Refill Clinic Research Articles

Evaluation and pharmacists perspective of repeat prescribing process in refill clinics

IntroductionRepeat prescription refers to a re-prescribed medications list issued by a refill clinic, commonly for stable chronic illnesses. The issues regarding repeat prescriptions have garnered increasing important in recent years, as no general agreement about a standardized protocol exists between organizations. Due to the importance of pharmacists’ involvement and intervention in the process of repeat prescription and the lack of local studies discussing this topic, the aim of this study was to assess pharmacists’ perspectives toward the repeat prescription process and identify the issues related to repeat prescriptions in refill clinics at tertiary hospitals. MethodologyA self-developed questionnaire was used to assess outpatient pharmacists’ perspectives toward the repeat prescription process. This was followed by a comprehensive review of the electronic health records (EHR) of patients who requested repeat prescriptions to identify related issues. The study was conducted at a tertiary teaching hospital from September 2019 to January 2020. ResultsBased on the questionnaire, 34 pharmacists reported receiving less than 10 repeat prescriptions per week (82.35%); nevertheless, around 88.24% of pharmacists have faced issues with the repeat prescription process, and only 15.65% of the issues got resolved. Most of the pharmacists (88.24%) showed a proactive attitude toward modifying the work process to reduce issues. Further, the review of the patients’ EHR identified 1766 prescriptions with related issues in 617 (14.02%) patients’ profiles. Most of these issues were seen in the elderly (46.7%). The most common issue encountered was “Patients came too early to request,” which accounted for 986 (55.8%) of the total issues, followed by the issue of “Refilling a restricted medication” reported at 247 (14%). Only 11% of these issues were completely resolved by pharmacists. ConclusionThe repeat prescription service might be associated with issues that lead to preventable adverse effects, especially among the elderly who are prone to such effects. Comprehensive reviews of patients’ profiles are necessary to assess their needs and avoid such issues.

Impact of an Oral Antineoplastic Renewal Clinic on Medication Possession Ratio and Cost-Savings.

The primary objective of this study was to evaluate the impact of a pharmacist-driven oral antineoplastic (OAN) renewal clinic on medication adherence and cost savings. This was a preimplementation and postimplementation retrospective cohort evaluation within a single US Department of Veterans Affairs health care system following implementation of a pharmacist-managed OAN refill clinic. The primary outcome was medication adherence defined as the median medication possession ratio (MPR) before and after implementation of the clinic. Secondary outcomes included the proportion of patients who were adherent from pre- to postimplementation and estimated cost-savings of this clinic. Patients were eligible for inclusion if they had received at least 2 prescriptions of the most commonly prescribed oral antineoplastic agents at the institution between September 1, 2013 and January 31, 2015. Of preimplementation patients, 96 of 99 (96.9%) were male and all patients (n = 35) in the postimplementation group were male. The mean age of the preimplementation group was 69.2 years while the postimplementation group was 68.4 years. Median MPR in the preimplementation group was 0.94, compared with 1.06 in the postimplementation group (P < .001). Thirty-six (36.7%) patients in the preimplementation group were considered nonadherent to their OAN regimen compared with zero patients in the postimplementation group. Estimated total cost savings was $36,335 in the postimplementation period. Implementation of a pharmacist-driven OAN renewal clinic was associated with a 12% increase in median MPR while saving an estimated $36,335 during the 5-month postimplementation period.

Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrospective Clinical Data Analysis.

There are significant medical risks of long-term opioid therapy (LTOT) for chronic pain. Consequently, there is a need to identify effective interventions for the reduction of high-dose full-agonist opioid medication use. The current study details a retrospective review of 240 patients with chronic pain and LTOT presenting for treatment at a specialty opioid refill clinic. Patients first were initiated on an outpatient taper or, if taper was not tolerated, transitioned to buprenorphine. This study analyzes potential predictors of successful tapering, successful buprenorphine transition, or failure to complete either intervention and the effects of this clinical approach on pain intensity scores. One hundred seven patients (44.6%) successfully tapered their opioid medications under the Centers for Disease Control and Prevention guideline target dose (90 mg morphine-equianalgesic dosage), 45 patients (18.8%) were successfully transitioned to buprenorphine, and 88 patients (36.6%) dropped out of treatment: 11 patients during taper, eight during buprenorphine transition, and 69 before initiating either treatment. Conclusions. Higher initial doses of opioids predicted a higher likelihood of requiring buprenorphine transition, and a co-occurring benzodiazepine or z-drug prescription predicted a greater likelihood of dropout from both interventions. Patterns of change in pain intensity according to treatment were mixed: among successfully tapered patients, 52.8% reported greater pain and 23.6% reported reduced pain, whereas 41.8% reported increased pain intensity and 48.8% reported decreased pain after buprenorphine transition. Further research is needed on predictors of treatment retention and dropout, as well as factors that may mitigate elevated pain scores after reduction of opioid dosing.

