Disease State Management Research Articles

Assessing Quality of Pharmacist-Led Education for Patients with COPD Using the Lung Information Needs Questionnaire: A Pilot Study.

Transitioning a patient from the hospital to home is an area of vulnerability for patients with Chronic Obstructive Pulmonary Disease (COPD). Patients with COPD frequently readmit as they often do not understand their disease state, medications or when to seek medical attention. The objective of this study is to determine the impact that pharmacist-led education has on a patient's understanding of their disease state by assessing the results of the Lung Information Needs Questionnaire (LINQ). This study uses a quasi-experimental design to formally assess pharmacist-led education provided to patients with COPD using the LINQ. The LINQ was used to assess knowledge of the disease state and medications before and after receiving education on disease state management, smoking cessation and proper medication use. A total of 17 patients completed the LINQ. The survey results showed a statistically significant improvement in patient understanding in 4 of the 6 targeted areas. Results from the formal assessment using the LINQ suggest that pharmacist-lead education for COPD patients is beneficial and reliable. This study presents a continued need for patient education and research in this high-risk patient population.

Characterization of pharmacy practice research centers across the United States.

Schools of Pharmacy are important contributors to pharmacy practice research and several have created research centers focusing on this area. To identify and characterize pharmacy practice research centers in the United States. A comprehensive list of research centers was gathered using three sources: 1) websites of Schools of Pharmacy obtained from the American Association of Colleges of Pharmacy website; 2) Google; and 3) department chairs. Two independent reviewers applied the following exclusion criteria to the list: 1) no affiliation with a School of Pharmacy; 2) no focus on research; 3) not an independent unit recognized at the school or university levels; and 4) research not focused on advancing pharmacy practice. Inter-rater reliability was calculated using a prevalence-adjusted bias-adjusted kappa (PABAK). A questionnaire was developed comprising 24 questions grouped into three sections - overall structure of the center, research and educational activities - and disseminated through center directors. Descriptive statistics of survey data were obtained. Twenty centers across 20 different states were identified. Survey response rate was 100%. Three-quarters of centers were at public institutions and half had an advisory board. Full-time equivalents ranged from 0.2 to 21. Areas of research primarily focused on medication and disease-state management and interprofessional collaboration in the ambulatory/outpatient setting. Few centers (35%) conducted experimental studies. Despite 85% centers conducting multi-site studies, the median number of sites engaged was low (range 1-3). Seven centers received over USD 1 million in total funding since inception. A majority of centers (90%) offered educational activities for both students and professionals. Pharmacy practice research centers are relatively small, received low funding and few conduct multi-site experimental studies. Collaboration among centers could be a means to overcome these issues.

PCV84 PHYSICIAN AND PATIENT PERCEPTIONS REGARDING CARE TRANSITIONS, ORAL ANTICOAGULANT TREATMENT AND MANAGEMENT OF NON-VALVULAR ATRIAL FIBRILLATION

To better understand challenges pertaining to care transitions, oral anticoagulant (OAC) treatment and management of non-valvular atrial fibrillation (NVAF) from the viewpoints of physicians and patients. Two surveys were conducted: one targeting 400 physicians who manage NVAF patients and the second targeting 400 NVAF patients. Physicians (cardiologists [C’s] and primary care physicians [P’s]) who treated NVAF patients were identified from medical claims in the HealthCore Integrated Research Database submitted between 3/1/14–3/31/16. Patients were identified from medical claims submitted between 4/1/15–3/31/16. Physician surveys assessed OAC treatment decision approaches and referral management strategies while patient surveys classified respondents according to self-reported OAC use and assessed perceptions around NVAF diagnosis, treatment and setting. Of 426 physicians (137 C’s; 289 P’s), 57% were in practice >20 years. C’s and P’s differed in OAC treatment philosophies and perceptions of management strategies: 84% C’s and 62% P’s assessed stroke risk prior to recommending OACs; 54% C’s reported co-managing patients with P’s vs 89% P’s reporting co-management with C’s. Of 398 NVAF patients, 25 never used OACs, 49 were prior only users and 324 were current users. Current OAC nonusers (never and prior usersn=74) differed from current users (n=324) in terms of AF diagnosis setting; 46% of current nonusers vs 31% of current users reported diagnosis in an emergency room. Among OAC never users, 40% reported treatment was never discussed. C‘s and P’s had perceived differences related to co-management of NVAF patients. High rates of NVAF diagnosis in acute care settings could result in gaps in transitions of care, particularly related communication about disease state and medication management. Further, the lack of discussions about NVAF treatments between physicians and patients may impact treatment initiation. Opportunities exist to target quality improvement interventions in NVAF patient co-management and transitions of care.

