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How a State Measures Up: Ambulatory Care Pharmacists' Perception of Practice Management Systems for Comprehensive Medication Management in Utah.

ABSTRACT: Comprehensive medication management (CMM) is a patient-centered standard of care that ensures a patient's medications are optimized. The CMM Practice Management Assessment Tool (PMAT) is a tool to assess areas of CMM practice management. The purpose of this project was to assess the state of CMM practice management based on clinical pharmacist perception for two health systems in the state of Utah, and to identify areas of excellence and/or improvement utilizing a novel method for PMAT analysis. The PMAT was distributed to all primary care-focused ambulatory care pharmacists employed by University of Utah Health (U of U Health) and Intermountain Healthcare (Intermountain). Ordinal responses were assigned to three possible categories of CMM support (High, Indifferent, and Low). Ten surveys were completed from U of U Health, and nine were completed from Intermountain. Thirty-two of the 86 survey questions resulted in a high level of support, and 25 questions resulted in a low level of support from the majority of respondents. Statistically significant differences between the institutions were found for 18 questions. The utilization of the PMAT within two Utah health systems highlighted areas of excellence and improvement and demonstrates a unique method for analysis of PMAT results.

SUBMITTER: Turner K

PROVIDER: S-EPMC7559078 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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How a State Measures Up: Ambulatory Care Pharmacists' Perception of Practice Management Systems for Comprehensive Medication Management in Utah.

Turner Kyle K Abbinanti Alan A Winter Bradly B Berrett Benjamin B Olson Jeff J Cox Nicholas N

Pharmacy (Basel, Switzerland) 20200801 3

Comprehensive medication management (CMM) is a patient-centered standard of care that ensures a patient's medications are optimized. The CMM Practice Management Assessment Tool (PMAT) is a tool to assess areas of CMM practice management. The purpose of this project was to assess the state of CMM practice management based on clinical pharmacist perception for two health systems in the state of Utah, and to identify areas of excellence and/or improvement utilizing a novel method for PMAT analysis. ...[more]

PMID: 32752207

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Project description:BackgroudWith the reform of medical system in China, Beijing municipal hospitals explored a new pharmaceutical care model and set up medication therapy management services (MTMs) in ambulatory care since 2019. We were one of the first hospitals to set up this service in China. At the present, there were relatively few reports about the effect of MTMs in China. In this study, we summarized the implementation of MTMs in our hospital, explore the feasibility of pharmacist-led MTMs in ambulatory care and the impact of MTMs on patients' medical costs.MethodsA retrospective study was conducted in a university-affiliated, tertiary comprehensive hospital in Beijing, China. The patients who received at least one MTMs and with complete medical records and pharmaceutical documents from May 2019 to February 2020 were included. Pharmacists provided pharmaceutical care for patients according to the MTMs standards issued by the American Pharmacists Association, identified the numbers and classification of the patients' perceived medication-related demands, identified medication-related problems (MRPs), and developed the medication-related action plans (MAPs). All MRPs found by pharmacists, pharmaceutical interventions, and resolving recommendations were documented, and calculate the cost of treatment drugs that patients can reduce.ResultsA total of 112 patients received MTMs in ambulatory care, among them 81 cases with the completed record were included in this study. 67.9% of patients had five or more diseases, 83% of them co-took over 5 drugs. While performing MTMs, 128 patients' perceived medication-related demands were recorded in all, monitoring and judgment of adverse drug reaction (ADR) (17.19%) was the most common demand. 181 MRPs were found, with an average of 2.55 MPRs per patient. Nonadherence (38%), excessive drug treatment (20%), and adverse drug events (17.12%) were the top three MRPs. Pharmaceutical care (29.77%), adjustment of drug treatment plan (29.10%) and referral to the clinical department (23.41%) were the top three MAPs. Whereby the MTMs provided by pharmacists, the cost-saving of each patient was about $ 43.2 monthly.ConclusionBy participating in the MTMs of outpatients, the pharmacists could identify more MRPs and develop personalized MAPs timely for patients, thereby promoting rational drug use and reducing medical expenses.

Project description:IntroductionThe use of medication therapy management (MTM) is a proven method for reducing medication errors. MTM services rely heavily on pharmacists as service providers, particularly in community health centers (CHCs). Thus, understanding the knowledge, attitudes, and practices (KAP) of MTM among pharmacists in CHCs is crucial to the strategy for the implementation of MTM program in Indonesia. This study aimed to assess the level of KAP regarding MTM among pharmacists working at CHCs and its associated factors and investigate pharmacists' perceptions of the barriers and facilitators of MTM provision in the future.MethodsA cross-sectional online survey was conducted. The respondents were pharmacists working at CHCs in 28 provinces in Indonesia. Descriptive statistics were used to summarize the responses. Demographic differences were determined using Chi-square and Kruskal-Wallis tests, and associations were identified using multivariable ordinal regression for knowledge and multivariable logistic regression for attitude and practice. Barriers and facilitators were determined from codes and categories of frequency derived from pharmacists' responses to the open-ended questions.ResultsOf the 1,132 pharmacists, 74.9% had a high level of knowledge, 53.6% had a positive attitude, and 57.9% had a positive practice toward MTM. Gender, practice settings, province of CHCs, years of practice, and experience in MTM services were factors associated with the KAP level. Respondents perceived that the chronic disease conditions in Indonesia, MTM service features, and current practices were facilitators of MTM provision. The lack of interprofessional collaboration, staff, pharmacist knowledge, patient cooperation, facilities/drug supply/documentation systems, stakeholder support, and patient compliance were the most common barriers to MTM implementation in the future.ConclusionMost of the pharmacists had high knowledge of MTM; however, only half had positive attitudes and practices toward MTM. Information about factors associated with the KAP level suggests that direct involvement is essential to improve pharmacists' understanding and view of MTM. Pharmacists also perceived barriers to the MTM provision in the future, such as interprofessional and pharmacist-patient relationships. A training program is needed to improve the KAP of MTM and develop skills for collaborating with other healthcare professionals and communicating with patients.

