Types of Interventions Made by Clinical Pharmacists in the IMPROVE Study

Abstract

The purpose of this study was to describe and evaluate the activities and interventions provided by ambulatory care clinical pharmacists during the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) study. A total of 523 patients were randomized into the intervention arm at nine Veterans Affairs medical centers if they were considered to be at high risk for drug-related problems. Patients randomized to the control group had no interventions and they are not reported. Using a standard form, pharmacists were asked to document the length of visit, method of contact, medical conditions addressed, and drug-related problems addressed and resolved during each contact. Seventy-eight ambulatory care clinical pharmacists documented 1855 contacts over 12 months, an average of 3.54 +/- 2.31/patient. The length of visits was 15 minutes or more for 73% of contacts. In-person contacts accounted for 1421 visits (76.6%), with the remainder being telephone contacts. During each contact the average number of drug-related problems addressed and resolved were 1.64 +/- 1.16 and 1.14 +/- 0.98, respectively. More drug-related problems were addressed and resolved when visits were 15 minutes or longer (p=0.001) and when the contact was in person (p=0.001). These data may provide information to clinical pharmacists developing pharmacy-managed clinics for patients at high risk for drug-related problems. The information may be a benchmark for types of interventions that can be made, as well as the time commitments required to make them.

Drug-related problems in elderly general practice patients receiving pharmaceutical care†

“…The reviewers identified a total of 20 citations as potentially meeting inclusion criteria. 14,19,[41][42][43][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] Inclusion and exclusion criteria were applied to the full articles, which resulted in exclusion of four articles 19,49,54,59 leaving a total of 16 articles. The agreement rate between reviewers for study selection was 92.7% (76/82) after title review, 92.2% (47/50) after abstract review, and 75% (15/20) after full article review.…”

“…This systematic overview summarises the DRP, recommendation, and outcomes data for the remaining nine studies. [41][42][43][44][45]50,51,53,55,58 Characteristics of the included studies are presented in Table 1.…”

“…From the eight studies that summarised demographic information, patients had a mean age of 66.8 to 83.5 years, with the proportion of women ranging from 1.9 to 79.3%. [41][42][43][44][45]50,51,53,58 Based on available data from the individual studies, patients had an average of 7.6 chronic medical conditions and were taking an average of 6.8 medications. 41,50,51,53,58 Six studies were based in the community (community pharmacies or outpatient general medicine clinics), 41,[43][44][45]50,51,53 two studies were conducted in hospital (general medicine ward), 55,58 and one study was conducted in a nursing home.…”

“…43,44 In Ellis et al, taking a non-formulary drug was excluded for technical reasons in 64 cases (2.1%). 45 The frequency with which each Hepler and Strand DRP category was identified in patients who received the pharmaceutical care intervention was calculated. Data were analysed separately for studies that reported DRP frequencies at the patient level (percentage of patients with each type of DRP).…”

Prescription Pattern Analysis of Antidiabetic Drugs in Diabetes Mellitus and Associated Comorbidities

“…Apart from the treatment with medicines diabetes also requires life style modifications which rely upon diet and regular exercise [14].…”