Improve Patient Health Outcomes Research Articles

Revitalization of a communication pharmacy course: The journey of reframing student perceptions

IntroductionDespite the conveniences and logistical safety benefits of health information technology, there is an increasing public need for improved communication in live and virtual encounters with healthcare providers, including pharmacists. Increasingly, the digital world necessitates the need for pharmacy curricula to improve healthcare professional students' fundamental professional communication skills. PerspectiveA new clinical faculty member's journey through revitalizing a pharmacy professional communication course is presented. The project utilized reframing and perception recalibration while adding experiential learning to add curricular application opportunities both face-to-face and virtually. ImplicationsDoctor of pharmacy programs require continued prioritization of the development and teaching of communication curricula to optimize future healthcare providers' effectiveness in improving patient health outcomes. Student perception of pertinence is improved by presenting clear subject matter progression, adapting materials to fit an empathy-based healthcare-specific aim, and pairing didactic material with a community introductory pharmacy practice experience.

The Numb Lip: Non-Small Cell Lung Cancer First Presenting in the Head and Neck

Diagnosing the cause of paraesthesia can be challenging. A patient with an unremarkable medical history, non-smoker and no known allergies, presented with paraesthesia in the distribution of the mental nerve with no obvious dento-alveolar pathology. After further investigations the patient was found to have multiple brain metastases and a solitary mandibular deposit, with the primary site being an adenocarcinoma of the lung. CPD/Clinical Relevance: As dental professionals, knowledge of head and neck manifestations of systemic conditions is required if prompt diagnosis and treatment is to occur, which will subsequently improve patient health outcomes.

Interventions to change clinicians’ behavior related to suicide prevention care in the emergency department: a scoping review

The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework. An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine the functional mechanisms of interventions and how these characteristics can influence emergency department clinicians' behaviors related to suicide prevention care. This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude. This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behaviour Change Wheel's intervention functions. Reported outcome measures were categorized. Findings were tabulated and synthesized narratively. This review included a total of 70 sources, describing 66 different interventions. Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivization (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches. Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and organization-level barriers for a given context. The ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors; however, current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.

The Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) Clinical Decision Support Early Warning System: Protocol for a Cluster Randomized Pragmatic Clinical Trial.

BackgroundEvery year, hundreds of thousands of inpatients die from cardiac arrest and sepsis, which could be avoided if those patients’ risk for deterioration were detected and timely interventions were initiated. Thus, a system is needed to convert real-time, raw patient data into consumable information that clinicians can utilize to identify patients at risk of deterioration and thus prevent mortality and improve patient health outcomes. The overarching goal of the COmmunicating Narrative Concerns Entered by Registered Nurses (CONCERN) study is to implement and evaluate an early warning score system that provides clinical decision support (CDS) in electronic health record systems. With a combination of machine learning and natural language processing, the CONCERN CDS utilizes nursing documentation patterns as indicators of nurses’ increased surveillance to predict when patients are at the risk of clinical deterioration.ObjectiveThe objective of this cluster randomized pragmatic clinical trial is to evaluate the effectiveness and usability of the CONCERN CDS system at 2 different study sites. The specific aim is to decrease hospitalized patients’ negative health outcomes (in-hospital mortality, length of stay, cardiac arrest, unanticipated intensive care unit transfers, and 30-day hospital readmission rates).MethodsA multiple time-series intervention consisting of 3 phases will be performed through a 1-year period during the cluster randomized pragmatic clinical trial. Phase 1 evaluates the adoption of our algorithm through pilot and trial testing, phase 2 activates optimized versions of the CONCERN CDS based on experience from phase 1, and phase 3 will be a silent release mode where no CDS is viewable to the end user. The intervention deals with a series of processes from system release to evaluation. The system release includes CONCERN CDS implementation and user training. Then, a mixed methods approach will be used with end users to assess the system and clinician perspectives.ResultsData collection and analysis are expected to conclude by August 2022. Based on our previous work on CONCERN, we expect the system to have a positive impact on the mortality rate and length of stay.ConclusionsThe CONCERN CDS will increase team-based situational awareness and shared understanding of patients predicted to be at risk for clinical deterioration in need of intervention to prevent mortality and associated harm.Trial RegistrationClinicalTrials.gov NCT03911687; https://clinicaltrials.gov/ct2/show/NCT03911687International Registered Report Identifier (IRRID)DERR1-10.2196/30238

Artificial Intelligence, Heuristic Biases, and the Optimization of Health Outcomes: Cautionary Optimism.

