Creating a Pharmacotherapy Collaborative Practice Network to Manage Medications for Children and Youth: A Population Health Perspective

Abstract

Children with special health care needs (CSHCN) use relatively high quantities of healthcare resources and have overall higher morbidity than the general pediatric population. Embedding clinical pharmacists into the Patient-Centered Medical Home (PCMH) to provide comprehensive medication management (CMM) through collaborative practice agreements (CPAs) for children, especially for CSHCN, can improve outcomes, enhance the experience of care for families, and reduce the cost of care. Potential network infrastructures for collaborative practice focused on CSHCN populations, common language and terminology for CMM, and clinical pharmacist workforce estimates are provided. Applying the results from the CMM in Primary Care grant, this paper outlines the following: (1) setting up collaborative practices for CMM between clinical pharmacists and pediatricians (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations.

Conceptually-Theoretical Justification and Updating of the Preventive Approach in the Implementation of a Pharmacist’s Information Consultancy Services in the Public Health System

“…Коллеги из Турции [11] и Японии [12] доказывают необходимость фармацевтического знания в профилактике проблем фармакотерапии в гериатрии. Американские коллеги обосновывают значимость фармацевтической информации в охране детского здоровья и выборе безопасной фармакотерапии в детской практике [13,14]. Ученые из университета Астон, Бирмингем, (Великобритания) в своих работах актуализируют необходимость фармацевтического, медицинского и педагогического сотрудничества с целью достижения максимальной терапевтической пользы у педиатрических пациентов с хроническими заболеваниями [15].…”

“…Методология ПФК основана на теории индивидуального подхода к пациенту при выборе фармакотерапии: «Разные больные по-разному реагируют на один и тот же лекарственный препарат, поэтому каждое на- значение нужно рассматривать как эксперимент, в ходе которого должна быть проверена гипотеза об индивидуальной эффективности и безопасности лекарственного средства». 12 Ученые фармакологи отмечают, что особое значение в организации медицинской помощи имеет индивидуальный подход к фармакотерапии, который базируется на особенностях соотношений клинических эффектов ЛС с фармакодинамическими и фармакологическими процессами [27] и приверженности пациента врачебным назначениям («Лекарства не будут работать, если их не принимать» 13 ). Вместе с тем, организаторы фармацевтического дела, рассматривают фармацевтическое консультирование как составную часть фармацевтической и медицинской помощи, целью которой выступает сохранение здоровья пациента посредством удовлетворения потребностей в рациональной фармакотерапии и соблюдения правил использования ЛП.…”

Opportunities for Comprehensive Medication Management (CMM) for Children with Special Healthcare Needs and Medical Complexity (CSHCN-CMC): The Methodology of a Prospective Case Series within a Collaborative Practice Agreement (CPA)

“…CSHCN-CMC often are administered multiple medications, many of which are liquid compounded nonsterile preparations (pCNSPs) [16,17]. Assuring continuity of care at care transitions for safe medication management has been identified as an often-daunting task for parents, caregivers, and the patient's healthcare team [18][19][20][21][22][23][24][25][26][27]. Suggestions for implementing, sustaining, and improving medication management have been forwarded in order to encourage development of a child-friendly medication use system, including…”

Making Meaningful Improvements in Pharmacotherapy and Medication Management for Children and Youth—A Modest Proposal

“…The Special Issue, “Development of a National Pediatric Pharmacotherapy Collaborative Practice Network,” has illuminated the vital global need for better care coordination and interprofessional collaboration in pharmacotherapy and medication management of children with medical complexity and special healthcare needs (CSHCN-CMC). From a population health perspective, we identified how coordination and outcomes might be improved from both practice and research perspectives, and what tools exist to assist clinical pharmacists and pediatricians to build more durable and sustainable comprehensive medication management practices around the world [1,2]. The work of the Professional Compounding Centers of America (PCCA) group [3] and ‘GOLDILOKs’ (Genome and Ontogeny-Linked Dose Individualization and cLinical Optimization for KidS) Clinic [4] illustrated personalized approaches to identifying, understanding, and responding to these patients’ unique drug therapy needs with evidence-based compounded formulations and genome-informed care planning.…”