Value Of Clinical Pharmacy Services Research Articles

The measure of impact: Proposal of quality metrics for solid organ transplant pharmacy practice

As healthcare continues its transition toward value-based care, it is increasingly important for transplant pharmacists to demonstrate their impact on patient care, health-related outcomes, and healthcare costs. Evidence-based quality and performance metrics are recognized as crucial tools for measuring the value of service. Yet, there is a lack of well-developed and agreed-upon specific metrics for many clinical pharmacy specialties, including solid organ transplantation. To address this need, a panel of transplant pharmacy specialists conducted a detailed literature review and engaged in several panel discussions to identify quality metrics to be considered for assessing the value of clinical pharmacy services provided to solid organ transplant recipients and living donors. The proposed metrics are based on the Donabedian model and are categorized to coincide with the typical phases of transplant care. The measures focus on key issues that arise in transplant recipients related to medication therapy, including adverse drug events, nonadherence, and clinical outcomes attributable to medication therapy management. This article proposes a comprehensive set of measures, any number of which transplant pharmacists can adopt and measure over time to objectively gauge the value of services they are providing to transplant recipients, the transplant center, and the overall healthcare system.

P50 Time and motion study to assess workload versus staffing at in paediatric hospital chemotherapy manufacturing unit

ObjectivesIn order to improve efficiency of the staff workload in the Paediatric Hospital Chemotherapy Manufacturing Unit, tasks conducted by the pharmacy staff were evaluated with their expected roles. The aims of this study were to establish an understanding of the workload at this unit and to develop a proposal for the unit to become technician-led.MethodsThe time taken to perform a pre-determined list of tasks by the senior pharmacy technician was recorded, collated, and compared to tasks performed by the pharmacist. This established the key activities that could be delegated from the pharmacist and the senior pharmacy technician to other members of staff. The findings were discussed with a focus group to establish the efficiency of the manufacturing unit and enable a proposal to be formed.Key findingsA substantial part of the pharmacist’s and senior pharmacy technician’s time was spent on activities which could be delegated to other members of staff of a lower pay band. The financial implication of this estimated that there would be a reduction of around £8,696.70 with the correct utilisation of the staff members. The pharmacists leading this manufacturing unit were spending most of their time on computing and training, therefore reducing the time available for them to focus on patient-facing clinical activities.ConclusionsThe current skill mix was highlighted as being inefficient, due to a lack of delegation from the pharmacists and senior pharmacy technician. A technician-led manufacturing unit can improve the focus of pharmacists on clinical tasks while reducing the cost of activities.ReferencesLord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: unwarranted variations. An independent report for the Department of Health 2016; 10–11: 34–40.Willett MS BK, Rich DS, Ereshefsky L. Prospectus on the economic value of clinical pharmacy services. A position statement of the American College of Clinical Pharmacy. Pharmacotherapy 1989; 9:45–50.Barnett MJ, et al. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 2009;15:18–31.Napier P, et al. Introducing a checking technician allows pharmacists to spend more time on patient-focused activities. Res Social AdmPharm 2018;14:382–386.

PNS290 EVIDENCE-BASED VALUE FRAMEWORK FOR THE EVALUATION OF CLINICAL PHARMACY SERVICES

To identify and evaluate potential outcome measures for the assessment of clinical pharmacy services (CPSs) in order to facilitate the implementation and monitoring of CPSs within the Hungarian healthcare system. A literature review on PubMed was conducted to identify original controlled studies assessing the effects of CPSs. Studies eligible for full-text data extraction were selected by title and abstract screening. Outcome measures were aggregated in four categories: clinical, patient-related, cost-related or health care professional-related outcomes. They were further analysed according to 1) sensitivity to capture benefits of CPSs, 2) generalisability and transferability, 3) measurability including the availability of standard measurement methods. In total, 46 publications with 73 CPSs interventions were included in the analysis. A large number (83) of outcome measures had been used to evaluate the effect of the interventions. The most prevalent measures included medication appropriateness (n=17) and readmission rates (n=12). Significant positive effects were most frequently related to outcomes sensitive to pharmacotherapy management. Very few studies could prove the benefit of CPSs in hard clinical endpoints partly due to short study duration and limited statistical power. List of recommended outcome measures for evaluation of CPSs were created based on feasibility of measuring potential outcomes. Evidence generated from low quality studies may lead to false expectations concerning the added value of CPSs in healthcare. More methodological research is needed to address the limitations of existing research methods to get more realistic evidence on the contribution of CPSs to health care. The proposed value framework may support implementation and improvement of CPSs. The short-listed outcome measures are recommended for inclusion to local studies for the evaluation of CPSs. Standardization of CPS interventions, appropriate study design, long study duration and sufficient sample size are also suggested in order to improve the validity and generalizability of conclusions.

