Medication Action Plan Research Articles

Medication therapy management and condition care services in a community-based employer setting

A program in which health-system pharmacists and pharmacy technicians provide medication therapy management (MTM), wellness, and condition care (disease management) services under contract with local businesses is described. The health-system pharmacy department's Center for Medication Management contracts directly with company benefits departments for defined services to participating employees. The services include an initial wellness and MTM session and, for certain patients identified during the initial session, ongoing condition care. The initial appointment includes a medication history, point-of-care testing for serum lipids and glucose, body composition analysis, and completion of a health risk assessment. The pharmacist conducts a structured MTM session, reviews the patient's test results and risk factors, provides health education, discusses opportunities for cost savings, and documents all activities on the patient's medication action plan. Eligibility for the condition care program is based on a diagnosis of diabetes, hypertension, asthma, heart failure, or hyperlipidemia or elevation of lipid or glucose levels. Findings are summarized for employers after the initial wellness screening and at six-month intervals. Patients receiving condition care sign a customized contract, establish goals, attend up to four MTM sessions per year, and track their information on a website; employers may offer incentives for participation. When pharmacists recommend adjustments to therapy or cost-saving changes, it is up to patients to discuss these with their physician. A survey completed by each patient after the initial wellness session has indicated high satisfaction. Direct cost savings related to medication changes have averaged $253 per patient per year. Total cost savings to companies in the first year of the program averaged $1011 per patient. For the health system, the program has been financially sustainable. Key laboratory values indicate positive clinical outcomes. A business model in which health-system pharmacists provide MTM and condition care services for company employees has demonstrated successful outcomes in terms of patient satisfaction, cost savings, and clinical benefits.

Time for action regarding cardiovascular emergency care at sports arenas: a lesson from the Arena study

Sudden cardiac arrest (SCA) is a common cause of death worldwide, most often triggered by ventricular fibrillation or asystole.1 The estimated prevalence in adult individuals (>35 years) is about 1 in 1000 per year in the USA.2 The major determinant for survival in such instances is the time to defibrillation,1 with the critical interval from the onset of a lethal arrhythmia to subsequent shock, to restore sinus rhythm, being 3–5 min.2 The efficacy of automated external defibrillators (AEDs) to prevent SCAs has been demonstrated in large public settings, such as airports and casinos3,4 and their implementation in other crowded venues has also been advocated.5 Large sports arenas typically gather several thousands of spectators, including adult and senior individuals with risk factor for cardiac events, repeatedly exposed to intense emotion.6 Although much attention is put on the athletes on the field, most cases of SCA in this setting will occur among spectators, and simply watching (emotional) sports events has been demonstrated to trigger cardiac events.7 The National Association of Emergency Medical Services Physicians (NAEMSP) recommends a medical action plan (MAP), including AEDs, as a blue-print for delivering emergency medical care at mass gathering events (e.g. more than 1000 persons).8 In the USA, moreover, AEDs are recommended in large sports facilities and gyms, and also in the school setting when the time to defibrillation exceeds the critical threshold of 5 min.9,10 On the contrary, no recommendations regarding acute cardiovascular care at sports arenas exist at present in Europe, and the current implementation of medical action plans (including AEDs) in major continental sports arenas is largely unknown. We sought to investigate the existing cardiovascular safety procedures of major sports arenas in Europe, with special attention to the availability of …

Perceptions of patients on Medicare Part D medication therapy management services

ObjectivesTo determine patients’ perceptions and expectations about medication therapy management (MTM) services pertaining to the core elements of an MTM service in the community pharmacy setting, and to develop educational strategies and outreach programs aimed at increasing patients’ knowledge of MTM services and the expanded role of pharmacists in the community pharmacy setting. DesignMulticenter, cross-sectional, anonymous study. SettingFour regional community chain pharmacies in Maryland and Delaware in January and February 2006. Patients81 patients who were 18 years of age or older and able to complete the survey. InterventionSurvey containing 14 questions administered within pharmacies, two of which had patient care centers that were providing clinical services. Main outcome measurePatients’ perceptions and expectations regarding MTM services. Results49 of 81 patients (60%) had never heard of MTM services. A total of 65 patients (80%) had never had or received a medication therapy review, 63 (78%) never had or received a personal medication record, and 70 (86%) never had or received a medication action plan. Some 56% of participants (n = 45) thought that pharmacist provision of medication therapy reviews, personal medication records, medication action plans, recommendations about medications, and referral to other health care providers was very important. At least 70% of participants (n = 57) thought that having one-on-one consultation sessions with pharmacists to improve communication and relationships with their pharmacists and to improve their medication use and overall health was very important. More than 50% of participants indicated that they would like to receive brochures or talk to their pharmacist to learn more about MTM services. ConclusionPatients have very limited knowledge of the core elements of an MTM service in the community pharmacy setting. Patients reported that pharmacist provision of MTM services was important, but they were concerned about privacy and pharmacists’ time. Patients are also supportive of and believe that MTM services can improve communication and relationship with their pharmacist and improve medication use. Patients appear to prefer receiving brochures and talking to pharmacists to learn more about MTM services. This survey identified a key opportunity for pharmacists to inform patients about MTM services.

