Impact of a clinical pharmacist on provider prescribing patterns in a primary care clinic

Wei, Enoch P.; Gregory, Patrick; Halpern, David J.; Felton, Makeba; Goldstein, Benjamin A.; Yeatts, John; Shah, Komal; Smith, Ben

doi:10.1016/j.japh.2021.10.007

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…While published data on this specific subject is limited, the results of our study are consistent with a previous study showing increased prescribing of these medications with pharmacist involvement in care. 31 The previous study contrasts with ours because the focus of the previous study was on PCP prescribing and excluded pharmacist prescribing, whereas our study evaluated all prescriptions including those by pharmacists. Furthermore, we found in our study that CPS were responsible for a large proportion of prescribing.…”

Section: Discussionmentioning

confidence: 87%

“…Results from a previous study found a 29 percent increase in prescribing rates of SGLT2i and GLP-1 receptor agonist when a clinical pharmacist was embedded in a primary care clinic (11.6% without a pharmacist compared to 15.0% with a pharmacist). 31 Assuming a similar rate of prescribing of study medications, a sample size of approximately 3100 patients was needed to detect a similar difference between groups with a power of 80% and a two-sided alpha of .05. This study was approved by the local institutional review board and was conducted in accordance with ethical standards for studies involving human subjects.…”

Section: Methodsmentioning

confidence: 99%

“…29,30 Additionally, clinical pharmacists have been shown to positively impact the prescribing of beneficial DM medications by PCP. 31…”

Section: Introductionmentioning

confidence: 99%

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Clinical Pharmacy Specialist Collaborative Management and Prescription of Diabetes Medications with Cardiovascular Benefit

Ballister

Hernandez

Quffa

et al. 2022

Journal of Pharmacy Practice

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Background Involvement of Clinical Pharmacy Specialists (CPS) in the care of patients with diabetes mellitus (DM) has been demonstrated to be beneficial. Whether this positive impact applies to increased use of cardiovascular risk-reducing medications is less well established. Objective To determine the association of CPS co-management on the prescription of diabetes medications with proven cardiovascular benefits for patients with DM and established cardiovascular disease in the primary care setting. Methods This retrospective cohort study evaluated patients in a Veterans Affairs health-system in primary care settings from February 1, 2019, through January 31, 2020. Patients were included if they had type 2 DM treated with at least one medication and had CVD. Patients were grouped into two cohorts for comparison, those with CPS co-management and those without. The primary outcome was the proportion of patients in each group with new prescriptions for empagliflozin or liraglutide initiated during the study timeframe. Results In total, 8058 patients were found eligible for inclusion in the study. Clinical co-management by a CPS was provided to 2099 patients. Study medications were prescribed, approved, and initiated in 596 patients during the study period, including 391 (18.6%) in the CPS group and 205 (3.4%) in the non-CPS group (P < .001). Conclusion This study showed CPS involvement is associated with increased prescribing of diabetes medications with proven cardiovascular benefits.

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Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Pharmacy Specialist Collaborative Management and Prescription of Diabetes Medications with Cardiovascular Benefit

Ballister

Hernandez

Quffa

et al. 2022

Journal of Pharmacy Practice

View full text Add to dashboard Cite

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“…We are unable to account for interventions made by other members of the interprofessional team, and it is possible that pharmacist presence in the clinic influences prescribing practices across physicians in the office even when the patient was not directly seen by the pharmacist. 16 Lastly, we did not evaluate patient medications, renal function, body mass index, incidence of hypoglycemia, acute care visits, or precise timing of the pharmacist encounter; in the future, these may be components to evaluate for stratification purposes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ambulatory Care Pharmacist-Led Diabetes Mellitus Management on Hemoglobin A1c Values Among Patients With Diabetes in a Primary Care Clinic Over Two Years