The use of artificial intelligence (AI) and machine learning (ML) in clinical care offers great promise to improve patient health outcomes and reduce health inequity across patient populations. However, inherent biases in these applications, and the subsequent potential risk of harm can limit current use. Multi-modal workflows designed to minimize these limitations in the development, implementation, and evaluation of ML systems in real-world settings are needed to improve efficacy while reducing bias and the risk of potential harms. Comprehensive consideration of rapidly evolving AI technologies and the inherent risks of bias, the expanding volume and nature of data sources, and the evolving regulatory landscapes, can contribute meaningfully to the development of AI-enhanced clinical decision making and the reduction in health inequity.

Barriers and facilitators to the uptake of new medicines into clinical practice: a systematic review

BackgroundImplementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research.MethodA systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them.ResultsA total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored.ConclusionThis systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines.RegistrationPROSPERO database (CRD42018108536).

The coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 in Malaysia.

BackgroundThe coronavirus disease 2019 (COVID‐19) pandemic has resulted in profound health challenges across the globe. Pharmacists' readiness to cope with the pandemic is critical in supporting and sustaining the healthcare workforce to meet the challenges.ObjectiveThis study aims to examine community pharmacists' views on their work environment, policies and preparedness for safe retail patronage to prevent the transmission of COVID‐19 and assess the variables influencing coping strategies during the pandemic.SettingAn online survey of pharmacists practising in community pharmacy setting in Malaysia.MethodA questionnaire‐based, cross‐sectional study was conducted in Malaysia to evaluate coping strategies of community pharmacists and pharmaceutical services provided during COVID‐19 pandemic. Between May 1 and July 31, 2020, the questionnaire was distributed to pharmacists working in community setting nationwide utilising a snowball sampling method.Main Outcome MeasureCommunity pharmacists' perceptions on safety, resilience, organisational support, and pharmaceutical services offered during COVID‐19 pandemic.ResultsA total of 217 pharmacists participated in the study. The vast majority of community pharmacists reported a positive outlook and were able to balance working with self‐care during this period. Most reported to have access to personal protective equipment such as gloves and hand sanitisers. A large proportion of community pharmacies also installed physical barriers in doorways or in front of the counter, put markings on the ground to section areas to ensure physical distancing, and controlled the number of customers who could access the pharmacy during this period. Innovations reported to be implemented included teleconsultations and providing curb‐side or drive‐through delivery and pickup services.ConclusionThe findings suggest the frontline and essential roles of community pharmacists in delivering pandemic responses, creating the opportunity to determine areas where community pharmacy services can be incorporated to strengthen the public health system and improve patient health outcomes.

Institutional factors affecting the electronic health information exchange by ambulatory providers

ObjectiveElectronic exchange of health information by health entities along the care continuum can vastly improve patient health outcomes as well as reduce costs. To realize the national goal of a health information highway, it is important for a large pool of ambulatory providers to engage in health information exchange (HIE) to share clinical information with affiliated and unaffiliated providers. Applying institutional theory, this research seeks to examine the key institutional factors that influence the HIE use by ambulatory practices. Material and MethodsData was gathered through a web-based survey of 320 ambulatory providers in the US state of Illinois. Partial least squares approach to structural equation modeling was used to examine the influence of five institutional factors viz. government, patients, peers, affiliates and technology vendors on the use of HIE by ambulatory providers to share clinical information with (i) affiliated providers, and (ii) external, unaffiliated providers. FindingsWe found positive and significant influence of government initiatives, patients, peers and affiliates on ambulatory providers’ HIE with affiliated providers (R2 = 0.347) and unaffiliated providers (R2 = 0.328). Peer influence was positive and significant for HIE with unaffiliated providers only. No significant influence of technology vendors on HIE use by ambulatory practices was found. ConclusionAddressing a critical gap in our knowledge of how ambulatory providers engage in HIE, we provide compelling evidence for the influence of institutional factors on ambulatory providers’ electronic HIE with both affiliated and unaffiliated providers. Policy makers and healthcare leaders need to pay attention to the institutional factors and frame appropriate programs to augment and promote the use of HIE by ambulatory providers.

