Adherence to Clinical Practice Guidelines for 7 Chronic Conditions in Long-term-Care Patients Who Received Pharmacist Disease Management Services Versus Traditional Drug Regimen Review

Abstract

CONCLUSION: This self-evaluation of the provision of pharmacist consultant services that focus on disease management in addition to DRR found a higher rate of adherence to clinical practice guidelines for 4 of 7 common chronic disease states in long-term-care patients compared with patients who received only traditional DRR services.KEYWORDS: Practice guidelines, Long-term care, Nursing homes, Geriatrics Moines, IA 50316. Tel: (515) Fax: (515) Copyright© 2007, Academy of Managed Care Pharmacy. All rights reserved. ABSTRACT Note: A commentary on the subject of this article appears on pages 68-69 of this issue.We have defined DSM as the provision of therapeutic recommendations to improve CPG adherence for common chronic medical conditions, which we have practiced since we began our LTCF pharmacist consulting service in 2001. In addition, we have delivered the traditional drug regimen review (DRR) process, which is defined in federal regulations as evaluating indications for medication use, effectiveness of therapeutic goal, medication dose, presence of monitoring and duplicate therapy, and potential for adverse drug reactions. 12We previously evaluated physician acceptance and perceived value of the pharmacist consultant interventions for 155 LTCF patients during an 8-month period. 13 Results showed that 523 of 559 recommendations (84.3%) were accepted by physicians and that 45% of recommendations were perceived as important by physicians. While 10.4% of pharmacist recommendations were made in response to federal guidelines in the DRR process, an additional 85.2% of recommendations were initiated as a result of a broader medication review, including DSM activities. These results demonstrated that our pharmacist recommendations were accepted and valued by physicians, but they did not allow us to evaluate the CPG adherence rates for the patients we served.The objectives of this study were to evaluate (1) the end outcome of CPG adherence and (2) the process outcome of the number of care recommendations made for patients from LTCFs who received DSM pharmacy consulting services compared with patients who received traditional DRR pharmacy consulting services.ss Methods Study DesignA retrospective chart review was conducted on 411 patients at 6 LTCFs. Two facilities (107 patients) received DSM consultant pharmacist services (provided by Kristin K. Horning and James D. Hoehns) and 4 facilities (304 patients) received traditional DRR services. The 4 DRR (control) facilities constituted a convenience sample located within 30 miles of the 2 LTCFs that had consultant DSM pharmacy services. These control LTCFs had varying types of pharmacist consulting services, with 2 homes receiving corporate services (218 patients) and 2 homes receiving independent pharmacist consulting services (86 patients). While the homes receiving DSM services were both for-profit, 2 control homes were for-profit and 2 homes were nonprofit. All homes had both Medicare and Medicaid participation. The investigators believed that the control homes ...

Acceptance Rates for Pharmacist-Initiated Interventions in Long-Term Care Facilities

“…Interventions were divided into five categories according to the type of patient problem identified. These categories included [1] drug utilization, [2] pain management, [3] nurse or patient administered treatment of eye or skin conditions, [4] pharmacotherapy for mental health, and [5] nonpharmacotherapy for interventions that did not fit into a larger category. The drug utilization category interventions included addressing subtherapeutic or supratherapeutic doses, unnecessary medications, unwanted side effects, and drug-drug interactions.…”

“…These included [1] new medication initiation, [2] existing medication discontinuation, [3] current medication dose or regimen adjustment, and [4] reviews without changes. Results are summarized in Table 3.…”

“…Chronic disease states with specific clinical practice guidelines, including diabetes, hypertension, and stroke, are highlighted in a recent study as common diagnoses among LTC patients. 2 Adherence to these guidelines is extremely important for managing these diseases. Patients receiving disease state management services by pharmacists are four to seven times more likely to…”

Value of Conducting Pharmacy Residency Training—The Organizational Perspective

“…For example, one program created learning opportunities for pharmacy residents in a long-term care project, serving as consultants, which provided additional revenue to the program. 16 Administrative Service Support Pharmacy residents contribute to organizational and departmental leadership and management activities and may serve on committees, become involved in formulary review, or have chief or lead resident responsibilities that limit the administrative role of the pharmacy staff. 17 In 1982, Schneider and colleagues prepared a cost-justification evaluation of a hospital pharmacy residency training program.…”

Point-of-Care INR Determination, Coumadin Dosage Changes, and Use of a Historical, Self-Updating Database in a Prison

“…In the community, the benefits of a pharmacist-based anticoagulation clinic are well documented (Dobesh, Phillips, & Haines, 2008;Horning, Hoehns, & Doucette, 2007;Witt, Sadler, Shanahan, Mazzoli, & Tillman, 2005).…”