JAPhA Practice Innovations最新文献

{"title":"Evaluation of missed opportunity for clinical pharmacist practitioner impact on medication management in a traumatic brain injury population","authors":"Jordyn T. Kettner,&nbsp;Tera L. Raymond","doi":"10.1016/j.japhpi.2024.100013","DOIUrl":"10.1016/j.japhpi.2024.100013","url":null,"abstract":"<div><h3>Background</h3><p>Traumatic brain injury (TBI) is a traumatically induced physiological disruption of normal brain function often with structural brain injury. Patients with TBI may have impaired cognitive function, which may affect medication adherence and patients’ understanding of their medication regimen, making medication management challenging. Clinical pharmacist practitioner (CPP)–driven medication management has been shown to decrease polypharmacy, increase medication adherence, and prevent adverse drug reactions in various disease states; however, there are few interventions for patients with TBI.</p></div><div><h3>Objectives</h3><p>This evaluation aimed to determine whether there are missed opportunities for CPP impact on medication management for patients with TBI at 1 Veterans Affairs medical center.</p></div><div><h3>Methods</h3><p>This was a single-center, retrospective, QI project. Patients were identified via a generated report of all patients with a diagnosis of TBI seen by a rehabilitation medicine provider between October 21, 2022, and January 1, 2023. Retrospective chart reviews were performed to determine the number of patients with polypharmacy, adherence concerns, duplicative therapy, and medications missing an indication.</p></div><div><h3>Results</h3><p>Ninety-two rehabilitation medicine visits for 78 unique patients were identified over the 3-month time period. Twenty-four of the 78 patients were identified to have all of the following: polypharmacy, adherence concerns, duplicative therapy, and medications without an indication. Of the 78 patients, 10 (15.6%) were followed by a primary care CPP within the 6 months before their rehabilitation medicine appointment.</p></div><div><h3>Conclusion</h3><p>This QI project identifies potential opportunities for CPP impact on medication management of patients diagnosed as having TBI.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 4","pages":"Article 100013"},"PeriodicalIF":0.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294996902400006X/pdfft?md5=9446ce0d22faa1cc40399432811b3153&pid=1-s2.0-S294996902400006X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities for interprofessional collaboration between pharmacists and hearing professionals in Pennsylvania: A descriptive geographic information system study","authors":"Lucas A. Berenbrok,&nbsp;Nico Chieffo,&nbsp;Audrey Leong,&nbsp;Emily Stuck,&nbsp;Mark DeRuiter,&nbsp;Elaine Mormer","doi":"10.1016/j.japhpi.2024.100012","DOIUrl":"10.1016/j.japhpi.2024.100012","url":null,"abstract":"<div><h3>Background</h3><p>In 2022, the Food and Drug Administration finalized regulations for over-the-counter (OTC) hearing aids, available without professional hearing services and without a prescription. As a result, community pharmacies now serve as locations where adults seek self-care solutions for hearing loss such as OTC hearing aids.</p></div><div><h3>Objectives</h3><p>We conducted a geographic information systems (GIS) analysis to identify Pennsylvania counties served by community pharmacies and hearing aid dispensaries, the practice locations of hearing professionals.</p></div><div><h3>Methods</h3><p>We obtained addresses of Pennsylvania pharmacies from the National Council for Prescription Drug Programs. Hearing aid dispensaries were obtained from the Pennsylvania Department of Health. GIS software was used to plot locations of pharmacies and hearing aid dispensaries. The number of pharmacies and hearing aid dispensaries was visualized on a Pennsylvania map, by county. Mean straight-line distances, in miles, from a hearing aid dispensary to its nearest pharmacy in any county and vice versa were calculated. This analysis was performed in early 2022.</p></div><div><h3>Results</h3><p>In Pennsylvania, there were more community pharmacies (2769) than hearing aid dispensaries (945). All 67 Pennsylvania counties had more pharmacies than hearing aid dispensaries. Pharmacies outnumbered hearing aid dispensaries by 1 in some rural counties to 382 in urban Philadelphia County. The mean straight-line distance from a hearing aid dispensary, starting point, to the nearest pharmacy, end point, was 0.63 miles. The mean straight-line distance from a pharmacy, starting point, to the nearest hearing aid dispensary, end point, was 3.24 miles.