et al. 2022

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Background: Previous evaluation in the literature of ambulatory care pharmacist management on glycosylated hemoglobin (HgbA1c) has been positive, but often limited to 6 to 12 months of follow up. Objective: The objective of this study is to evaluate the impact of an ambulatory care pharmacist on HgbA1c among patients with diabetes in a primary care clinic over two years. Methods: Retrospective chart review was conducted on patients with type 2 diabetes managed by the ambulatory care pharmacist. Patients with at least one HgbA1c value ≥7% in the two-year pre-intervention period were included. The primary outcome was the change in mean HgbA1c from baseline to two years post-intervention. The secondary outcome was the change in mean of all HgbA1c values over two years pre-intervention compared to two years post-intervention. Results: Data for 116 patients was analyzed two years prior to and two years after ambulatory care pharmacist service initiation. The mean HgbA1c at baseline pre-intervention was 8.8% compared to a mean HgbA1c of 7.8% two years post-intervention. A total of 12.9% of patients (n=15) had a baseline HgbA1c of less than 7% pre-intervention, compared to 42.2% of patients (n=49) two years post-intervention (p<0.001). The overall mean HgbA1c was 8.8% in the two-year pre-intervention period and 8.2% in the two-year post-intervention period (p<0.001). Among patients with an overall mean HgbA1c ≥8% in the pre-intervention period, the mean HgbA1c was 9.8% pre-intervention and 8.7% post-intervention. Conclusion: Ambulatory care pharmacist interventions demonstrated a significant impact on HgbA1c reduction over two years of follow up.

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“…The physician-pharmacist collaborative clinics were first introduced in the United States, aiming to optimize medical treatment and reduce medical expenses (Hammad et al, 2011;Wei et al, 2022). The mode of physician-pharmacist collaboration was based on Medication Therapy Management (MTM), a service provided by pharmacists to ensure optimum therapeutic outcomes for individualization by reducing the risk of adverse events, improving patient medication compliance and quality of care (Oladapo and Rascati, 2012;Miller et al, 2016;Brandt and Cooke, 2017;Song et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study

et al. 2023

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Background: Physician-pharmacist collaboration is a well-established care mode for the management of type 2 diabetes mellitus (T2DM) in developed countries, but no study has been conducted in primary healthcare in China. This study aims to evaluate the effects of physician-pharmacist collaborative clinics to manage T2DM in primary healthcare in China, and to better understand the factors influencing the implementation of physician-pharmacist collaborative clinics.Methods: Two hundred and sixty-seven patients involved in a 12-month randomized controlled trial were assigned to physician-pharmacist collaborative clinics and usual clinics, completing surveys regarding medication compliance, quality of life (QoL) and care-seeking behavior at the baseline, 3rd, 6th, 9th and 12th month respectively, and diabetes knowledge at baseline and 12th month. A sample of twenty-two Patients, nine physicians and twelve pharmacists participated in semi-structured face-to-face interviews. The quantitative and qualitative data was integrated by triangulation.Results: Patients in physician-pharmacist collaborative clinics had significant improvements in medication compliance (p = 0.009), QoL (p = 0.036) and emergency visits (p = 0.003) over the 12-month. Pairwise comparison showed the medication compliance score in the intervention group had been significantly improved at 3rd month (p = 0.001), which is more rapidly than that in the control group at 9th month (p = 0.030). Factors influencing the implementation of physician-pharmacist collaborative clinics were driven by five themes: pharmaceutical service, team-base care, psychological support, acceptability of care and barriers to implementation.Conclusion: Integration of quantitative and qualitative findings showed the effectiveness of physician-pharmacist collaborative clinics in patient medication compliance and QoL in primary healthcare. The qualitative study uncovered barriers in insufficient clinical experience and understaffing of pharmacist. Therefore, the professional training of the primary pharmacist team should be improved in the future.Clinical Trial Registration:clinicaltrials.gov, identifier ChiCTR2000031839.

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Impact of a clinical pharmacist on provider prescribing patterns in a primary care clinic

Cited by 9 publications

References 20 publications

Clinical Pharmacy Specialist Collaborative Management and Prescription of Diabetes Medications with Cardiovascular Benefit

Clinical Pharmacy Specialist Collaborative Management and Prescription of Diabetes Medications with Cardiovascular Benefit

Impact of Ambulatory Care Pharmacist-Led Diabetes Mellitus Management on Hemoglobin A1c Values Among Patients With Diabetes in a Primary Care Clinic Over Two Years

Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study

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