Achieving blood pressure control among renal transplant recipients by integrating electronic health technology and clinical pharmacy services

Introduction The contributions of transplant pharmacists to clinical and translational research in the United States are ill‐defined and have not been systematically reviewed. Objectives The American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network conducted a systematic review of available pharmacist‐led research publications involving solid organ transplantation with the intent to quantify and describe pharmacist‐led research endeavors and their changes over time. Methods An electronic search of Scopus was conducted to identify publications in the field of solid organ transplantation by pharmacist authors between January 1, 1975 and May 25, 2017. Articles were excluded if they were written in non‐English languages or originated from non‐US countries. Review articles, case reports, surveys, basic science research, pre‐clinical studies, and non‐transplant research were further excluded. Studies were categorized as one of four phases on the clinical and translational research spectrum, adapted from the Harvard Clinical and Translational Science Center description of a T1 to T4 classification system. Results A total of 10 354 publications were identified by the systematic search with 547 full‐text English‐language publications included in the analysis. Pharmacists served as the first author in 87% of the articles and as the senior author in 67% of the articles. A total of 71% of the articles included more than one pharmacist author. Transplant pharmacists published more studies that employed a retrospective or observational study design (55% and 78%, respectively). A total of 37% of studies were funded. On the spectrum of clinical and translation research, pharmacists were most involved in T3 (translation to practice) research (72%), followed by T2 (translation to patients) research (23%). Conclusions Transplant pharmacists are increasingly represented in the US literature and frequently published across domains. Further demonstrating the relevance of pharmacist‐delivered interventions and outcomes is a critical area of practice focus.

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“…Of the 547 publications reviewed, only 10 papers (1.8%) focused on pharmacist‐delivered interventions and their outcomes (Table 4). 6‐15 …”

Section: Resultsmentioning

confidence: 99%

Observations from a systematic review of pharmacist‐led research in solid organ transplantation: An opinion paper of the American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network

Pilch

Park

Lichvar

et al. 2020

J Am Coll Clin Pharm

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“…Zullig pilots a medication calendar that incorporates reminders using Meducation ®; technology (Zullig et al, 2014 ). Chan evaluates the effects of using electronic monitoring devices for adherence to inhaled corticosteroids, whilst Migliozzi looks at controlling blood pressure using home monitoring (Chan et al, 2015 ; Migliozzi et al, 2015 ). Sayner compares self-reported adherence data with information collected form a medication event monitoring system (Sayner et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

A Scoping Review of the Quality and the Design of Evaluations of Mobile Health, Telehealth, Smart Pump and Monitoring Technologies Performed in a Pharmacy-Related Setting

et al. 2018

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Background: There is currently a need for high quality evaluations of new mobile health, telehealth, smart pump and monitoring technologies undertaken in a pharmacy-related setting. We aim to evaluate the use of these monitoring technologies performed in this setting.Methods: A systematic searching of English articles that examined the quality and the design of technologies conducted in pharmacy-related facilities was performed using the following databases: MEDLINE and Cumulative index to Nursing and Allied Health Literature (CINAHL) to identify original studies examining the quality and the design of technologies and published in peer-reviewed journals. Extraction of articles and quality assessment of included articles were performed independently by two authors. Quality scores over 75% are classed as being acceptable using a “relatively conservative” quality benchmark. Scores over 55% are included using a “relatively liberal” cut-off point.Results: Screening resulted in the selection of 40 formal evaluations. A substantial number of studies (32, 80.00%) were performed in the United States, quantitative in approach (33, 82.50%) and retrospective cohort (24, 60.00%) in study design. The most common pharmacy-related settings were: 22 primary care (55.00%); 10 hospital pharmacy (25.00%); 7 community pharmacy (17.50%); one primary care and hospital pharmacy (2.50%). The majority of the evaluations (33, 82.50%) reported clinical outcomes, six (15.00%) measured clinical and economic outcomes, and one (2.50%) economic only. Twelve (30.00%) quantitative studies and no qualitative study met objective criteria for “relatively conservative” quality. Using a lower “relatively liberal” benchmark, 27 quantitative (81.82%) and four qualitative (57.41%) studies met the lower quality criterion.Conclusion: Worldwide, few evaluations of mobile health, telehealth, smart pump and monitoring technologies in pharmacy-related setting have been published.Their quality is often below the standard necessary for inclusion in a systematic review mainly due to inadequate study design.