</p></div><div><h3>Conclusion</h3><p>This GIS analysis supports the participation of pharmacists in initiatives such as OTC hearing aids that increase population access to hearing care.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 3","pages":"Article 100012"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969024000058/pdfft?md5=50d3718ffdbdd026c9009464a8f39be9&pid=1-s2.0-S2949969024000058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring pharmacy clinical workload in the emergency department: Current status and a plan for action","authors":"Raneem Pallotta,&nbsp;Christian Carlson,&nbsp;Elizabeth VanWert","doi":"10.1016/j.japhpi.2024.100014","DOIUrl":"10.1016/j.japhpi.2024.100014","url":null,"abstract":"<div><h3>Background</h3><p>Inpatient pharmacy productivity workload ratios historically encompass dispensing functions including numbers of medication orders verified, dispensed, and billed for and full-time equivalents (FTEs) but do not include pharmacy clinical activities. Clinical pharmacy activities are difficult to capture because they generally require manual documentation and vary among health systems. The emergency medicine pharmacists’ (EMPs) role adds additional complexity to capturing clinical activities given that bedside response and verbal recommendations are difficult to capture outside of manual documentation. It is unknown how many health systems use EMP-specific workload metrics.</p></div><div><h3>Objectives</h3><p>The purpose of our survey was to determine the percentage of hospital pharmacies that use EMP-specific workload metrics, to describe workload metrics used by EMPs and to quantify time spent on clinical activities, and to describe methods for implementing EMP metrics.</p></div><div><h3>Methods</h3><p>A 13-item questionnaire was developed, pretested, and sent to EMPs practicing in hospitals in the United States through 2 EMP national committee e-mail listservs. Survey completion online included questions on hospital characteristics, number of EMP FTEs, clinical services provided and time spent on these tasks, and current workload metrics used.</p></div><div><h3>Results</h3><p>Full responses to the survey were received from 100 pharmacists, with an overall response rate of 9.8%. Workload metrics specific to EMP activities were used by 15.1% of responders. Workload metrics were used but not tailored to EMP activities for 43% of responders, and 41.9% responded that no metrics were used whatsoever. Ten responders provided commentary on types of EMP activities tracked, which included bedside response for critical patients, culture callback, drug information and dosing, time to antibiotic administration, and medication histories. No universal software for metric tracking was identified.</p></div><div><h3>Conclusion</h3><p>A survey of EMP clinical services and workload metrics indicated that although 43% of responders use non-EMP-specific metrics, only 15.1% reported workload metrics that capture EMP clinical activities.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 3","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969024000071/pdfft?md5=92a71783a73262b2d0c785487ffd4b5a&pid=1-s2.0-S2949969024000071-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of pharmacist-prescribed contraceptive services: A case series of early adopters","authors":"Jennifer A. Campi,&nbsp;Sally Rafie,&nbsp;Jenny L. Newlon,&nbsp;Ashley H. Meredith","doi":"10.1016/j.japhpi.2024.100011","DOIUrl":"10.1016/j.japhpi.2024.100011","url":null,"abstract":"<div><h3>Background</h3><p>The objective of this study was to interview five early adopters of pharmacist-prescribed contraceptive services to gain insight into successful implementation, with a focus on each pharmacy’s approach, successes, challenges, lessons learned, and practice implications.</p></div><div><h3>Case Summaries</h3><p>The five pharmacists who were interviewed included men and women working for independent, chain, and hospital system pharmacies in rural, suburban, and urban areas in various states. Each pharmacy had a unique approach to implementation of pharmacist-prescribed contraceptive services and a variety of service features. The pharmacists were asked about their motivation for starting the service, implementation processes, financial justification, challenges, and successes. Similarities and differences in the intervention characteristics (processes), outer setting (factors outside of the pharmacy), inner setting (factors within the pharmacy), and individual characteristics were compared to determine lessons learned and practice implications for implementation of pharmacist-prescribed contraceptive services.