Development and implementation of a telephone medication therapy management program for Medicare beneficiaries

A pharmacist-provided telephone medication therapy management (MTM) program for Medicare beneficiaries is discussed. The Medicare Modernization Act of 2003 requires the provision of MTM to eligible beneficiaries. Using an MTM framework as a guide, Scott & White Health Plan (SWHP), a regional Medicare Part D plan, developed and implemented a pharmacist-provided telephone MTM service for Medicare beneficiaries. A clinical pharmacist, practicing pharmacists, and physicians at SWHP were responsible for developing the MTM program. The MTM coordinator, who was also a pharmacist, worked with an information systems programmer to develop a custom-built database to support the documentation needs. Patients who were identified by SWHP as eligible to receive MTM services were mailed an MTM program information brochure each quarter. The brochure, which was sent out in two-week increments to manage the call volume, described the program and invited patients to participate. Interested patients were instructed to call SWHP to enroll in the MTM program. The medication therapy review, a core component of MTM, consisted of two steps: preassessment and assessment. Problems identified during the preassessment were confirmed or disproved, and during the assessment, medication-related problems were assessed. After the consultation, patients were mailed a portable personal medication record to use to fill out their medication lists. They also received a medication action plan that was tailored to each individual patient. The pharmacist provided consulting services and intervened to address medication- and health-related problems and to refer the patient to other health care providers if needed. A regional health plan successfully developed and implemented a telephone MTM service for Medicare beneficiaries provided and managed by pharmacists.

Texas pharmacists' opinions about and plans for provision of medication therapy management services

ObjectivesTo determine pharmacist awareness of medication therapy management (MTM), confidence in and intentions to provide MTM, related training needs, and barriers to MTM provision; and to assess pharmacist and practice site characteristics that are related to confidence in providing MTM. DesignNonexperimental cross-sectional study. SettingMay 2006 in Texas. Participants1,833 Texas community pharmacists who were affiliated with the Texas Pharmacy Association. InterventionAn anonymous, self-administered online survey was e-mailed to participants. Main outcome measuresAwareness of MTM legislation, confidence in providing MTM, intentions to provide MTM, and barriers to MTM provision. Pharmacist and practice site characteristics were also collected. ResultsThe response rate was 11.8% (n = 157). Overall, pharmacists (>75%) were aware of the three criteria for targeted beneficiaries. They were confident in providing medication therapy review (MTR), creating a personal medication record (PMR), and performing intervention and referral but were only somewhat confident in creating a medication action plan. Pharmacists disagreed or were neutral about having adequate documentation systems for MTM. The majority of respondents intend to become MTM providers (74%) and were interested in additional training (78%). Independent pharmacists, those with adequate documentation systems, and those who had previously provided patient care services were more confident regarding MTM provision. ConclusionPharmacist intentions to provide MTM indicate that they are eager to expand their roles as patient care providers. Pharmacist confidence in providing MTR, creating a PMR, and performing the intervention and referral suggest that pharmacists already have many of the skills necessary to provide MTM; however, more education about creating action plans and using documentation systems may help pharmacists become successful MTM providers.

An Aim of Medical Equipment Guide Decision and Action Plan in the Future(The 6th Medical Devices Safety Measures Society)

An Aim of Medical Equipment Guide Decision and Action Plan in the Future(The 6th Medical Devices Safety Measures Society)

College Fitness Center Emergency Readiness

College Fitness Center Emergency Readiness

Evaluation and Sustainability of the Healthy Learners Asthma Initiative

The Healthy Learners Asthma Initiative (HLAI) involved collaboration between Minneapolis Public Schools (MPS), local health care providers/payors, parents, and other partners. The intervention included development of enhanced asthma care in school health offices and clinic performance improvement projects to foster adoption of National Institutes of Health asthma guidelines. Goals were to improve asthma management among school children and reduce asthma-related school absences, hospitalizations, and emergency department visits. The effectiveness evaluation utilized a randomized community trial design with 16 elementary and middle schools matched and randomly assigned to either an intervention or a control group. Outcomes investigated were (a) school health office impacts and (b) school attendance. Data sources included school health office records, district attendance, enrollment, and demographics files. Following implementation of the HLAI, asthma visits to health offices were significantly lower in intervention schools compared to control schools (91 vs 121 visits per 100 students with asthma per month), and intervention schools had greater availability of medication and asthma action plans and more peakflow measurements, asthma education, and parent communication. Clinics initiated significantly more asthma action plans and sent them to MPS. Attendance differences between groups were limited to students who received asthma care through the school health office. Monitoring of asthma management activities provided through school health offices from 2002 to 2005 indicates sustained implementation of enhanced asthma care in schools and increased asthma communication between school, parents, and health care providers.

