CONSULTANT PHARMACIST最新文献

{"title":"CMS Publishes Final Nursing Facility Payment Rule.","authors":"Paul Baldwin","doi":"10.4140/TCP.n.2018.604.","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.604.","url":null,"abstract":"","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36586673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joanne S. Hirshfield: Destined to Be a Pharmacist.","authors":"Marlene Z Bloom","doi":"10.4140/TCP.n.2018.540.","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.540.","url":null,"abstract":"<p><p>The 2018-2019 president of the American Society of Consultant Pharmacists (ASCP), has been involved in ASCP for the last 30 years. Her perspective is that all senior care pharmacists are \"consultant\" pharmacists because they give advice and don't just dispense, whether they work at a chain drug store or a nursing facility. Her highest priority is to meet the educational needs for the members and give them the tools they need to practice their profession.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36586668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Person-Centered Care: Evaluation of a Resident-Directed Medication Administration Program.","authors":"Amal M Badawoud,&nbsp;Mary Martha Stewart,&nbsp;Margarita Orzolek,&nbsp;Krista L Donohoe,&nbsp;Patricia W Slattum","doi":"10.4140/TCP.n.2018.553.","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.553.","url":null,"abstract":"<p><p><b>Objective</b> The resident-directed medication administration program (RDMA) is a personalized medication approach designed to improve the medication administration process in long-term care facilities (LTCFs). This evaluation aimed to document staff experience with the RDMA program compared with staff working in facilities using a facility-directed medication administration program (FDMA). <b>Design</b> This descriptive program evaluation invited staff members to share their experiences with the medication administration process through an anonymous survey. <b>Setting</b> Three LTCFs using a RDMA program and three LTCFs using a FDMA program operated by a nonprofit health system in the mid-Atlantic region. <b>Participants</b> All medication administration staff working in six LTCFs were invited to participate (n = 28), and 22 evaluable surveys were returned. Pharmacists (n = 2), providers (n = 5), and nursing staff (n = 4) working in the RDMA facilities described their experiences with the RDMA program. <b>Primary Outcome Measures</b> Time spent administering medications, satisfaction with the medication administration process, medication administration error rate. <b>Results</b> Most staff members were satisfied with the program and would recommend it for other facilities. Medication administration staff at RDMA facilities reported that they were able to spend more time engaged with residents and less time administering medications. There were fewer medication administration errors in RDMA facilities. <b>Conclusion</b> Implementation of a personalized approach to medication administration is feasible and can promote a positive staff experience with the medication administration process with fewer medication errors.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36586671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton Pump Inhibitor Use in Older Adults: Long-Term Risks and Steps for Deprescribing.","authors":"Sara Pezeshkian,&nbsp;Susan E Conway","doi":"10.4140/TCP.n.2018.497","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.497","url":null,"abstract":"<p><p>Proton pump inhibitors (PPIs) are commonly prescribed for treatment of acid-related gastrointestinal disorders. PPI use is approved for a duration of 2 to 12 weeks, depending on complication and severity. Many users lack an appropriate indication for continued therapy past the recommended duration. Long-term PPI use is associated with several adverse drug events, including acute interstitial nephritis, fractures, and Clostridium difficile-associated diarrhea (CDAD). Cautious prescribing and regular monitoring is essential, especially for older adults, as they may be at higher risk for these adverse effects. Deprescribing, defined as lowering dosage, switching to as-needed use, or complete discontinuation, should be considered for many PPI users. Patient education is critical. Alternative therapy considerations include histamine-2-receptor antagonists, as they are found to be associated with reduced CDAD and fracture events. Additional strategies include tapering off PPIs and modifying lifestyle to reduce the potential rebound hypersecretion that may occur as a result of discontinuation. The most significant lifestyle modification is weight loss. Additional lifestyle interventions include upright head of bed elevation, avoiding meals close to bedtime, and avoiding high-fat meals within two to three hours of reclining.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Long-Term Care Is Changing.","authors":"Paul Baldwin","doi":"10.4140/TCP.n.2018.532","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.532","url":null,"abstract":"","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can You Hear Me Now?","authors":"H Edward Davidson","doi":"10.4140/TCP.n.2018.470","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.470","url":null,"abstract":"","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulant Use in High Stroke-Risk Patients With Nonvalvular Atrial Fibrillation.","authors":"Hannah K Nguyen,&nbsp;Douglas Humber,&nbsp;Harvey Checkoway,&nbsp;Daniel Blanchard,&nbsp;Jonathan H Watanabe","doi":"10.4140/TCP.n.2018.521","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.521","url":null,"abstract":"<p><p>Background Oral anticoagulants (OACs) are recommended for nonvalvular atrial fibrillation (NVAF) patients with moderate-to high-stroke risk. Objective To examine nationally reflective OAC usage in incident NVAF patients longitudinally. Design Three-year retrospective cohort analysis. Setting Medicare Part D recipients in the contiguous United States.