The application of telepharmacy in rural hospitals varies across the United States but is not widespread, and many states have not defined regulations for telepharmacy in hospitals.
Health care is experiencing increasing pressure to implement evidence-based interventions that improve quality, control costs, and maximize value. Unfortunately, many clinical services and interventions to optimize medication use do not consistently produce the intended humanistic, clinical, and economic outcomes. The lack of conclusive results is believed to stem from the widely recognized research-to-practice gap. The field of implementation science seeks to discover and apply strategies designed to accelerate successful integration of interventions into routine practice. This primer provides an overview of implementation science principles for pharmacists and other health care providers interested in accelerating practice transformation to improve health care delivery and, ultimately, patient care.
In primary care, clinical pharmacists often deliver a service called comprehensive medication management (CMM). While research has identified that CMM positively influences most aspects of the Quadruple Aim, it is unclear how CMM-both the service and the role of the pharmacist-may influence the primary care provider's (PCP) clinical work, professional satisfaction, and burnout (described here as PCP's work-life). We aimed to identify how PCPs perceive CMM impacts their work-life. Methods: Sixteen PCPs were interviewed. Interview questions centered on how CMM affects their work-life. After interviews were transcribed, a codebook was developed by 2 researchers and from the codes, themes were identified. Results: PCPs spoke of the pharmacist being an added skillset and resource and a collaborative partner in caring for patients. They also described 7 outcomes of having CMM available that contribute to their work-life. These outcomes were: decreased workload, satisfaction patients are receiving better care, reassurance, decreased mental exhaustion, enhanced professional learning, increased provider access, and achievement of quality measures. Lastly, the PCPs described barriers and areas of opportunity related to CMM. Conclusion: Our findings suggest PCPs believe CMM, in general, positively affects their work-life. CMM's impact on PCPs aligns with many previously identified drivers of burnout and engagement among providers. These results shed light on how CMM may foster achievement of the Quadruple Aim. (J Am Board Fam Med 2019;32:462-473.
OBJECTIVE Philosophy of practice is the foundation of any patient care practice because it provides a set of professional values and beliefs that guide actions and decisions in practice. Study objectives were to understand how pharmacists providing comprehensive medication management (CMM) describe their philosophy of practice and compare how participants' philosophies align with predefined tenets of a CMM philosophy of practice. METHODS An instrument with closed and open-ended items was developed and administered online to the lead pharmacist at 36 clinics participating in a large CMM study. Participants were asked to describe their philosophy of practice, rate how well their current practice activities align with five predefined CMM philosophy of practice tenets, and provide examples of how they carry out each tenet and how they could improve. Responses were coded, and descriptive analysis was used to calculate participants' practice alignment with the five philosophy of practice tenets. RESULTS Thirty pharmacists completed the instrument. Twelve codes emerged that participants used to describe their philosophy of practice. These codes were mapped to five predefined tenets of a philosophy of practice. Only 3 (10%) participants included all five tenets in their philosophy of practice, 8 (26.7%) included four, 8 (26.7%) included three, 6 (20%) included two, and 5 (16.7%) included one tenet. Overall, participants rated their alignment with the five tenets highly. "Embracing a patient-centered approach" received the highest mean score of 9.17/10; "Meeting a societal need" had the lowest mean score of 8.37/10. CONCLUSION Participants described their philosophy of practice with significant variability. CMM requires a single and consistently applied philosophy of practice to guide practice and the role of the practitioner. We propose five core tenets that resulted from this assessment to be embraced by pharmacists providing CMM and included in their philosophy of practice. KEY WORDS comprehensive medication management, philosophy of practice, clinical pharmacy services.
With the continuing evolution of pharmacy as a clinical profession, the need to prepare well‐trained clinicians beyond the knowledge gained from a doctor of pharmacy degree program is magnified. Such training is afforded by pharmacy residency programs, which have expanded from hospital sites to practice settings as diverse as managed care organizations and public health departments. Although the resident benefits from the intensive training program, the sponsoring institution also derives many benefits from hosting the residency. Fundamentally, residents are licensed pharmacists who provide several contributions to the organization at generally a much‐reduced direct cost. Federal funding for graduate medical education, often referred to as Medicare pass‐through funds, is a common source of support for the conduct of postgraduate year one residency programs in health system settings; other sources of funding may be found in organizational and academic outlets. Residents may be integral in expanding the revenue of an organization by serving as patient care providers, developing or enhancing services, and billing for services delivered. By virtue of the roles they can assume, residents can facilitate the redeployment of existing pharmacists to other areas, tasks, or projects, thus expanding the capabilities of the department. Increasing the capacity to conduct experiential education for pharmacy students, and the compensation for such activity, can be an additional benefit. Practice sites that conduct residency training often experience a greater degree of employee satisfaction and higher employee retention rates. Engaging in quality improvement and assessment activities, assisting in staff development, and supporting innovative approaches to care are additional activities that pharmacy residents can support. This primer from the American College of Clinical Pharmacy was developed to highlight the value an organization can realize by conducting pharmacy residency training.
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