Identify Drug Therapy Problems Research Articles

Practice module training to increase pharmacist knowledge and skills in identifying drug therapy problems in hypertensive patients

Background: Pharmacists are responsible for drug therapy given to patients to achieve therapeutic results in pharmaceutical services. Various studies state that there are still many hypertension sufferers who have not reached the target of therapy. This happens because there are still many problems with drug therapy. Aim: This study aimed to increase pharmacists' knowledge and skills in identifying drug therapy problems (DTP) in hypertensive patients at primary care centres (PHCs). Method: This study was attended by forty PHC pharmacists in the Surabaya area. The research was conducted in May-August 2020, with a pre-and post-test control group design. The research sample consisted of 20 pharmacists in the treatment group and 20 in the control group. The different test was carried out with the Wilcoxon test. Result: The results showed a difference between the pre-and post-test results of pharmacist knowledge (p < 0.05), indicating increased pharmacists’ knowledge. There were differences in the skills of pharmacists in collecting patient demographic data, finding DTP, and conducting intervention (p < 0.05). Conclusion: Practice module training can improve pharmacists’ knowledge and skills in identifying DTP.

Drug Therapy Problem: Prevalence and Associated Risk Factors Among Hypertensive Patient

Drug therapy problem is an event involving drug therapy that actually or potentially interferes with the desired health outcomes. This study aimed to identify drug therapy problems encountered by hypertensive patients receiving care in BUK Clinic, Nigeria. It was a retrospective analysis of the medical records of adult hypertensive patients. A total of 206 patient folders were used for the study. The data were collected from the patient’s medical records using the Pharmaceutical Care Network Europe (PCNE) Classification tool Version 9.1 (PCNE, 2020). Data were analyzed using the IBM Statistical Product and Service Solutions (SPSS). The total number of drug therapy problem found was 314 of which majority was effect of drug treatment not optimal [P1.2] 155(49.4%) followed by adverse drug event [P1.3] 155(49.0%) and no effect of drug therapy despite correct use [P1.1] 5(1.6%) was the least type of drug therapy problem encountered. The major cause of drug therapy problem was inappropriate drug according to guidelines/formulary and inappropriate combination of drugs (C1.1 & C1.3) which account for 80(26.4%) of drug related problem. Prevalence of drug therapy problem was high (85.9%). Number of Antihypertensives on (P=0.022) and age(P=0.025) were significantly associated with increased drug therapy problem. Increased drug therapy problem can lead to increase in complications, increased hospital stays, emergency hospitalization and increased medical cost.

Clinical pharmacists’ interventions and therapeutic drug monitoring in patients with mycobacterial infections

PurposeInfections caused by non-tuberculous mycobacterium (NTM) are increasing, less well-known by health care clinicians, and usually require long term treatment with multiple antimicrobials. There is no existing evidence on clinical pharmacists’ involvement in the care of patients with NTM infections. We sought to characterize pharmacists’ interventions in providing medication management for patients with NTM infections. MethodsA retrospective review of patients aged 18 years or older seen by a pharmacist specializing in NTM from January 1, 2018 through June 1, 2020 was performed. Charts were reviewed for drug therapy problems identified by a pharmacist. Details regarding therapeutic drug monitoring (TDM) and subsequent dose adjustments were obtained. ResultsSeventy-seven patients were included. Median age was 68.5 years, and most patients were female. The most common mycobacterium species treated was Mycobacterium avium/intracellulare complex. Majority of pharmacist consults (63.6%) were referred by Pulmonology physicians, with remainder by Infectious Diseases clinicians. Identified drug therapy problems included: needs additional therapy (23%), unnecessary therapy (24.3%), different drug needed (6.8%), dose too low (75.7%), dose too high (20.3%), adverse drug reaction (31.1%), and adherence (8.1%). Fifteen patients had TDM performed during treatment. A clinical pharmacist was involved in evaluation of all TDM results. Over half of patients with TDM levels had at least 1 dose change made. A minority of patients (16.9%) experienced clinical failure. ConclusionClinical pharmacists should be involved in this complex care to optimize medication management through identification of drug interactions, tailoring antimicrobial dosing, managing TDM results, and providing adherence counseling.