Project description:BackgroundThe health risks associated with poor medication practices in the home suggest that patients would benefit from home-based medication reviews that could detect and resolve these issues. However, remuneration for home visits often excludes ambulatory, nonhomebound patients. A subset of these patients have issues that cannot be adequately identified and resolved during the course of a typical pharmacy-based medication review.PurposeThis study aims to characterize the prevalence and nature of "hidden in the home" medication management issues in nonhomebound patients.MethodsPharmacists facilitated subject enrollment among patients at 6 community pharmacies in Toronto over a 15-month period, from January 2016 to March 2017. Patients taking 5 or more chronic medications who were ambulatory (able to visit the pharmacy) and scored 3 points or higher on a prescreening questionnaire were invited to participate. Visits included a standard medication review, the identification of drug therapy problems and an assessment of the patient's medication and organization/storage practices, followed by a medication cabinet cleanup.ResultsOne hundred patients were recruited, with a mean age of 76.9 years and taking on average 10 chronic medications. Pharmacists identified a total of 275 drug therapy problems (2.75 per patient). The most common issues reported additional therapy required (23.6%), nonadherence (23.3%) and adverse drug reactions (17.8%). For those patients 65 years or older (87%), 32% were found to be using at least 1 medication on the Beers Criteria list, while 6% were using 3 or more. Sulfonylureas, non-steroidal anti-inflammatory drugs and short-acting benzodiazepines were the most commonly implicated drugs. Medications were removed from the homes of 67% of the patients, with expiry of medication being the most common reason for removal (54.2%). The mean duration of a home visit was 49.5 minutes.ConclusionPharmacist-directed home medication reviews offer an effective mechanism to address the pharmacotherapy issues of patients taking multiple medications. These findings highlight the frequency of medication management issues in this group and suggest that home medication reviews could serve to minimize inappropriate use of medication and maximize health care cost savings in this unique patient population. Can Pharm J (Ott) 2019;152:xx-xx.

Project description:BackgroundWith the approval of biosimilars for subcutaneously administered products, such as adalimumab, etanercept and insulin, biosimilars become increasingly available in ambulatory care. Little is known about the knowledge and attitudes of healthcare providers who are in charge of dispensing and prescribing biosimilars in this context. This study aims to assess the knowledge and perception about biosimilars among community pharmacists and physicians.MethodsBelgian community pharmacists (n = 177) and physicians (n = 30) were surveyed on their knowledge, experience with dispensing/prescribing biologicals including biosimilars, perception regarding interchangeability, switching and substitution and informational and educational needs. Descriptive and statistical analyses were performed.ResultsOnly 32% of community pharmacists and 52% of physicians had yet dispensed/prescribed a biosimilar. Approximately 35% of community pharmacists felt insufficiently trained to counsel patients with biosimilar therapy, which was significantly higher compared to their self-assessed competence to counsel patients with biological therapy in general (p = 0.023). Community pharmacists experienced questions about similarity between reference products and biosimilars (47%) and their interchangeability (42%). Over 40% of physicians found patient uncertainty about efficacy and safety challenging when prescribing biosimilars. A similar proportion of physicians would only prescribe a biosimilar in indications for which the biosimilar has been tested clinically. The majority of pharmacists (58%) was in favor of substitution of biologicals, on the condition that the prescriber would be contacted. Also over 40% of physicians was open to this approach in case of substitution. Educational support, budget for additional staff and transparency about savings were considered suitable stimuli to incentivize biosimilar use. The need for information about biologicals including biosimilars was nearly unanimous among community pharmacists. Also 67% of physicians requested more information. Both community pharmacists and physicians preferred to be informed by their respective professional associations.ConclusionsThis study showed a substantial need for targeted educational measures to increase the knowledge and confidence about both biological medicines in general and biosimilars in particular among Belgian community pharmacists and physicians. The results may inform educational and policy measures to stimulate biosimilar use in ambulatory care.

Dataset Information

How a State Measures Up: Ambulatory Care Pharmacists' Perception of Practice Management Systems for Comprehensive Medication Management in Utah.

Publications

How a State Measures Up: Ambulatory Care Pharmacists' Perception of Practice Management Systems for Comprehensive Medication Management in Utah.

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