APA Kicks Off New MH State Advocacy Forum

Back to table of contents Previous article Next article Government & LegalFull AccessAPA Kicks Off New MH State Advocacy ForumLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:7 Sep 2021https://doi.org/10.1176/appi.pn.2021.10.6AbstractPsychiatrists from state district branches will come together at monthly meetings to share best practices and lessons learned while advocating for mental health laws in their state.At the inaugural session of the new Legislative Representatives Forum, more than half of APA’s district branches (DBs) gathered virtually in June to share their experiences, tools, and tips for shaping mental health care legislation within their states.Debra Koss, M.D., helped launch APA’s Legislative Representatives Forum so district branches can share best practices for mental health advocacy at the state level.The goal is to create a community of advocates. The forum came about because members noticed an uptick in legislation at the state level that impacted psychiatry, such as access to care measures, explained Debra Koss, M.D., a child and adolescent psychiatrist and clinical assistant professor of psychiatry at Rutgers Robert Wood Johnson Medical School.“As legislators become more aware and interested in this work, it is critical that we as physicians are joining them at the table, lending our expertise and bringing the science to shape legislation. Without that expertise, the potential for unintended consequences with new legislation is high.”For example, many state lawmakers expanded access to telehealth during the pandemic and are now seeking to rescind those regulations out of concern that wider access could potentially increase costs. “This would put an abrupt halt to treatment for many patients,” Koss said. Ultimately, physicians who are using telehealth to provide treatment are meeting the same standards of care and maintaining patients’ continuity of care, thereby lowering costs by reducing emergency room and hospital utilization. “Yet those are not messages that lawmakers will hear unless we get involved.”The forum is intended for legislative representatives, DB presidents, and DB executive directors. “Certainly it’s very exciting to see the turnout we’ve had, and we hope that all DBs will join us. I really appreciate the diversity of voices that is available to us in the forum,” Koss said.At that first meeting in June, participants found that although their local politics in each state differ, they share many of the same concerns. The most pressing issues among attendees were expanding access to telehealth and ensuring fair payment for it; increasing compliance with mental health parity; halting scope of practice expansion for nonpsychiatrists; and implementing 988, the three-digit hotline for suicide prevention and mental health crisis.Katherine Kennedy, M.D., chair of APA’s Council on Advocacy and Government Relations, said the goal of the forum is for state DBs to collaborate, harness new approaches, and share the tools and resources created by APA staff in the Department of Government Relations, such as model legislation.“Being in a forum with others facing similar challenges helps energize you. We tend to live in our silos, and sometimes we are reinventing the wheel. The forum allows members to share the setbacks they’ve encountered—as well as effective approaches and best practices—so states can help each other succeed.”Kennedy said she sees legislative advocacy as a way to improve patient health outcomes at the population level and reduce the health disparities created by the social and structural determinants of health. For example, DBs that attend the forum might learn from other states how they are tackling opioid overdoses among people who have been recently released from incarceration. “You can save lives,” she said.“Imagine what we could accomplish if we had the collective wisdom of all our legislative representatives and could share with one another the lessons learned within each of our own states. Ultimately, it’s a way to enhance our ability to be effective advocates for mental health care.” ■ ISSUES NewArchived

Nutrition Graduate Students have Neutral Perceptions, Attitudes, and Self-efficacy Related to Utilizing and Conducting Research