Ceftriaxone Use Evaluation in Western Zone Tigray Hospitals, Ethiopia: A Retrospective Cross-Sectional Study.

Drug use evaluation is a systematic approach to determining the appropriateness of drug use, identifying drug therapy problems, and proposing interventions. Ceftriaxone is one of the most widely used drugs in hospitals, requiring the performance of drug use evaluation. This study was aimed at evaluating the appropriateness of ceftriaxone use at Kahsay Abera and Mearg hospitals in the Western zone of Tigray, Ethiopia. An institution-based retrospective cross-sectional study design was conducted in both hospitals from December 2015 to August 2016 using standardized and pretested data collection formats. Systematic random sampling was used, and a total of 800 patients' medication records (patients who took ceftriaxone) from both hospitals (400 each) were assessed in this study. Statistical analysis was performed by using the statistical package for social sciences (version 20). The overall appropriateness of ceftriaxone use in Kahsay Abera and Mearg hospitals was 247 (61.75%) and 252 (63.0%), respectively. The majority of inappropriate use of ceftriaxone was noted in indication errors at both Kahsay Abera (71.2%) and Mearg hospitals (52.0%). The treatment duration in Kahsay Abera (69%) and Mearg hospitals (88%) was in the range of 2-7 days. Mostly, a 2-gram ceftriaxone daily dose was prescribed in both Kahsay Abera and Mearg hospitals, accounting for 285 (71.25%) and 318 (79.5%), respectively. In this study, the top three diseases, indicated for ceftriaxone in both hospitals, were typhoid fever, urinary tract infection, and pneumonia in descending order. Among the medications coadministered with ceftriaxone, the top three coprescribed drugs with ceftriaxone in Kahsay Abera Hospital were metronidazole (17.25%), tramadol 68 (11.28%), and diclofenac (8.96%), but in Mearg Hospital, next to metronidazole, drugs like paracetamol and doxycycline were the most common coprescribed medicines along with ceftriaxone. The appropriateness of ceftriaxone use in Kahsay Abera and Mearg hospitals was 247 (61.8%) and 252 (63%), respectively, in which about one-third of patients' charts were not compliant with the standard treatment guidelines of Ethiopia for general hospitals. In Kahsay Abera and Mearg hospitals, the empiric use of ceftriaxone was 262 (65.5%) and 375 (93.8%), respectively.

Drug therapy problems and predicting factors among ambulatory epileptic patients in Jimma Medical Center, Southwest Ethiopia.

BackgroundThe care of epileptic patients is complicated by the cognitive adverse effect of the drug, disease, pharmacokinetics, and pharmacodynamics properties of antiepileptic drugs which in turn intensify the risk of drug therapy problems among epileptic patients.ObjectiveTo assess drug therapy problems and predicting factors among ambulatory epileptic patients at Jimma University Medical Center, Southwest Ethiopia, from September 2020 to May 2021.MethodologyA hospital-based prospective observational study was conducted. A semi-structured questionnaire was used to collect data from patients as well as from charts. Drug therapy problems were identified using Cipolle’s, Morley, and Strand drug therapy problem identification and classification method. Data were entered into Epi data manager version 4.6 and exported to statistical software package for social science version 23.0 for analysis. Multiplestepwise backward logistic regression analysis was carried out to identify predictors of drug therapy problems. The 95% CI was used to show an association between the dependent and independent variables. P-value < 0.05 was considered as statistically significant.ResultsOf the total 320 epileptic patients 224(70.0%) patients had at least one drug therapy problem. A total of 395 drug therapy problems were identified among two hundred twenty-four patients with an average of 1.2 drug therapy problems per patient. The frequently identified drug therapy problems were non-compliance 115(29.11), adverse drug reaction 110(27.84%), and dose too low 103(26%). Getting of a drug by purchasing [AOR = 4.6,95%CI:(2.05–10.7)], poorly involvement of the patients in therapeutic decision making [AOR = 3.02,95%CI:(1.5–6.06)], the number of medications ≥ two [AOR = 5.3,95%CI:(1.2–22.9)] and having had uncontrolled seizure [AOR = 10.9,95%CI:(4.9–24.2)] were independent predictors of drug therapy problems.ConclusionsDrug therapy problems were common among epileptic patients in the study area. Patients who were getting their drugs by purchasing, poorly involved in therapeutic decision making, having had an uncontrolled seizure, and taking two and above drugs were more likely to experience drug therapy problems. Therefore, due attention should be given to patients with the aforementioned problems to decrease the occurrence of drug therapy problems and improve overall outcomes among epileptic patients.