Implementation of a medication therapy management program in a primary care clinic

ObjectiveThis study examined the use of a medication therapy management (MTM) program by clinic-embedded pharmacists within a primary care clinic primarily by evaluating the impact on patient identification for pharmacy services. Secondary outcomes included characterizing intervention type, targeted drugs and disease states, and barriers to successful interventions, SettingPrimary care clinic. Practice descriptionCoxHealth Center Steeplechase is a primary care clinic of 13 providers with a clinic-embedded pharmacist, pharmacy residents, and student pharmacists providing chronic disease state management under collaborative practice agreements. Practice innovationCommunity pharmacists have an established history of providing services through MTM programs. Clinic-embedded pharmacists have the potential to participate in these programs as well, and many barriers to providing patient care services reported by community pharmacists can be overcome by clinic-embedded pharmacists, potentially allowing for greater success of MTM interventions. EvaluationA 4-week pilot, in which clinic-embedded pharmacists dedicated 4 hours per week of effort to MTM services, examined the effectiveness of the program at identifying patients not otherwise receiving clinical pharmacy services, types of identified interventions, intervention success rates, barriers to intervention success, and revenue generation. ResultsThe clinical pharmacy team attempted 46 interventions in 34 unique patients in this 4-week pilot. Of the identified patients, 67.7% (n = 23) had no contact with the clinical pharmacy team in the previous year. Targeted interventions were more frequently attempted (targeted interventions n = 42; comprehensive reviews n = 4) and more successful than comprehensive medication reviews (88% vs. 25% success rate). Barriers to success included patient refusal of services, inability to contact the patient, and inapplicability of targeted interventions. ConclusionImplementation of an MTM program in one clinic required coordinated interdepartmental efforts to implement, but it effectively expanded pharmacy services by identifying patients not otherwise referred to the clinical pharmacy team for chronic disease management.

Pharmacists in Public Health: Scope in Home and Abroad

In the course of recent years, the job of pharmacists has advanced alongside the human services needs of our populace. Notwithstanding dispensing medications and guaranteeing persistent security, the present pharmacists are playing a bigger job as medical instructors, teachers and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility permits them to show more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care gives to individual patients, pharmacists have developed their reach to influence the public health of communities. A pharmacist is uniquely positioned to gives disease state management through appropriate medication therapy management that has been reveal to improve patient outcomes and decrease overall health care costs. This job could easily compare to ever as nature is demanding new practice and installment models that are required to additionally enhance care and results while tending to the unsustainable increments in medicinal services costs.

Benefits of a Clinical Pharmacist in Outpatient Diabetes Disease State Management

Diabetes is a chronic disease state affecting millions of patients, many of which have uncontrolled diabetes and not under a physician's care. The economic and health impacts that a pharmacist can have on patients overall health is well known. As an increasing number of patients suffer from uncontrolled diabetes and its complications which makes the role of pharmacists more important than ever to provide patients with knowledge of the many therapeutic options available, appropriate self-testing techniques, and other important lifestyle modifications. The role of pharmacists has expanded to include ambulatory care in an outpatient setting. The purpose of this study is to evaluate the impact of pharmacist involvement in diabetes management in an ambulatory clinic, where there previously has been no pharmacist participation. Comparing data from a pilot study performed without pharmacist involvement, pharmacists have been able to achieve better Hgb A1C reductions than the pilot study performed in fiscal year 16 (FY16) at an average of 3.36 ± 1.76. Although the sample size of patients was small at only 5, these are promising results of the impact that in depth patient education can have on improving outcomes.

Endothelial glycocalyx: Role in body fluid homeostasis and fluid management.

Endothelial glycocalyx layer (EGL) coating the luminal surface of vascular endothelium plays an essential role in maintaining the normal fluid homeostasis of the body. This highly fragile layer can be damaged by a number of pathophysiological conditions and interventions. Disease state management should be directed to maintain EGL integrity to improve patient's outcome. When intravenous (IV) fluids are used, appropriate type, rate and amount of fluid should be determined by the pathophysiology of the condition and measures to maintain the integrity of the EGL. This review depicts the structure and function of the EGL, its alteration in common pathological states and the rationale of IV fluid management to preserve EGL in such conditions.