Explore nutrition graduate students’ perceptions, attitudes and self-efficacy related to utilizing and conducting research. Low levels of research utilization and engagement have been reported by nutrition professionals. Numerous studies have investigated dietitians’ perceptions, attitudes and self-efficacy related to utilizing and conducting research but few studies have focused on these factors in nutrition students. Nutrition graduate students from a faith-based university (n=45, 93% female) participated in an online survey that assessed experience, perceptions, attitudes, and self-efficacy related to research. All items were adapted from valid, reliable 5-point scales scored from strongly disagree to strongly agree. Overall students had neither positive nor negative attitudes regarding research being part of a dietitian’s role (3.60±0.72). Students agreed that RDs should apply research in practice (4.51±0.85), but were less likely to believe that RDs should conduct research (3.90±0.95). Students’ rated their research self-efficacy slight above neutral (3.83± 0.71). Students were most confident in their ability to collect data and to develop research questions and were less confident in their ability to consent subjects and analyze data. Students were somewhat confident in their ability to participate in evidence-based practice (3.82, ±0.73) and in their ability to engage in collaborative research (3.98±0.78). Overall students had neutral perceptions, attitudes, and self-efficacy related to utilizing and conducting research as a part of their future career. Future research should examine the potential for additional graduate level research courses or experiences to improve students’ perceptions, attitudes and self-efficacy related to utilizing and conducting research. This may encourage students to utilize and conduct research upon entering the workforce and may in turn improve patient health outcomes.

Cost‐effectiveness of a mobile phone text messaging program (KIDNEYTEXT) targeting dietary behaviours in people receiving haemodialysis

There is little information available to inform the cost-effectiveness of eHealth interventions in improving patient health outcomes. A trial-based economic evaluation was undertaken aiming to inform the feasibility of conducting a mobile phone text messaging programme targeting dietary behaviours in people receiving haemodialysis. A trial-based economic evaluation from a health system perspective of a 6-month pilot randomised controlled trial was undertaken. One hundred and thirty patients receiving haemodialysis from six dialysis units across Sydney, Australia, were enrolled into the KIDNEYTEXT study. Usual care (inperson dietary counselling) was compared with usual care plus three semi-personalised dietary mobile phone text messages per week over a 6-month period. The outcomes of this economic evaluation included: cost of intervention, cost-effectiveness and marginal effects on total costs. The cost of developing and maintaining the KIDNEYTEXT intervention was US $110 per participant. Total costs were US $1418 higher in the usual care arm compared to the intervention arm. The incremental benefits for quality-adjusted life adjusted years were 0.01 [95% confidence interval (CI)=-0.03 to 0.06] and dietary adherence (i.e., adherent to three or more dietary guidelines at 6 months) being 0.04 (95% CI=-0.15 to 0.24). The largest component of total costs was related to unplanned admissions to hospital. Mobile phone text messages targeting dietary behaviours may be cost saving, at the same time as maintaining similar or improved dietary behaviours. A larger trial with a longer follow-up time is warranted.

Direct primary care: Family physician perceptions of a growing model.

INTRODUCTIONDirect Primary Care (DPC) is a relatively new primary care practice model in which patients receive unlimited access to a defined set of primary care services in exchange for a monthly practice-specific membership fee. DPC is a bottom-up physician-driven approach in contrast to typical top-down insurer-centric healthcare delivery reform efforts. The degree to which physicians are aware of this practice model and whether they believe it addresses two key challenges facing primary care, access and administrative burden, are unclear.METHODSAn online survey was distributed in July 2017 to 672 members of a research marketing sample of the American Academy of Family Physicians (n=225; response rate 33%). Based on AAFP definitions, the survey consisted of both open- and close-ended questions that gauged family physicians’ awareness of DPC, as well as their perceptions about the model.RESULTSMost respondents (85%) had heard of DPC and 8% practised in a DPC model at the time of the survey. In general, respondents reported that DPC can offer positive outcomes through lower administrative burden for physicians, improved doctor–patient relationships, and better access. Respondents also suggested DPC may result in improved patient health outcomes and lower overall healthcare spending. Respondents’ concerns included inappropriateness of the model for vulnerable populations and physician shortages. Survey responses differed depending on whether the respondent practised in a DPC model. DPC physicians had a more favorable view of the model and were focused on benefits to patients rather than benefits to physicians.CONCLUSIONSAny changes to practice models will require a better understanding of clear definitions of practice models. Further education is required about the specific benefits to vulnerable patients and practice standards. As the perceptions of DPC vary by practice experience, DPC physicians appear to be strong potential advocates of the model.

