Integrated Pharmacy Services Research Articles

Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study

BackgroundPolypharmacy and potentially inappropriate medications (PIMs) are still frequent among older adults in nursing homes. Deprescribing is an intervention that has been shown to be effective in reducing their use. However, the implementation of deprescribing in clinical practice has not yet been widely evaluated. The Quality Circle Deprescribing Module (QC-DeMo) intervention has been trialled through an effectiveness-implementation hybrid type 2 design. The intervention consists of a quality circle workshop session between healthcare professionals HCPs (physicians, nurses, and pharmacists) within a nursing home, in which they define a consensus to deprescribe specific PIMs classes. The aim of this study was to evaluate the implementation of the QC-DeMo intervention in nursing homes.MethodsThis observational study focuses on the implementation part of the QC-DeMo trial. Implementation was based on the Framework for Implementation of Pharmacy Services (FISpH). Questionnaires at baseline and follow-up were used to evaluate reach, adoption, implementation effectiveness, fidelity, implementation, maintenance and the implementation strategies. Other data were collected from the QC-DeMo trial and routine data collected as part of the integrated pharmacy service where the QC-Demo trial was embedded. Implementation strategies included training of pharmacists, integration of the intervention into an existing quality circle dynamic and definition of tailored strategies to operationalise the consensus by each nursing home.ResultsThe QC-DeMo intervention was successfully implemented in 26 nursing homes in terms of reach, fidelity, adoption, implementation and implementation effectiveness. However, the intervention was found to be implemented with low maintenance as none of the nursing homes repeated the intervention after the trial. Implementation strategies were well received by HCPs: training was adequate according to pharmacists. Pre-existing quality circle dynamic facilitated interprofessional collaboration as involvement and support of each HCP was rated as high. HCPs recognized a specific and important role for each HCP in the deprescribing process. The most relevant tailored strategies to implement the consensus defined by each nursing home were identification of the patients by the pharmacist and a systematic review of medication’s patients.ConclusionsThe implementation of a Quality Circle on Deprescribing is feasible but its maintenance in practice remains challenging. This study explores multiple implementation outcomes to better inform future implementation efforts of these types of interventions.Trial registrationClinicalTrials.gov (NCT03688542), registered on 26.09.2018.

Reduced emergency room visits and improved medication adherence of an integrated oncology pharmaceutical care practice in China.

We described our initial experience of a new integrated oncology phamaceutical care practice to enhance the quality of pharmacy service and patient care in Huashan hospital.Data sources: A retrospective study was performed from August 2019 to September 2020. Patients were described as integrated pharmacy service group and routine care group. Medication adherence of patients in integrated pharmacy service group was recorded by the online management system. Patient satisfaction and the cumulative incidence of emergency room (ER) and outpatient visit were evaluated between two groups.Data summary: In total, 323 patients received the integrating oncology pharmacy service. The percentage of the patients missing administration every day was reduced from 29.7% to 0.3% within a 40-day monitoring and intervention period. There was a significant difference on patient satisfaction with pharmacy service in two groups (P < 0.05). Fewer patients in the integrated pharmacy service group visited clinic and ER compared with routine care group (33.1% vs. 59.2%; P < 0.05). As a new practice model, the integrated program is adopted to provide patient care and ongoing monitoring for cancer patients. The practice model delivers high continuity of care for cancer patients and improves communication and collaboration between healthcare professionals and oncology patients. The practice also provides the potential of developing hospital pharmaceutical service and optimizing disease prevention and treatment strategies.

Evolution of potentially inappropriate medication use in nursing homes: Retrospective analysis of drug consumption data

The use of potentially inappropriate medication (PIMs) is frequent in nursing homes (NHs), and leads to worsened health outcomes for their residents. Numerous initiatives to curb their use have been launched. Most studies of PIMs use in NHs, however, focused on their prevalence, and provide few insights on the evolution of their use. The objective of this analysis is to measure the evolution of PIMs use in the nursing NHs of western Switzerland taking part in an integrated pharmacy service (IPS). Drug consumption data from 166 NHs were collected for 2014 to 2018, through the monitoring of the IPS. These data were cross-referenced with validated PIMs lists (Beers' list and Norwegian General Practice-Nursing Home, NORGEP-NH) to compute the number of potentially inappropriate defined daily doses per average resident (DDD/res) in each NH. Linear mixed-effects models were used to assess the evolution of PIMs use over time, following the NORGEP-NH classification of PIMs and the drug classes involved. In 2018, the number of DDD/res was 7.3 (SD 1.9); of those, 2.2 (SD 0.8) were potentially inappropriate. Psycholeptics, psychoanaleptics and antihypertenseives were the most-used PIMs. Between 2014 and 2018, the number of potentially inappropriate DDD/res decreased by 0.03 per year (CI95 [-0.05; -0.01]). This study complements others that focused on the prevalence of PIMs use in NHs. The statistically significant reduction in the use of PIMs is an encouraging sign, but is probably not clinically meaningful for NH residents. With the growing concerns of the potential harms of these drugs, more specific interventions and implementation strategies need to be developed to help clinicians further reduce their use in NHs.