The Excellence of Pharmacy Service: Past, Present and Future

Pharmacy education continues to evolve to better prepare pharmacists for their roles and responsibilities in an increasingly complex health care environment with advanced patient health needs. Another important factor is the pharmacists themselves. Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs. All people who take medications are at risk of actual or potential drug therapy problems. These problems are a significant source of morbidity and mortality when left undetected and unresolved and drive huge costs across the health system. As drug therapy experts, pharmacists provide drug therapy management services built around a partnership between the pharmacist, the patient (or his or her caregiver), physicians and other members of a patient’s health care team.

Impact of Chronic Disease State Management by Clinical Pharmacists on Diabetes Outcomes: Interim Results of a Prospective Pilot Study

Impact of Chronic Disease State Management by Clinical Pharmacists on Diabetes Outcomes: Interim Results of a Prospective Pilot Study

Impact of an ambulatory care pharmacist in an occupational health clinic

ObjectivesTo describe and evaluate a novel practice setting for a pharmacist within an occupational health clinic. SettingAmbulatory care facility. Practice DescriptionImplementation and evaluation of a new practice site embedding a clinical pharmacist into the workplace to provide ambulatory care services, such as comprehensive medication management, disease state management, and immunizations to a broad diversity of patients. Practice InnovationA clinical pharmacist provides pharmacy services as part of a collaborative occupational health clinic at a large, self-insured company. The pharmacy services are open to employees and family members with any chronic disease states, elevated biometric results, or medication questions, with the goal of improving patient care on a consistent basis. During visits, the pharmacist works to identify and resolve drug-related problems by educating the patient or reaching out to the patient’s health care provider and to develop strategies with the patient to achieve desired health care outcomes. The pharmacist assists with patient outreach events and immunizations during the flu clinic. EvaluationIdentification of drug-related problems, resolution status, patient satisfaction via survey results, immunizations provided. ResultsIn 4.3 years of operation, the pharmacist conducted 604 visits with 172 patients. During these visits, the pharmacist identified 611 drug-related problems, of which 49.4% have been confirmed as resolved. All patients who completed the patient satisfaction survey said that they would recommend the pharmacy services to others. For the past 3 years, the pharmacist and pharmacy students immunized approximately 1000 patients each year during the company flu clinic. ConclusionAn occupational health clinic is a unique and convenient location for a pharmacist to provide ambulatory care services to employees and family members, as long as methods to identify patients and appropriate sources of referral exist. The pharmacist was able to help patients resolve approximately 50% of identified drug-related problems, and patients were highly satisfied with services provided.

Engaging with In-need Rural Patient Populations through Public Health Partnerships.

A public health partnership was established between a state Medicare Regional Care Collaborative Organization (RCCO), the state health department, a pharmacy school and three community pharmacies located in rural Colorado to optimize the utilization of a free public health service provided through each pharmacy. Fourth-year pharmacy students were allocated year-round by the University of Colorado to support disease management and medication therapy management (MTM) services offered to patients in three rural towns served by the RCCO. Faculty from the school of pharmacy reviewed data provided by the RCCO to identify patients who could benefit from MTM or disease state management (DSM) services. These patients were contacted and encouraged to take advantage of these free pharmacy-based services. Additionally, a number of targeted interventions were performed within these populations to optimize their health. Concerted efforts were made to improve information flow and communication between these pharmacy sites and partnering medical offices. Additionally, pharmacy students were successfully integrated in to medical offices to work alongside medical providers in these communities. This manuscript describes the implementation and coordination of this project as well as the impact these pharmacies had on the communities they served.

Financial impact of patients enrolled in a medication adherence program at an independent community pharmacy