Validation of the Intermountain Risk Score and Get with the Guidelines—Heart Failure Score in predicting mortality

ObjectiveThe Intermountain Risk Score (IMRS) was evaluated for validation as a mortality predictor and compared with the American Heart Association’s Get With The Guidelines—Heart Failure (GWTG-HF) risk score in a...

Association between Medication Non-Adherence and Increases in Hypertension and Type 2 Diabetes Medications.

Importance: Medication non-adherence is highly costly and leads to worse disease control and outcomes. However, knowledge about medication adherence is often disconnected from prescribing decisions, and this disconnect may lead to inappropriate increases in medications and higher risks of adverse events. Objectives: To evaluate the association between medication non-adherence and the likelihood of increases in the intensity of medication regimens for two chronic conditions, hypertension and type 2 diabetes. Design: Cohort Study. Setting and Participants: This study used US national pharmacy claims data for Medicare Part D (ages ≥ 65) and commercial (ages 50–64) plans to evaluate medication adherence and its association with the likelihood of receiving an increase in medication intensity for patients with hypertension and/or oral diabetes medication fills. Patients had an index fill for hypertension (N = 2,536,638) and/or oral diabetes (N = 701,376) medications in January 2015. Medication fills in the follow-up period from August 2015 to December 2016 were assessed for increases in medication regimen intensity. Main Outcome(s) and Measure(s): The proportion of days covered (PDC) over 181 days was used as a measure for patient’s medication adherence before a medication addition, medication increase, or dosage increase. Differences in the likelihood of experiencing an escalation in medication intensity was considered between patients with a PDC < 80% vs. PDC ≥ 80%. Results: Among Medicare Part D and commercial plan patients filling hypertension and/or oral diabetes medications, non-adherent patients were significantly more likely to experience an intensification of their medication regimens (p < 0.001). Conclusions and Relevance: This study found a significant association between non-adherence to medications and a higher likelihood of patients experiencing potentially inappropriate increases in treatment intensity. Sharing of objective patient refill data between retail pharmacies and prescribers can enable prescribers to have more targeted discussions with patients about their adherence and overall treatment plan. Additionally, it can increase safe medication prescribing and plausibly reduce adverse drug events and healthcare costs while improving patient health outcomes.

Medication reviews in community pharmacy: a scoping review of policy, practice and research in Canada

Abstract Objectives This scoping review aims to systematically map the empirical evidence on publicly funded medication reviews provided by community pharmacists in Canada and identify gaps that could inform future research directions. Methods We used a scoping review framework and PRISMA guidelines for Scoping Reviews to conduct the study. Three electronic databases were searched for papers published between January 2000 until August 2020. Data was charted on study characteristics, and a thematic synthesis was performed. Key findings Of 41 original studies included, most were conducted in Ontario (n = 21). Majority of the studies employed quantitative designs (70%). Five major themes identified were program uptake, patient health outcomes, stakeholder beliefs and attitudes, processes and collaboration and pharmacy workplace culture, which varied considerably. At the individual, organizational and policy levels, many factors were interrelated and influenced the implementation of reimbursed medication reviews by community pharmacists. Gaps in eligibility policy highlighted some patients who may have complex needs are excluded. Variation in clinical outcomes may relate to different types of medication review and pharmacist practice across Canada. Few researchers evaluated eligibility criteria, the impact of policy changes, strategies to engage patients and healthcare professionals, patient–pharmacist communication or compared practice models of medication reviews. About 12% of the research applied a theoretical framework. Summary Publicly funded medication reviews in Canadian community pharmacies reduce medication-related problems and potentially improve patient health outcomes. Future research and policies could consider addressing barriers and exploring models for sustainable delivery of high-quality medication reviews internationally.