National Survey of Pharmacy Practice at MOH Hospitals in Saudi Arabia 2016-2017: Prescribing and Medication Management

Objective: To explore National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia 2016: Prescribing and medication management. Methods: It is a 4-months cross-sectional National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia. The study consisted of two parts; the demographic information and the second part contained eighty-five questions divided into eight domains drove from American Society of Health-System Pharmacists (ASHP), Saudi Pharmaceutical Society (SPS) survey, and the international standard of Joint Commission of Hospital Accreditation. The 5-point Likert response scale system was used with closed and ended questions. An electronic questionnaire was distributed to the one hundred eighty-five directors of pharmacies at MOH hospitals. The study discussed and analyzed National Survey of Pharmacy Practice at MOH hospitals in Saudi Arabia: the prescribing and medication management. Results: The survey questionnaire distributed to 185 of hospitals, the rate of reply, was 105 (56.75%) hospitals. The highest score of committee shared by the hospital pharmacy was the pharmacy and therapeutics committee (4.33), quality management committee (4.06), infection control committee (3.88), while the lowest scores were Anticoagulation committee (2.14), DUE committee (2.16) and IV therapy committee (1.99). The most therapeutic guideline available in the hospital pharmacies were antibiotics guidelines (2.91) followed by infection control (2.84) and anticoagulation guidelines (2.13). The majority formulary management method used was restricted prescribing certain expensive drugs 33 (33.1%), review of non-formulary drugs prior approval 27 (25.7%), and the closed drug formulary 14(13.3%). The most drug utilization activities used at the hospitals were Used as the basis for revision of drug-use policies and procedures 44 (41.9%) and Incorporated into medical staff credentialing considerations 27 (25.7%) The pharmacist has the privilege to write medication orders were 18 (17.1%) only. The pharmacist commonly prescribed over the counter medications 19 (57.6%) and antibiotics 15 (45.5%) through the prescription cosigned by physician 55 (52.4%). Followed by Drugs under prescribing protocol 39 (37.1%) and Medications Refill Clinic 26 (24.8%). Conclusion: The hospital seldom participated in the therapeutic guidelines, and the few pharmacists shared in essential hospital committees despite the unique role of providing medication information. Expanding pharmacy activities will improve the prescribing system, patient clinical outcomes, and prevent drug misadventures. Key word: Prescribing, Medication management, Ministry of health, Saudi arabia.

Ideas and innovations: Inclusion of pharmacists in chronic pain management services in a primary care practice

Nonmalignant chronic pain management involves an ongoing process of complex evaluations including proper patient selection, proper prescribing, and careful monitoring. In the Pain Management Refill Clinic, patients are stabilized on an opioid regimen by either a pain specialist or a primary care physician (PCP). The PCP assumes long-term prescription of the regimen and proper follow-up. The inclusion of pharmacists in the management of patients suffering from chronic pain has allowed the physicians to improve opioid prescribing, documentation, and monitoring in accordance with chronic nonmalignant pain guidelines.

Using an Electronic Medication Refill System to Improve Provider Productivity in an Accountable Care Setting.

