Pharmacists' Patient Care Process Research Articles

Impact of the Pharmacists' Patient Care Process on Medication Adherence in Older Adults With Multimorbidity

OBJECTIVE: To determine whether the pharmacistled Geriatric Education and Medication Management (GEMM) clinic utilizing the Pharmacists' Patient Care Process (PPCP) improves therapeutic and safety outcomes in ambulatory older adults. DESIGN/PATIENTS: This is a retrospective, case series of veterans newly enrolled into the GEMM clinic from September 2013 to September 2015. SETTING: This study was conducted in an ambulatory pharmacist-led clinic at the Baltimore Veteran Affairs Medical Center in Maryland. INTERVENTION: Demographic, clinical, laboratory, and pharmacy fill data were collected from the computerized patient record system. Medication use patterns were collected using the clinic's supplemental medication reconciliation flowsheet. Descriptive statistics were used to analyze data. MAIN OUTCOME MEASURE(S): Change in adherence rate, number of potentially inappropriate medications, and number of care transitions within the 12-month study period. RESULTS: The primary outcome of medication adherence was high throughout the 12-month study period; beginning at 91.1% at baseline and increasing to 99.0% by the fourth quarter. There was a 36.4% decrease in number of potentially inappropriate medications (PIMs) from 22 at baseline to 14 at 12 months. Medication-related, short-term care transitions decreased from 10 to 4 in the pre- to post-clinic enrollment time frame. Only one subject experienced a long-term care transition during the study period. CONCLUSIONS: Implementing the PPCP in the pharmacist-led GEMM clinic improved medication adherence and persistence, decreased number of PIMs, and assisted in preventing care transitions in ambulatory older adults with multimorbidity and polypharmacy.

Impact of the Pharmacists' Patient Care Process on Medication Adherence in Older Adults With Multimorbidity

OBJECTIVE: To determine whether the pharmacistled Geriatric Education and Medication Management (GEMM) clinic utilizing the Pharmacists' Patient Care Process (PPCP) improves therapeutic and safety outcomes in ambulatory older adults. DESIGN/PATIENTS: This is a retrospective, case series of veterans newly enrolled into the GEMM clinic from September 2013 to September 2015. SETTING: This study was conducted in an ambulatory pharmacist-led clinic at the Baltimore Veteran Affairs Medical Center in Maryland. INTERVENTION: Demographic, clinical, laboratory, and pharmacy fill data were collected from the computerized patient record system. Medication use patterns were collected using the clinic's supplemental medication reconciliation flowsheet. Descriptive statistics were used to analyze data. MAIN OUTCOME MEASURE(S): Change in adherence rate, number of potentially inappropriate medications, and number of care transitions within the 12-month study period. RESULTS: The primary outcome of medication adherence was high throughout the 12-month study period; beginning at 91.1% at baseline and increasing to 99.0% by the fourth quarter. There was a 36.4% decrease in number of potentially inappropriate medications (PIMs) from 22 at baseline to 14 at 12 months. Medication-related, short-term care transitions decreased from 10 to 4 in the pre- to post-clinic enrollment time frame. Only one subject experienced a long-term care transition during the study period. CONCLUSIONS: Implementing the PPCP in the pharmacist-led GEMM clinic improved medication adherence and persistence, decreased number of PIMs, and assisted in preventing care transitions in ambulatory older adults with multimorbidity and polypharmacy.

Pharmacists' Patient Care Process: A State "Scope of Practice" Perspective.

Explore the intersection of the Pharmacists' Patient Care Process (PPCP) and state laws in order to identify laws that may impede the delivery of optimal patient care. A review of the PPCP identified six areas in which state laws can limit full pharmacist engagement: 1) ordering and interpreting laboratory tests; 2) participating in a collaborative practice agreement; 3) independently prescribing certain medications; 4) independently adapting medications; 5) administering medications; and 6) effective delegation. A framework is put forth to organize how these scope of practice matters are interrelated. For pharmacists to fully engage in the PPCP, state laws must enable full participation. By unleashing pharmacists to fully engage in the process, patient care delivery and outcomes can be improved, and total health care costs can be reduced.

