impact of the COVID-19 Pandemic on Pharmacist Interventions: A Retrospective Study with Inpatients in a University Hospital.

Despite growing interest in understanding the challenges faced by multidisciplinary health teams during the COVID-19 pandemic, there is a lack of studies specifically focusing on changes in pharmacist interventions and drug-related problems. To analyze and compare the interventions performed by pharmacists during comprehensive medication management in the adult intensive care unit and general internal medicine ward of the University Hospital of the University of São Paulo, Brazil, for defined periods before the onset of the COVID-19 pandemic and during the pandemic itself. All pharmacist interventions performed in relation to inpatient prescriptions from March to December 2019 (before the pandemic) and from March to December 2021 (during the pandemic) were collected and tabulated. These interventions were then classified according to the Pharmaceutical Care Network Europe (PCNE) system, version 9.1, and categorized based on first-level codes of the Anatomical Therapeutic Chemical classification system. The analysis revealed substantial changes in the patterns of pharmacist interventions and the therapeutic classes of drugs for COVID-19-positive and COVID-19-negative patients during the pandemic relative to patients in the pre-pandemic period. Among COVID-19-positive patients, interventions were predominantly related to enhancing patient safety (PCNE code P2), drug selection (C1), dose selection (C3), prescribing and dispensing processes (C5), the drug-use process (C6), and patient transfers between different levels of care (C8). The drug-related problems addressed by pharmacist interventions primarily involved COVID-19-positive patients in the pandemic period and were related to systemic hormonal preparations (excluding sex hormones and insulins), anti-infective agents for systemic use, nervous system and drugs for the blood and blood-forming organs. The results of this study highlight the adaptability and competence of pharmacists in responding to critical scenarios such as the COVID-19 pandemic. These scenarios are characterized by new work dynamics, the hiring of additional professionals, an increase in the number of beds, the rapid evolution of evidence-based information, and drug shortages that necessitate the use of alternative medications. Pharmacists play a crucial role in ensuring patient safety during these difficult times.

Infringement of clinical pharmacist's authority.

Clinical pharmacists are healthcare practitioners who have advanced education and training in comprehensive medication management. Clinical pharmacists work with other members of the healthcare team to manage particular medications or disease states. Even though clinical pharmacists are members of healthcare teams, there are still many cases of challenge in the interprofessional relationship with other healthcare team members, especially related to drug management. Increasing interprofessional communication between physicians and clinical pharmacists within the healthcare system could enhance the role of clinical pharmacists. Earlier studies reported that physicians were comfortable with pharmacists detecting and preventing prescription errors, but were uncomfortable with them recommending drug therapy to patients. Acceptance of pharmacists' suggestions by prescribers is a necessary component of the evaluation of clinical pharmacy services. The role of clinical pharmacists could be improved by increasing interprofessional communication between doctors and clinical pharmacists in the healthcare system.

A collaborative pharmacist-led intervention to prevent hospital readmissions among elderly patients discharged from the emergency department: a retrospective cohort study

Unplanned hospital readmission is a safety and quality healthcare measure, conferring significant costs to the healthcare system. Elderly individuals, particularly, are at high risk of readmissions, often due to issues related to medication management. Pharmacists play a pivotal role in addressing medication-related concerns, which can potentially reduce readmissions. This retrospective single-centre cohort study, conducted from November 2022 to February 2023 in an emergency department, aimed to determine if integrating emergency medicine pharmacists into Emergency Department care models reduces unplanned hospital readmissions within 28 days and to identify the interventions they employ. The inclusion criteria included patients aged ≥ 65, taking ≥ 3 medications, and presenting with falls, cognition changes, or reduced mobility and were planned for discharge to home from the emergency department. Collaborating with the Emergency Department Aged Care Service Emergency Team, a pharmacist provided comprehensive medication management consultations, discharge liaison services, and other pharmacy related interventions to eligible participants whenever the pharmacist was available. Patients who met the eligibility criteria but did not receive pharmacist interventions due to the pharmacist's unavailability served as the control group. This method was chosen to ensure that the control group consisted of comparable patients who only differed in terms of receiving the pharmacist intervention. The study included 210 participants, with 120 receiving pharmacist interventions and 90 acting as controls. The results revealed a significant reduction in unplanned hospital readmissions among participants who received pharmacist interventions (10.0%, n = 12) compared to controls (22.2%, n = 20), with a notable difference of 12.2% (95% confidence interval 2.4–23.4%, p = 0.01). A total of 107 interventions were documented, emphasising medication selection recommendations (28.0%) and identification of adverse drug reactions/drug-drug interactions (21.5%) as primary areas of focus. These findings suggest that integrating skilled pharmacists into Emergency Department Aged Care Service Emergency Team (ASET) lowered the rate of unplanned hospital readmission within 28 days resulting in improved hospital performance metric outcomes. This highlights the potential role of pharmacists in addressing medication-related issues and enhancing the quality and safety of healthcare delivery, particularly for elderly patients transitioning from the ED to home care settings.