</p></div><div><h3>Practice Implications</h3><p>The pharmacists interviewed encountered common challenges in implementing pharmacist-prescribed contraception services, including lack of community awareness, difficulty justifying the service financially, difficulty with time management, staying updated with changing regulations, and managing staff turnover. Successful contraception service implementation strategies included efficient workflow integration, financial justification of the service, and increasing community awareness of the service.</p></div><div><h3>Conclusion</h3><p>These early adopter case studies can serve as a reference for pharmacists wanting to implement contraceptive services in their pharmacies. By incorporating lessons learned and anticipating challenges, more pharmacies may be able to offer contraceptive services, further increasing patient access to contraceptives.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 3","pages":"Article 100011"},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969024000046/pdfft?md5=38ad6551749be4809cd6a8634565138d&pid=1-s2.0-S2949969024000046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a pharmacist-driven insulin dispensing program in a management services organization","authors":"Tina Benny,&nbsp;Marija Lapkus,&nbsp;Genevieve Hale,&nbsp;Cynthia Moreau,&nbsp;Alexandra Perez,&nbsp;Erika Zwachte","doi":"10.1016/j.japhpi.2024.100010","DOIUrl":"https://doi.org/10.1016/j.japhpi.2024.100010","url":null,"abstract":"<div><h3>Background</h3><p>Insulin prices have tripled in the United States over the past decade. The affordability of insulin products may affect patient adherence and, as a result, glucose control. Providers may need to consider less expensive insulin options to improve patient outcomes.</p></div><div><h3>Objective</h3><p>This study aimed to evaluate the impact of a low-cost, in-office insulin dispensing program led by pharmacists in a management services organization on patient glucose control, adherence to routine laboratory tests, and patient satisfaction.</p></div><div><h3>Methods</h3><p>This multicenter, retrospective cohort study was conducted at 2 primary care clinics in South Florida. The primary outcome was the change in mean hemoglobin A1c (HbA1c) at baseline versus 6 months after insulin program enrollment. The secondary outcomes included mean HbA1c at baseline versus 12 months after insulin program enrollment, patient satisfaction evaluated with a survey, and adherence to routine laboratory tests, specifically HbA1c and urine albumin to creatinine ratio before and after enrollment.</p></div><div><h3>Results</h3><p>A total of 21 patients met inclusion criteria. The mean HbA1c before program enrollment was 9.4% compared with a mean HbA1c of 8.6% 6 months after enrollment (<em>P</em> = 0.058) and 8.4% 12 months after enrollment when available (<em>P</em> = 0.097). Of the 12 patients who completed the patient satisfaction survey, 11 (91.7%) agreed or strongly agreed that they were satisfied with pharmacist involvement in insulin management and planned to continue using the insulin program.</p></div><div><h3>Conclusion</h3><p>Among patients with type 2 diabetes enrolled in a low-cost, in-office insulin program, change in mean HbA1c after 6 and 12 months was not statistically significant.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 3","pages":"Article 100010"},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969024000034/pdfft?md5=ab9555ad49cd7dc9014a00a8245a7920&pid=1-s2.0-S2949969024000034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140647318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacists’ perspectives on psilocybin in Canada","authors":"Elizabeth Sugiarto,&nbsp;Rebecca Leung,&nbsp;Jamie Yuen","doi":"10.1016/j.japhpi.2023.100003","DOIUrl":"10.1016/j.japhpi.2023.100003","url":null,"abstract":"<div><h3>Background</h3><p>Psilocybin is the main psychoactive component of a naturally occurring psychedelic organism commonly referred to as “magic mushrooms.” Existing literature demonstrates beneficial neurologic effects in treatment-resistant depression, cancer-associated depression and anxiety, and substance use. The evidence base for psilocybin use is on the rise with the U.S. Food and Drug Administration owing to a resurgence in clinical research. As such, pharmacists need to be adequately equipped to navigate questions from consumers and care providers. There is currently no literature describing pharmacists’ perspectives on psilocybin. Evaluating pharmacists’ knowledge, experiences, and opinions about psilocybin may yield beneficial and applicable data to develop educational programs and clinical tools and guide psilocybin policy making.