Number Of Drug Therapy Problems Research Articles

Improving medication prescribing-related outcomes for vulnerable elderly in transitions on high-risk medications (IMPROVE-IT HRM): a pilot randomized trial protocol.

Seniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group. The design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets; completes consult, including priorities for improving prescribing negotiated with the patient; starts the care plan; ensures a detailed discharge medication reconciliation and circle-of-care communication; and sees the patient at least twice after hospital discharge via virtual visits to consolidate the care plan in the community. Control group receives usual care. Primary outcomes are feasibility - recruitment, retention, costs, and clinical - number of drug therapy problems improved, with secondary outcomes examining coordination of transitions in care, quality of life, and healthcare utilization and costs. Follow-up is to 3-month posthospital discharge. If results support feasibility of ramp-up and promising clinical outcomes, a follow-up definitive trial will be organized using a developing national platform and medication appropriateness network. Since the intervention allows a very scarce medical specialty expertise to be offered via virtual care, there is potential to improve the safety, outcomes, and cost of care widely. ClinicalTrials.gov identifier: NCT04077281.

Impact of Resveratrol and Pharmaceutical Care on Type 2 Diabetes Mellitus and Its Neuropathic Complication: A Randomized Placebo Controlled Clinical Trial

Background. Management of diabetic neuropathy (DN) is a challenging issue. Therefore, integration of pharmaceutical care provided by the clinical pharmacists with pharmacotherapy may provide multifaceted approach to target the management of hyperglycemia and diabetic neuropathic complication. This study aimed to evaluate the effects of resveratrol (Resv) and/or pharmaceutical care (PC) on glycemic control and amelioration of diabetes-associated neuropathic complications. Patients and Methods. A four-arm randomized placebo-controlled clinical trial assigned 120 patients from the Diabetes and Endocrinology Center in Sulaymaniyah City, Iraq. The patients were divided into four groups. The Resv group (n = 30) received 500 mg Resv capsules once daily. The Placebo group (n = 30) received placebo capsules. Resv + PC (n = 30) received Resv 500 mg capsules with PC. Placebo + PC (n = 30) received placebo capsule plus PC. The duration of the intervention was 90 days. Drug therapy problems (DTPs) have been utilized as an important domain in PC. Clinical signs, symptoms, and neuropathic abnormalities were assessed using the Michigan Neuropathy Screening Instrument (MNSI), Douleur Neuropathique 4 (DN4) questions, and nerve conduction studies (NCSs) of the lower-limb sensory and motor nerves. Results. 97 patients from all the groups completed the study. At baseline, 84% of the Resv, 87% of the Placebo, and 92% of each of Resv + PC and Placebo + PC groups, respectively, had at least one DTP. The provision of PC resulted in a dramatic reduction in the number of DTP. Resveratrol with PC significantly ameliorated hyperglycemic status, neuropathic signs, and symptoms, as evidenced by a decrease in MNSI and DN4 scores and improvement in electroneurographic parameters. Conclusion. These findings support the integration of the PC concept into a pharmacotherapy intervention; they also encourage supplementation of Resv with conventional diabetes therapy to emphasize on the importance of this herbal medicine with the provision of PC in the management of diabetes and its neuropathic complications. This trial is registered with NCT05172947.

Prescribers' approval rate of pharmacist-initiated interventions to optimise patients' clinical status of hypertension in the ambulatory care setting.

This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers' approval rate of pharmacists' interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb - Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients' latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Sub-therapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients' health outcomes.

The association between drug therapy problems and blood pressure control of patients with hypertension in public health center setting.

Patients with hypertension are at risk of experiencing Drug Therapy Problems (DTPs). However, few have studied the pattern of DTPs in Indonesian public health center (PHC) and how it affected the blood pressure control. This study aims to identify DTPs and its association to blood pressure control among patients with hypertension in Indonesian PHCs. A descriptive, observational and cross-sectional study involving 150 selected persistent hypertensive patients was conducted from August to December 2019 in 63 PHCs in Surabaya. A questionnaire asking patients' experiences during treatment of hypertension was used. Chi-square test was used to analyze the association between DTPs and blood pressure control. The majority of respondents were aged 50-65 (54.7%), female (76%), only half has controlled blood pressure (52.7%) and most of them used three to four medicines at the same time (57.3%). A total 563 DTPs was identified with 15.6% was unnecessary drug use, 11.4% indicated need for additional drug therapy, one-fifth experienced dosage too low (21.5%) and nonadherence (19.2%) and 26% suffered from adverse drug reactions. There was a significant association between number of DTPs and blood pressure control (P<0.05). Most patients experienced more than two DTPs and undertook more than three medicines at the same time. There is a significant association between the number of DTPs in hypertensive patient and the blood pressure control.

