Impact and Feasibility of Implementing a Systematic Approach for Medication Therapy Management in the Community Pharmacy Setting: A Pilot Study

Murray, Marie E; Barner, Jamie C.; Pope, Nathan; Comfort, Mark D

doi:10.1177/0897190018779847

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…With their dedication to medication surveillance, pharmacists are leading candidates to manage requesting of PGx testing, recording of PGx results and application of the PGx guidelines. This is confirmed by other pilot studies performed in pharmacy settings [31,32,33,34,35]. However, we found that both pharmacists and GPs are very able to record PGx results in their EMRs as contra-indications (96% and 33% of pharmacists and GPs, respectively); enabling deployment of relevant guidelines by the clinical decision support system when a drug-gene interaction is encountered both at prescribing and dispensing.…”

Section: Discussionsupporting

confidence: 85%

Pharmacist-Initiated Pre-Emptive Pharmacogenetic Panel Testing with Clinical Decision Support in Primary Care: Record of PGx Results and Real-World Impact

Wouden

Bank

Özokcu

et al. 2019

Genes

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Logistics and (cost-)effectiveness of pharmacogenetic (PGx)-testing may be optimized when delivered through a pre-emptive panel-based approach, within a clinical decision support system (CDSS). Here, clinical recommendations are automatically deployed by the CDSS when a drug-gene interaction (DGI) is encountered. However, this requires record of PGx-panel results in the electronic medical record (EMR). Several studies indicate promising clinical utility of panel-based PGx-testing in polypharmacy and psychiatry, but is undetermined in primary care. Therefore, we aim to quantify both the feasibility and the real-world impact of this approach in primary care. Within a prospective pilot study, community pharmacists were provided the opportunity to request a panel of eight pharmacogenes to guide drug dispensing within a CDSS for 200 primary care patients. In this side-study, this cohort was cross-sectionally followed-up after a mean of 2.5-years. PGx-panel results were successfully recorded in 96% and 68% of pharmacist and general practitioner (GP) EMRs, respectively. This enabled 97% of patients to (re)use PGx-panel results for at least one, and 33% for up to four newly initiated prescriptions with possible DGIs. A total of 24.2% of these prescriptions had actionable DGIs, requiring pharmacotherapy adjustment. Healthcare utilization seemed not to vary among those who did and did not encounter a DGI. Pre-emptive panel-based PGx-testing is feasible and real-world impact is substantial in primary care.

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Section: Discussionsupporting

confidence: 85%

Pharmacist-Initiated Pre-Emptive Pharmacogenetic Panel Testing with Clinical Decision Support in Primary Care: Record of PGx Results and Real-World Impact

Wouden

Bank

Özokcu

et al. 2019

Genes

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“…On the other hand, economic evaluation of clinical pharmacy services has been promoted since the late 1990s 62 , 63 and positive economic benefits as a result of pharmacists’ interventions and services have been reported. 64 Among the great challenges to improving the quality of healthcare despite limited healthcare resources, economic outcomes are an increasingly substantive focus among healthcare policy-makers, consumers, and payers during their decision-making process with regard to identifying the most cost-effective healthcare interventions and developing reasonable remuneration mechanisms for the professional services provided. 65 – 67 To be able to achieve a sustainable development of pharmacists’ interventions in COPD management, there needs to be a reasonable remuneration system for which economic indicators about the pharmacists’ intervention, such as reductions in direct costs, unscheduled hospital days, or total treatment costs, would be highly relevant.…”

Section: Discussionmentioning

confidence: 99%

Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model

Yao

Ung

et al. 2020

COPD

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This study aimed 1) to identify and analyse the professional services provided by community pharmacists for chronic obstructive pulmonary disease (COPD) management; and 2) to develop a logic model for community pharmacy practice for COPD management. Methods: A systematic review with a logic model was applied. English-language databases (PubMed, Web of Science, Embase, and Scopus) and a Chinese database (CNKI) were searched for articles published between January 2009 and June 2019. Studies concerning pharmacists and COPD were identified to screen for studies that focused on professional services provided at a community pharmacy level. Evidence on economic, clinical, and humanistic outcomes of interventions was summarized. Results: Twenty-five articles were included in this study. Four categories of COPD-related interventions by community pharmacists were identified: 1) primary prevention; 2) early detection; 3) therapy management; and 4) long-term health management. The most common outputs examined were improvement in inhaler technique, medication adherence, and rate of smoking cessation. The clinical (improved quality of life, reduced frequency and severity of symptoms and exacerbation), humanistic (patient satisfaction), and economic (overall healthcare costs) outcomes were tested for some interventions through clinical studies. Contextual factors concerning pharmacists, healthcare providers, patients, facilities, clinic context, and socioeconomic aspects were also identified. Conclusion: Studies in the literature have proposed and examined different components of professional services provided by community pharmacists for COPD management. However, relationships among outcomes, comprehensive professional services of community pharmacists, and contextual factors have not been systematically tested. More well-designed, rigorous studies with more sensitive and specific outcomes measures need to be conducted to assess the effect of community pharmacy practice for COPD management.

