Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

Hanlon, Joseph T.; Lindblad, Catherine I.; Gray, Shelly L.

doi:10.1016/s1543-5946(04)90002-5

Cited by 116 publications

(63 citation statements)

References 33 publications

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“…For example, medication nonadherence, leading to poor disease control, also can lead to increased hospitalizations and can be an important driver of overall medical costs. 28 Although findings of some studies call into question the relationship between improved medication adherence and clinical outcomes or health care costs, 26,29 other studies have found a beneficial effect of adherence on clinical outcomes. 20,30 Recognizing drug interactions and adverse drug reactions are part of the expertise of a clinical pharmacist and may have contributed to minimizing ER visits in the intervention group as evidenced in other settings.…”

Section: A Prospective Trial Of a Clinical Pharmacy Intervention In Amentioning

confidence: 99%

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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BACKGROUND: There is evidence that pharmacist interventions improve clinical outcomes. The few studies that address economic outcomes (a) often report estimated instead of actual medical costs, (b) report only medication costs, or (c) have been conducted in settings that are not typical of community-based primary care.OBJECTIVES: To (a) determine whether a clinical pharmacist's recommendations to physicians regarding optimizing medication therapy are related to medical costs in capitated patients in an internal medicine practice, and (b) compare what primary care physicians (PCPs) in a comparison group actually did proactively to optimize medication therapy versus what a clinical pharmacist would have recommended to them.METHODS: This was a prospective, controlled study comparing 2 internal medicine practices. Study enrollment was performed using a screening process carried out every 1-2 weeks on a rolling basis for 1 year from July 2001 through June 2002. Eligibility criteria for prospective enrollment were (a) 1 or more risk factors: at least 1 chronic disease or an event (e.g., emergency room visit, adverse drug reaction, medication nonadherence) or aged 50 years or older, (b) a scheduled visit to see a PCP within 2 weeks from the screening date or a diagnosis of diabetes without a PCP visit during the first 6 months of the study, (c) need for optimization of medication therapy as determined by a clinical pharmacist on the screening date, and (d) 12 months of continuous insurance eligibility before enrollment in the study. For inclusion in the final study analyses, patients were also required to have continuous insurance eligibility through 12 months from study enrollment. One clinical pharmacist made recommendations to optimize medication therapy in the intervention group. For the comparison group, the same pharmacist proposed recommendations that remained concealed from the physicians. The primary outcome measure was per patient per year (PPPY) medical cost, based on plan liability (gross allow able costs minus patient costs), excluding prescription drug cost. Additional outcome measures included numbers of outpatient visits, hospital admissions, emergency room (ER) visits per 1,000 patients, and hospital days; and percent of recommendations that were accepted by the PCPs. Changes in outcome measures from the pre-intervention to postintervention period were compared across study groups in a difference-indifference analysis, using the Student's t-test for normally distributed data and the Mann-Whitney U-test (nonparametric) for skewed data.RESULTS: There were 127 and 216 adult patients in the intervention and comparison groups, respectively. The primary outcome, change in mean PPPY medical (excluding pharmacy) cost, did not differ significantly between the groups (P = 0.711). The between-group difference in the change in ER visits per 1,000 patients approached statistical significance (P = 0.054). Intervention group patients were more likely than comparison group patients to have the following issues...

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Section: A Prospective Trial Of a Clinical Pharmacy Intervention In Amentioning

confidence: 99%

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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“…Elderly patients are known to be more vulnerable to DRP due to age-related physiological changes that may change pharmacokinetics and pharmacodynamic properties of drugs and frequent comorbidities that require the prescription of multiple drugs (Chan et al, 2012). These factors generate polypharmacy, which is one of the major determinants of many DRP aspects, such as adverse drug events, drug interactions and inappropriate drug selection (Chan et al, 2012;Elliot et al, 2012;Hanlon et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Impact of pharmacy residents in pharmaceutical hospital care

Aguilera¹,

Matos²,

Ganassin

et al. 2015

Afr. J. Pharm. Pharmacol.

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The study aimed to identify and analyze drug-related problems (DRP), negative outcomes associated with medication (NOM) and the impact of pharmaceutical performance through interventions by pharmacy residents at the University Hospital of Campo Grande, Mato Grosso do Sul, Brazil. This retrospective, cross-sectional single-center study analyzed data registered in Pharmaceutical Intervention forms recorded by pharmacy residents between March 2011 and February 2012. DRP and NOM were classified according to the definitions proposed by the Third Consensus of Granada (2007). A total of 256 pharmaceutical interventions from 155 patients were registered, of which 50.78% were from patients of 60 years of age or above. Majority of interventions took place in the surgery wards, medical clinic and adult intensive care unit, with 89.06% of interventions being accepted. Among these interventions, 401 DRP, of which 21.07% were related to the probability of adverse effects, and 298 NOM, of which 33.87% were related to non-quantitative safety problems, were observed. Anti-infectives for systemic use were shown to be the group most often involved with DRP. Treatment effectiveness was the reason for intervention in 80.23% of forms. A close relationship between physicians and pharmacists ensures more rapid identification of prescription errors, possible adverse effects, DRP and NOM. Despite of the issue importance, the published studies on the topic remains scarce. The results of studies that evaluate DRP and NOM collaborate with the analysis of the pharmaceutical service provided to hospitalized patients in the present study.

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“…These students then may increase the amount of time spent counseling, which has been shown to improve patient outcomes. [28][29][30][31][32] Students also need to be aware of how the healthcare system functions in order to better understand the experiences of their patients. Many students have had limited experience as a "patient," since younger adults make American Journal of Pharmaceutical Education 2011; 75 (8) Article 158.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Geriatric Medication Game on Pharmacy Students’ Attitudes Toward Older Adults

Chen¹,

Plake²,

Yehle³

et al. 2011

American Journal of Pharmaceutical Education

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Objective. To examine the impact of participation in the Geriatric Medication Game on pharmacy students' perceptions of and attitudes toward older adults and familiarity with common disabilities that affect them and the process of seeking health care. Design. In the game, first-year pharmacy students "became" older adults during a 3-hour pharmacy practice laboratory. They were given aging-related challenges (eg, impaired vision or mobility) and participated as patients in simulated healthcare scenarios, such as a visit to a physician's office and a pharmacy. Assessment. After playing the game, students completed a 5-question reflection about their experiences and attitudes toward older adults. Content analysis was performed to identify themes from 4 years of student (n 5 625) reflections. Predominant themes included: improved attitudes toward older adults, better understanding of patient experiences, and increased willingness to provide assistance. Conclusions. Incorporating the Geriatric Medication Game into the pharmacy curriculum may facilitate students' understanding of the challenges that older adults face and improve future interactions.

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Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?

Cited by 116 publications

References 33 publications

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Impact of pharmacy residents in pharmaceutical hospital care

Impact of the Geriatric Medication Game on Pharmacy Students’ Attitudes Toward Older Adults

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