Evaluation of Video-enhanced Case-based Activities Guided by the Pharmacists’ Patient Care Process

Objective. To design and develop a series of technology-enhanced, case-based learning activities framed by the Pharmacists' Patient Care Process (PPCP), and to evaluate the impact of these activities on student perceptions and performance. Methods. A mixed methods approach was used to generate both quantitative and qualitative data. Survey and focus group interviews were used to analyze student perceptions. Performance on a pre- and post-assessment was used to measure the impact of PPCP case-based learning activities. Results. Students demonstrated positive attitudes overall towards the case-based learning activities. Themes emerged during focus group interviews regarding awareness of the PPCP, engagement in learning, and a desire for realistic experiences. Significant changes were observed for the pre- and post-assessment within the plan and follow-up parameters, as well as for the total score within each disease state. Conclusion. The use of technology-enhanced, case-based modules framed around a standardized patient care process resulted in positive student perceptions and improved scores on a patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge.

Validity and reliability pilot study of a tool for assessing ambulatory care pharmacist practice

The reliability and validity of a survey tool that aims to assess and stratify patient care services provided by ambulatory care pharmacists were evaluated. The Tool for Assessing Ambulatory Care Pharmacist Practice (TAAPP) was developed by updating the Pharmaceutical Care Clinical Pharmacist Questionnaire. The TAAPP is organized into 2 sections that include 5 domains derived from the Pharmacists' Patient Care Process (PPCP). The first section of the TAAPP gathers the demographic information of the respondents as well as practice site characteristics. The second section aims to assess the activities that ambulatory care pharmacists participate in when providing direct patient care, stratified by PPCP domains. After the TAAPP was created, face validity was established by the study investigators and content validity was confirmed by 5 experts in ambulatory care pharmacy. Lastly, a reliability study was conducted and included pharmacists providing ambulatory care services in outpatient clinics who had been working at their clinical practice site for at least 2 years. The survey was disseminated electronically through a national pharmacy organization listserver. The results of this pilot study support both face and content validity of the TAAPP survey as well as internal consistency reliability of the TAAPP scores when used to evaluate pharmaceutical practices of ambulatory care pharmacists practicing in outpatient clinics throughout the United States. Internal consistency reliability testing demonstrated that the TAAPP scores were reliable with a Cronbach's α of >0.7 for each domain and the TAAPP overall.

The Report of the 2017-2018 Professional Affairs Standing Committee: The Development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Graduates

The 2017-2018 AACP Professional Affairs Committee addressed the charges of (1) developing a self-reflection/self-assessment tool for pharmacy faculty and preceptors to allow them to assess their capability and confidence with Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, the Pharmacists' Patient Care Process (PPCP), and the Entrustable Professional Activities (EPAs) for New Pharmacy Graduates and (2) creation of a plan for AACP to utilize in the development of preceptor continuing education and training programs. This report describes the framework, rationale and process for the development of the Preceptor Self-Assessment Tool for Entrustable Professional Activities for New Pharmacy Graduates (PSAE Tool), the pre-test for the PSAE tool, and the online pilot test and its results for the PSAE Tool. The committee provides recommendations for AACP in the continued development and distribution of the PSAE Tool to the schools of pharmacy. Considerations for AACP and the schools of pharmacy to consider in the continuing professional development (CPD) for all preceptors are also discussed. The committee provides a policy statement, adopted by the AACP House of Delegates, regarding the commitment of AACP regarding the CPD for all preceptors. The committee also provides several recommendations to AACP and suggestions to schools of pharmacy and other stakeholder groups pertaining to the committee charges.

Integration of the Pharmacists’ Patient Care Process (PPCP) into a Comprehensive Disease Management Course Series

Objective. To implement and assess the curricular integration of the Pharmacists' Patient Care Process (PPCP) in a course series for second- and third-year pharmacy students. Methods. The five-step PPCP was integrated within a four-semester pharmacotherapy course starting with the introductory course lectures. Beginning in the spring of 2015, the five steps of the PPCP were delivered to 129 P2 students, along with rollout of curricular integration within corresponding classroom and seminar activities and assessments. Integration focused on the development of course-specific lecture and seminar materials, a faculty guidance strategy and templates, and evaluation approaches for course assessments. Student comprehension and utilization of the PPCP were assessed via 61 unique assessments (12 examinations and 49 quizzes). Faculty incorporation and perception of the PPCP were evaluated via survey. Results. Overall, students demonstrated the most understanding on the lowest levels of the PPCP: 83.6% and 82.2% for the Collect and Implement components, respectively, compared to the higher-level components of Planning (78.0%) and Follow-up (76.0%). Faculty understanding, integration, and utilization of the PPCP in course materials were assessed approximately 6 months after implementation. Twenty-two faculty (96% of course instructors) participated in the survey. Eighteen (82%) have modified instructional materials to incorporate PPCP and among these, 89% agreed/strongly agreed that they possessed a clear understanding of the PPCP. Conclusion. Implementing a successful curricular change such as the integration of the PPCP across multiple courses requires a multi-faceted approach. The development of faculty templates and provision of support through various methods are necessary to ensure consistent and comprehensive integration across the curriculum. Additionally, evaluation of student performance and achievement of intended outcomes should be used to guide curricular assessments and continuous quality improvements throughout the process.

