Drug therapy problems and medication discrepancies during care transitions in super-utilizers

Surbhi, Satya; Munshi, Kiraat D.; Bell, Paula C.; Bailey, James E.

doi:10.1016/j.japh.2016.07.004

Cited by 27 publications

(67 citation statements)

References 40 publications

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“…7,21 Among indirect methods, patient questionnaires such as Morisky medication adherence scale has been used in many studies and has produced reliable results for patients with hypertension and diabetes; 22 however, the accuracy and validity of this method remains uncertain in patients with multiple chronic conditions using multiple concurrent medications. 13 Adherence to Refills and Medication Scale (ARMS) is another patient-reported measure that can be used for chronic disease population and is a reliable medication adherence scale for patients with low literacy. 23 However, the drawback of using most patient-reported adherence measures is that they provide a subjective way to measure adherence and patients may obfuscate and provide desired answers, and also subject to recall bias.…”

Section: Methods To Measure Adherencementioning

confidence: 99%

“…11,13,14 Fisher and colleagues found that patients residing in low-income ZIP code areas were more likely to not fill their new prescriptions. 11 Additionally, in our previous study we found that more than 50% of vulnerable patients with MCC and polypharmacy (taking multiple medications concurrently for disease management), and those residing in medically underserved area, did not have all essential chronic and acute medications within three days of hospital discharge.…”

Section: Medication Adherencementioning

confidence: 99%

“…11 Additionally, in our previous study we found that more than 50% of vulnerable patients with MCC and polypharmacy (taking multiple medications concurrently for disease management), and those residing in medically underserved area, did not have all essential chronic and acute medications within three days of hospital discharge. 13 In another study by Kripalani and colleagues, who evaluated medication reconciliation problems among inner-city patients after hospital discharge, found that only 40% patients filled their medications on the day of their discharge, 20% filled them within 1-2 days, 18% waited for 3-9 days, and 22% did not fill them until 12 days after discharge.…”

Section: Medication Adherencementioning

confidence: 99%

“…16 Along with the issue of medication nonadherence, vulnerable patients with MCC and those experiencing frequent transitions of care are at far greater risk for drug therapy problems and adverse drug events (ADE). Following hospital discharge, nearly 81% of the hospitalized patients experience drug therapy problems, 13 14% to 75% of patients experience medication discrepancies, 13,17,18 and 11% to 30% of patients experience ADE of which about half are considered preventable or ameliorable. 19,20 Taken together, these study findings suggest that medication management is critical during the vulnerable period of care transitions, especially among patients who are at risk of drug therapy problems and medication nonadherence.…”

Section: Medication Adherencementioning

confidence: 99%

“…The major causes of medication discrepancies were higher number of comorbidities, difficulty in picking up and paying for medications, and transportation. 13 Additionally, Kripalani and colleagues found that medication costs and transportation served as major barriers to proper medication use after hospital discharge among innercity patients.…”

Section: Barriers To Medication Adherencementioning

confidence: 99%

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Medication Nonadherence, Health Care Utilization, and SafeMed Care Transitions Model Impact in Super-Utilizers

Surbhi¹

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Section: Methods To Measure Adherencementioning

confidence: 99%

Section: Medication Adherencementioning

confidence: 99%

Section: Medication Adherencementioning

confidence: 99%

Section: Medication Adherencementioning

confidence: 99%

Section: Barriers To Medication Adherencementioning

confidence: 99%

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Medication Nonadherence, Health Care Utilization, and SafeMed Care Transitions Model Impact in Super-Utilizers

Surbhi¹

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Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

Talon

Pérez

Yan

et al. 2019

J Am Coll Clin Pharm

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Studies evaluating the cost-effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient-level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies wereincluded. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non-randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59-95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost-effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence. K E Y W O R D Scost-benefit analysis, health services research, pharmacoeconomics, pharmacy

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Quality measures of clinical pharmacy services during transitions of care

King

Burkhardt

Rafferty

et al. 2021

J Am Coll Clin Pharm

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The impact of clinical pharmacy transitions of care (TOC) services on relevant quality measures (QMs) has been a major focus in the recent biomedical literature. The 2020 ACCP Transitions of Care Task Force was charged with updating a 2012 white paper that focused on process indicators of quality clinical pharmacy services during TOC. The Task Force extensively reviewed the recent literature and regulatory measures relevant to TOC services. Given the wide heterogeneity and apparent uncertainty in these measures, the Task Force identified a need to define broader groupings for QMs so that pharmacy TOC services could more be reliably compared across various institutions and practice settings. The Task Force recommends QMs for the processes used to identify, and ultimately resolve, medication discrepancies (QM‐1) and medication therapy problems (MTPs) (QM‐2). Although interventions through various processes can be used to resolve medication discrepancies and MTPs, the findings of these interventions are closely aligned with the major outcomes from these TOC services. Therefore, the Task Force strongly recommends that the successful resolution of medication discrepancies and MTPs be studied for their potential roles as intermediate, or surrogate, QMs (iQM‐1, iQM‐2, respectively) because these are most likely to directly influence or predict quality related to major outcomes from TOC services. In addition, three QMs related to major outcomes are recommended, which are consistent with the triple aim: QM‐3: Health Care Utilization (HCU), QM‐4: Satisfaction and Engagement, and QM‐5: Economics. QM‐3, QM‐4, and QM‐5 span patient‐centered outcomes to institutional, or clinician‐based, outcomes. Specific metrics used for each QM are recommended. In addition to highlighting confounding variables affecting findings in the recent literature, broader contextual considerations that may support TOC services or span multiple practice settings are summarized. Future studies must adopt standard QMs and seek to understand the potential of iQMs to accurately predict success within major patient‐centered and institutional outcomes.

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Drug therapy problems and medication discrepancies during care transitions in super-utilizers

Cited by 27 publications

References 40 publications

Medication Nonadherence, Health Care Utilization, and SafeMed Care Transitions Model Impact in Super-Utilizers

Medication Nonadherence, Health Care Utilization, and SafeMed Care Transitions Model Impact in Super-Utilizers

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

Quality measures of clinical pharmacy services during transitions of care

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