Drug Therapy Problems and Associated Factors Among Hypertensive Patients in North Wollo Public Hospitals, Northeast Ethiopia: Institutional-Based Cross-Sectional Study.

Drug therapy problems (DTPs) are common in people with hypertension and may threaten the effective management of the disease. The purpose of this study was to determine the prevalence and predictors for DTPs in hypertensive people in North Wollo public hospitals. On patients with hypertension, a cross-sectional study based in a health institution was carried out using an interviewer-administered structured questionnaire and medical record review from 6 November 2022 to 18 January 2023. All hypertensive patients, ages 18 and older, who underwent regular follow-ups for at least 12 months were included in the study using a simple random sampling method. Multivariate logistic regression analysis was used to establish the association between independent variables and the occurrence of DTPs. Unnecessary drug therapy, the need for additional drug therapy, ineffective drugs, dosage too low, dosage too high, adverse drug reactions, and noncompliance were the outcome variables. The study included 376 hypertensive patients. Of the total participants, 258 (68.6%) were female. The mean number of drug therapy problems per patient was 1.55 ± 0.307, with 298 participants (79.3%) reporting having at least one such problem. This study found that the need for additional drug therapy was the most prevalent problem (149, 39.66%). Polypharmacy (AOR = 2.487, 95% CI = 1.375-4.499, p = 0.003), presence of comorbidity (AOR = 1.886, 95% CI = 1.035-3.439, p = 0.038), and uncontrolled BP (AOR = 2.961, 95% CI = 1.669-5.254, p = <0.001) predicts the development of drug therapy problems. Patients with hypertension who are on follow-up experience drug therapy problems frequently. Promoting the involvement of clinical pharmacists in designing, implementing, and monitoring therapeutic plans is recommended to decrease the occurrence of drug therapy problems.

Impact Analysis of a Pharmacist-Led Home-Medication Review Service Within an interprofessional Outreach Team

To describe the demographic and clinical characteristics of frail and homebound communitydwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. Retrospective, cross-sectional chart-review study using data from patient records. Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. 171 patients received a HMR between January 1, 2016, and May 31, 2018. Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. Frail and homebound communitydwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.

Description of a Comprehensive Medication Management service in an adult intensive care unit

Objective: To describe the results of a Comprehensive Medication Management (CMM) service offered to patients of an adult intensive care unit. Methods: A descriptive cross-sectional study of the results of the CMM service (April 2017 to November 2018). All the patients followed up in the CMM service were included in the sample of this study. The service was integrally based on the Pharmaceutical Care Practice and, therefore, used the Pharmacotherapy Workup (PW) method. the drug therapy Problems (DTP) were quantified and classified according to the PW method. The main medications involved in the DTP were also described, as well as the acceptance of the interventions by the multidisciplinary care team members and patients. Results: 146 patients were followed up during the study period, and 512 DTP were identified. Of these DTP, most were related to medication safety (37.7%) and to indication (37.5%). The main causes were high dose (23.0%, with emphasis on dose adjustments in cases of kidney injury), need for additional medication (18.9%, inclusion of medication for electrolytic, glycemic, and prophylactic control), and unnecessary medication (18.6%, emphasis on de-prescription of antibiotics that were not indicated). Most of the problems (23.6%) were related to the therapeutic class of systemic anti-infective agent. Of the total DTP detected, 81.6% were resolved. A total of 451 interventions were implemented, of which 92.9% (n=419) were with physicians. The majority of the interventions with physicians were accepted (n=344, 82.1%). Conclusion: A high number of drug therapy problems have been detected and resolved by the CMM pharmacist, with emphasis on safety problems. The high acceptability of the interventions reinforces the need for the service applied to the critical patient.