ObjectivesTo determine the financial impact of attributed patients enrolled in a medication adherence program at Community Pharmacy Enhanced Services Network (CPESN) pharmacies. SettingFive independently owned Moose Pharmacy locations in rural North Carolina, which are CPESN pharmacies. Practice descriptionMoose Pharmacy has a longstanding history of innovative change. Each Moose Pharmacy location provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication review, disease state management programs, point-of-care testing, and compounding. Practice innovationCertain CPESN pharmacies, including Moose Pharmacy, were attributed complex Medicare or Medicaid patients having at least 1 chronic medication and at least 80% of medications filled at a CPESN pharmacy. Patients were included if they were attributed to a study location and enrolled in the Moose Medication Adherence Program (MooseMAP) for more than 12 months. Patients were excluded if they were younger than 18 years of age or had less than 12 months of prescription fill data. Reviewed data included patient demographics, chronic and acute medications, immunizations, MooseMAP type, number of chronic medication prescribers, chronic medication class, payer, and patient health risk indicators. Yearly profit for prescriptions filled was determined per patient. Independent-samples t test was used to assess data. EvaluationYearly profit per prescription was $10.35 for combined chronic, acute, and immunization prescriptions, $10.57 for chronic prescriptions, $26.95 for acute prescriptions, and $27.69 for immunizations. Mean profit for strip packaging was $1561.82 per year compared with $1208.01 per year with bottles (P = 0.021). There was a positive correlation between profit and number of prescriptions filled per 12 months (r = 0.56; P < 0.001), number of medication classes (r = 0.27; P < 0.001), and higher-risk indicator scores (r = 0.21; P < 0.001). ConclusionEnrolling complex patients in a medication adherence program can benefit community pharmacies, particularly CPESN pharmacies, through chronic medication fills and yearly profit. Greater profit is generated when prescriptions are dispensed in strip packaging instead of bottles.

Michigan Pharmacists Transforming Care and Quality: Developing a Statewide Collaborative of Physician Organizations and Pharmacists to Improve Quality of Care and Reduce Costs.

Inappropriate drug use, increasing complexity of drug regimens, continued pressure to control costs, and focus on shared accountability for clinical measures drive the need to leverage the medication expertise of pharmacists in direct patient care. A statewide strategy based on the collaboration of pharmacists and physicians regarding patient care was developed to improve disease state management and medication-related outcomes. Blue Cross Blue Shield of Michigan (BCBSM) partnered with Michigan Medicine to develop and implement a statewide provider-payer program called Michigan Pharmacists Transforming Care and Quality (MPTCQ), which integrates pharmacists within physician practices throughout the state of Michigan. As the MPTCQ Coordinating Center, Michigan Medicine established an infrastructure integrating clinical pharmacists into direct patient care within patient-centered medical home (PCMH) practices and provides direction and guidance for quality and process improvement across physician organizations (POs) and their affiliated physician practices. The primary goal of MPTCQ is to improve patient care and outcomes related to Medicare star ratings and HEDIS measures through integration of clinical pharmacists into direct patient care. The short-term goal is to adopt and modify Michigan Medicine's integrated pharmacist practice model at participating POs, with the long-term goal of developing a sustainable model of pharmacist integration at each PO to improve patient care and outcomes. Initially, pharmacists are delivering disease management (diabetes, hypertension, and hyperlipidemia) and comprehensive medication review services with future plans to expand clinical services. In 2015, 10 POs participated in year 1 of the program. In collaboration with the MPTCQ Coordinating Center, each PO identified 1 "pharmacist transformation champion" (PTC). The PTC implemented the integrated pharmacist model at 2 or 3 practice sites with at least 2 practicing physicians per site. MPTCQ is a unique collaboration between a large academic institution, physician organizations, a payer, and a statewide coordinating center to improve patient care and address medication-related challenges by integrating pharmacists into a PCMH network. Pharmacists can actively provide their medication expertise to physicians and patients and optimize quality measure performance. This project was funded by Blue Cross Blue Shield of Michigan. Choe and Spahlinger are employees of Michigan Medicine. Tungol Lin, Kobernik, Cohen, Qureshi, Leyden, and Darland are employees of Blue Cross Blue Shield of Michigan. At the time of manuscript preparation, Share and Wesolowicz were employees of Blue Cross Blue Shield of Michigan. Study concept and design were primarily contributed by Choe, along with the other authors. Choe, Tungol Lin, and Kobernik collected data, and data interpretation was performed by Choe, Tungol Lin, Cohen, and Wesolowicz. The manuscript was written primarily by Choe, along with Tungol Lin and assisted by Kobernik, Cohen, Leyden, and Qureshi. The manuscript was revised by Leyden, Spahlinger, Share, and Darland. Material from this manuscript was previously presented as an education session at the 2016 AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 19-22, 2016; San Francisco, California.