Drug Therapy Problems Associated with Antibiotics Prescriptions in University of Uyo Health Centre, Uyo, Nigeria

Introduction: Antibiotic resistance has contributed as one of the greatest public health threats at present. This study aimed at identifying drug therapy problems (DTPs) associated with prescriptions of antibiotics to patients attending the University of Uyo Health Centre and presented a seminar as an intervention.&#x0D; Method: A prospective observational study was carried out. One hundred (100) patient folders with 147 antibiotics prescriptions were used for the survey for the first-month collation of antibiotics prescriptions while one hundred and sixty (160) patient folders with 160 antibiotics prescriptions were used at the second -month of the survey. The seminar presentation on drug therapy problems associated with antibiotics prescriptions was held after the first -month of the survey. Data obtained were analyzed by using descriptive statistical tools such as frequency, mean, standard deviation and bar chart. The statistical analytical tool such as student T- test was used and significance was considered at p ≤ 0.05.&#x0D; Result: The first survey involved 147 prescriptions of antibiotics. Prescriptions with DTPs were 77 (52.4%) while the most frequently occurring DTPs was drug interactions (37.1%), followed by inappropriate dosage frequency (23.7%) and unnecessary medication (22.7%). The follow up survey included 160 prescriptions of antibiotics, out of which 112 (70%) prescriptions of antibiotics contained 209 DTPs. The most frequent DTPs was drug interactions (49.3%), followed by inappropriate dosage duration (19.1%) and inappropriate dosage frequency (11.5%). The results also showed that antibiotics prescriptions with DTPs were significantly increased in the follow-up survey (p=0.00) of the study. Drug interaction (p=0.00), overdosing (p=0.00), underdosing (p=0.00) and Inappropriate dosage duration (p=0.00) were significantly increased in the follow-up survey.&#x0D; Conclusion: This study had indicated prevalence of DTPs associated with antibiotic prescriptions. Drug interaction, inappropriate dosage frequency and unnecessary medication were very common among antibiotic prescriptions.

Developing clinical reasoning: An introduction for pharmacy preceptors

AbstractClinical reasoning is the thinking and decision‐making process undertaken to solve and manage a clinical problem. This process differs from problem solving or critical thinking and refers to the process of identifying drug therapy problems and optimizing therapeutic options. While clinical reasoning is a professional expectation of pharmacists in practice, pharmacy preceptors may find it difficult to teach and assess the complexity and nuances of clinical reasoning. The purpose of this guide is to briefly review clinical reasoning processes in pharmacy practice and to summarize practical strategies for preceptors to implement with their learners to promote the development of clinical reasoning.