Even within fully integrated health care systems, primary care providers (PCPs) often lack support for medication management. Because challenges with conducting medication reconciliation, improving adherence, and achieving optimal patient outcomes continue to be prevalent nationally, it is critical that PCPs are provided the resources and support they need to provide high-quality, patient-centered care in an accountable care environment. Sharp Rees-Stealy Medical Group uses a fully electronic medication refill system that allows for a centralized team to manage all incoming requests. Over time, 16 disease-specific protocols were created that allowed the pharmacy team to absorb approximately 80% of incoming refill requests for all enrolled PCPs. The refill clinic assessed all clinic information that a PCP would normally review in order to approve a refill. Tasks performed by the clinical pharmacists included medication reconciliation, dosage adjustment, and coordination of distribution from external mail order and retail pharmacies. In 2014, the number of tasks related to refill management reviewed by the refill/medication therapy management service totaled 302,592, resulting in 140,350 refill authorizations and multiple interventions related to medication use. Physicians have estimated that the service provides between 20 and 30 minutes of time savings per day. Assuming an annual PCP salary of around $200,000, 20 to 30 minutes per day would amount to $33 to $50 saved per day per physician. The savings is even higher when time savings from other clinical staff is included. The development of this electronic medication refill service has provided the following important lessons: (a) organizations rely on a leader or champion to push through process reforms--this program started with reluctant physicians first to determine best practices; (b) the lack of clinical pharmacist profiles within electronic health records (EHR) is a serious concern, since the creation of these profiles may not be easy or timely; and (c) PCPs working within an EHR environment will quickly embrace the idea of a service that can save them up to 30 minutes per day. With PCPs continuing to take on additional population health management tasks in accountable care organizations, pharmacists can provide workload offsets by meaningfully contributing to medication-related care.

Clinical Pharmacist interventions in Refill Clinic at Tertiary Care Eye Specialist Hospital

Objective: To describe the role of Clinical Pharmacists in the Medication Refill Clinic area as a part of a multidisciplinary team in which he/she can provide education to patients and caregivers on the safe and appropriate use of medications, counsel on medication compliance, monitor and manage medication side effects, as well as screen for dangerous drug interactions. Methods: The data of this prospective, single-centered, chart review based study have been collected since the clinic launched in June 2011 till December 2013 in King Khalid Eye Specialist Hospital which is a Tertiary Hospital in KSA. Types of interventions documented during the patient–pharmacist visit are categorized as medication review and patient compliance. Key findings: Out of the total 16,417 patients, 3641 (22.2%) are noncompliant. The Clinical Pharmacist identified 18 intervention types. The most frequent interventions are as follows: Eye screening (24.8%), Counseling (13%), Physician/ER referral (12.4%), Therapeutic substitution/switch (10.8%), and Frequency changed (7%). Summary: This prospective analysis is a document evidence showing Clinical Pharmacist positive outcomes in the management of ophthalmic patients. Dissemination of this information would be valuable because it could raise the awareness of other Healthcare Professionals regarding Pharmacist as effective clinicians in care of ophthalmic patients.

Clinical pharmacy experience in ophthalmology setting of using collaborative drug therapy management (CDTM)

BackgroundAn increased influx of patients and limited access to specialised healthcare due to insufficient medical staff in ophthalmology has been reported for more than a decade. For this reason, our...

Impact of a Clinical Pharmacist-Managed Medication Refill Clinic.

To evaluate the impact of a clinical pharmacist managed medication refill clinic on physician workload. A retrospective case study was conducted for patients receiving refill authorizations or denials from the clinical pharmacist from 2008 to 2010. Data related to refill request volume and interventions undertaken were collected. A total of 5706 refill requests were processed by the clinical pharmacist during the study period. The collaboration decreased physician refill request volume up to 60%. Of the total amount of refill requests processed, 42% required the pharmacist to make an intervention. The most common interventions were reminders for follow-up. The collaboration between a clinical pharmacist and family physicians to develop a clinical pharmacist managed medication refill clinic decreased physician workload and improved patient care.