The study of Pharmacoeconomics analysis on anti tuberculosis drugs Rifampicin & Ethambutol

Cost-benefit analysis can be used to quantify the value of clinical pharmacy services. Providing Effective Therapy and Minimum cost, Quantify costs of care, Quantify outcomes, Assess whether and by how much average costs and outcomes differ among treatment groups, Compare magnitude of difference in costs and outcomes and evaluate “value for costs” by reporting a cost-effectiveness ratio, net monetary benefit, or probability that ratio is acceptable – Potential hypothesis: Cost per quality-adjusted life year saved significantly less than Rs.75,000, To Perform sensitivity analysis. For providing good effective therapy with less adverse drug reaction at affordable price, Cost-Identification, Cost-Effectiveness Analysis, Cost-Utility Analysis, Cost-Benefit Analysis, Clinical outcomes: Cure, comfort and survival, Humanistic outcomes: Physical, emotional, social function, role performance, Economic outcomes, Economic Evaluation, Cost of Illness Evaluation (COI), Cost Benefit Analysis (CBA), Cost Minimization Analysis, Cost Effective Analysis: Cost Utility Analysis.

Lecture 1-Justification of the Value of Clinical Pharmacy Services and Clinical Indicators Measurements-Introductory Remarks from a Traveler on a 40-Year Wayfaring Journey with Clinical Pharmacy and Pharmaceutical Care.

Without question, health care delivery, and clinical pharmacy’s purpose in it, is changing rapidly all over the world. Pharmacy’s place in the new health care environment is ensured only to the extent that the purpose of pharmaceutical care is understood and transmitted to the global structures of these developing organizational patterns and paradigm shifts. While the current trend toward commodification of illness and treatment seems to be driving efforts to consolidate the economic factors of pharmaceutical distribution, a new type of practice—patient-driven health care—has continued to shape the interactions of pharmacists and patients all over the world. A thorough understanding of the above factors involved in pharmacy’s history, present, and future are necessary for clinical practice preparation, as well as for value justification. How clinical pharmacy will succeed in this kind of social and economic milieu is precisely why this series of lectures and roundtables will help us embrace many of the vexing issues that clinical pharmacy administrators and practitioners face in daily practice.

Examination of psychosocial predictors of Chinese hospital pharmacists' intention to provide clinical pharmacy services using the theory of planned behaviour: a cross-sectional questionnaire study.

ObjectivesMain study aim was as follows: (1) to explore the usefulness of the theory of planned behaviour (TPB) model in predicting Chinese hospital pharmacists' intention to provide clinical pharmacy services (CPSs), including auxiliary CPSs and core CPSs; (2) to identify the main factors affecting the Chinese hospital pharmacists' intention to provide core CPSs based on TPB quantitatively.DesignCross-sectional questionnaire study.SettingThe study was conducted in 22 general hospitals in seven cities located in the eastern and western part of China.Participants416 hospital pharmacists (292 (70.2%) female) entered and completed the study.Primary and secondary outcome measuresQuantitative responses with hospital pharmacists' intention, attitude, subjective norms (SNs) and perceived behavioural control (PBC) over provision of CPSs and their past behaviour (PB)-related CPSs.ResultsThe structural equation model analysis found that attitude (p=0.0079, β=0.12), SN (p=0.038, β=0.10) and the pharmacists' intention to provide auxiliary CPSs (p=0.0001, β=0.63) significantly predicted of their intention to provide core CPSs, accounting for 54.0% of its variance. Attitude (p=0.0001, β=0.35), PBC (p=0.0182, β=0.12) and PB (p=0.0009, β=0.15) are significant predictors of pharmacists' intention, accounting for 21% of the variance in pharmacists' intention to provide auxiliary CPSs.ConclusionsThe TPB with the addition of PB is a useful framework for predicting pharmacists' intention to provide CPSs in Chinese hospital care context. Strategies to improve hospital pharmacists' intention to provide CPSs should focus on helping the individuals related medical care see the value of CPSs, altering their perception of social pressure towards core CPSs and the removal of obstacles that impede the translation of intentions into behaviour.

The effect of a diabetes collaborative care management program on clinical and economic outcomes in patients with type 2 diabetes.