Drug Utilization Study of Diuretics in Children with Hydrocephalus

Hydrocephalus is a condition characterized by a dynamic imbalance between formation and absorption of cerebrospinal fluid that increases the size of intracranial space of the brain and, in some situations, an extension of the outer space of the brain with or without increased ventricular size. This study aimed to examine the use of diuretics and identify drug therapy problems in hospitalized children with hydrocephalus through the medical record. The study design is observational retrospective with time-limited sampling based on data in medical records at 2010-2013 periods, found 17 of 70 patients using diuretics therapy. There are three categories of diuretic which are used were mannitol (70.6%), acetazolamide (23.5%), and a combination of mannitol and acetazolamide (5.9%). Diuretics can be used for pre-op, post-op, and pre &amp; post-op on all types of hydrocephalus. Still, the specific use of diuretics may be caused by variations in comorbid diagnoses, clinical data, and laboratory data for each patient. Adverse drug reactions are potentially dominant in DTP analysis, and these are 7 of 17 patients. Monitoring of serum electrolytes such as sodium and potassium is needed because it decreases are potential adverse drug reactions of diuretics.

Medication related problems

The improper use of drugs can leads to patient morbidity and even mortality. Drug therapy problems are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying drug therapy problems help patients to achieve their goals of therapy and understand the best possible outcomes from drug therapy. To identify, resolve and prevention of drug therapy problems, the practitioner must understand how patients with drug therapy problems present in the clinical setting. Stating the problem and identifying the cause requires involves clinical judgment by the practitioner. All patient problems involving medications can be categorized into seven types. These include all side effects, toxic reactions, treatment failures, or the need for additive, synergistic, or preventive medications, as well as noncompliance. During 2002, there were 3.3 billion prescriptions dispensed from community pharmacies throughout the United States and over 44,000 hospitalized patients die each year resulting from medical errors. Recent research, on drug-related problems and adverse drug reactions has identified several categories of risk factors that may be used to identify patients who are susceptible to drug related problems and adverse drug reactions. It is essential that practitioners who intend to provide pharmaceutical care understand the descriptions and identification of each type of drug therapy problem as well as their common causes. Continuous referral to the seven categories of drug therapy problems ensures that a consistent, rational, comprehensive, and effective care plan can be established for even the most complicated patient.

Pharmacist-Led Audits for Older Adults With Cancer Yield Significant Interventions

Older adults with cancer have comorbidities that require medical management and confounders of chemotherapy and supportive medications exacerbate polypharmacy. A multidisciplinary team model was created to address these needs within the Cancer Aging and Resiliency (CARE) clinic. To reconcile medications for accuracy, compliance, side effects, and effectiveness, a pharmacist-led audit includes identification of potential therapeutic duplications, drug-drug interactions, or potential medication inappropriateness identified using Beers criteria. A pharmacist led review of patient’s prescriptions can identify drug therapy problems (DTP) and result in safer medication management. METHODS: A retrospective review of pharmacy specific interventions was conducted using CARE Clinic patient data from February 2016 to October 2019 evaluating data from n=259 patients. RESULTS: A preliminary analysis of n=137 patients who had received medication reconciliation were included. The mean number of medications per patient was 13.1 ± 5.7 and 457 DTP were identified leading to 523 medication related interventions. There was an average of 3.3 DTP per patient. The most common types of DTP included medication reconciliation (n=137, 30.0%), potentially inappropriate medication (PIM) (n=74, 16.2%), administration/technique (n=35, 7.7%), and drug-drug interaction (n=28, 6.1%). The most frequent types of interventions involved education to the patient (n=166, 31.7%), medication reconciliation (n=137, 26.2%), medication discontinuation (n=84, 16.1%), patient to discuss further with physician (n=39, 7.5%), and medication initiated (n=35, 6.7%). Updated results involving approximately 259 patients will be presented. CONCLUSION: Comprehensive medication review within a multidisciplinary setting for the management of older adults with cancer can reduce polypharmacy and inappropriate medication use.

A Prospective Observational Study of Drug Therapy Problems in Pediatric Ward of a Referral Hospital, Northeastern Ethiopia.