Anatomy, Physiology and Drugs Triangular Dynamics in Steven Johnsons Syndrome

The incidence of Steven Johnson syndrome has been on the increase within the last two years in Nigeria This renewed the interest on this disease to explore the dynamics for improved patient care This review outlined the relationship between anatomic or structural changes physiological variations and the effect of drugs in Steven Johnson rsquo s syndrome Better understanding of the fundamental structural and physiological changes in affected patients is vital to improve the treatment and or the initial management procedures in resource limited environments This article showed the relationship between structural features functions and treatment Tailoring treatment to the anatomical physiological changes and the effect of drugs and causative agents suggests a triangular dynamic trend in the disease state management

HIV update: Impact on chronic diseases

Abstract Objective To update pharmacists on select chronic disease state management for persons living with HIV. Data sources Clinical guidelines from the U.S. Department of Health and Human Services, American Association for the Study of Liver Diseases, American Diabetes Association, American College of Cardiology/American Heart Association Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, U.S. prescribing information, drug information databases, PubMed articles. Study selection At the author's discretion based on relevance of the information presented. Summary Widespread use of combination antiretroviral therapy in the last 2 decades has given rise to an aging HIV population. Management has shifted from acute opportunistic infection treatment to chronic comorbid disease state management. Common HIV comorbid conditions include hyperlipidemia, diabetes, cardiovascular disease, kidney dysfunction, psychiatric illness, and viral hepatitis B and C coinfection. While treatment guidelines do not drastically differ in recommendations, there are unique aspects of care to consider for persons living with HIV infection. Conclusion Historically, the pharmacist's role in HIV care has been to provide antiretroviral adherence counseling and drug information. As the HIV population continues to age, chronic disease state management has become a primary focus. As pharmacotherapy specialists, pharmacists have the clinical skills and knowledge to help optimize treatment outcomes for many comorbid conditions.

Establishing Clinical Pharmacy Services With Prescribing Privileges in a Federally Qualified Health Center Primary Care Clinic

Objectives: To describe the process and cost of establishing clinical pharmacy services with prescribing privileges in a federally qualified health center (FQHC) primary care clinic. Setting: The primary care clinic was located in a low-income area of Southern California and served patients with Medicaid and Medicare. The primary care clinic had preventive medicine and family medicine physicians, a family medicine residency program, behavioral health services, and a registered dietician. Practice Innovation: New clinical pharmacy services were established at this FQHC primary care clinic. The medication assistance program was a stepping stone to establish rapport with the physicians. Credentialing and privileging was implemented for clinical pharmacists. An open protocol collaborative practice agreement was developed to allow clinical pharmacists to manage ambulatory patients. Results: From August 2014 to June 2015, the clinical pharmacist interacted with 392 patients and spent 336 hours educating patients and providing disease state management. The pharmacist also provided consults to residents and providers. Diabetic patients made up 76% of all clinical pharmacy encounters. There were 86 face-to-face clinical pharmacy appointments with the pharmacist. The average time for clinical pharmacy appointments was 77 minutes. Conclusion: By describing ways to develop rapport with providers, how to credential and privilege pharmacists, and explain resources and costs of setting up a service, the hope is that more clinical pharmacists will be able to incorporate into independent or FQHC primary care clinics for improved management of ambulatory patients.

Patient Satisfaction of Pharmacist-Provided Care via Clinical Video Teleconferencing

Purpose: Patient satisfaction with the use of telehealth in disease state management provided by pharmacists has not been fully studied. We hypothesized that patient satisfaction with pharmacist-provided consultations via clinical video teleconferencing (CVT) would not differ from face-to-face delivery. Methods: Patients were recruited from 2 primary care provider sites from September 2015 to May 2016. Patients completed a survey to evaluate their satisfaction and quality of provider–patient communication with the method in which consultation with a pharmacist was provided. The survey was a 10-item, patient self-reported questionnaire. The primary outcome evaluated patients’ scores on assessment of the provider’s use of patient-centered communication. The secondary outcome evaluated patients’ scores on assessment of the provider’s clinical competence and skills and interpersonal skills. Results: There were a total of 57 surveys collected. For both the primary outcome and secondary outcome, over 80% of collected responses for each question in both clinics were scored a 5 that indicates patients were very satisfied with the provider’s use of patient-centered communication and clinical competence and skills. For both the primary and secondary outcomes, there were no statistically significant differences in patients’ scores that assessed provider’s use of patient-centered communication nor the provider’s clinical competence and skill. Conclusion: The results of this study indicate patients are satisfied with pharmacists’ use of patient-centered communication and clinical competence and skills via both CVT and face-to-face consultations supporting our research hypothesis that patient satisfaction with care provided via CVT did not differ from face-to-face provided care.