Implementación piloto de la gestión integral de la farmacoterapia a pacientes hospitalizados con enfermedades cardiovasculares

Context: Comprehensive medication management service provides comprehensive pharmaceutical care to patients to meet their pharmacotherapeutic needs and improve their quality of life in terms of health. Aims: To describe the results of the pilot implementation of the comprehensive medication management service provided to inpatients with cardiovascular diseases. Methods: Longitudinal, prospective and intervention study was carried out, with qualitative research elements. The sample included patients with cardiovascular diseases and more than five days from the Cardiology Service of the “Saturnino Lora” Provincial Hospital in Santiago de Cuba. The care process was developed according to the OFIL's Guide for the implementation of Comprehensive Medication Management. The patients’ medication experiences were evaluated according to Ramalho de Oliveira et al. The evaluation of drug-related problems and the clinical outcomes was carried out according to the Pharmacotherapy Work-up Method. Results: Twenty patients were included, 65% male. The mean age was 66.2 ± 13.1 years. Eighty percent of the patients had hypertension. One hundred percent received antihypertensive and antithrombotic drugs. Forty percent reported body as a pharmacotherapeutic experience. One hundred and thirty-three drug-related problems were detected and 45.1% corresponded to safety problems. One hundred and fifty-five pharmaceutical interventions were performed and 89% were accepted. Ninety percent of the patients achieved positive clinical outcomes. Conclusions: The pilot implementation of the comprehensive medication management service contributed to the resolution of drug-related problems and showed positive clinical outcomes in patients with cardiovascular diseases.

Clinical Pharmacy Services in a Neurosurgical Intensive Care Unit in Iran: A Focus on a Comprehensive Medication Management Model

Background: Critically ill patients treated in the intensive care unit (ICU) are at risk of drug-related problems (DRPs), clinical pharmacists are specifically trained in pharmacotherapy evaluations with the abilities to identify and manage drug-related complications. This study aims to identify areas where clinical pharmacists can be effective in the ICU. The primary outcomes of this study were determining the clinical aspect of clinical pharmacists in the ICU, type, and number of clinical pharmacist interventions. Methods: This was a prospective, interventional study in a teaching hospital in Iran. A clinical pharmacist was dedicated to implement comprehensive medication management (CMM); All Pharmacotherapy Problems were categorized. Results: During the monitoring of 162 patients by the clinical pharmacist, 1524 interventions were conducted. The most frequent pharmacotherapy-related problems identified were drug selection (33.3%), dose adjustment (17.3%), and fluid and electrolyte management (12.9%). Conclusion: Clinical pharmacists’ interventions could reduce the rate of DRPs by pharmacotherapy evaluation and may have important role in many aspects of patient’s management.

An analysis of the impact on total cost of care within a pharmacist‐led comprehensive medication management program

AbstractIntroductionThe rise in health care expenditures continues to pose a significant concern regarding the longevity of the current health care system design. The literature has demonstrated a positive return on investment (ROI) when pharmacists perform medication management services. Building upon positive ROI literature, a clinically integrated network (CIN) in Michigan developed an approach to patient targeting for comprehensive medication management (CMM) services in existing alternative payment model (APM) Medicare Advantage, Medicaid, and Commercial contracts.ObjectivesThe primary objective of this study was to examine the real‐world impact of an advanced ambulatory care pharmacy model, inclusive of embedded clinic‐based ambulatory pharmacists, centralized ambulatory pharmacists, centralized population health pharmacists, and specially trained pharmacy technicians, on the total cost of care (TCOC) within a large integrated health system.MethodsFor CMM dates of service occurring in calendar year 2022, pharmacy and medical claims were evaluated during the 6‐month period prior to and following the initial CMM patient encounter. Upon completion of the study period, data were evaluated to assess TCOC and utilization trends for the study population.ResultsStatistically significant differences in median TCOC ($1427.84, p &lt; 0.001), prescription drug costs ($222.82, p &lt; 0.001), and medical costs ($462.26, p &lt; 0.001) were observed between the pre‐CMM and post‐CMM timeframes for the study population. A 16% reduction in hospital admissions was observed between the pre‐CMM and post‐CMM timeframes.DiscussionThis study further supports that pharmacist intervention as part of a CMM program can favorably affect health care costs. Criteria such as a population's benchmark costs and utilization, insurance product types, and core conditions present can help determine whether expanding or initiating CMM services could be beneficial in improving care and health care costs.

Preoperative medication management turnkey order set for nonemergent adult cardiac surgery

ObjectiveThe management of preoperative medications is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, first presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Numerous guidelines and expert consensus documents have been published to provide guidance in preoperative medication management. Our objective is to integrate these documents into an evidence-based order set that will facilitate standardized implementation of best practices for preoperative medication management for nonemergent adult cardiac surgery. MethodsSubject matter experts were consulted to translate existing guidelines and peer reviewed literature into a sample turnkey order set for the preoperative management of patients’ medications. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the order set in bold type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in italicized type. ResultsHolding antiplatelet and anticoagulant medications before nonemergent cardiac surgical procedures may reduce the risk of bleeding. Sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 agonists should also be discontinued to prevent acidosis and aspiration, respectively. Specific guidance for frequently used medications are complied within the manuscript, less frequently used medications are listed seperately. ConclusionsDespite strong recommendations from major guidelines and consensus manuscripts, variation exists in preoperative medication orders, with limited availability of succinct implementation tools. This turnkey order set may facilitate standardized comprehensive preoperative medication management before nonemergent cardiac surgery.

Comprehensive medication management (CMM): Application of a new pharmaceutical practice in onco-hematology

The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP. The aim of this study is to assess the impact of the applying a clinical pharmacist-driven comprehensive medication management (CMM) service to onco-hematology patients. This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1. Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%. The integration of CMM services in onco-hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

IntroductionThe intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. MethodsA retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. ResultsThe study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. ConclusionThis study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study.

comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. complementary mixed-methods pre-post study, based on an embedded quasi-experimental model. geriatric fracture centre. qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. thirty community-dwelling patients aged ≥65years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. as patients' individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.