</p></div><div><h3>Objective</h3><p>The objective of this study was to evaluate the interest and opinions of pharmacists on psilocybin as an emerging therapeutic option.</p></div><div><h3>Methods</h3><p>Licensed pharmacists in Canada were invited to participate in an anonymous, online, 44-item survey aimed at evaluating pharmacists’ experiences, knowledge, and attitudes toward psilocybin. Recruitment for the study was done through multiple Canadian pharmacy association newsletters and via LinkedIn.</p></div><div><h3>Results</h3><p>Results showed that 73% of pharmacists lacked formal education about psilocybin. Forty percent of pharmacists had conversations about psilocybin less than once a month whereas 60% of pharmacists have never received questions about psilocybin. Furthermore, pharmacists are not comfortable with their knowledge with making recommendations (75%), monitoring (57%), or recommending doses of psilocybin (64%) to patients.</p></div><div><h3>Conclusion</h3><p>Pharmacists are open to embracing a role in psilocybin therapy and dispensing. Creation of clinical practice guidelines and increased accessibility to education materials are necessary to supplement pharmacists’ knowledge on psilocybin and improve their confidence when advising patients.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 2","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969023000039/pdfft?md5=4a43d162f6c9858fdb8e155770b69da7&pid=1-s2.0-S2949969023000039-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135565125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pharmacist-led vaccine assessment and patient counseling on unmet vaccination needs in the community pharmacy setting","authors":"Ryan Lilly,&nbsp;Linda Dang,&nbsp;Jordan Frangello,&nbsp;Denise Roque,&nbsp;Yifei Liu","doi":"10.1016/j.japhpi.2023.100004","DOIUrl":"10.1016/j.japhpi.2023.100004","url":null,"abstract":"<div><h3>Objective</h3><p>Community pharmacists play an important role in administering vaccines, and a vaccine assessment form (VAF) can be incorporated into the workflow of a community pharmacy. The objective of this study was to evaluate the impact of implementing a VAF combined with pharmacist-led patient counseling on unmet vaccination needs in a community pharmacy setting.</p></div><div><h3>Methods</h3><p>The VAF was a pre-existing questionnaire developed by Walgreen Co (Deerfield, IL) based on the recommendations of the Centers for Disease Control and Prevention. Inclusion criteria were English-speaking patients older than 18 years who visited the pharmacy for at least one vaccine during a 6-month period and completed the VAF. Five pharmacists provided immunization education, determined unmet vaccination needs, and provided individualized patient counseling. Five outcomes were documented: (1) the number of unmet vaccination needs identified, (2) vaccines received in the same visit at the pharmacy, (3) a vaccination appointment for a later date at the pharmacy, (4) a referral was made, and (5) refusal by patients for further action. Descriptive statistics and phi coefficients were used for data analysis.</p></div><div><h3>Results</h3><p>A total of 133 patients visited the pharmacy to receive at least one vaccine and completed the VAF. Pharmacists identified 126 unmet vaccination needs, and the most common ones were for influenza, Tdap, PPSV23, and herpes zoster. The most common outcome was referrals, and the most common reason for delaying a vaccine was cost. Phi coefficients indicated statistically significant associations between identified unmet vaccination needs and referrals across vaccine types.</p></div><div><h3>Conclusion</h3><p>A VAF combined with pharmacist-led patient counseling addressed unmet vaccination needs. In addition, pharmacists made referrals to close immunization gaps.