</p><p><strong>Participants: </strong>52,465 Medicare beneficiaries with incident NVAF in 2010 with two or more atrial fibrillation diagnoses seven or more days apart. Main outcome measure Stroke risk via congestive heart failure, hypertension, age greater than or equal to 75, diabetes, stroke, vascular disease, age 65-74, sex category (CHA2DS2-VASc) score. Primary outcome was proportion of patients receiving one or more OACs post-NVAF diagnoses. Results Of 48,980 high-risk patients, 32.7% received one or more OAC within 60 days of diagnosis. By close of 2011, 48% had one or more OAC. OAC use increased to 52.9% by close of 2012. Conclusions Fewer than 33% of high-risk NVAF patients received OACs within 60 days of diagnosis in 2010. Despite increased use over time, oral anticoagulation was below 53% at study end. Use of OACs declined with CHA2DS2-VASc greater than 6. Expanded efforts are warranted to augment OAC use in high stroke-risk patients.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Predictive Model to Identify Skilled Nursing Facility Residents for Pharmacist Intervention.","authors":"Lauren J Heath,&nbsp;Thomas Delate,&nbsp;Linda Weffald,&nbsp;Dwight C Paulson,&nbsp;Julie K Sanchez,&nbsp;Sheri J Herner","doi":"10.4140/TCP.n.2018.504","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.504","url":null,"abstract":"<p><p>Objective Develop a predictive model to identify patients in a skilled nursing facility (SNF) who require a clinical pharmacist intervention. Design Retrospective, cross-sectional. Setting Nine freestanding SNFs within an integrated health care delivery system. Patients Patients who received a clinical pharmacist medication review between January 1, 2016, and April 30, 2017. Identified patients (n = 2,594) were randomly assigned to derivation and validation cohorts. Interventions Multivariable logistic regression modeling was performed to identify factors predictive of patients who required an intervention (i.e., medication dose adjustment, initiation, or discontinuation). Patient-specific factors (e.g., demographics, medication dispensings, diagnoses) were collected from administrative databases. A parsimonious model based on clinical judgment and statistical assessment was developed in the derivation cohort and assessed for fit in the validation cohort. Main Outcome Measures Model to predict patients requiring clinical pharmacist intervention. Secondary outcome was a comparison of factors between patients who did and did not receive a clinical pharmacist intervention. Results Ninety-five factors were assessed. The derivation (n = 1,299) model comprised 22 factors (area under the curve [AUC] = 0.79, 95% confidence interval [CI] 0.74-0.84). A clopidogrel dispensing (odds ratio [OR] = 2.42, 95% CI 1.19-4.91), fall (OR = 2.47, 95% CI 1.59-3.83), or diagnosis for vertebral fracture (OR = 2.33, 95% CI 1.34-4.05) in the 180 days prior to clinical pharmacist medication review were predictive of requiring an intervention. The model fit the validation cohort (n = 1,295) well, AUC = 0.79 (95% CI 0.74-0.84). Conclusion Administrative data predicted patients in a SNF who required clinical pharmacist intervention. Application of this model in real-time could result in clinical pharmacist time-savings and improved pharmacy services through more directed patient care.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Other Side of the Opioid Debate: Treating Older Adults With Chronic Pain.","authors":"Caren McHenry Martin","doi":"10.4140/TCP.n.2018.478","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.478","url":null,"abstract":"<p><p>Prescriptions for opioids and opioid-related overdoses have been on the rise-and in the news-in the United States for more than a decade. New guidelines and legislation related to opioid prescribing provide clinical challenges for many pharmacists and prescribers, particularly in the treatment of older adults with chronic pain. Careful patient selection, along with proper opioid dosing and monitoring, enables the pharmacist and prescriber to continue to treat the older adult with pain effectively.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Regimen Complexity Index in the Elderly in an Outpatient Setting: A Literature Review.","authors":"Emily G Brysch,&nbsp;Kimberly A B Cauthon,&nbsp;Bethany A Kalich,&nbsp;G Blair Sarbacker","doi":"10.4140/TCP.n.2018.484","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.484","url":null,"abstract":"<p><p>Objective To review current literature reporting outcomes associated with utilization of the Medication Regimen Complexity Index (MRCI) with older adults in an outpatient setting. Data sources The National Library of Medicine via PubMed, International Pharmaceutical Abstracts, and the Cochrane Database were used to identify clinical trials evaluating outcomes associated with utilization of the MRCI. The medical subject heading terms \"geriatrics\" and \"medication adherence\" were used in combination with key terms \"medication regimen complexity index\" and \"medication complexity.\" Study selection/data extraction Seventy-five articles met the search criteria and were reviewed. Studies were included if they had MRCI-related outcomes and were performed in patients 60 years of age and older in an outpatient setting. Eleven articles met the stated criteria. Data synthesis Higher MRCI scores may be associated with increased mortality rates, medication nonadherence, and unplanned hospitalizations; however, when compared with medication number, MRCI did not better predict increased medication nonadherence and unplanned hospitalizations. Conclusion The MRCI is a useful tool to determine medication complexity; however, current literature is limited by its observational design. Also, MRCI does not take into account potential factors such as high-risk medications and comorbid conditions, which may affect MRCI scores; therefore, additional trials are warranted before suggesting pharmacists implement this tool in their everyday practice.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36464926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}