Background A drug therapy problem is any undesirable event experienced by a patient during drug therapy that interferes with achieving the desired goals of therapy. It has been pointed out that hospitalized pediatric patients are particularly prone to drug-related problems. Identifying drug therapy problems enables risk quantification and determination of the potential impact of prevention strategies. The purpose of this study was to assess the drug therapy problems in a pediatric ward of Dessie Referral Hospital, northeast of Ethiopia, and to identify associated factors for drug therapy problems. Methods A prospective observational study design was carried out to assess drug therapy problems in a pediatric ward of Dessie Referral Hospital from February 1, 2018, to May 30, 2018. Ethical approval was obtained, and informed consent was signed by each study participant's parent before the commencement of the study. All patients admitted to the ward during the study period were included in the study. Data was collected by trained pharmacy staffs through medical record reviews of patients using a prepared standard checklist and semistructured questionnaire. The collected data were cleared and checked every day for completeness and consistency before processing. Data were entered, and descriptive statistical analysis was done using SPSS Version 20 Software. A P value of less than 0.05 was considered significant. Results The participants' mean age was 2.32 years with the standard deviation (SD) of 0.76 years. Among 81 patients, 71 (87.7%) of them had at least one drug therapy problem per patient which indicates that the prevalence of the drug therapy problem was substantially high. Needs additional drug was the most predominantly encountered drug therapy problem accounted (30 (25.2%)). On the other hand, ineffective drug was the least (3 (2.5%)) drug therapy problem. Antibiotics (47 (39.5%)) followed by fluid and electrolyte (25 (21%)) were classes of drugs mostly involved in the drug therapy problem. The main risk factors reported to the occurrence of the drug therapy problems were prescribing and dose calculation errors. Conclusion The present study revealed that majority of the patients had at least one DTP per patient; this indicates that prevalence of DTP was very high in the study area. Needs additional drug therapy followed by noncompliance was the major cause of the occurrence of DTP. Antibiotics were the main class of drugs involved in the drug therapy problem, and among the risk factors assessed, prescribing and dose calculation errors showed statistical significance.

Assessment of Knowledge and Competencies of Community Pharmacists for Differentiated HIV Care and Services in Jos, Nigeria

Background: Knowledge and competence of community pharmacists in HIV care, are essential for translating the goals of differentiated care into improved outcomes.&#x0D; Aims: To assess the knowledge and competence of community pharmacists in Jos, for differentiated HIV care and services.&#x0D; Study Design: Cross-sectional questionnaire survey.&#x0D; Place and Duration of Study: Community pharmacies in Jos North and Jos South local government areas of Plateau state, North-Central Nigeria, between September to November, 2018.&#x0D; Methodology: We included community pharmacists who responded to six items on knowledge of HIV therapeutics with each correct answer recording a score of 1 and zero for wrong answers. Respondents with a correct score of 5 or 6 represent good knowledge. We examined competence on a 36 item scale graded 1 for weak competence and 5 for strong competence. Factor analysis; reduce the 36 scale items down to competency domains. Frequencies and percentages for reported competencies were presented. In addition, aggregated scores for each of the competency domains were used to compare respondents based on years of experience, educational level and employment status in community pharmacy. All levels of significance were set at p≤ 0.05.&#x0D; Results: 73 out of 110 community pharmacists responded to the questionnaire. Of these, only 25% reported good level of knowledge in HIV therapeutics. 69% reported strong competency in identifying drug therapy problems, 31% inter-professional and patient communication. There was statistically significant difference in competency domains based on years of practice experience and employment status p&lt;0.05. Respondents with 10 years or less of practice experience recorded higher mean ranked scores compared to those with 11 or more years. Similarly, employed pharmacists recorded higher mean ranked scores than those who owned their business.&#x0D; Conclusion: Overall, respondents reported low knowledge and weak competency in HIV care emphasizing the need for specialized training before implementation of differentiated care model.