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“…The nonadherence to clinical guidelines represented by both overuse and underuse provides opportunities to improve patient care in a cost-effective manner. In particular, pharmacists can lead the development and implementation of standardized order sets, 31–33 collaborative practice agreements, 34 or other innovative pharmacy services 35,36 to improve guideline adherence for G-CSF use at their institutions. Future research should (1) examine the association between physician-level characteristics and pegfilgrastim use in a nationally representative sample of linked clinical and administrative data to steer future updates to clinical guidelines; (2) assess interventions to improve pegfilgrastim underuse and overuse; namely, implementation of order sets in existing computerized physician order entry systems that default to include G-CSF for all regimens with FN risk ≥ 20% and omit G-CSF for regimens with a risk < 20% or with palliative intent; and (3) assess the risk of FN in clinical practice for patients receiving G-CSF for primary prophylaxis according to guideline recommendations versus those who are eligible, but not receiving G-CSF.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia

Zullo

Lou

Cabral

et al. 2018

J Oncol Pharm Pract

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Introduction Guidelines recommend pegfilgrastim for primary prophylaxis of febrile neutropenia after highly myelosuppressive chemotherapy. While deviations from guidelines could result in overuse and increased costs, underuse is also a concern and could compromise quality of care. Our objectives were to evaluate guideline adherence and quantify the extent to which physician heterogeneity may influence pegfilgrastim use. Methods We randomly sampled 550 patients from a retrospective cohort of those who received infusions at an academic cancer center between 1 September 2013 and 1 September 2014. Electronic medical and drug dispensing records provided information on patient characteristics, chemotherapy characteristics, prescribing physician, and pegfilgrastim administration. Results We included 154 patients treated by 25 physicians. About half of patients were male and mean age was 61.3 years. Forty (26.1%) patients had no febrile neutropenia risk factors, 62 (40.5%) had one, and 51 (33.3%) had two or more. Thirty patients (19.5%) received pegfilgrastim, of which 12 (40%) received palliative chemotherapy. Nine (60%) of 15 patients on a regimen with a febrile neutropenia risk ≥ 20% received pegfilgrastim. Pegfilgrastim use significantly varied by cancer type (p < 0.01), chemotherapy regimen (p < 0.001), and regimen febrile neutropenia risk (p < 0.001). Multivariable analysis reaffirmed the association between chemotherapy regimen febrile neutropenia risk ≥ 20% and pegfilgrastim use (odds ratio (OR) = 10.1, 95% confidence interval (CI): 1.6-62.7) and suggested that 31% (95% CI: 8%-71%) of the variation in use was attributable to physician characteristics. Conclusion Pegfilgrastim was potentially overused for palliative chemotherapy and underused for chemotherapy regimens with febrile neutropenia risk ≥ 20%. Successful interventions to modify prescribing practices likely require an understanding of the relationship between specific physician characteristics and pegfilgrastim use.

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Achieving blood pressure control among renal transplant recipients by integrating electronic health technology and clinical pharmacy services

Cited by 14 publications

References 11 publications

Observations from a systematic review of pharmacist‐led research in solid organ transplantation: An opinion paper of the American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network

Observations from a systematic review of pharmacist‐led research in solid organ transplantation: An opinion paper of the American College of Clinical Pharmacy Immunology/Transplantation Practice and Research Network

A Scoping Review of the Quality and the Design of Evaluations of Mobile Health, Telehealth, Smart Pump and Monitoring Technologies Performed in a Pharmacy-Related Setting

Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia

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