Clinical pharmacy in medical practice: the impact of detection, prevention and resolution of Drug Therapy Problems (DTPs) on patients with chronic diseases

(i). Background &amp; objective: Recently, the role of pharmacists in the healthcare settings has dramatically evolved through the application of pharmaceutical care process. However, this new role has not been fully elucidated and reflected in the Iraqi healthcare system. Therefore, the aim of this study was to evaluate the&#x0D; &#x0D; impact of clinical pharmacist intervention on the management of patients with common chronic diseases. &#x0D; (ii) Methods: a randomised controlled trial study was performed with 125 patients with one or more of these conditions: hypertension, hyperlipidaemia and Diabetes mellitus. They have divided into two groups i.e. intervention and non-intervention groups. &#x0D; (iii) Results: The results revealed that pharmacist intervention played a significantly role in the management of chronic diseases given that a significant reduction in the various clinical parameters such as blood pressure, lipid profile, HbA1c and FPG were observed among the intervention group. Apart from development of a therapeutic relationship with the patients, these results are largely amounted to the detection, prevention and resolution of a massive number of DTPs among the patients in the intervention group.&#x0D; (iv) interpretation &amp; Conclusion: Clinical pharmacist intervention can play a pivotal role in the management of patients with chronic diseases. This could be extended to the other healthcare settings as well. Moreover, clinical pharmacist plays a key role in the achievement of therapeutical goals and avoiding Drug Therapy Problems (DTPs).

Clinical pharmacy in medical practice: the impact of detection, prevention and resolution of Drug Therapy Problems (DTPs) on patients with chronic diseases

(i). Background &amp; objective: Recently, the role of pharmacists in the healthcare settings has dramatically evolved through the application of pharmaceutical care process. However, this new role has not been fully elucidated and reflected in the Iraqi healthcare system. Therefore, the aim of this study was to evaluate the impact of clinical pharmacist intervention on the management of patients with common chronic diseases. (ii) Methods: a randomised controlled trial study was performed with 125 patients with one or more of these conditions: hypertension, hyperlipidaemia and Diabetes mellitus. They have divided into two groups i.e. intervention and non-intervention groups. (iii) Results: The results revealed that pharmacist intervention played a significantly role in the management of chronic diseases given that a significant reduction in the various clinical parameters such as blood pressure, lipid profile, HbA1c and FPG were observed among the intervention group. Apart from development of a therapeutic relationship with the patients, these results are largely amounted to the detection, prevention and resolution of a massive number of DTPs among the patients in the intervention group. (iv) interpretation &amp; Conclusion: Clinical pharmacist intervention can play a pivotal role in the management of patients with chronic diseases. This could be extended to the other healthcare settings as well. Moreover, clinical pharmacist plays a key role in the achievement of therapeutical goals and avoiding Drug Therapy Problems (DTPs).

Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization.

Objectives:To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified.Methods:A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified.Results:The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not.Conclusions:This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.

Impact of a Layered Learning Practice Model on Delivery of Clinical Pharmacy Key Performance Indicators under a Tertiary Care Centre Oncology Service

The layered learning practice model (LLPM), within which a pharmacist supervises both a pharmacy resident and a student, mitigates the growing demand for clinical rotations that has accompanied national expansion of Doctor of Pharmacy programs. A Canadian collaborative of hospital pharmacists established consensus on 8 clinical pharmacy key performance indicators (cpKPIs), activities associated with improved patient outcomes. Increased implementation of the LLPM alongside cpKPI measurement offers opportunities to compare the LLPM with standard practice in terms of pharmaceutical care delivery. To quantify clinical productivity, as measured by proportions of eligible patients receiving cpKPIs and absolute numbers of completed cpKPIs, across scenarios involving pharmacists working with and without pharmacy learners. In this retrospective observational study, pharmacy students, pharmacy residents, and pharmacists recorded completion of 7 cpKPIs for oncology inpatients over a total of 6 months in 2017 and 2018. Clinical productivity was described across the following 3 scenarios: presence of one or more pharmacists with one resident and one or more students (P-R-S); presence of one or more pharmacists with one or more students (P-S); and presence of one or more pharmacists only (P; standard practice). During the study, there were 685 recorded admissions to the inpatient oncology service. Generally, the proportions of patients who received cpKPIs were similar for scenarios with and without pharmacy learners present. Standardized to 20 pharmacist workdays, the total number of cpKPIs 1, 2, 3, 5, 6, and 7 (255 with P-R-S scenario, 281 with P-S scenario, and 258 with P scenario) and the total number of drug therapy problems resolved (i.e., cpKPI 3; 153 with P-R-S scenario, 180 with P-S scenario, and 149 with P scenario) were similar across the scenarios. Scenario P had fewer admitted patients per pharmacist workday (3.2) than scenarios P-S and P-R-S (3.4 and 3.7, respectively), which may have contributed to a trend toward greater proportions of patients receiving cpKPIs under scenario P. Compared with standard practice, integration of pharmacy learners within an oncology unit did not appear to impair clinical productivity, as demonstrated by the comparable proportions of patients receiving cpKPIs and the total number of completed cpKPIs.

Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care.

To evaluate the process of clinical medication review for elderly patients with polypharmacy performed by non-dispensing pharmacists embedded in general practice. The aim was to identify the number and type of drug therapy problems and to assess how and to what extent drug therapy problems were actually solved. An observational cross-sectional study, conducted in nine general practices in the Netherlands between June 2014 and June 2015. On three pre-set dates, the non-dispensing pharmacists completed an online data form about the last 10 patients who completed all stages of clinical medication review. Outcomes were the type and number of drug therapy problems, the extent to which recommendations were implemented and the percentage of drug therapy problems that were eventually solved. Interventions were divided as either preventive (aimed at following prophylactic guidelines) or corrective (aimed at active patient problems). In total, 1292 drug therapy problems were identified among 270 patients, with a median of 5 (interquartile range 3) drug therapy problems per patient, mainly related to overtreatment (24%) and undertreatment (21%). The non-dispensing pharmacists most frequently recommended to stop medication (32%). Overall, 83% of the proposed recommendations were implemented; 57% were preventive, and 35% were corrective interventions (8% could not be assessed). Almost two-third (64%) of the corrective interventions actually solved the drug therapy problem. Non-dispensing pharmacists integrated in general practice identified a large number of drug therapy problems and successfully implemented a proportionally high number of recommendations that solved the majority of drug therapy problems.

Evaluation of Collaborative Medication Reviews for High-Risk Older Adults

Despite the widespread use of medication reviews, many older adults are still exposed to the risks of polypharmacy. To quantify and describe the drug therapy problems identified and interventions undertaken by pharmacists before and after implementation (on July 1, 2015) of collaborative medication review for high-risk older adult patients (> 80 years of age). A retrospective single-centre pre-post cohort study was conducted between July 1, 2014, and July 31, 2016, to characterize the impact of collaborative medication reviews-consisting of a thorough medication review by a pharmacist and care conferences with the hospitalist and family physician-on prescribing patterns in an Acute Care for Elders unit. A standardized template was used to conduct medication reviews for the post-implementation group, whereas a chart review was conducted for the pre-implementation group. The primary outcomes were the number of drug therapy problems identified by the clinical pharmacists and the associated interventions by the pharmacists, which were categorized as clinical or compliance interventions. Secondary outcomes included the number of medications at discharge, the rate of hospital readmission within 30 days, and the length of hospital stay. A total of 137 patients were identified for inclusion in either the pre-implementation group (n = 70) or the post-implementation group (n = 67). After implementation of collaborative medication reviews, there were statistically significant increases in the mean number of drug therapy problems identified (p < 0.001), the mean number of interventions undertaken (p = 0.004), and the median length of hospital stay (p < 0.001). There was no difference between the 2 groups in the number of medications at discharge, the proportion of patients taking more than 5 medications at discharge, or readmission within 30 days. At the study institution, implementation of a quality improvement program that included pharmacist-led medication reviews and collaborative care conferences involving community and hospital care providers helped to improve documentation by clinical pharmacists of potential medication-related problems and led to more interventions to optimize patients' medication regimens.