Clinical pharmacy services (CPS) in the primary care setting have been shown to help patients attain treatment goals and improve outcomes. However, the availability of CPS in community-based primary care is not widespread. One reason is that current fee-for-service models offer limited reimbursement opportunities for CPS in the community setting. Furthermore, data demonstrating the value of CPS in this setting are limited, making it difficult for providers to determine the feasibility and sustainability of incorporating CPS into primary care practice. To (a) evaluate the association between a pharmacist-led, diabetes collaborative drug therapy management program and patient outcomes, including glycemic control and health care costs, and (b) assess short-term economic outcomes in a primary care setting. A retrospective cohort analysis was conducted using medical record data. This study was conducted using patients with uncontrolled type 2 diabetes (T2DM), defined as HbA1c ≥ 7.0%. Outcomes were compared between patients referred to a diabetes collaborative care management (DCCM) intervention from 2009-2012 and patients who did not participate in the DCCM program. To illustrate the difference in HbA1c between the 2 cohorts over the follow-up period, mean time adjusted HbA1c values were estimated using a panel-type random effects regression model, with results plotted at 90-day intervals from index date through the end of the study period. To help control for confounding by other factors, multivariate regression models were run. A difference-in-difference model was employed to estimate the effect of the program on resource utilization and all-cause charges. A total of 303 DCCM and 394 comparison patients were included. Mean (95% CI) age was 57.4 years (55.963, 58.902) versus 59.9 years (58.613, 61.276; P < 0.001) with 48% and 44% female for DCCM and comparison patients, respectively (P = 0.49). Mean baseline HbA1c was higher for DCCM (10.3%; 10.10, 10.53) than comparison patients (8.4%; 8.26, 8.61; P < 0.001). The greatest reduction in HbA1c was seen for both groups at 9 and 12 months post-index date. At these time points, the mean time adjusted difference in HbA1c between groups was no longer significant. Multivariate modeling identified that the DCCM program was associated with a -0.44% (-0.64, -0.25; P < 0.001) lower HbA1c at follow-up relative to the comparison group controlling for potential confounders, including baseline HbA1c. Change in resource utilization from pre- to post-index date did not differ between groups. However, in the difference-in-difference multivariate analysis the difference in mean all-cause charges from the 12-month pre- to post-index periods DCCM patients experienced a smaller average increase in charges ($250) than comparison patients ($1,341; coefficient = -0.423; 95% CI = -0.779, -0.068). A pharmacist-led diabetes collaborative care management program in a patient-centered primary care setting was associated with significantly better follow-up glycemic control relative to comparison patients. Further, the data suggest that the DCCM program was associated with a less substantial increase in all-cause total costs in patients with uncontrolled T2DM relative to comparison patients, which could translate into reduced costs and improved outcomes to managed care payers.

CHAPTER 1 Ensuring pharmacy practice is fit for purpose in Evidence-based Pharmacy 2nd edition

This book is being updated at a time of financial crisis leading to downward pressure on healthcare budgets. This means that pharmacists have to be even smarter at demonstrating their...

Opportunities and Responsibilities for the Academy in the Medical Home

Opportunities and Responsibilities for the Academy in the Medical Home

Exploring the value of clinical pharmacy services for patients with diabetes in safety net settings

The role of the pharmacist in safety net settings has not been well studied, specifically in meeting unmet needs of vulnerable patients with diabetes. To identify unmet management and medication-related needs of patients with diabetes who are receiving care in two distinct underserved practices in Pittsburgh, PA. Individual, semi-structured interviews with patients from a free clinic (FC) and a federally qualified community health center (FQHC) in Pittsburgh were conducted. Inclusion criteria included: adults at least 18 years old with uncontrolled diabetes (A1C>7%) who received health care services from either the FC or the FQHC. Participants completed a short demographic survey and answered questions about their perceptions and attitudes in four thematic areas: (1) self-management of diabetes; (2) medication-related needs; (3) the role of the pharmacist in their care; and (4) how pharmacists can be better integrated in their diabetes management. Transcripts were analyzed using principles of Grounded Theory. Twenty-nine interviews were conducted: 15 participants were from the FC, and 14 were from the FQHC. Five main themes emerged from each site including: patients experience challenges managing their diabetes, patients identify the emotional struggle associated with living with diabetes, patients feel that they are "on their own" to care for their diabetes, patients desire a personal and caring relationship with their pharmacist, and patients value a pharmacist who is knowledgeable about diabetes care. These results will help provide guidance to pharmacists working in safety net settings who are interested in expanding clinical pharmacy services for patients with diabetes.