Social media health interventions to improve diabetes mellitus patient outcome: a systematic review.

The use of modern technology and social media has revolutionized the way health information is distributed to diabetes mellitus patients. Social media can be used as a medium of providing health interventions to improve patient health outcomes. Social media is able to provide a more intensive communication facility between healthcare professionals and patients. We aim to systematically review and describe the effect of social media interventions on health outcomes of patients with diabetes mellitus. A systematic review was carried out from three electronic databases (Pubmed, Scopus, and Medline). Eligible publications are studies that describe the application of social media interventions on the health outcomes of patients with diabetes mellitus. Fourteen studies were selected for this systematic review, 10 studies with a randomized controlled trial design, and 4 studies with a nonrandomized controlled trial design. Six studies only used interventions using social media, A blend of face-to-face social media intervention was used in 6 studies, 2 studies used a combination of telephone and social media intervention. One study had treatment behavior outcomes with improvement in treatment behavior, 6 studies had clinical outcomes (an improvement in HbA1c values in the four studies), 6 studies had treatment behavior outcomes and clinical outcomes (1 study had improved treatment behavior and clinical outcomes, 3 studies had improved treatment behavior outcome only), and 1 study had medication adherence outcome (no improvement in medication adherence). These findings indicate that the intervention using social media can improve the health outcomes of diabetes mellitus patients.

Development and validation of a systematic process for expansion of clinical pharmacy activities for comprehensive medication management in primary care within the Department of Veterans Affairs

AbstractMedication misadventures can be considered either misuse, underuse, or overuse of medication therapy. With over 80% of Americans taking at least one medication per week and an increased percentage of hospital readmissions associated with a medication‐related problem, a strategy must be integrated that can ensure medications are optimized. Comprehensive medication management (CMM) is a patient‐centered process for ensuring medication optimization and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. The Department of Veterans Affairs (VA) is the largest integrated health care system in the United States and has strong clinical pharmacy practice in primary care. In an effort to increase the practice of the clinical pharmacy specialist delivering CMM, we outline a national implementation program conducted by the VA Pharmacy Benefits Management Services Clinical Pharmacy Practice Office to evaluate individual facility quality care needs, matched clinical pharmacist training needs, and the overall impact achieved with clinical pharmacist expansion of CMM.

Exploring pharmacists' perceptions of integrating pharmacists into the general practice setting

BackgroundIn several countries worldwide, pharmacists have integrated into the general practice setting. This has resulted in enhanced medication management, a reduction in patients' appointments with general practitioners (GPs), and decreased medication costs. However, there is a paucity of research that has focused on exploring pharmacists' views of this emerging role prior to its implementation in countries where it is not yet commonplace. ObjectiveTo explore pharmacsists' perceptions of integrating pharmacists into the general practice setting, the proposed roles for such pharmacists, and the factors affecting integration. MethodsSemi-structured interviews were conducted with pharmacists in Ireland, who were sampled based on years of experience in community pharmacy and work location using convenience and snowball sampling. The interviews were audio-recorded and transcribed verbatim, which subsequently underwent thematic analysis. ResultsTwelve pharmacists – with a median of six years' experience as a community pharmacist – were interviewed between September and October 2019. Four main themes were generated:(i) expectations of integrated role (including the importance of role definition, pharmacist experience, and increased job satisfaction);(ii) altered pharmacist-patient dynamic in primary care (including patient trust, patient safety, and the impact on community pharmacist roles);(iii) GP-pharmacist relationship (including pre-existing relationships, autonomy, reducing GP workload, and individual GP attributes);(iv) logistical issues and financial implications (including practice characteristics, co-location time, and supporting evidence-based implementation). ConclusionThis study is unique as it has focused solely on exploring pharmacists' perceptions of integrating into general practice in a country where such roles are mostly non-existent. The attitudes of pharmacists in this study were primarily positive, for reasons such as intrinsic motivation, reducing GP workload, and improving patient health outcomes. However, the routine implementation of these roles will require funding and support from key stakeholders (other than pharmacists) and should be guided by the evidence from other countries.