The Innovative Canadian Pharmacogenomic Screening Initiative in Community Pharmacy (ICANPIC) study

ObjectivesThe safety and efficacy of medications can vary significantly between patients as a result of genetic variability. As genomic screening technologies become more widely available, pharmacists are ideally suited to use such tools to optimize medication therapy management. The objective of this study was to evaluate the feasibility of implementing personalized medication services into community pharmacy practice and to assess the number of drug therapy problems identified as a result of pharmacogenomic screening. SettingThe study was conducted in 2 busy urban community pharmacies, operating under the brand Shoppers Drug Mart, in Toronto, Ontario. Practice innovationPharmacists offered pharmacogenomic screening as part of their professional services program. Eligible patients received a buccal swab followed by DNA analysis with the use of Pillcheck. Pillcheck is a genotyping assay that translates genomic data and generates a personalized evidence-based report that provides insight into patients' inherited drug metabolic profile. After receiving the report, pharmacists invited patients back to the clinic for interpretation of the results. Clinically significant drug therapy problems were identified and recommendations for medication optimization forwarded to the primary care physician. ResultsOne hundred patients were enrolled in the study. Average age was 56.7 years, and patients were taking a mean of 4.9 chronic medications. Pharmacists cited the most common reasons for testing as ineffective therapy (43.0%), to address an adverse reaction (32.6%), and to guide initiation of therapy (10.4%). An average of 1.3 drug therapy problems directly related to pharmacogenomic testing were identified per patient. Pharmacist recommendations included change in therapy (60.3%), dose adjustment (13.2%), discontinuation of a drug (4.4%), and increased monitoring (22.1%). ConclusionThese results highlight the readiness of community pharmacists to adopt pharmacogenomic screening into practice and their ability to leverage this novel technology to positively affect medication therapy management. Community pharmacists are ideally suited to both offer personalized medication services and interpret genomic results.

Impact of a medication therapy management service on the clinical status of patients with chronic obstructive pulmonary disease.

Background At this moment, there is no information in the literature showing the impact of comprehensive medication management (CMM) service delivered to patients with chronic obstructive pulmonary disease. Objective This study aims to present the clinical outcomes of this service provided to patients with chronic obstructive pulmonary disease. Settings Public specialty pharmacy where high cost drug treatments are provided for medical conditions not covered by the primary care such as COPD, located in Minas Gerais State, Brazil. Methods A retrospective analysis was conducted for 83 patients. The dependent variable in this study was the sum of the drug therapy problems detected during the first and second consultation. The independent variables were age, number of diseases and medications, diagnosis of hypertension, dyslipidemia and diabetes, and tabagism. Univariate and multivariate analyses were performed using Pearson's Chisquare test. A level of significance of 5% was adopted for all analyses. Main outcomes Number, types and proportion of resolved drug therapy problems. Results Two hundred seventy seven drug therapy problems were identified, of which 53.1% were resolved. The most frequent drug therapy problem was the "use of unnecessary drug therapy" (n=55; 19.8%). The identification of three or more drug therapy problem was higher among patients using five medications or more and among those using ten or more (p<0.05). After the delivery of medication therapy management, the proportion of patients presenting "stable" clinical status was raised from 27 to 54% (p=0.001). Conclusion CMM service demonstrates a positive impact on clinical outcomes of patients with chronic obstructive pulmonary disease and should prioritize patients with polypharmacy because they might have a higher number of drug therapy problems.

Shared decision making and medication therapy management with the use of an interactive template

ObjectivesTo evaluate the preliminary efficacy, feasibility, and acceptability of a template-based intervention to facilitate shared decision making (SDM) in medication therapy management (MTM) consultations; and to examine the type and number of drug therapy problems (DTPs) discussed and how resolution was communicated to patients' primary care providers (PCPs). SettingAn internal medicine clinic at a large safety-net hospital. Practice descriptionHennepin County Medical Center is an urban safety net hospital serving an ethnically-diverse population with about 50 percent of patients enrolled in Medicaid. Within its internal medicine clinic, the study setting, over 100 clinicians participate in the primary care of approximately 25,000 discrete patients. Practice innovationThis is the first study to use a template format to facilitate SDM with pharmacists in MTM consultations. The template approach is more flexible than the use of decision aids, facilitating discussion around various issues. InterventionsPatients completed template-guided interventions with pharmacists trained in SDM. EvaluationWe analyzed the electronic health record used during the intervention, as well as post-appointment surveys administered to patients and pharmacists, for indications of SDM efficacy, feasibility, and acceptability. ResultsTwenty patients and four pharmacists participated in the study. Free-text comments demonstrated that both patients and pharmacists appreciated the intervention, although some pharmacists had concerns including consultation length and SDM applicability. On average, two DTPs were identified per consultation and were most commonly related to appropriate compliance (30% of DTPs), appropriate indication (26%), medication effectiveness (23%), and safety (21%). ConclusionUsing a template to facilitate SDM within MTM consultations appears to be effective, feasible, and acceptable. DTP identification exemplifies a potential application of template-guided SDM. These results will be used to inform future work refining the intervention and developing robust comparative analyses.