Progressive disclosure cases: The design and evaluation of use in multiple therapeutics courses

Background and purposeCase-based learning is used frequently throughout pharmacy education. Although beneficial, stand-alone cases may result in segmented learning that does not simulate realistic longitudinal patient care. We report the development, implementation, and evaluation of a longitudinal progressive disclosure case surrounding a single patient spanning two different therapeutics courses. Educational activity and settingA patient case was developed surrounding topics in two third professional year therapeutics courses occurring sequentially in the same semester. Changes to the patient's status were provided to students longitudinally via “disclosures.” Students were assessed via quizzes and written assessment and plans. Students completed four perceptions of confidence surveys via a four-point Likert Scale. Surveys included questions surrounding confidence in areas of the pharmacists’ patient care process (PPCP) before and after courses utilizing the progressive disclosure case. Case assessment grades were used to evaluate the impact on student performance on course examinations. Students also completed a survey on final perceptions of the activity. FindingsSeventy students were enrolled in the two courses participating in the progressive disclosure case and there were 50 (71.4%) matched, completed surveys completed for analysis. Significant improvements were seen in several questions surrounding confidence in the areas of the PPCP between the beginning and conclusion of courses that contained the progressive disclosure case. No correlation between case activity grades and examination performance was found. Discussion and conclusionOverall, student confidence in patient care skills associated with information collection, assessment, plan design, and monitoring improved with the use of progressive disclosure cases within two sequential therapeutics courses.

Use of a Video Module to Improve Faculty Understanding of the Pharmacists' Patient Care Process.

To evaluate change in faculty's knowledge and perceptions after an online video module on the Pharmacists' Patient Care Process (PPCP). An educational video module on the PPCP was developed and disseminated to full-time faculty members at Samford University, McWhorter School of Pharmacy. Voluntary and anonymous pre- and post-test assessments were evaluated and analyzed. Thirty faculty completed the pre-assessment, and 31 completed the post-assessment (73% and 75% response rates, respectively). A significant improvement in faculty perceptions was indicated by an increase in agreement with the majority (80%) of questions on attitudes toward the PPCP on the post-test. Faculty's knowledge of the introduction and assessment of PPCP within the school's curriculum was significantly increased after viewing the video module. After viewing the module, more faculty were also able to correctly identify the majority of the PPCP components and their corresponding practice activities. A short video module was effective at improving faculty knowledge and perceptions of the PPCP. Development of a similar faculty development module is feasible for implementation in other Schools of Pharmacy.

Implementing the Pharmacists’ Patient Care Process at a Public Pharmacy School

The Joint Commission of Pharmacy Practitioners has provided the profession of pharmacy a patient-centered care model known as the Pharmacists' Patient Care Process (PPCP). This process will serve to provide consistency throughout the profession as it becomes incorporated throughout pharmacy practice and education. A description of the early stages of implementing the PPCP at one public college of pharmacy provides insights into opportunities for education and assessment.

Beyond the Pharmacists’ Patient Care Process: Cultivating Patient Care Practitioners by Utilizing the Pharmaceutical Care Framework

The adoption of a standard pharmacists’ patient care process (PPCP) for the profession, and inclusion of the PPCP in the ACPE Standards 2016, are positive steps for pharmacy education and creates consistency among pharmacy practitioners, regardless of practice setting. The PPCP, and its implications for practice, needs to continue to be embraced by educators and emphasized with students. The PPCP should be the patient care process taught to students and integrated throughout didactic courses and experiential experiences. However, teaching the PPCP or a particular service, such as Medication Therapy Management (MTM) or Comprehensive Medication Management (CMM), is not enough. The patient care process must be taught as one component of pharmaceutical care. Without also learning the philosophy of practice and practice management systems, student pharmacists will not be prepared for the realities of practice. Pharmacists are taking on new roles, getting paid in new ways, and in positions to take responsibility for a patient’s medication-related needs. Student pharmacists need to be in a position to take advantage of these opportunities as they progress throughout their careers.
 Conflict of Interest
 We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.
 
 Type: Idea Paper