Query: patient monitoring community pharmacy

title: Impact of Adherence Education and Monitoring on Community Pharmacy Performance Scores and Patient Satisfaction
abstract: Adherence, specifically to noninsulin diabetes medications, statins, and renin angiotensin system antagonists (i.e. angiotensin converting enzyme inhibitors (ACEi) angiotensin II receptor blockers (ARBs) and aliskiren) is a measure tracked by the Centers for Medicare and Medicaid Services (CMS) to give Medicare Part D plans a star rating; pharmacies are impacted by these star ratings. The pharmacy is given a performance score based on the measure. Some pharmacies use a performance information management platform (PIMP) that allows pharmacies to better understand performance information to impact patient care.  (1) To evaluate if a monthly adherence monitoring and education service impacts the percentage of patientsadherent determined by pharmacy performance scores; (2) To determine patient satisfaction with the service in a large community pharmacy chain.  A six month prospective interventional pilot study including patients with a proportion of days covered (PDC) of less than 80% for oral diabetes or renin angiotensin system antagonists (RASA) medications was conducted in two pharmacies of a large community pharmacy chain in Southwest Virginia. Using pharmacy internal data analytics and PIMP data, the percentage of patients who are adherent to oral diabetes or RASA medications was determined including the baseline PDC for each patient. At the start of the study, the standard of care in this large community chain pharmacy was to address adherence, follow up in one month and every three months thereafter. In this study, pharmacists provided monthly telephonic adherence monitoring and education for a six month period. Each session was scripted for medication adherence history, education and data collection. The pharmacist provided guidance and counseling based on how the patient answered the questions. Pharmacists gathered information about adherence patterns and behaviors using a 14 item Likert scale and multiple choice based questionnaire during the first session. After completion of the final adherence monitoring and education session, pharmacists gathered patient satisfaction information using an eight item Likert scale questionnaire. At the end of the six month period, using PIMP data, the percentage of patients adherent to oral diabetes or RASA medications was determined based on pharmacy performance scores. The data was analyzed using uni variate and bi variate statistics to determine if there was a difference in pharmacy performance scores from the pre study analysis. The adherence patterns and behaviors, as well as patient satisfaction with the program was evaluated to determine factors influencing nonadherence.  A total of 55 patients were identified in two pharmacies, ten of which were excluded or declined involvement, leaving 45 enrolled in the adherence monitoring and education service. Of the 45 enrolled patients, ten completed the adherence patterns and behaviors questionnaire. About half of the patients were men (50.95% with an average age of 71.17 years and taking an average of 6.55 prescription medications. All patients had Medicare Part D insurance and majority had a yearly income of less than $40,000. The average baseline PDC was 68.92. In pharmacy 1, the average performance score for oral diabetes medications trended down and the average performance score for hypertension medications trended up over the study period. In pharmacy 2, the average performance score for oral diabetes medications trended up and the average performance score in hypertension medications trended up over the study period. The adherence patterns and behaviors questionnaire revealed the majority of patients rarely forgot to take medications or run out of medications. Additionally, cost of medications did not seem to impact adherence and majority of patients knew the names and indications of their medications. Only one patient completed the patient satisfaction survey.  An adherence monitoring and education service had mixed results in improving patient adherence and pharmacy performance scores. Only one patient completed the satisfaction survey, thus no conclusions can be made regarding patient satisfaction of the program. More research needs to be done regarding telephonic adherence programs.

title: Screening Services in a Community Pharmacy in Poznan (Poland) to Increase Early Detection of Hypertension
abstract: Community pharmacies in many countries around the world provide healthcare services for patients. Pharmacists trained as medication experts provide a wide range of patient care services related to medication therapy, patient education, disease prevention, and health promotion. Professional training, expertise, and skills qualify pharmacists to engage in health screenings. These screening programs performed by community pharmacists can help to identify risk factors, facilitate early detection of common diseases, and assist physicians with making effective diagnoses.  In this study, we created and tested a novel model to provide professional monitoring and counseling on blood pressure by community pharmacists. The aims of the study were to identify the prevalence of elevated blood pressure among patients visiting a community pharmacy and describe the demographic characteristics of patients with hypertension (sex, age, education, body weight, and hypertension risk factors)  The research project was conducted in an accredited community pharmacy in Poznan, Poland, from January to April 2019. A total of 118 anonymous patients (30.5% men and 69.5% women) participated in this study. To qualify for this study, participants had to be older than 18 years of age and have no previous diagnosis of hypertension or other cardiovascular disease.  Based on the blood pressure screenings, 61.9% of patients were qualified for the standard consultation (SC: normal blood pressure) 21.2% for the intensive consultation (IC: normal blood pressure and hypertension risk factor) 16.9% patients with elevated blood pressure for the high risk consultation (HRC: referred to a physician) and 3.4% received a diagnosis of hypertension. We qualified 35.6% with a high pressure value (greater than 140/90 mmHg)  The novel model for blood pressure control screening and counseling implemented in a generally accessible community pharmacy may help with early detection of hypertension problems, lead to initiation of effective patient counseling by a community pharmacist, and result in early referral of the patient to a physician.