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 2","pages":"Article 100004"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969023000040/pdfft?md5=a32f4b1881da3e1fcf6d2e108971ceba&pid=1-s2.0-S2949969023000040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication discrepancies across care transitions and the role of pharmacy technicians: A retrospective chart review","authors":"Samantha Liaw,&nbsp;Kristal Ragbir-Toolsie,&nbsp;Rubiya Kabir,&nbsp;Sebastian Choi,&nbsp;Kayla Finuf,&nbsp;Colm Mulvany,&nbsp;Gisele Wolf-Klein,&nbsp;Judith Beizer,&nbsp;Liron Sinvani","doi":"10.1016/j.japhpi.2024.100009","DOIUrl":"10.1016/j.japhpi.2024.100009","url":null,"abstract":"<div><h3>Background</h3><p>After hospitalization, older adults are increasingly discharged to postacute care facilities such as skilled nursing facilities (SNFs). Medication reconciliation and obtaining the best possible medication history (BPMH) are key components of medication management for care transitions and essential for preventing medication errors and adverse drug events.</p></div><div><h3>Objective</h3><p>This study aimed to assess medication discrepancies across care transitions after a Certified Pharmacy Technician (CPhT) obtains the BPMH on hospital admission.</p></div><div><h3>Methods</h3><p>Single-center, retrospective chart review and included adults ≥ 18 years admitted to the medicine service and discharged to a SNF between November 2016 and June 2017. Medication lists were evaluated for discrepancies across 3 transitions: hospital admission to hospital discharge (Time I), hospital discharge to SNF admission (Time II), and SNF admission to SNF discharge (Time III). Discrepancies were categorized by medication class, type of discrepancy, and whether it was potentially intentional or unintentional.</p></div><div><h3>Results</h3><p>In 127 patients, the average age was 83.3 (SD 9.16), 61% (n = 77) were female, and 67% (n = 85) were white. Median hospital length of stay (LOS) was 6 days (interquartile range [IQR] 4-10) and SNF LOS 21 days (IQR 15-30). Across 381 transitions, 6322 medications were reviewed, and 2602 discrepancies identified. The total number of medication discrepancies was 1034 (Time I), 687 (Time II), and 881 (Time III), respectively. All patients had at least one medication discrepancy. The average number of potentially unintentional discrepancies per patient at each transition was 0.14, 0.2, and 0.16, respectively. The most common discrepancy type was omissions (39%), and the highest number of discrepancies in the potentially intentional and unintentional discrepancy groups was gastrointestinal (21%) and cardiovascular medications (24%), respectively.</p></div><div><h3>Conclusion</h3><p>Medication discrepancies are common across all care transitions. Future studies are needed to evaluate the role of CPhT in obtaining the BPMH on hospital admission for reducing medication discrepancies across the continuum of care.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 3","pages":"Article 100009"},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969024000022/pdfft?md5=a9df89222cceaf4bae3f9fbdc62661fd&pid=1-s2.0-S2949969024000022-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of pharmacist involvement in multidisciplinary home visits in a primary care–based management services organization","authors":"Andrea Bush,&nbsp;Tina Benny,&nbsp;Mekaliah Creese,&nbsp;Genevieve Hale,&nbsp;Erika Zwachte,&nbsp;Devada Singh-Franco,&nbsp;Dana Holger","doi":"10.1016/j.japhpi.2024.100008","DOIUrl":"10.1016/j.japhpi.2024.100008","url":null,"abstract":"<div><h3>Background</h3><p>Health care delivery has shifted from fee-for-service to value-based models, allowing pharmacists to integrate within value-based organizations to improve patient outcomes. Although previous studies describe pharmacist involvement in value-based office settings, limited knowledge exists on pharmacist integration in multidisciplinary home visits in a value-based setting.</p></div><div><h3>Objectives</h3><p>This study aimed to describe the integration of pharmacists into multidisciplinary chronic care management (CCM) home visits involving paramedics within a primary care–focused value-based setting. The primary objective is to identify the types and frequency of medication-related problems (MRPs) identified by pharmacists during home visits. The secondary objectives are to determine the number and types of recommendations made to and accepted by providers and patient satisfaction with the pharmacist during the home visit.</p></div><div><h3>Methods</h3><p>Primus Health, a primary care–focused management services organization, integrated pharmacists in CCM home visits. Two ambulatory care pharmacy residents and one clinical pharmacist conducted home visits from January to May 2023 to complete medication reconciliation, identify MRPs, and provide pharmacy support services for patients and providers. A password-protected database was built for data collection and analysis. The data are presented in aggregate.