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“…Previous studies have shed light on the progressive multifactorial problems, that were facing the vast majority of asthma patients around the world, several studies that were carried out to address asthma therapy related problems, such as controllers under prescribing, quick-reliever overusing, poor inhaling technique and medication non-compliance, furthermore, patients' poor perception of their disease [4,5]. Thus, various approaches to asthmatic care are essential.…”

Section: Introductionmentioning

confidence: 99%

“…Long term medication management services, which are provided to asthmatic patients have achieved and maintained significant improvements and significant decrease in the overall asthma-related costs, although medications' high costs, this is due to increased adherence and use [4,5]. Medication Adherence is a critical base for a successful management of chronic diseases such as asthma, since nonadherence to self-management medication is very common among asthmatics, in an effort to progress asthma management and achieve optimistic health outcomes, Lung Association of Saskatchewan has employed an intervention plan to provide an effective and enhanced quality asthma education for asthmatics patients and the health care providers, along with encouraging access to spirometer instruments [6].…”

Section: Introductionmentioning

confidence: 99%

Investigating the value of medication management review for asthma patients: A randomized controlled study

Al-Bahnasi,

Basheti

2024

ELECTRON J GEN MED

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Background: Asthma remains a major worldwide challenge, which threatens health and economies. The vast majority of asthmatics continue to experience uncontrolled asthma; thus, the need for enhancing patients’ awareness, targeting the behavior of both physicians and patients to reach optimal medications’ use is arising. Medication management review (MMR) service can be delivered by pharmacists to help resolve this dilemma. Aims: To assess the clinical and humanistic outcomes of MMR service for asthmatic patients in Jordan. Via this service, the pharmacist identifies treatment related problems (TRPs) and resolves them either directly or by sending the physician a letter with recommendations. Methods: A prospective randomized single blinded intervention-control study was conducted over 15 months, in outpatient clinics of public hospitals in Jordan. Asthmatics were recruited and randomized into intervention and control groups. MMR service was delivered for all patients by the researcher to identify patients’ TRPs based on updated guidelines. Recommendations were sent to intervention patients’ physician for resolution. Pharmacist level recommendations were resolved by pharmacist for the intervention patients. All patients were reassessed at three months. Results: Patients with asthma (n=152) were recruited, and 959 TRPs were identified at baseline with no significant differences between both groups. A significant decrease in TRPs was noticed for the intervention group at follow-up, going down from 6.540±1.685 at baseline to 2.800±0.924 TRP per patient at follow-up (p< 0.001). Regarding TRPs at three-month follow-up, a significant difference (intervention group: 2.800±0.924, control group: 5.920±1.679 control, p< 0.001). Conclusions: MMR service, which was delivered to asthma patients for the first time in Jordan proved successful in identifying and resolving TRPs for asthma patients. Such outcomes are beneficial in improving asthma control for asthma patients in Jordan.

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Impact and Feasibility of Implementing a Systematic Approach for Medication Therapy Management in the Community Pharmacy Setting: A Pilot Study

Abstract: Implementing this systematic approach to providing MTM into the pharmacy workflow may lead to an improvement in CMR completion rate. However, the sample size is small, and the results and process may not be generalizable to other sites.

Cited by 7 publications

References 13 publications

Pharmacist-Initiated Pre-Emptive Pharmacogenetic Panel Testing with Clinical Decision Support in Primary Care: Record of PGx Results and Real-World Impact

Pharmacist-Initiated Pre-Emptive Pharmacogenetic Panel Testing with Clinical Decision Support in Primary Care: Record of PGx Results and Real-World Impact

<p>Promoting Community Pharmacy Practice for Chronic Obstructive Pulmonary Disease (COPD) Management: A Systematic Review and Logic Model</p>

Investigating the value of medication management review for asthma patients: A randomized controlled study

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