Evaluation of Pharmacist Involvement in Medicare Wellness Visits

Purpose: To evaluate the difference in the number of drug therapy interventions between patients seen by pharmacists and patients seen by nonpharmacist providers during Medicare Annual Wellness Visits (AWVs). Methods: Pharmacists completed the medication history portion of AWVs at a primary care, interdisciplinary clinic in Central Texas. Drug therapy problems were collected and compared to those identified by physicians conducting AWVs. Drug therapy problems were grouped into 4 categories: indication, effectiveness, safety, and adherence. Each category was divided into subcategories to further specify the problem. Results: Fifty patients received an AWV in each group. Pharmacists identified more drug therapy problems in all 4 categories as compared to physicians (100 vs 20 interventions, respectively) and significant differences were detected in most subcategories: indication without medication (P = .005), suboptimal regimen (P = .0034), drug–drug interaction (P = .0267), warning/precaution requiring additional monitoring (P = .0267), nonadherence (P = .0058), and patient lack of understanding medication therapy (P = .005). Conclusion: Pharmacist involvement in AWVs helped identify drug therapy problems.

Integrating a health information exchange into a community pharmacy transitions of care service

ObjectiveTo describe the incorporation of a state health information exchange (HIE) into a community pharmacy transitions of care (TOC) service and to assess its impact on 30-day readmission rates. SettingThree suburban community pharmacies in Olathe, Kansas. Practice descriptionBalls Food Stores is a grocery store chain which operates 21 supermarket community pharmacies in the Kansas City metropolitan area. Practice innovationBalls Food Stores launched a pharmacist-led self-referral TOC study in which a state HIE was utilized to collect discharge information from patients’ electronic medical records (EMRs) to facilitate TOC comprehensive medication reviews (CMRs). EvaluationDescriptive statistics were used to assess types and outcomes of identified drug therapy problems and the ability to access Kansas Health Information Network EMRs. A chi-square test was used to assess 30-day readmissions between patients who accepted and declined the service. ResultsForty patients were identified for inclusion and 18 elected to participate in the service. The majority of participants were white females with a median age of 64.5 years. Out of 40 study patients, 85% had an EMR available; 12.5% of patients had a medication list included in their EMR hospitalization documentation. Participants who underwent the service had a statistically significantly lower rate of overall 30-day hospital readmission than those who declined (11.1% vs 36.4%, P = 0.032). Among the 18 TOC CMRs performed, 90 drug therapy problems were identified and 77 were resolved in collaboration with a patient, caregiver, or physician. ConclusionIncorporation of a state HIE into a community pharmacist-led TOC service is a novel strategy for collecting patient data. During the study, no TOC participants were readmitted within 30 days. However, pharmacists found HIE data alone was insufficient to perform TOC CMRs for the majority of participants. In order to expand state HIE utilization, more health systems will need to upload a minimum standard data set to help facilitate care.

EVALUATION OF DRUG THERAPY PROBLEMS IN ASTHMA PATIENTS RECEIVING CARE IN TWO HOSPITALS IN SOUTH-EASTERN NIGERIA

Objective: To evaluate drug therapy problems in asthma patients visiting a secondary and tertiary hospital in South-Eastern Nigeria.Methods: This study was a retrospective, cross-sectional analyses of the medical records of adult asthmatic patients receiving care in two hospitals in Enugu State, within a 15-year period. The Pharmaceutical Network Care Europe (PCNE) tool version 6.2 was used to assess drug therapy problems. The IBM Statistical Product for Services Solution (SPSS) version 20.0 was used for analysis. For all results, P ≤ 0.05 was considered statistically significant.Results: Majority of the patients were below 60 y old (81.2%); female (68.8%) and were on more than two drugs (95.3%). Majority of the identified drug therapy problems (DTPs) were adverse reactions (65.7%). The inappropriate drug combination was the major cause of DTPs (65.6%). Only about 23.4% of the intervention outcomes were known. University of Nigeria Teaching Hospital (UNTH) had more interventions (35.9%) than Medical Centre (8.0%) (χ2 = 6.323; df = 1; **P = 0.012); and more of the outcomes of their interventions known (38.5%) compared to Medical Centre (0.0%) (χ2 = 12.559; df = 1; **P ˂ 0.001).Conclusion: Adverse reactions and inappropriate drug selection were the major identified DTPs and major cause of DTPs, respectively. Most DTPs had no interventions. The documented interventions included stopping of the drugs, change of drugs or dosage, change of instructions for use and starting of new drugs. Most interventions had unknown outcomes. UNTH had more interventions with known outcomes than the University of Nigeria Medical Centre.