Exploring Australian pharmacists’ perceptions and attitudes towards dispensing HIV medicines in the community setting

AbstractBackgroundInvolving community pharmacists in the provision of care to people living with HIV has the potential to improve health outcomes.AimTo explore community pharmacists’ perceptions and attitudes regarding the supply of HIV medicines following the Australian Government’s decision to list antiretroviral drugs (ARTs) on the Pharmaceutical Benefits Scheme (PBS) in 2016.MethodsA purposive sample of community pharmacists around Australia was invited to participate in an anonymous, online questionnaire that collected demographic information, and pharmacists’ perceptions and attitudes towards dispensing and counselling HIV antiretroviral medicines.ResultsOf the 91 participants, the majority had not dispensed an HIV medicine. Most participants reported feeling comfortable when counselling people living with HIV about their medicines. However, most reported a lack of confidence in knowledge of HIV and HIV medicines, and a lack of confidence in counselling these patients about their medicines and managing the complex issues they experience. There was a statistically significant difference in genders with females reporting less confidence compared with males. Unsurprisingly, confidence in knowledge of HIV and HIV medicines was associated with confidence in counselling people living with HIV.ConclusionIncreased accessibility to HIV antiretroviral medicines through community pharmacies for Australians living with HIV has potentially improved patient health outcomes. However, community pharmacists need to be both confident and comfortable in talking to these patients. This study has identified that Australian community pharmacists would benefit from continuing professional education on this topic. These findings could also be relevant for improving outcomes of patients taking other high‐cost drugs.

Adherence to cardiovascular pharmacotherapy by patients in Iraq: A mixed methods assessment using quantitative dried blood spot analysis and the 8-item Morisky Medication Adherence Scale.

This study evaluated the adherence to prescribed cardiovascular therapy medications among cardiovascular disease patients attending clinics in Misan, Amara, Iraq. Mixed methods were used to assess medication adherence comprising the Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8) and determination of drug concentrations in patient dried blood spot (DBS) samples by liquid chromatography-high resolution mass spectrometry. Three hundred and three Iraqi patients (median age 53 years, 50.5% female) who had been taking one or more of the nine commonly prescribed cardiovascular medications (amlodipine, atenolol, atorvastatin, bisoprolol, diltiazem, lisinopril, losartan, simvastatin and valsartan) for at least six months were enrolled. For each patient MMAS-8 scores were determined alongside drug concentrations in their dried blood spot samples. Results from the standardized questionnaire showed that adherence was 81.8% in comparison with 50.8% obtained using the laboratory-based microsample analysis. The agreement between the indirect (MMAS-8) and direct (DBS analysis) assessment approaches to assessing medication adherence showed significantly poor agreement (kappa = 0.28, P = 0.001). The indirect and direct assessment approaches showed no significant correlation between nonadherence to prescribed cardiovascular pharmacotherapy and age and gender, but were significantly associated with the number of medications in the patient’s treatment regimen (MMAS-8: Odds Ratio (OR) 1.947, 95% CI, P = 0.001; DBS analysis: OR 2.164, 95% CI, P = 0.001). The MMAS-8 results highlighted reasons for nonadherence to prescribed cardiovascular pharmacotherapy in this patient population whilst the objective DBS analysis approach gave valuable information about nonadherence to each medication in the patient’s treatment regimen. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence objectively in Iraq to cardiovascular pharmacotherapy. This information combined with MMAS-8 can provide clinicians with an evidence-based novel approach to implement intervention strategies to optimise and personalise cardiovascular pharmacotherapy in the Iraqi population and thereby improve patient health outcomes.