The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model

Hawley, Chelsea E.; Triantafylidis, Laura K.; Paik, Julie M.

doi:10.1016/j.japh.2019.05.010

Cited by 11 publications

(22 citation statements)

References 55 publications

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“…13,21,24,[38][39][40][41][42] Our study confirmed that older patients may travel several hours to access in-person care, and that home telehealth may address this. 1,13,21,38,39,43 Convenience is a primary reason that older adults engage in home telehealth. 24,38,43 This was similar to our study, where all interviewees reported that the visits were convenient.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Integration of Home Telehealth Visits Amidst COVID‐19: What Do Older Adults Need to Succeed?

Hawley

Genovese

Owsiany

et al. 2020

J American Geriatrics Society

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102

124

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Our objective was to identify and address patient-perceived barriers to integrating home telehealth visits. DESIGN: We used an exploratory sequential mixedmethods design to conduct patient needs assessments, a home telehealth pilot, and formative evaluation of the pilot. SETTING: Veterans Affairs geriatrics-renal clinic. PARTICIPANTS: Patients with scheduled clinic visits from October 2019 to April 2020. MEASUREMENTS: We conducted an in-person needs assessment and telephone postvisit interviews. RESULTS: Through 50 needs assessments, we identified patient-perceived barriers in interest, access to care, access to technology, and confidence. A total of 34 (68%) patients were interested in completing a home telehealth visit, but fewer (32 (64%)) had access to the necessary technology or were confident (21 (42%)) that they could participate. We categorized patients into four phenotypes based on their interest and capability to complete a home telehealth visit: interested and capable, interested and incapable, uninterested and capable, and uninterested and incapable. These phenotypes allowed us to create trainings to overcome patient-perceived barriers. We completed 32 home telehealth visits and 12 postvisit interviews. Our formative evaluation showed that our pilot was successful in addressing many patient-perceived barriers. All interviewees reported that the home telehealth visits improved their wellbeing. Home telehealth visits saved participants an average of 166 minutes of commute time. Five participants borrowed a device from a family member, and five visits were finished via telephone. All participants successfully completed a home telehealth visit. CONCLUSIONS: We identified patient-perceived barriers to home telehealth visits and classified patients into four phenotypes based on these barriers. Using principles of implementation science, our home telehealth pilot addressed these barriers, and all patients successfully completed a visit. Future study is needed to understand methods to deploy larger-scale efforts to integrate home telehealth visits into the care of older adults.

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Section: Discussionmentioning

confidence: 99%

“…However, when given the opportunity, many older patients can effectively engage in telehealth 13,20‐25 . We hypothesized that telehealth might improve access to care, but we were unsure if our patients were interested or if they had the technology and confidence to attempt a home telehealth visit 1 …”

Section: Introductionmentioning

confidence: 99%

Rapid Integration of Home Telehealth Visits Amidst COVID‐19: What Do Older Adults Need to Succeed?

Hawley

Genovese

Owsiany

et al. 2020

J American Geriatrics Society

Self Cite

102

124

View full text Add to dashboard Cite

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“…The success of the pharmacists' roles on improving medication understanding, beliefs, and adherence has been previously reported in the adult population and in a variety of specialty care settings. [31][32][33] These models should be considered and trialed in the pediatric population, especially in the complex care setting. Specialized pediatric pharmacists, incorporated into clinic visits, can provide an initial evaluation of parental understanding, provide baseline education and ongoing assessments and educational updates at subsequent clinic visits and/ or through telehealth visits.…”

Section: Discussionmentioning

confidence: 99%

Perceived Versus Demonstrated Understanding of the Complex Medications of Medically Complex Children

Blackmer¹,

Fox²,

Arendt³

et al. 2021

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Parents and caregivers of children with medical complexity (CMC) manage complex medication regimens (CMRs) at home. Parental understanding of CMRs is critical to safe medication administration. Regarding CMR administration, we 1) described the population of CMC receiving CMRs; 2) assessed parental perceived confidence and understanding; and 3) evaluated parental demonstrated understanding. METHODS Cross-sectional clinic-based assessment of knowledge and understanding of CMC using CMRs who received primary care in a large pediatric complex care clinic. CMRs were identified by the receipt of ≥1 of the following: 1) ≥10 concurrent medications; 2) ≥1 high-risk medication; or 3) ≥1 extemporaneously compounded medication. Parents reported their perceived confidence and understanding of CMRs, and then demonstrated understanding through 3 medication-related tasks. RESULTS Of 156 CMCs, most were <10 years of age (63.5%), white (75%), had neurologic impairment (76.9%), and used a median of 8 medications (IQR, 5–10). Parents were female (76.9%) with a mean age of 38.8 ± 11.5 years, white (69.9%), spoke English (94.2%), and had some college education (82.1%). On 11 confidence and understanding statements, most parents reported a high perceived level of understanding and confidence, with combined agreement or strong agreement ranging between 81.2% and 98.7%. Only 73.1% correctly identified medications taken for specified conditions, 40.4% reported complete dosing parameters, and 54.8% correctly measured 2 different medication doses. Significant differences existed between parental perceived understanding versus the 3 demonstrated tasks (all p < 0.05). CONCLUSIONS Substantial opportunities exist to improve medication safety and efficacy in the outpatient, in-home setting including improved medication-specific education and medication-related supports.

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“…Therefore, it is of paramount importance to design and conduct ad hoc studies, preferably involving a renal multidisciplinary team. There is some evidence that involving clinical pharmacologists or clinical pharmacists in the management of polypharmacy patients significantly improved the capability to uncover, prevent or manage the risk of DDIs ( Al Raiisi et al., 2019 ; Hawley et al., 2019 ). The implementation of such professional figures in CKD patient care is beneficial in supporting clinicians and benefit patients, leading to increased medication knowledge, decreased length and rates of hospitalization, and significantly improved the quality of life in renal patients even at the latest stage of disease ( Stemer and Lemmens-Gruber, 2011 ; Salgado et al., 2013 ; Sathvik et al., 2007 ; PAI et al., 2009 ; Pai et al., 2009 ).…”

Section: Clinical Significance and Perspectivesmentioning

confidence: 99%

Drug-drug interactions in polypharmacy patients: The impact of renal impairment

Papotti

Marchi

Adorni

et al. 2021

Current Research in Pharmacology and Drug Discovery

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Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Therefore, multiple pharmacological prescriptions are very common in these patients. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses. It has been estimated that the prevalence of DDIs in CKD patients ranged between 56.9% and 89.1%, accounting for a significant increase in healthcare costs, length and frequency of hospitalization, with a detrimental impact on health and quality of life of these patients. Despite these recognized high-risk conditions, scientific literature released on this topic is still limited. Basing on the most commonly prescribed therapies in patients with CKD, the present short review summarizes the current state of knowledge of the putative DDIs occurring in CKD patients undergoing polytherapy. The most relevant underlying mechanisms and their clinical significance are also debated.

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The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model

Cited by 11 publications

References 55 publications

Rapid Integration of Home Telehealth Visits Amidst COVID‐19: What Do Older Adults Need to Succeed?

Rapid Integration of Home Telehealth Visits Amidst COVID‐19: What Do Older Adults Need to Succeed?

Perceived Versus Demonstrated Understanding of the Complex Medications of Medically Complex Children

Drug-drug interactions in polypharmacy patients: The impact of renal impairment

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