A STUDY OF DRUG RELATED PROBLEM IN UROLOGIC PATIENTS: A COHORT PROSPECTIVE STUDY

Objective:Drug therapy problems (DRPs) are the clinical domain of the pharmaceutical care practitioner. The purpose of identifying drug therapy problems is to help patients on achieving their goals of therapy and realizing the best possible outcomes from drug therapy. The purpose of this study was to determine the number of DRPs and to classifyDRPs that occurred in post-operative patients from urology surgery ward.Methods:A 3-month prospective study was conducted by considering62 hospitalized post-operative patients from urology surgery ward at the Teaching Hospital in Surabaya, East Java, Indonesia. Clinical pharmacists were involved in medical rounds to identify DRPs.Results:From 37 patients, 81 DRPs were identified in this study. About 20 patients were considered to have more than one DRP. The most common identified DRPs were over-dosage (38%), drug use without indication (20%),improper drug (11%), drug interaction (10%), untreated indication(9%), adverse drug reaction (7%), failure to receive drug (4%) and sub-therapeutic drugs (1%). The clinical pharmacists were involved in doing dose adjustment, monitoring, evaluating drug discontinuation, doing drug substitution and, additional therapy, counseling to patients, increasing dose and referring to prescriber.Conclusion:The most identified DRPs were over-dosage, drug use without indication and improper drug. Clinical pharmacist’s intervention were required toidentify, prevent, resolve DRPs and assist patient on achieving their goals of therapy and improving their quality of life.

Improving the Effectiveness of Medication Review: Guidance from the Health Literacy Universal Precautions Toolkit.

Although routine medication reviews in primary care practice are recommended to identify drug therapy problems, it is often difficult to get patients to bring all their medications to office visits. The objective of this study was to determine whether the medication review tool in the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit can help to improve medication reviews in primary care practices. The toolkit's "Brown Bag Medication Review" was implemented in a rural private practice in Missouri and an urban teaching practice in California. Practices recorded outcomes of medication reviews with 45 patients before toolkit implementation and then changed their medication review processes based on guidance in the toolkit. Six months later we conducted interviews with practice staff to identify changes made as a result of implementing the tool, and practices recorded outcomes of medication reviews with 41 additional patients. Data analyses compared differences in whether all medications were brought to visits, the number of medications reviewed, drug therapy problems identified, and changes in medication regimens before and after implementation. Interviews revealed that practices made the changes recommended in the toolkit to encourage patients to bring medications to office visits. Evaluation before and after implementation revealed a 3-fold increase in the percentage of patients who brought all their prescription medications and a 6-fold increase in the number of prescription medications brought to office visits. The percentage of reviews in which drug therapy problems were identified doubled, as did the percentage of medication regimens revised. Use of the Health Literacy Universal Precautions Toolkit can help to identify drug therapy problems.

Identifying Drug Therapy Problems Through Patient Consultation at Community Pharmacies: A Quality Improvement Project.