Effect of an integrated clinical pharmacy service with the general medical units on patient flow and medical staff satisfaction: a pre‐ and postintervention study

AbstractBackgroundHealth services are under pressure to accommodate increasing numbers of emergency department presentations. This can contribute to prescribing errors. Integration of a pharmacist into the general medical team may reduce the incidence of prescribing errors on discharge and improve patient flow and medical staff satisfaction.AimThis study evaluated the effect of an integrated pharmacy service provided to the general medical units (GMUs) on patient flow and medical staff satisfaction.MethodThis study was a 4‐week pre‐ and postintervention study involving GMUs at a major metropolitan hospital in Australia. During the intervention period, an integrated clinical pharmacy service, which included attending medical ward rounds and assisting with the preparation of discharge prescriptions, was provided to medical units. The primary endpoint was the median time (min) past 9am that patients were discharged from the ward. Secondary outcomes included the proportion of prescriptions requiring an amendment and medical staff satisfaction with the service.ResultsThere were 87 and 84 patients discharged from the medical units before and after the intervention. During the intervention period, pharmacists prepared 79% of prescriptions, which reduced the proportion requiring an amendment from 65% to 17% (p &lt; 0.01). Patients were discharged 77 min earlier during the postintervention period (median 380 vs 303 min after 9am; p = 0.03). Medical staff felt the integrated clinical pharmacy service improved patient flow and should be incorporated into standard practice.ConclusionsAn integrated clinical pharmacy service with proactive pharmacist intervention within the GMUs improved patient flow and medical staff satisfaction, and decreased prescriptions requiring an amendment.

Impact of an integrated pharmacy service on hospital admission costs

Impact of an integrated pharmacy service on hospital admission costs

Impact of an integrated pharmacy service on hospital admission costs

Impact of an integrated pharmacy service on hospital admission costs

The impact of pharmacy services on opioid prescribing in dental practice

ObjectivesTo compare rates of dental opioid prescribing between periods of full and partial integration of pharmacy services and periods of no integration. MethodsThis observational study used a retrospective chart review of opioid prescriptions written by dental providers practicing in a free dental clinic for the medically underserved over a period of 74 months. Pharmacy services were fully integrated into the practice model for 48 of the 74 months under study. During this time frame, all dental opioid orders required review by the pharmacy department before prescribing. Outcomes related to prescribing rates and errors were compared between groups, which were defined by the level of integrated pharmacy services. Demographic and prescription-specific data (drug name, dose, quantity, directions, professional designation of individual entering order) and clinic appointment data were collected and analyzed with the use of descriptive and inferential statistics. ResultsA total of 102 opioids were prescribed to 89 patients; hydrocodone-acetaminophen combination products were the most frequently used. Opioid prescribing rates were 5 times greater when pharmacy services were not integrated (P <0.001); and dentists were 81% less likely to prescribe opioids when pharmacy was fully integrated (odds ratio 0.19, 95% confidence interval 0.124-0.293; P <0.001). Frequency of hydrocodone use compared with other opioids did not decrease after the rescheduling of hydrocodone to a Schedule II controlled substance. The frequency of prescribing errors was not statistically different between groups, although there were numerically fewer errors with integrated pharmacy services. ConclusionThe literature reports that dentists are the third most frequent prescribers of opioids. The findings from this study suggest that collaboration between pharmacists and dentists has the potential to decrease opioid utilization in primary dental practice.

Helping the vulnerable: why we need integrated pharmacy services for the homeless

Helping the vulnerable: why we need integrated pharmacy services for the homeless

Clinical Outcomes Associated With Receipt of Integrated Pharmacy Services by Hemodialysis Patients: A Quality Improvement Report

Reducing medication-related problems and improving medication adherence in hemodialysis patients may improve clinical outcomes. In 2005, a large US dialysis organization created an integrated pharmacy program for its patients. We aimed to compare the outcomes of hemodialysis patients enrolled in this program and matched control patients. Quality improvement report. Hemodialysis patients with concurrent Medicare and Medicaid eligibility who chose to receive program services and propensity score-matched controls; the propensity score was an estimated function of demographic characteristics, comorbid conditions, medication exposure, serum concentrations, and vascular access method. Program services included medication delivery, refill management, medication list reviews, telephonic medication therapy management, and prior authorization assistance. Relative rates of death and hospitalization. Survival estimates calculated with the Kaplan-Meier method; mortality hazards compared with Cox regression; hospitalization rates compared with Poisson regression. In outcome models, there were 8,864 patients receiving integrated pharmacy services and 43,013 matched controls. In intention-to-treat and as-treated analyses, mortality HRs for patients receiving integrated pharmacy services versus matched controls were 0.92 (95% CI, 0.86-0.97) and 0.79 (95% CI, 0.74-0.84), respectively. Corresponding relative rates of hospital admissions were 0.98 (95% CI, 0.95-1.01) and 0.93 (95% CI, 0.90-0.96), respectively, and of hospital days, 0.94 (95% CI, 0.90-0.98) and 0.86 (95% CI, 0.82-0.90), respectively. Cumulative incidences of disenrollment from the pharmacy program were 23.4% at 12 months and 37.0% at 24 months. Patients were not randomly assigned to receive integrated pharmacy services; as-treated analyses may be biased because of informative censoring by disenrollment from the pharmacy program; data regarding use of integrated pharmacy services were lacking. Receipt of integrated pharmacy services was associated with lower rates of death and hospitalization in hemodialysis patients with concurrent Medicare and Medicaid eligibility. Studies are needed to measure pharmacy program use and assess detailed clinical and economic outcomes.

