Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting

Deyo, Jennifer; Smith, Ben; Biola, Holly; Ferry, Evan M.; Orto, Victoria; Patel, Binakumari; Stillwell, Tracy

doi:10.1016/j.japh.2020.01.013

Cited by 9 publications

(29 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 As a transition takes place toward ambulatory cervical and lumbar procedures, it is important to understand their safety when compared to inpatient procedures as well as in comparison to other orthopedic procedures. [29][30][31] Our study found that spine procedures were associated with higher complications in the inpatient setting and lower complications in outpatient cases when compared to other orthopedic procedures.…”

Section: Discussionmentioning

confidence: 65%

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

et al. 2021

View full text Add to dashboard Cite

Background: Spinal surgery is associated with an inherently elevated risk profile, and thus far there has been limited discussion about how these outpatient spine patients are benefiting from these same-day procedures against other typical outpatient orthopedic surgeries.Methods: Orthopedic patients who received either inpatient or outpatient surgery were isolated in the American College of Surgeons National Surgical Quality of Improvement Program (2005Program ( -2016. Patients were stratified by type of orthopedic surgery received (spine, knee, ankle, shoulder, or hip). Mean comparisons and chi-squared tests assessed basic demographics. Perioperative complications were analyzed via regression analyses in regard to their principal inpatient or outpatient orthopedic surgery received.Results: This study included 729 480 surgical patients: 32.5% received spinal surgery, 36.5% knee, 24.1% hip, 4.9% shoulder, and 1.7%ankle. Of those who received a spinal procedure, 74.7% were inpatients (IN), and 25.3% were outpatients (OUT): knee: 96.1% IN, 3.9% OUT; hip:98.9% IN, 1.1% OUT; ankle: 29% IN, 71% OUT; and shoulder: 52.6% IN, 47.6% OUT. Hip patients were the oldest, and knee patients had the highest body mass index out of the orthopedic groups (P , .00). Spine IN patients experienced more complications than the other orthopedic groups and had the lowest OUT complications(both P , .05). This same trend of having higher IN complications than OUT complications was identified for hip, shoulder, and knee. However, ankle procedures had greater OUT procedure complications than IN (P , .05). After controlling for age, body mass index, and Charlson Comorbidity Index, IN procedures, such as knee, hip, spine, and shoulder, were significantly associated with experiencing postoperative complications. From 2006 to 2016, IN and OUT surgeries were significantly different among complications experienced for all of the orthopedic groups (P , .05) with complications decreasing for IN and OUT patients by 2016.Conclusions: Over the past decade, spine surgery has decreased in complications for IN and OUT procedures along with IN/OUT knee, ankle, hip, and shoulder procedures, reflecting greater tolerance for risk in an outpatient setting.Level of Evidence: 3. Clinical Relevance: Despite the increase in riskier spine procedures, complications have decreased over the years. Surgeons should aim to continue to decrease inpatient spine complications to the level of other orthopedic surgeries.

show abstract

Section: Discussionmentioning

confidence: 65%

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

et al. 2021

View full text Add to dashboard Cite

show abstract

“…22 Seven QES had moderate overall risk of bias with one or two domains assessed as unclear or high risk of bias. 19,21,[23][24][25][26]31 The remaining two had more than two domains assessed as unclear or high risk of bias and were therefore assessed with high overall risk of bias. 18,20 All but one QES study had high risk in performance bias due to the lack of a control group.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…9,12,25,30 All medications were a deprescribing target in two RCTs and one QES. 10,11,24 Proton pump inhibitors (PPIs) were targeted in two QES, 20,31 one QES targeted non-statin lipid-lowering medication 26 and one cohort study targeted antidiabetics. 28 Regarding the success of deprescribing of a certain medication class, PIMs, benzodiazepines and anticholinergics were considered in only one study each, with a negative overall result.…”