Opioid use in young veterans

Data suggest an increase in prescription opioid abuse in recent years. Young veterans represent a group with major risk factors for prescription opioid abuse. The objectives of this study are: (A) to determine the prevalence of chronic opioid use in young veterans over time; (B) to describe the prescribing patterns and monitoring of chronic opioid therapy in young veterans; and (C) to assess opioid management within Veterans Affairs Palo Alto Health Care System (VAPAHCS) with an emphasis on effectiveness and safety. This is a Veterans Affairs Research and Development (R&D) Committee and IRB-approved retrospective, single-center study of young veterans aged 18-30 years on chronic opioid therapy during the study years January 1, 2003, to October 1, 2008. A subset of the study population who were receiving long-acting opioids for a minimum of 6 months was included in the effectiveness and safety analyses. Data were obtained from the Veterans Integrated Service Network (VISN 21) data warehouse, outpatient prescription records, and from electronic chart review. The prevalence of chronic opioid use in young veterans has increased from 3 percent in 2003 to 4.5 percent in 2007. Patients on average were exposed to two different opioids and had three different opioid prescribers. Nearly 80 percent of the opioid prescriptions during the study were prescribed by primary care providers and less than 1 percent was from pain specialists. Only 31 percent of patients on chronic opioids had undergone urine drug testing and only 5 percent had signed opioid treatment agreements. No difference in median pain score was observed following initiation of long-acting opioid therapy, and 22 percent of patients (4 of 18) met the prespecified definition of being a responder to long-acting opioid therapy. Five patients (28 percent) on long-acting opioids experienced adverse drug reactions. The prevalence of chronic opioid use in young veterans has been on the rise in recent years. Young veterans receiving care at VAPAHCS have often had multiple opioid prescribers and have trialed multiple opioid analgesics. Many improvements in appropriate monitoring and management of these patients can be made, which may include providing more training to current staff the development of an opioid refill clinic, and greater utilization of the pain management specialists. Further larger study is warranted to identify successful strategies for improving prescribing and monitoring of opioids as well as potential predictors of response to chronic long-acting opioid therapy.

Impact of pharmacist-operated general medicine chronic care refill clinics on practitioner time and quality of care.

To assess the impact of pharmacist-operated refill clinics on practitioner (physician/physician assistant) time. Secondary objectives included assessment of disease state control, drug acquisition costs, and human resource allocation. The study ran from October 1, 1993 through January 31, 1994. At one clinic the pharmacist performed chart review only and did not see the patient. At the second site the pharmacist also interviewed the patient. The pharmacist used no treatment algorithms. Practitioner and pharmacist time before and after implementation of the refill clinics was measured on 3 consecutive days of normal clinic operation. Two state correctional facilities. The study population consisted of patients receiving chronic care who were observed during regular clinic hours. We evaluated pharmacist and practitioner time before and after pharmacist involvement. Hypertension was the only disease state yielding sufficient numbers for statistical analysis. We used a two-tailed paired t-test with the priori level set at 0.05. We also evaluated the number of patients with disease state control before and after clinic implementation, drug acquisition costs, and human resource allocation. The refill clinic pharmacist reduced practitioner time commitment in both clinics. The greatest impact on practitioner time was found in the interview clinic. Quality of care was maintained equally between the two clinics, with a positive impact on human resource allocation. In the managed care environment, pharmacist-run refill clinics can decrease practitioner time commitment allowing reallocation of human resources while maintaining current quality of care.

Medication Refill Clinics: The Veterans Administration Medical Center Experience

Medication refill clinics have been operating for about two decades. These clinics provide cost-effective and high-quality pharmaceutical care to patients who require refills on their medications. The following article describes one Veterans Affairs Medical Center's experience with a medication refill clinic. Guidelines for setting up a refill clinic are presented, including clinic development and justification, training of the practitioner, policies and procedures, and quality assurance management. Benefits of the clinic also will be discussed.

Financial Impact of a Pharmacist-Managed Medication Refill Clinic

Financial Impact of a Pharmacist-Managed Medication Refill Clinic

Pharmacist-managed patient assessment and medication refill clinic

The effectiveness of a pharmacist in determining the appropriateness of prescription renewal for patients appearing at a hospital-based refill clinic was investigated. In part 1, data were collected on the clinic as it traditionally functioned with staff physicians evaluating the patients. In parts 2 and 3, data were collected with the pharmacist assuming the assessment function. In part 2, a physician reviewed the pharmacist's decisions before the patient left. In part 3, the pharmacist functioned without supervision and the physician reviewed patient records retrospectively. Physician agreement with the pharmacist's decisions was the primary criterion for determining effectiveness, and was found to be 99% in part 2, for a total of 105 patients. In part 3, physician agreement remained at the 99% level for a total of 106 patients. Patient waiting time was about the same in each part of the study because of clinic procedures beyond the pharmacist's control. A pharmacist can be cost-effective in this role if the task is combined with regular pharmaceutical functions.