Developing an integrated pharmacy service in a specialized Italian hospital

In 1998, we were asked to develop a pharmacy service in Palermo, Italy, as part of a larger collaboration between the University of Pittsburgh Medical Center (UPMC) and two Italian hospitals. A literature search for information about the practice of pharmacy in Italy only yielded information on

Snapshot of Hospital Pharmacy Workforce in Australia

To provide a snapshot of current staff utilisation, a questionnaire was sent to 248 Australian hospitals with an identified hospital pharmacy service. The data returned from 101 hospital pharmacy services provided a snapshot of where hospital pharmacists are currently working, what they spend their time doing, and the role of pre‐registration pharmacists and pharmacy support staff in providing hospital pharmacy services.Key findings of the responses from these 101 hospital pharmacy services showed that in 2000‐2001: 1. 129.16 of the 929.46 pharmacists establishment full‐time equivalent positions (14%) were vacant; 2. one in three hospital pharmacists worked part time; 3. one in three hospital pharmacists had a postgraduate qualification; and 4. on average 41 % of pharmacists' time was devoted to clinical services, 39% to distribution services and 16% to management activities.The full report is available at: http://www.shpa.org.au/documents/snapshotworkforce.pdf

Integrated pharmacy services: cornerstone of a new model of care at celebration health.

Integrated pharmacy services: cornerstone of a new model of care at celebration health.

Inpatient High-Dose Chemotherapy with Outpatient Autologous Stem Cell Support: A Model of Continuous Pharmaceutical Care

The adult autologous bone marrow transplant (ABMT) program at Duke University Medical Center has developed an innovative outpatient approach to managing patients with solid tumors with ABMT during their postchemotherapy period of myelosuppression and recovery. The use of colony-stimulating factors in combination with peripheral blood progenitor cells (PBPCs) and bone marrow for hematologic support plus implementation of prophylactic antibiotics with sequential once-daily empiric antibiotic modification regimen were key to the success of this approach. This program reduces the duration of hospitalization, and thus the costs associated with a traditionally complex and difficult therapy. More than 400 patients have been treated in the outpatient setting since May 1992. Patients are initially admitted for 5 days of hospitalization to receive combination high-dose chemotherapy with continuous hydration and antiemetic support. Twenty-four hours after completion of chemotherapy, patients are discharged on oral prophylactic antibiotics, electrolyte supplements, and antiemetic agents. Close to half of the patients are readmitted to the inpatient unit during their period of ambulatory supportive care. Continuous provision of drug therapy and clinical pharmacy services require ongoing communication between pharmacy and both outpatient and inpatient personnel. Months of planning with nurse, physician, and pharmacist input were required to develop a program that meets the changing needs of patients undergoing a complex and potentially toxic therapy. Reliable 7-day pharmaceutical services was one of the essential components required for operation of such an outpatient program. This article reviews the basic principles and procedures used in treating patients in the Duke Outpatient ABMT program, with a focus on the complexity of supportive care issues that occur in the ambulatory setting, and the development of integrated pharmacy services for the program will be discussed.

Using pharmacists' perceptions in planning changes in pharmacy practice

Pharmacists' perceptions of and goals for clinical pharmacy services, as well as the proportion of time devoted to clinical services, were studied at one hospital as part of the process for establishing departmental goals. Three methods were used in evaluating pharmacists' perceptions of clinical pharmacy services. The first was a departmental survey. Second, staff members were asked to generate and prioritize a list of goals for clinical pharmacy services; this was done by means of an interactive, small-group process. Finally, a work-sampling study was performed that indirectly measured use of staff pharmacist and technician time. Staff pharmacists perceived that clinical pharmacy services were being provided to individual patients; however, support for these services from upper management was perceived as inadequate. Staff development had the highest priority for the further development of clinical pharmacy services. Only 19.7% of pharmacists' time was devoted to clinical services. Data from all three studies were incorporated into the development of a strategic plan that set forth long-term departmental goals and objectives. The plan includes a statement of commitment to develop management systems to eliminate deficiencies identified in the study. Among the changes in pharmacy operations introduced as a result of the survey were (1) a career-ladder system, (2) new opportunities for staff development, and (3) improved documentation systems. Surveying staff perceptions of existing services, joint goal setting and prioritization, and work-sampling studies formed the basis for the development and implementation of a new model of integrated pharmacy services at this institution.