Partners in School Asthma Management: Evaluation of a Self-Management Program for Children With Asthma

The "Partners in School Asthma Management" program for inner-city elementary school children comprises (1) case finding; (2) linkage of school nurses, parents, and clinicians; (3) a computer-based tailored educational program; and (4) school environmental assessment and intervention. Case finding identified 1730 children in 60 elementary schools with probable asthma; 835 (96% Hispanic or African American) joined the study. Baseline, posttest, and follow-up measures of asthma knowledge, self-efficacy, and self-management behavior were obtained from the children, and data on symptoms, emergency department visits, and hospitalizations were obtained from their parents. The schools provided data on grades and absences. Each school had a baseline and follow-up environmental assessment. The children in the intervention group showed greater increases in knowledge, self-efficacy, and some aspects of self-management. No differences between groups were found in health status variables, school performance, attendance, or levels of environmental allergens in schools. In 15 schools, an enhanced intervention allowed children and their parents to meet with a project physician, develop an asthma action plan, and receive a 1-month supply of medication; the project physician then followed up with the child's community physician. Children participating in this enhanced intervention had better school performance and fewer absences than the comparison group. Overall, the program was effective in improving children's asthma self-management but not in improving their health status. While the case-finding, computer-based self-management training program and linkage system were successfully implemented, the program failed in creating needed changes in the medical (action plans by community physicians) and physical environments (reduced school allergen levels) of the children.

Emergency Medical Service—Mass Gathering Action Plans

A carefully thought out medical action plan must be created and then enacted for every mass gathering event. Each plan must adhere to all local, regional, and state regulations while ensuring an acceptable level of staffing. The EMS provider, its medical director, the event's coordinator, and all other agencies with which they must interact in case of a mass casualty must endorse the plan. Each plan must be event specific, comprehensive, and proactive in nature. Each plan needs to address many components (see Table 1).

Helping Teens Navigate a Safe Passage From Childhood to Adulthood

Helping Teens Navigate a Safe Passage From Childhood to Adulthood

Assessing Patient Satisfaction with Pain Management Through a Continuous Quality Improvement Effort

A quasi-experimental study was conducted to evaluate patient satisfaction with pain management before and after a continuous quality improvement (CQI) project in a large, university medical center. The CQI project aim was to implement American Pain Society (APS) quality improvement guidelines regarding the recognition and prompt treatment of pain. A modified version of the questionnaire recommended by the APS Subcommittee on Quality Assurance Standards was used to survey 83 patients prior to implementation of the CQI effort and 89 patients one year later. Half of the patients reported moderate to severe pain both before and after the CQI project. Less than half reported complete relief of pain after treatment. Despite significant levels of pain and ineffective treatment, greater than 90% of patients reported being satisfied with pain management. Responses to open-ended questions were analyzed. Findings from the study are being used to develop a medical center-wide action plan to guide further CQI efforts to improve pain management.

Characteristics of state legislation governing medical care at mass gatherings

Organized mass gathering medical care (MGMC) has existed in the United States for 30 years, but there is little evidence to support any standard of care or uniformity in its delivery. Objective. To determine whether MGMC regulations exist within state EMS legislation and to describe the characteristics of any such regulations. Methods. The authors conducted a cross-sectional survey of US. state EMS directors in fall 1998 to determine the prevalence of formal legislation governing MGMC. The lead author received copies of legislation from every state EMS office that indicated such legislation existed. Results. Responses were obtained from all 50 state EMS offices and that of the District of Columbia (n = 51). Only six (12%) states provide regulatory guidance for MGMC. These regulations reside within departments of health in all six states and within the divisions of EMS in three of these six. Only one state requires physician oversight of a medical action plan and minimum staffing by EMS personnel, respectively. No state addresses early defibrillation capability or EMS scope of practice. There is no agreement on the definition of either a mass gathering or minimum resource deployment. Public health and hygiene practices at mass gatherings also lack uniformity. Conclusion. Few states regulate MGMC. Existing regulations are poorly developed and lack both standardized terminology and content.