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.

Access to patients’ health records for drug therapy problem determination by pharmacists

To evaluate differences in the number and type of drug therapy problems (DTPs) identified by pharmacists with and without access to patients' primary care health records; determine the confidence level of pharmacists in their assessment of DTPs with and without access to health records; and determinethe type of information pharmacistsneed to confirm their assessment. The study design was an exploratory and comparative evaluation of comprehensive medication management assessments. Pharmacists initially completed patient assessments without access to the patient's primary care health record. Pharmacists documented the visit according to the standard of care and documented the assessment in a standardized study form. Pharmacists then reviewed the patient's primary care health record and documented a revised assessment in the standardized study form. The standardized form included sections about the number of DTPs, the classification of DTPs, the pharmacist's confidence level in identifying DTPs, and the information needed to increase the pharmacist's confidence level in identifying DTPs. Pharmacists evaluated 24 patients and identified 132 DTPs. After reviewing patients' primary care health records, 31 DTPs were deemed "false DTPs," 3DTPs were recategorized, and 9 new DTPs were identified. Practitioner confidence levels in DTP determination improved after reviewing patients' primary care health records. The health information most frequently identified as desirable after the initial review was laboratory tests. Pharmacists identified more DTPs with lower confidence levels without access to patients' primary care health records. Fewer DTPs were deemed "confirmed DTPs" and confidence in the practitioners' assessments improved after review of the primary care health records. Access to primary care health records can help community pharmacists build an efficient and comprehensive medication management practice.

MTM services within community health centers

INTRODUCTION Pharmacists are well-trained, yet often underutilized within the primary care delivery system to identify, resolve, monitor and prevent medication-related problems (MRPs). Medication therapy management (MTM) is a term which describes a broad range of services that are provided by pharmacists to optimize individual patients’ therapeutic outcomes. The MTM care process includes conducting a comprehensive patient medication assessment to identify appropriateness of drug therapy, developing and documenting a care plan to achieve patient-specific goals of therapy and performing followup evaluation to resolve drug therapy problems. When structured to allow patients, pharmacists, physicians, and other caregivers to coordinate efforts toward achieving drug therapy treatment goals, MTM services can improve clinical outcomes, improve patient medication adherence, enhance medication safety, and stabilize or reduce health expenditures. In the state of Connecticut, a network of pharmacists provides diverse clinical services in various healthcare settings. Recently, this network provided MTM services within community health centers across the state; the network and process of MTM implemented is described here.

Conjoint analysis of patient preferences on Medicare medication therapy management

ObjectivesTo identify attributes of medication therapy management (MTM) valued by Medicare beneficiaries and to determine patient preferences and willingness to pay for MTM attributes. DesignCross-sectional contingency valuation study. SettingSix senior centers in Memphis, TN, from September 2007 through August 2008. Participants355 Medicare beneficiaries. InterventionA discrete choice experiment was used, in which each study participant was asked to choose from two different hypothetical MTM services defined by seven attributes (service setting, provider type, number of drug therapy problems, provider experience in overall practice, provider experience in geriatrics, time spent, and cost of MTM service) and associated levels. Main outcome measuresPatient preferences for different attributes of MTM services and patients’ estimated marginal willingness to pay for each attribute level. ResultsStudy participants viewed cost (relative importance 32.2%) as the most important attribute of MTM, followed by service setting (24.2%), provider experience in overall practice (19.5%), and provider experience in geriatrics (16.6%). Community pharmacies (β = 0.146, P = 0.007) were the most preferred environment for MTM services, followed by clinics, whereas telephone consultation was the least preferred environment (β = −0.349, P < 0.001). Study participants were willing to spend as much as $31.76 (95% CI 19.84–45.27) to trade telephone MTM for clinic-based MTM. They also were willing to pay $13.31 more (3.60–23.65) for MTM service at a community pharmacy compared with clinic-based MTM. ConclusionHealth plans should consider developing community pharmacy—based MTM options, at least for Medicare beneficiaries without mobility limitations.