Evaluation and justification of clinical pharmacy services

Pharmacy managers often must justify clinical pharmacy services (CPSs). This can be done by generalizing evidence from the literature or by conducting local evaluations. In either case, it is important that the clinical, humanistic or economic benefits of CPSs are considered, and limitations of the studies recognized. The basic model for the evaluation of CPSs includes the consideration of costs and outcomes, as well as the inclusion of a comparator group. Recent systematic reviews and individual studies provide good evidence regarding the value of CPSs, and are discussed here. Benefit-to-cost ratios of selected CPSs are also provided. While much of the evidence for CPSs has been conducted in the hospital setting, in the future, CPS expansion will occur in ambulatory care settings and will be benefited by healthcare reform efforts.

Pharmacists' Perceptions of Barriers to Implementing Medication Therapy Management and the Role of Pharmacy Technicians in Overcoming the Barriers

Background: Recent literature supports the value of clinical pharmacy services in the outpatient setting, but pharmacists must overcome barriers to the implementation of clinical services to establish an effective and efficient program. Objective: To identify pharmacists' perceptions of barriers to the implementation of medication therapy management (MTM) and perceptions of collaboration with pharmacy technicians. Methods: Surveys were sent to all 415 community pharmacists in a supermarket pharmacy chain marketing area in Ohio. Pharmacists completed the anonymous survey to indicate their opinions regarding a series of potential barriers to the implementation of MTM, including education and training, current and desired roles of pharmacy technicians, and support from store management. Results: Of responding pharmacists, 16.2% reported that they had personally participated in an MTM encounter, with an average number of encounters per pharmacist of 1.4. Pharmacists reported a desire for additional training in disease states commonly addressed in MTM, MTM systems, and MTM service elements, but 50.5% felt comfortable as a provider of MTM without additional training. More than 90% of pharmacists reported that sufficient staffing and overlap affords the opportunity for 0–5 MTM encounters per week. Pharmacists reported that few technicians are trained to assist with MTM, but more than 70% of pharmacists would seek technician assistance with scheduling, billing, and patient correspondence. Conclusions: Although technician assistance may help to reduce pharmacist staffing and training needs, few technicians are trained for clinical support roles. Incorporation of clinical pharmacy technicians into the MTM process may improve the economics and efficiency of MTM and reduce barriers to the implementation of MTM.

Letters

Letters

2006 National Clinical Pharmacy Services Survey: Clinical Pharmacy Services, Collaborative Drug Management, Medication Errors, and Pharmacy Technology

To determine the extent of 15 hospital-based clinical pharmacy services, 51 different drugs managed under protocol by pharmacists, medication errors, and pharmacy technology in United States hospitals. A survey was mailed, as well as sent electronically, to pharmacists in 2893 hospitals. A total of 1125 surveys were returned (38.9% response rate). The 1125 hospitals had 14,315,506 patients admitted, which represented 45.7% of the 31,324,496 admissions to all U.S. hospitals in 2006. The proportion of clinical pharmacy services provided by Veterans Affairs (VA) hospitals was higher compared with non-VA hospitals. In all hospitals, the clinical pharmacy services with the greatest growth from 1989-2006 were pharmacist-provided admission drug histories (300% increase), pharmacist participation on medical rounds (292.3% increase), drug protocol management (208% increase), pharmacist-conducted clinical research (166.7% increase), pharmacist-provided drug information (150% increase), and pharmacist-provided pharmacokinetic consultation (117.5% increase). A total of 864 hospitals (76.8%) had pharmacists providing drug protocol management (collaborative drug management). Pharmacists managed a mean +/- SD of 9.18 +/- 10.23 different drugs/hospital (7932 protocols). Drugs commonly managed included aminoglycosides (64.4% of hospitals), vancomycin (63.8%), warfarin (37.8%), low-molecular-weight heparins (32.7%), unfractionated heparin (30.0%), fluoroquinolones (30.0%), antiparkinsonian drugs (22.8%), proton pump inhibitors (22.7%), human immunodeficiency virus drugs (21.9%), and cephalosporins (19.7%). The mean number of medication errors reported/hospital increased by 151.4% between 1995 and 2006. The percentage of patients who experienced a medication error increased from 4.7% to 6.5% between 1995 and 2006 (a 38.3% increase). A total of 220 hospitals (19.6%) had computerized prescriber order entry systems, 263 (23.4%) had bar coding for drug administration, and 439 (39.0%) used robotics for dispensing. This study provides continuing evidence of the growth and value of clinical pharmacy services and clinical pharmacists in our nation's hospitals. These data will guide hospital pharmacy directors and clinical coordinators in allocating resources to optimally meet their patients' needs.

