To assess the rates of therapeutic international normalized ratio (INR) levels between pharmacist-managed clinics compared to traditional physician-management and to determine the variation in rates of therapeutic INR levels between pharmacist-managed clinic data compared to physician-management. Retrospective, randomized, chart review. Referral only, outpatient, pharmacist based anticoagulation clinic under a community based tertiary care health system. Sixty-four patients with at least 1 year's worth of visits to the pharmacist managed clinic were reviewed for INR stability. The average percentage of visits within the defined therapeutic range, was 71.1% for the physician-managed group versus 81.1% for the pharmacist-managed group (P < 0.0001). The estimated variance in average therapeutic INR rates was double for the physician-managed group (365.7) versus the pharmacist-managed group (185.2) (P = 0.004). The pharmacist-managed anti-coagulation clinic had higher rates of INRs determined to be therapeutic and also exhibited significantly less variability in therapeutic INR rates relative to the physician-managed service.
Background Penicillin skin testing (PST) is a novel way to reduce the use of broad-spectrum agents in penicillin-allergic patients. This study evaluated the outcomes of patients with antimicrobials prescribed with and without PST in a community health system. Methods We performed a quasi-experimental study that compared an intervention group of 100 patients who completed PST over an open enrollment period beginning January 2016 with a matched control group of 100 patients who were penicillin allergic. Patients in the control group were matched to infection diagnosis codes of members of the PST group and randomly selected and matched on a 1:1 basis. The primary outcome was noncarbapenem beta-lactam days of therapy (DOT). The secondary outcome assessed the average cost of antimicrobial therapy for the intervention group before and after PST. Results Seventy of the 98 patients (71%) who tested negative had changes directly made to their antimicrobial regimens. Beta-lactam DOT for the PST group were 666/1094 (60.88%, with 34.82% being a penicillin specifically). Beta-lactam DOT for the control group consisted of 386/984 (39.64%, with 6.4% being a penicillin specifically). The chi-square test of homogeneity for beta-lactam DOT between the 2 groups was significant ( P < .00001). Changes to the antimicrobial regimen after PST saved the average patient $353.03 compared with no change in the pre-PST regimen ( P = .045). Conclusions PST led to immediate antimicrobial de-escalation in the majority of patients who tested negative. This led to a significant increase in beta-lactam usage, specifically penicillins. These benefits were also associated with significant cost savings to patients.
Background Pharmacists can optimize outcomes related to diabetes mellitus (T2DM) by taking advantage of telehealth opportunities despite the COVID-19 Public Health Emergency (COVID-19 PHE). Objective Identify and compare changes in T2DM outcomes prior to (August 2019 through February 2020) and during (March 2020 through October 2020) the COVID-19 PHE. Secondary objectives were to identify and compare pay-for-performance metrics and additional fee-for-service submitted in these patients. Methods This study examined changes in T2DM outcomes at one primary care office within a community health system. Pharmacists started regularly using Remote Patient Monitoring (RPM) services during the COVID-19 PHE to reduce in-person visits. Patients with an initial A1C greater than or equal to 8% were included. Data collected included comorbidities, change in A1C, and diabetes and statin medication therapy adherence. Percentage of Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) measures met, and billing code frequencies were also assessed. Results In the pre COVID-19 PHE group (N=30), the average three and six month A1C reductions were 1.3% and 1.2%, respectively, while the reductions were 2.0% and 2.2% in the during COVID-19 PHE group (N=61). The percentage of patients appropriately initiated or maintained on statins was 96.2% in the pre COVID-19 PHE group versus 82.6% in the during COVID-19 PHE group. Related to HEDIS, statin adherence was 95.2% in the pre COVID-19 PHE group and 84.2% in the during COVID-19 PHE group while A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% pre COVID-19 PHE versus 73.8% during the COVID-19 PHE. Diabetes medication adherence related to HEDIS and medication reconciliation related to MIPS was 100% for both groups. Conclusion Data demonstrates the opportunity for pharmacists to maintain and improve clinical outcomes related to T2DM despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.
This qualitative study explores key patient experience impressions responsible for driving quality. Differences between primary and specialty care patient perspectives were analyzed using a mixed-methods design in high-, median-, and low-quality performing practices. We found that primary care patients highly value provider listening, time spent with provider, and consistent and effective coordination of care. Specialty care patients were found to highly value provider clinical skill acumen/outcomes, being kept informed with timely updates and care instructions, and a stress- and pain-free experience. We conclude that differing patient types attach greater value to different elements of their health care experiences.
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