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Ambulatory care pharmacy

Bayan Sharif-Chan, Dipti Tankala, Christine Leong, Zubin Austin, Marisa Battistella
Objective. To compare peer teaching in a medical and a pharmacy clinical teaching unit and to provide suggestions for future research in pharmacy near-peer teaching. Methods. This exploratory observational study used principles of ethnographic methodology for data collection and analysis. Observations were collected in a large downtown teaching hospital. An average of 4-6 hours per day were spent observing a team of medical trainees from the Faculty (School) of Medicine in the general internal medicine (unit for two weeks, followed by a team of pharmacy trainees in an ambulatory hemodialysis (HD) unit for two weeks...
September 25, 2016: American Journal of Pharmaceutical Education
Noll L Campbell, Anthony J Perkins, Pamela Bradt, Sinem Perk, Ronald C Wielage, Malaz A Boustani, Daniel B Ng
STUDY OBJECTIVE: To determine the association between Anticholinergic Cognitive Burden (ACB) score and both cognitive impairment and health care utilization among a diverse ambulatory older adult population. DESIGN: Retrospective cohort study. DATA SOURCE: Medication exposure and other clinical data were extracted from the Regenstrief Medical Record System (RMRS), and cognitive diagnosis derived from a dementia screening and diagnosis study...
October 6, 2016: Pharmacotherapy
Vani Nimbal, Jodi B Segal, Robert J Romanelli
BACKGROUND: Generic drug use in the outpatient setting is typically measured with adjudicated pharmacy claims; however, not all delivery systems have access to these data for their clinical populations. OBJECTIVE: To develop an algorithm to estimate generic drug use in an outpatient setting using electronic health records (EHR) data. METHODS: Twenty-five therapeutic classes were chosen with the potential for low generic use that were prescribed to managed care beneficiaries in a health care system in Northern California...
October 2016: Journal of Managed Care & Specialty Pharmacy
Emma Wallace, Ronald McDowell, Kathleen Bennett, Tom Fahey, Susan M Smith
OBJECTIVES: Multimorbidity, defined as the presence of 2 or more chronic medical conditions in an individual, is associated with poorer health outcomes. Several multimorbidity measures exist, and the challenge is to decide which to use preferentially in predicting health outcomes. The study objective was to compare the performance of 5 count-based multimorbidity measures in predicting emergency hospital admission and functional decline in older community-dwelling adults attending primary care...
2016: BMJ Open
Jin Han, Shubha Bhat, Michel Gowhari, Victor R Gordeuk, Santosh L Saraf
Ambulatory care clinical pharmacy services have expanded beyond primary care settings, but literature supporting the benefits of clinical pharmacy involvement with patients who have rare diseases such as sickle cell disease (SCD) is lacking. Hydroxyurea is the only agent approved by the U.S. Food and Drug Administration for the treatment of SCD; full benefit in controlling pain episodes and other complications is achieved through monitored escalation to a maximum tolerated dose. The primary objective of this analysis was to evaluate the impact of a newly implemented clinical pharmacy service on the management of patients with SCD...
September 16, 2016: Pharmacotherapy
Jorge E Machado-Alba, Juan Carlos Moncada, Paula Andrea Moreno-Gutiérrez
INTRODUCTION: Medication errors outside the hospital have been poorly studied despite representing an important threat to patient safety. OBJECTIVE: To describe the characteristics of medication errors in outpatient dispensing pharmacists reported in a pharmaco-surveillance system between 2005 and 2013 in Colombia. MATERIALS AND METHODS: We conducted a descriptive study by reviewing and categorizing medication error reports from outpatient pharmacy services to a national medication dispensing company between January, 2005 and September, 2013...
2016: Biomédica: Revista del Instituto Nacional de Salud
Brianna A da Silva, Mahesh Krishnamurthy
CASE DESCRIPTION: A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. DISCUSSION: Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up...
2016: Journal of Community Hospital Internal Medicine Perspectives
Emily M Hawes, Caron Misita, Jena Ivey Burkhart, Lauren McKnight, Zachariah M Deyo, Ruth-Ann Lee, Caroline Howard, Stephen F Eckel
PURPOSE: The prescribing authorities, clinical activities, and productivity documentation strategies of ambulatory care clinic-based pharmacists practicing within a large academic health system are described. SUMMARY: North Carolina law encourages progressive pharmacy practice through acquisition of the clinical pharmacist practitioner (CPP) designation. Qualified CPPs are authorized to provide collaborative drug therapy management services, including medication prescribing and ordering of laboratory tests, according to defined protocols and under physician supervision...
September 15, 2016: American Journal of Health-system Pharmacy: AJHP
Simon W Lam, Giavanna Russo-Alvarez, Cari Cristiani, Michael B Rothberg
BACKGROUND: Health care reform and the projected shortage of primary care physicians necessitate more efficient use of multidisciplinary collaboration. No studies, to date, have evaluated factors associated with treatment success among patients referred to a clinical pharmacist. OBJECTIVE: To develop a prediction model using patient factors to assist in selecting patients with diabetes most likely to benefit from pharmacy interventions. METHODS: A retrospective, nested case-control study was performed...
September 1, 2016: Annals of Pharmacotherapy
Robert Penington, Jo Ann Stubbings
BACKGROUND: The past 25 years have seen a substantial increase in the effect of specialty drugs on patient care. These agents were initially not considered financially viable because they often served a comparatively small market of patients. However, the extended monopoly afforded to manufacturers of these drugs by the Orphan Drug Act of 1983 has made treatment of rare diseases, which specialty drugs often target, a more viable option. As a result, pharmaceutical companies began to increase research and development expenditures in this area, and the pipeline of specialty drugs began to grow in the late 1980s...