An Update on Evidence of Clinical Pharmacy Services’ Impact on Health-Related Quality of Life

To describe and critique recent studies of clinical pharmacy services that have evaluated impact on health-related quality of life (HRQL) and to determine whether studies that lacked a control group were more likely to report a statistically significant impact on HRQL. MEDLINE, EMBASE and International Pharmaceutical Abstracts were searched (March 1999-December 2004) using terms for HRQL and clinical pharmacy services. All original research articles in English identified from the data sources were examined. Abstracts were screened by 2 reviewers, and studies were included if a clinical pharmacy service was evaluated and pre-/post - HRQL outcomes were reported. Of 1152 citations identified by the literature search, 36 articles met the inclusion criteria. Twenty-two studies had a condition-specific focus. Fifteen studies incorporated a generic HRQL measure (primarily the short-form-36 items), 13 studies used a condition-specific measure, and 8 studies included both. Significant impact on one or more domains of HRQL was predominantly demonstrated in interventions relating to asthma, hypertension, and chronic heart failure. Statistically significant change in HRQL was reported in 8 of 21 studies that used a randomized controlled design (38%), in 2 of 5 studies with a nonrandomized design with control group (40%), and in 6 of 8 studies without a control group (75%; chi2 2.00; p = 0.16). Since 1999, the number of published studies of clinical pharmacy services that evaluated HRQL as an endpoint has more than tripled. Study designs have improved in terms of longer length of follow-up, and a wider breadth of clinical services has been evaluated. Certain pharmacy services, such as asthma management, appear to offer the most convincing evidence for the value of clinical pharmacy services in terms of measurable short-term HRQL benefit.

Personal digital assistants for documenting primary care clinical pharmacy services in a health maintenance organization

As pharmacy practice continues to evolve, the need for data that demonstrate the value of clinical pharmacy services increases in importance. However, data collection via traditional manual documentation is time-consuming, cumbersome, and often inconsistent. A standardized electronic documentation

How to develop and implement a program to continuously demonstrate the value of clinical pharmacy services.

This paper summarizes key elements that support the success of clinical pharmacy services to continuously improve the quality of drug therapy. Five drivers identify a successful model for continuously demonstrating the value of clinical pharmacy services: knowing the organizational culture; providing leadership; recruiting pharmacy sponsors; showing tenacity; and acting with management courage. Difficulties encountered when communicating the value of clinical pharmacy services within a health care organization usually arise because of failure to include one of these drivers.

The value of clinical pharmacy services

The value of clinical pharmacy services

Ambulatory care pharmacy services: has the agenda changed?

To provide an extensive review of ambulatory care clinical pharmacy services and evaluate the services and research data in the field. MEDLINE was searched from January 1992 through July 1999. Search terms included pharmacy, clinical pharmacy, and pharmaceutical care, cross-referenced with ambulatory care, primary care, family medicine, and managed care. Relevant peer-reviewed studies and reports since our previous article in 1992 were selected and described. Literature prior to 1992 was briefly reviewed. The relevant literature was reviewed and some examples from the authors' institutions are provided. Much research has continued to be published documenting the value of clinical pharmacy services in ambulatory care, including in community pharmacy, anticoagulation services, family medicine, primary care clinics, Veterans Affairs Medical Centers, and managed care. However, these innovative services are underrepresented in the community at large. The vast majority of the public does not have access to these types of services. There will be continued and dramatic expansion of ambulatory care pharmacy services in the new decade beginning in the year 2000. It will be critical that standards of practice be very high. We believe there is a critical need for visible demonstration projects and large multicenter research projects that demonstrate the value of these services.

Value of community pharmacists' interventions to correct prescribing errors.

The purpose of this analysis was to estimate the economic value created by community pharmacists who routinely screen for and correct prescribing-related problems during the course of their dispensing activities. Three expert judges evaluated the documented interventions of community pharmacists practicing in five states. The judges agreed that 28.3 percent of the identified problems could have resulted in patient harm had the pharmacist not intervened to correct the problem. The direct cost of medical care that was avoided as a result of pharmacists' intervention activities was estimated to be $122.98 per problematic prescription, or +f42.32 per each new prescription order that was screened during the study. Clinical pharmacy services can and do create significant value by enhancing the achievement of positive patient outcomes and by avoiding negative outcomes. Research to develop reliable methods for measuring and monitoring the value of clinical pharmacy services must continue. Mechanisms must be created to encourage and reward pharmacists who consistently provide services that add measurable value to patient care.