Pharmacist linkage in care transitions: From academic medical center to community

Bloodworth, Lauren S.; Malinowski, Scott S.; Lirette, Seth T.; Ross, Leigh Ann

doi:10.1016/j.japh.2019.08.011

Cited by 16 publications

(43 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[39][40][41] Most interventions included repeated consultations. 8,9,21,[24][25][26]28,32,33,35,37,38,40,41 Pharmacist-conducted medication reviews were evaluated in 12 RCTs. 22,25,[27][28][29][30][31][32]34,35,38 Within the context of continuous care, pharmacists developed or updated medication plans 22,25,28,33,41 and monitored HF medications with respect to guideline concordance or the medication appropriateness index (MAI).…”

Section: Pharmacist Interventionsmentioning

confidence: 99%

“…8,9,21,[24][25][26]28,32,33,35,37,38,40,41 Pharmacist-conducted medication reviews were evaluated in 12 RCTs. 22,25,[27][28][29][30][31][32]34,35,38 Within the context of continuous care, pharmacists developed or updated medication plans 22,25,28,33,41 and monitored HF medications with respect to guideline concordance or the medication appropriateness index (MAI). 23,27,28 They supported regular medication supply, for example, by filling dosing aids, 22,25,36,42 and coordinated discharge medication within transitions of care.…”

Section: Pharmacist Interventionsmentioning

confidence: 99%

See 1 more Smart Citation

The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta‐analysis

et al. 2021

View full text Add to dashboard Cite

Aims Patients with heart failure (HF) have poor outcomes, including poor quality of life, and high morbidity and mortality. In addition, they have a high medication burden due to the multiple drug therapies now recommended by guidelines. Previous reviews, including studies in hospital settings, provided evidence that pharmacist care improves outcomes in patients with HF. Because most HF is managed outside of hospitals, we aimed to synthesize the evidence for pharmacist care in outpatients with HF. Methods and resultsWe conducted a systematic literature search in PubMed of randomized controlled trials (RCTs) and integrated the evidence on patient outcomes in a meta-analysis. We found 24 RCTs performed in 10 countries, including 8029 patients. The data revealed consistent improvements in medication adherence (independent of the measuring instrument) and knowledge, physical function, and disease and medication management. Sixteen RCTs were included in meta-analyses. Differences in all-cause mortality (odds ratio (OR) = 0.97 [95% CI, 0.84-1.12], Q-statistic, P = 0.49, I 2 = 0%), all-cause hospitalizations (OR = 0.86 [0.73-1.03], Q-statistic, P = 0.01, I 2 = 45.5%), and HF hospitalizations (OR = 0.89 [0.77-1.02], Q-statistic, P = 0.11, I 2 = 0%) were not statistically significant. We also observed an improvement in the standardized mean difference for generic quality of life of 0.75 ([0.49-1.01], P < 0.01), with no indication of heterogeneity (Q-statistic, P = 0.64; I 2 = 0%). Conclusions Results indicate that pharmacist care improves medication adherence and knowledge, symptom control, and some measures of quality of life in outpatients with HF. Given the increasing complexity of guideline-directed medical therapy, pharmacists' unique focus on medication management, titration, adherence, and patient teaching should be considered part of the management strategy for these vulnerable patients.

show abstract

Section: Pharmacist Interventionsmentioning

confidence: 99%

Section: Pharmacist Interventionsmentioning

confidence: 99%

The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta‐analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…77,81,82 Studies with no significant reductions in 30-day HCU rates in any population have included small sample sizes or very narrow patient populations (eg, cardiac or pulmonary diagnoses only). 22,28,54,[83][84][85][86][87][88] Overall, adequate study power determination for general or targeted populations should limit the number of studies with nonsignificant results. Furthermore, because of wide variability in daily staffing, contributions from pharmacy team members (eg, specialists, generalists, residents, students, technicians), and overall extent and quality of services, it is prudent to assess the results that consider these likely confounders.…”

Section: Satisfaction Amentioning

confidence: 99%

“…Other studies have only found reduced rates in patients with moderate‐ to high‐risk disease identified by medication classes or admission diagnoses 77,81,82 . Studies with no significant reductions in 30‐day HCU rates in any population have included small sample sizes or very narrow patient populations (eg, cardiac or pulmonary diagnoses only) 22,28,54,83‐88 …”

Section: Quality Measures and Associated Metricsmentioning

confidence: 99%

Quality measures of clinical pharmacy services during transitions of care

King

Burkhardt

Rafferty

et al. 2021

J Am Coll Clin Pharm

View full text Add to dashboard Cite

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.

show abstract

“…However, the literature studies describing collaborative relationships between these care settings within pharmacy have demonstrated improved patient outcomes. 1,2,3 Still, best practices for establishing such partnerships on a broader scale have not, to our knowledge, been addressed. Consensus recommendations, or Guiding Statements, for establishing partnerships across care settings have recently been described.…”

mentioning

confidence: 99%

Building a transformative partnership between health‐system and community‐based pharmacies

Vest

Clifton²,

Cochran

et al. 2020

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Purpose Health‐system pharmacists and community‐based pharmacists have long held professional relationships. However, the success of each group is often not interdependent and aligned. In 2018, the American College of Clinical Pharmacy (ACCP), CPESN USA, and the National Community Pharmacists Association (NCPA) Innovation Center led a meeting to build patient‐centered pharmacist teams to achieve medication optimization across care settings. Seven community pharmacists and health‐system/clinic‐based pharmacist teams participated in this meeting and left with the intentional commitment to build sustainable partnerships. This report describes the establishment of this partnership, and the subsequent application of Guiding Statements for these collaborations. This report also describes both the successes realized and the lessons learned, and to serve as practical recommendations for institutions interested in pursuing similar partnerships. Results Initial learnings from these partnerships have provided a proof of concept that an intentional approach to the relationship between a health‐system/clinic‐based pharmacist and community‐based pharmacist can lead to improvements in patient care as well as a professional collaboration. We experienced improved communication and closed‐loop care, improved professional relationships across care settings, and enhanced clinical services. However, these partnerships were not without challenges. For instance, lack of interoperability and limited electronic health record access made certain outcomes difficult to track. Conclusion The purposeful establishment of partnerships between health‐system/clinic‐based pharmacists and community‐based pharmacists, built upon the needs of both entities, allowed institutions to develop an aligned commitment to care for shared patients. Over the initial years of these partnerships, many successes were realized and lessons were learned. Both the successes and the challenges can serve as beneficial resources for institutions interested in developing similar partnerships.

show abstract

Pharmacist linkage in care transitions: From academic medical center to community

Cited by 16 publications

References 22 publications

The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta‐analysis

The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta‐analysis

Quality measures of clinical pharmacy services during transitions of care

Building a transformative partnership between health‐system and community‐based pharmacies

Contact Info

Product

Resources

About