September 2016: Journal of Managed Care & Specialty Pharmacy
Chris I Wong Quiles, Stephanie Gottsch, Usha Thakrar, Belen Fraile, Amy L Billett
BACKGROUND: The impact of ambulatory bloodstream infections (Amb-BSIs) in pediatric oncology and stem cell transplant (PO/SCT) patients is poorly understood, although a large portion of their treatment increasingly occurs in this setting. This study aimed to understand the economic impact and length of stay (LOS) associated with these infections. PROCEDURE: Charges and LOS were retrospectively collected and analyzed for Amb-BSI events leading to a hospital admission between 2012 and 2013 in a tertiary, university-affiliated hospital...
August 24, 2016: Pediatric Blood & Cancer
Daniela Petruta Primejdie, Marius Traian Bojita, Adina Popa
BACKGROUND: The elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design. METHODS: All reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed...
2016: BMC Pharmacology & Toxicology
David Peddie, Serena S Small, Katherin Badke, Maeve E Wickham, Chantelle Bailey, Adam Chruscicki, Christine Ackerley, Ellen Balka, Corinne M Hohl
BACKGROUND: Adverse drug events (ADEs) are unintended and harmful events related to medication use. Up to 30% of serious ADEs recur within six months because culprit drugs are unintentionally represcribed and redispensed. Improving the electronic communication of ADE information between care providers, and across care settings, has the potential to reduce recurrent ADEs. OBJECTIVE: We aim to describe the methods used to design Action ADE, a novel electronic ADE reporting system that can be leveraged to prevent unintentional reexposures to harmful drugs in British Columbia, Canada...
2016: JMIR Research Protocols
Maya Dewan, Heather Wolfe, Carola Young, Bimal Desai
BACKGROUND AND OBJECTIVES: A safety event drew attention to unsafe and inappropriate payer formulary alerts. These alerts display formulary, coverage, and eligibility data from the pharmacy benefits manager in response to an electronic prescription. They are intended to redirect prescribers to medications that are covered by insurance; however, these alerts were found to be inaccurate and contribute to potentially harmful alerts. Our objective was to reduce inappropriate payer formulary alerts by 30% within 1 year and to change the ePrescribing certification requirements to prevent future instances of harm...
September 2016: Hospital Pediatrics
Elizabeth Eckstrom, Margaret B Neal, Vicki Cotrell, Colleen M Casey, Glenise McKenzie, Megan W Morgove, Gary E DeLander, William Simonson, Kathie Lasater
Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This article describes a project that engaged an interprofessional teaching team to support interprofessional clinical teams to reduce fall risk in older adults by implementing the AGS/BGS guidelines...
August 2016: Journal of the American Geriatrics Society
Elizabeth Hohner, Melinda Ortmann, Umbreen Murtaza, Sheeva Chopra, Patricia A Ross, Meghan Swarthout, Leigh Efird, Emily Pherson, Mustapha Saheed
PURPOSE: The implementation of an emergency department (ED)-based clinical pharmacist transitions-of-care (TOC) program is described. SUMMARY: The intervention program consisted of collaboration between ED and ambulatory care pharmacists to provide patient-specific comprehensive medication review and education in the ED setting and to help ensure a coordinated transition to the ambulatory care setting by scheduling an ambulatory pharmacy clinic or home-based visit...
August 1, 2016: American Journal of Health-system Pharmacy: AJHP
Heather Neville, Larry Broadfield, Claudia Harding, Shelley Heukshorst, Jennifer Sweetapple, Megan Rolle
BACKGROUND: Pharmacy technicians are expanding their scope of practice, often in partnership with pharmacists. In oncology, such a shift in responsibilities may lead to workflow efficiencies, but may also cause concerns about patient risk and medication errors. OBJECTIVES: The primary objective was to compare the time spent on order entry and order-entry checking before and after training of a clinical support pharmacy technician (CSPT) to perform chemotherapy order entry...
May 2016: Canadian Journal of Hospital Pharmacy
Robyn Teply, Mikayla Spangler, Laura Klug, Jennifer Tilleman, Kelli Coover
Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week's responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective...
June 25, 2016: American Journal of Pharmaceutical Education
Caleb Hui, Regis Vaillancourt, Lissa Bair, Elaine Wong, James W King
BACKGROUND: Detection, monitoring and treatment of adverse drug reactions (ADRs) are paramount to patient safety. The use of a comprehensive electronic health record (EHR) system has the potential to address inadequacies in ADR documentation and to facilitate ADR reporting to health agencies. However, effective methods to maintain the quality of documented ADRs within an EHR have not been well studied. OBJECTIVE: To evaluate the accuracy and effectiveness of ADR documentation transfer throughout the implementation of a comprehensive EHR system...
June 2016: Drugs—Real World Outcomes
Benjamin Chastek, Stephanie Korrer, Saurabh P Nagar, Frank Albers, Steve Yancey, Hector Ortega, Mark Forshag, Anand A Dalal
BACKGROUND: Despite intensive pharmacotherapy, a considerable number of patients with severe asthma have inadequate disease control. Patients with severe asthma who experience exacerbations consume significant health care resources. OBJECTIVE: To assess health care resource utilization and associated costs among patients with persistent severe asthma who experienced exacerbations compared with patients with persistent but nonsevere asthma. METHODS: This retrospective analysis of a national administrative claims database identified patients aged ≥ 12 years who had at least 1 medical claim with an asthma diagnosis in 2012 and had continuous medical and pharmacy coverage under a commercial or Medicare Advantage plan from January 1, 2012, to December 31, 2013...
July 2016: Journal of Managed Care & Specialty Pharmacy
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