</p></div><div><h3>Results</h3><p>Twenty-one visits involving 15 patients were conducted and 77 MRPs were identified. The most common MRPs were nonadherence (11.6%), laboratory monitoring needed (11.6%), and overdue vaccination (11.6%). Twenty-three of 36 recommendations (63.9%) made to providers were accepted, leading to a therapeutic change. Commonly accepted recommendations were decreasing dose (21.7%), medication deprescription (21.7%), and ordering of laboratory tests (21.7%). All patients agreed or strongly agreed that they were satisfied with the pharmacist-provided care during the home visit.</p></div><div><h3>Conclusions</h3><p>Integration of pharmacists into multidisciplinary CCM home visits led to the resolution of MRPs and demonstrated a potential need for enhanced clinical pharmacy services for home care patients in primary care–focused value-based settings.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 2","pages":"Article 100008"},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969024000010/pdfft?md5=eef91e912e5f91cda239da2140b4ecaf&pid=1-s2.0-S2949969024000010-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Permissionless innovation in the pharmacy business model: The case for the membership pharmacy model","authors":"Kenneth C. Hohmeier,&nbsp;Phil Baker,&nbsp;Ethan Lobo","doi":"10.1016/j.japhpi.2023.100007","DOIUrl":"10.1016/j.japhpi.2023.100007","url":null,"abstract":"<div><h3>Background</h3><p>There continue to be calls to move away from traditional “fee for service” health care models in favor of patient-centered, value-based models. Concurrent with national efforts, grassroots innovation with novel practice change models are developing at the local level and holds similar potential to transform the pharmacy practice model. One of these innovative models, the membership pharmacy model, may be the least dependent on existing barriers to practice transformation because it is centered on the sale of services rather than products.</p></div><div><h3>Objective</h3><p>To discuss the difference between volume-based and value-based pharmacy models, focusing on how these models impact prescription adherence and patient outcomes. Application of the value-based pharmacy model will be described in the context of Good Shepherd Pharmacy located in Memphis, TN.</p></div><div><h3>Case Summary</h3><p>The volume-based model is centered on prescription fulfillment, with pharmacies incentivized to maximize the number of prescriptions filled. Conversely, the value-based model treats prescription fulfillment as an expense and emphasizes medication adherence as the primary goal. This shift in focus leads to a radical change in the pharmacy’s business model, aligning economic incentives with patients’ best interests. In the value-based model, pharmacies operate on a membership or subscription basis, where revenue is generated through recurring membership fees instead of individual prescription fills. This encourages pharmacies to manage prescription fulfillment efficiently and helps patients reduce their prescription burden, ultimately improving their bottom line.</p></div><div><h3>Practice Implications</h3><p>The value-based pharmacy model is distinguishable from the volume-based model in several aspects. In the value-based model, prescription fills are considered an expense rather than a profit center, and the inventory model shifts from “Just-in-Case” to “Just-in-Time.” Medication synchronization of patients’ refills is a key feature of the value-based model, as it reduces operational costs and maximizes profit per patient. Key performance indicators also shift from being product-centric to patient-centric and reward the organization for improving adherence.</p></div><div><h3>Conclusion</h3><p>The value-based pharmacy model represents a significant departure from traditional pharmacy practices. By incentivizing pharmacies to promote medication adherence and focus on long-term customer relationships, this model has the potential to improve patient outcomes. Further research is needed to study the model’s impact across different settings and patient populations, financial sustainability, and means of spread and scale.</p></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"1 2","pages":"Article 100007"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949969023000076/pdfft?md5=7e585f5a9a9976db320142dfd4ce705a&pid=1-s2.0-S2949969023000076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}