Section: Outcomes Of Interventionsmentioning

confidence: 99%

“…The selected studies comprised nine RCTs with 2304 participant, [9][10][11][12][13][14][15][16][17] nine QES with 461 participants, [18][19][20][21][22][23][24][25][26] five cohort studies with 1466 participants [27][28][29][30][31] and one economic evaluation. 32 The economic evaluation reported the cost effectiveness of deprescribing interventions on a subpopulation from another RCT, which was also included in the review.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The mean ages ranged from 28 to 98 years, and 19 studies had more than 50% female participants (ranging from 57% to 84%). Twelve studies were conducted in primary healthcare centres, 10,11,[18][19][20][21][22]24,26,27,29,31 seven in one or more community pharmacies, 9,13,[15][16][17]30,32 two in integrated healthcare systems, 14,28 and three in outpatient clinics (dealing with mental illnesses and/or dementia). 12,23,25…”

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Community‐based pharmacists' role in deprescribing: A systematic review

Bužančić

Kummer

Držaić

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding.The aim of this study is to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing and to evaluate the impact on the success of deprescribing and clinical outcomes. Methods: Library and clinical trials databases were searched from inception to March 2020. Studies were included if they explored deprescribing in adults, by communitybased pharmacists and were available in English. Two reviewers extracted data independently using a pre-agreed data extraction template. Meta-analysis was not performed due to heterogeneity of study designs, types of intervention and outcomes. Results: A total of 24 studies were included in the review. Results were grouped based on intervention method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; predefined pharmacist-led deprescribing interventions; and pharmacist-led collaborative interventions. All types of interventions resulted in greater discontinuation of medications in comparison to usual care. Educational interventions reported financial benefits as well. Medication review by community-based pharmacist can lead to successful deprescribing of high-risk medication, but do not affect the risk or rate of falls, rate of hospitalisations, mortality or quality of life. Pharmacist-led medication review, in patients with mental illness, resulting in deprescribing improves anticholinergic side effects, memory and quality of life. Pre-defined pharmacist-led deprescribing did not reduce healthcare resource consumptions but can contribute to financial savings. Short follow-up periods prevent evaluation of long-term sustainability of deprescribing interventions. Conclusion: This systematic review suggests community-based pharmacists can lead deprescribing interventions and that they are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.

show abstract

Pharmacist care in Federally Qualified Health Centers: A narrative review

Rodis

Irwin

Valentino

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Federally Qualified Health Centers (FQHCs) are critical to providing care to underserved populations in the United States. Their focus on interprofessional care has also made FQHCs ideal locations to integrate pharmacists into care teams and advance pharmacy practice. However, despite long-standing involvement by pharmacists, there have been limited attempts to synthesize this literature. We conducted a comprehensive search for published literature on the roles of pharmacists in FQHCs and narrowed our search to 54 manuscripts and abstracts for inclusion in this narrative review. We found that pharmacists in FQHCs are providing care that is interprofessional, multifaceted, and evolving rapidly in response to environmental changes.Pharmacists are routinely involved in the traditional management of chronic disease, such as diabetes, hypertension, behavioral health, and respiratory conditions. In addition, pharmacists have forged roles in preventive care, infectious disease, and pain management. Models include appointment-based approaches; however, there was also heterogeneity in approaches consistent with the dynamic nature of the healthcare system in the United States with engagement in population health, transitions of care, and telehealth, as a few examples. Collaborative practice agreements were used to deliver care in some cases, although this was not commonplace, and reimbursement by third party payers was rarely addressed. Relationships with community pharmacies, often driven by the 340B Drug Pricing Program, were also noted.Recommendations for future research in this area include increasing the rigor of future research by standardizing pharmacy interventions and including comparator groups, a greater focus on financial sustainability, and further exploration of how state laws surrounding pharmacist provider status and scope of practice impact pharmacy service development.

show abstract

Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting

Cited by 9 publications

References 10 publications

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

Community‐based pharmacists' role in deprescribing: A systematic review

Pharmacist care in Federally Qualified Health Centers: A narrative review

Contact Info

Product

Resources

About