title: Assessment of patient perceptions concerning a community pharmacy based warfarin monitoring service
abstract: To assess patient perceptions of a North Carolina community pharmacy based warfarin monitoring service.  Prospective study of patients 18 years of age and older, who filled a prescription for warfarin, in one of five Raleigh area community pharmacies, between May 1, 2010 and October 31, 2010. A 14 item survey, along with a self addressed stamped envelope, was mailed to 330 identified patients. The survey inquired about details of current anticoagulation monitoring services, interest in utilizing a local community pharmacy for this service, and confidence in a pharmacist managed program.  26% of surveys were returned. 48% of surveyed individuals responded that they would be interested in having their warfarin monitoring performed by a trained pharmacist in a community pharmacy setting.  Many participants responded that the community pharmacy would be more convenient than or as convenient as their current location. This may be a new clinical service that could be offered in certain community pharmacies.

title: Clinical outcomes of community pharmacy services: A systematic review and meta analysis.
abstract: Community pharmacy services (CPS) have been shown to be positive in many disease management and patient care programs, but clinical outcomes were followed by process indicators and methodological flaws in previous researches made it difficult to prove the effectiveness of clinical outcomes of CPS. Therefore, this study attempted to review the clinical outcomes of CPS. Interventions included are provision of medication review, patient education, adherence assessment, health/lifestyle advice, physical assessment, monitoring, prescribing, or adjusting and administering therapy from community pharmacists. By searching for key words like community pharmacists, pharmaceutical services, clinical outcomes in MEDLINE and EMBASE and manually searching (up to June 2017) 1910 studies investigating the clinical outcomes of CPS were obtained. After screening the titles, abstracts and full texts for relevancy, 52 researches with controlled groups were included and assessed for methodological quality. Finally, 25 studies were selected for the meta analysis based on their common endpoints: systolic blood pressure, diastolic blood pressure and glycosylated haemoglobin. The Cochrane tool was used to assess the risk of bias. Chi square and I square tests were performed to assess heterogeneity, and the weighted mean differences were estimated using random effect models. Of the 52 articles, 47 studies demonstrated that CPS had positive clinical outcomes, 3 studies showed mixed outcomes and 2 studies revealed no effects. In the meta analysis, intervention groups displayed greater reductions in systolic BP (95% CI: 8.198 2.356) diastolic BP (95% CI: 3.648 0.645) and HbA1c (95% CI: 0.905 0.224) than usual care groups. CPS have positive clinical outcomes, particularly significant reductions in systolic BP, diastolic BP and HbA1c. It was difficult to find out which intervention(s) of CPS directly led to certain changes and influence of CPS might be underestimated for only three common surrogate endpoints. More researches should be conducted with sufficient data.

title: Impact of wellness coaching and monitoring services provided in a community pharmacy.
abstract: To assess the clinical and patient centered outcomes of health coaching provided in the workplace by community pharmacists.  Prospective interventional cohort study.  11 independent community pharmacy chain locations in northwest and central Missouri, from January 2010 to January 2011.  81 benefit eligible patients and 23 community pharmacy coaches employed by the self insured pharmacy chain.  Patients were stratified into monitoring groups according to baseline screening values for cholesterol, blood pressure, fasting blood glucose (FBG) body mass index (BMI) and waist circumference. Patients selected their pharmacist coach. Follow up appointments occurred monthly to quarterly. Appointments consisted of education, goal setting, and monitoring through evaluation of treatment goals and physical assessment.  Change from baseline in mean total cholesterol, serum triglycerides, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, systolic blood pressure (SBP) diastolic blood pressure (DBP) FBG, weight, BMI, waist circumference, health related quality of life (HRQoL) and patient satisfaction.  Patients' total cholesterol, LDL cholesterol, HDL cholesterol, DBP, and FBG were reduced significantly. Mean changes in triglycerides, SBP, weight, BMI, and waist circumference were not statistically significant. The 36 Item Short Form Health Survey version 2.0 showed improvements in both the Physical and Mental Component Summaries but did not reach statistical significance. More than 90% of patients were satisfied with the service and the care they received.  Wellness coaching by a pharmacist provided in a community pharmacy can result in significant improvements in cardiovascular risk factors, with a trend toward improved HRQoL. In addition, patients were satisfied with the wellness program from the start of the project.