This study aimed to identify drug therapy problems during patient counseling at prescription pickup in the community pharmacy setting. This descriptive quality improvement project assessed the number of drug therapy problems identified during patient consultation. Data were collected for 2 months at 6 community pharmacies in Arizona. The criterion for inclusion was any patient new or transferred prescription consultation provided by a pharmacist or pharmacy intern. Three doctor of pharmacy candidates collected data on a standardized form. The percentage and type of drug therapy problems identified during patient consultation were calculated. Data collectors counseled patients on 1305 prescriptions, and of those, 29 drug therapy problems (2.2%) were identified after the pharmacists' final check. The most common problems involved patient drug allergy or sensitivity (20.7%). This project suggests that drug therapy problems in a community pharmacy setting can be identified via patient counseling at the time of prescription pickup.

Impact of pharmacist intervention in conjunction with outpatient physician follow-up visits after hospital discharge on readmission rate.

The Medicare Hospital Readmissions Reduction Program (MHRRP) which took effect on October 1st, 2012 holds providers accountable for quality of care delivered, placing a greater focus on care coordination. Innovative strategies in medication management in the acute care and outpatient primary care settings require vigilant pharmacist intervention. The objective of this study is to determine if pharmacist-provided medication reconciliation service in conjunction with hospital follow-up outpatient physician visits reduces hospital readmission rate. This was a prospective study in which physician-initiated outpatient hospital follow-up appointment scheduling was used to identify patients at time of hospital discharge. All patients ≥50 years of age were eligible for outpatient pharmacist visits. Emergency room visits were excluded. Data collected included: patient demographics, characteristics of identified drug therapy problems, accuracy of outpatient medication histories and time required by pharmacist to perform the reviews. Patient adherence to early (24-72 hours) outpatient hospital follow-up visit was also evaluated. Previous year's readmission data for high risk patients who received only physician visits were also collected for comparison with those who were jointly visited by pharmacists and physicians. A total of 98 patients were assigned to receive pharmacist intervention in conjunction with physician hospital follow-up visits. Nine of the 98 patients seen by pharmacists at hospital follow-up visits were readmitted (9.2%) to a hospital within 30 days of discharge. Out of the 236 patients seen during the same period the previous year (2011) for physician alone hospital follow-up visits 46 were readmitted (19.4%) within 30-days of hospital discharge. The difference between these groups was statistically significant (p = 0.023), with patients in the pharmacist intervention group experiencing a reduction in 30-day readmission risk. Physician alone outpatient follow-up was associated with earlier mean time to readmission, 12.8 days vs. 18.3 days in the pharmacist intervention group (p = 0.042). Pharmacist involvement in hospital discharge follow-up visits reduced overall readmission rate in high risk patients and improved monitoring of drug therapy, and medication history accuracy when compared to physician-alone visits.

TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate

To determine if a community pharmacy-based transition of care (TOC) program that included the full scope of medication therapy management (MTM) services (TransitionRx) decreased hospital readmissions, resolved medication-related problems, and increased patient satisfaction. Prospective, quasi-experimental study. Nine Kroger Pharmacies located in Western Cincinnati. Patients older than 18 years of age and discharged from two local hospitals with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease, or pneumonia. Patients were recruited from two local hospitals and referred to the community pharmacy for MTM services with the pharmacist within 1 week of discharge. Pharmacists reconciled the patients' medications, identified drug therapy problems, recommended changes to therapy, and provided self-management education. At 30 days after discharge, research personnel conducted telephone surveys, using a previously validated survey instrument, to assess hospital readmissions and patient satisfaction. Pharmacist interventions and medication-related problems were documented. A total of 90 patients completed the study. Of these, 20% of patients in the usual care group were admitted to the hospital within 30 days compared with 6.9% of patients in the intervention group (P = 0.019). In the 30 patients who received MTM services from the pharmacist, 210 interventions were made. The overall mean patient satisfaction with the TOC process was not significantly different between patients who were seen by the pharmacist and those who were not seen by the pharmacist. Community pharmacies successfully collaborated with hospitals to develop a referral process for TOC interventions. Patients who received MTM services from the pharmacist experienced significantly fewer readmissions than patients who received usual care.