A qualitative study exploring professional pharmacy services offered by community pharmacies in the state of Sarawak, Malaysia

Objectives The aim of this research is to obtain in-depth information on various aspects regarding the provision of professional pharmacy services by community pharmacies in Sarawak, Malaysia. Methods Semi-structured interviews were conducted with a diverse group of community pharmacists selected via purposive and snowball sampling. The resultant interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Key findings In all, 20 community pharmacists took part in the study upon data saturation. Monitoring of health parameters, smoking cessation, weight management, medication review and disease state management were the extended pharmacy services provided. Service provision was influenced by respondents' intrinsic motivations, including having a desire to help others and achieving professional satisfaction. Practical and business considerations were other rationales for services provision. Intra-organisational barriers faced, including lack of time, personnel and physical space constrained services provision. Cultural issues, lack of committed customers, stock availability and price issues were extra-organisational challenges faced. The availability of market demands influenced respondents' plans for further service expansion. Conclusions Community pharmacists have both noble intentions and commercial motivations to provide professional pharmacy services. However, various intra-organisational and extra-organisational barriers limit the variety of services provided by respondents. Demonstration of a more proactive attitude amongst pharmacists, as well as more opportunities for collaboration and strategic incentives by the government may be useful in encouraging them to expand the range of professional services. Consequently, the positive change will unlock their potential to improve the health and well-being of the general population.

Clinical pharmacists in primary care: Provider satisfaction and perceived impact on quality of care provided.

Purpose:The purpose of this study is to evaluate primary care provider satisfaction and perceived impact of clinical pharmacy services on the disease state management in primary care.Methods:A cross-sectional survey with 24 items and 4 domains was distributed anonymously to pharmacy residency program directors across the United States who were requested to forward the survey to their primary care provider colleagues. Primary care providers were asked to complete the survey.Results:A total of 144 primary care providers responded to the survey, with 130 reporting a clinical pharmacist within their primary care practice and 114 completing the entire survey. Primary care providers report pharmacists positively impact quality of care (mean = 5.5 on Likert scale of 1–6; standard deviation = 0.72), high satisfaction with pharmacy services provided (5.5; standard deviation = 0.79), and no increase in workload as a result of clinical pharmacists (5.5; standard deviation = 0.77). Primary care providers would recommend clinical pharmacists to other primary care practices (5.7; standard deviation = 0.59). Primary care providers perceived specific types of pharmacy services to have the greatest impact on patient care: medication therapy management (38.6%), disease-focused management (29.82%), and medication reconciliation (11.4%). Primary care providers indicated the most valuable disease-focused pharmacy services as diabetes (58.78%), hypertension (9.65%), and pain (11.4%).Conclusion:Primary care providers report high satisfaction with and perceived benefit of clinical pharmacy services in primary care and viewed medication therapy management and disease-focused management of diabetes, hypertension, and pain as the most valuable clinical pharmacy services. These results can be used to inform development or expansion of clinical pharmacy services in primary care.

Pharmacist-Managed Diabetes Center Interventions Ensure Quality and Safety in Elderly Patients.

This quality-improvement study aimed to replicate historical Patient Safety Clinical Pharmacy Services Collaborative results in high-risk Medicare beneficiaries with diabetes to achieve reductions in A1C, adverse drug events (ADEs), and potential ADEs (pADEs). The model included an interdisciplinary team led by a pharmacist located inside a community pharmacy to provide disease state management and medication therapy management (MTM) to the study population. Apple Discount Drugs is an independent community pharmacy located in Salisbury, Maryland. The interdisciplinary team included pharmacists, respiratory therapists, durable medical equipment (DME) specialists, and a referring prescriber. High-risk Medicare beneficiaries, defined as patients with A1C > 9.0% and/or a documented history of three or more hypoglycemic events in the previous six months (defined by blood glucose < 70 mg/dL, patient-described signs and symptoms of hypoglycemia, or a combination of each). All patients were 65 years of age and older and diagnosed with type 2 diabetes mellitus. Patients received longitudinal diabetes self-management education (DSME) and MTM from pharmacist certified diabetes educators. MTM included a comprehensive medication review performed by a pharmacist. The study looked at the effects of the program's interventions on A1C and ADEs. The study cohort saw a 90% reduction of patients with an A1C > 9.0% compared with baseline. ADEs were reduced by 49% and pADEs were reduced by 67%. An integrated, pharmacist-directed DSME and MTM program for high-risk Medicare beneficiaries resulted in improvements in A1C quality measure and mitigated medication associated harm.