title: Blood pressure monitor validation, calibration, and community pharmacy practice: a pilot cross sectional survey in Hampshire, UK.
abstract: The blood pressure (BP) monitoring service offered by community pharmacy allows patients to have their BP measured and advice provided without visiting their general practitioner. Few studies have checked the validation and calibration status of monitors in community pharmacy practice. Lack of calibration can lead to poor readings, potentially leading to poor clinical decisions, increasing patient's treatment burden, costs, and reducing their quality of life  Validated monitors follow set accuracy criteria [2 4]

title: [A Questionnaire Survey on Cooperation between Community Pharmacies and Hospitals in Outpatient Chemotherapy Comparison of Roles of Pharmacists in Community Pharmacy and Hospitals]
abstract: Previous reports suggested that sharing outpatient information during chemotherapy is very important for managing pharmaceutical usage between community pharmacies and hospitals. We herein examined using a questionnaire survey whether pharmaceutical management for outpatient chemotherapy is desired by community and hospital pharmacists. The response rates were 44.3% (133/300) for pharmacists in community pharmacies and 53.7% (161/300) for pharmacists in hospitals. Prescriptions for outpatients during chemotherapy were issued at 88.2% of the hospitals. Currently, 28.9% of hospital pharmacists rarely provide pharmaceutical care, such as patient guidance and adverse effect monitoring, for outpatients receiving oral chemotherapy. Furthermore, whereas 93.7% of hospital pharmacists conducted prescription audits based on the chemotherapy regimen, audits were only performed by 14.8% of community pharmacists. Thus, outpatients, particularly those on oral regimens, were unable to receive safe pharmaceutical care during chemotherapy. Community pharmacists suggested that hospital pharmacists should use "medication notebooks" and disclose prescription information when providing clinical information to community pharmacists. They also suggested sending clinical information to hospital pharmacists by fax. On the other hand, hospital pharmacists suggested the use of "medication notebooks" and electronic medical records when providing clinical information to community pharmacists. In addition, they suggested for community pharmacists to use electronic medical records when providing clinical information to hospital pharmacists. As there may be differences in opinion between community and hospital pharmacists, mutual preliminary communication is important for successful outpatient chemotherapy.

title: Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre and Post Implementation of a Pharmacy Protocol at a Community Teaching Hospital
abstract: Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence.  The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist driven DOAC protocol.  Data were collected on adult patients admitted to a community teaching hospital who received DOAC therapy for at least 2 days between January and March 2015 (pre intervention group) and between January and March 2016 (post intervention group) These data were analyzed to measure inappropriately prescribed DOACs, defined based on DOAC indication, renal function, drug interactions, and other pertinent patient specific factors. Prior to the start of data collection for the post intervention group, a pharmacist driven protocol was developed and implemented. DOAC education was provided to pharmacists, including an evidence based prescribing table to guide appropriate DOAC therapy. Comparisons were made between the pre intervention and post intervention groups to determine the impact of the pharmacist driven service on appropriate DOAC prescribing.  Fifty patients were analyzed in the pre intervention group compared with 85 patients in the post intervention group, with a total of 333 and 816 doses administered, respectively. Of the total doses administered, 32.4% were considered inappropriate in the pre intervention group compared with 13.8% in the post intervention group (adjusted odds ratio [OR] 0.42, 95% CI, 0.19 0.96; p 0.039)  Implementing a pharmacist driven DOAC service significantly improved appropriate prescribing of these agents. Provider education regarding DOAC use is essential to further increase appropriate prescribing of DOACs, optimize patients' therapy, and prevent adverse drug events.

title: COMMUNITY PHARMACISTS PERCEPTION ON PATIENT COUNSELING AND CONTINUING PHARMACY EDUCATION PROGRAM IN EAST MALAYSIA
abstract: Nowadays, community pharmacist plays an important role in medication counseling, patients' side effects monitoring and drug information delivery. The need of patient counseling has become a vital part of the pharmacy practice and pharmaceutical care. Through Continuing Pharmacy Education (CPE) program, pharmacists can develop into professions in different areas including drug delivery, drug information, technology and patient education. This study was conducted to evaluate the perception of community pharmacists towards patient counseling and continuing education program in Sabah and Sarawak, East Malaysia. A cross sectional study design utilizing questionnaires was prepared by an extensive literature review. The research was carried out in four major areas in Sarawak; Sibu, Kuching, Bintulu and Miri and in three major areas Sabah; Kota kinabalu, Sepilok, Tawau by convenience sampling method. Descriptive analysis was conducted using SPSS version 18. Perception of community pharmacists towards patients counseling and continuing education program was analysed using scaling method. A cut off score of 25.8 was used to indicate the perception of community pharmacists. The Pharmacists scored a cut off point of 25.8 and above were considered to have good perception. A sample of 174 community pharmacists from Sabah and Sarawak were participated in this study. All of the respondents except one had positive perception towards patient counseling and continuing education program. Overall, almost all the community pharmacists had positive perception towards patient counseling and continuing education program in Sabah and Sarawak, East Malaysia. Further research is needed to evaluate perception of community pharmacists in different states of Malaysia and explore more on continuing education program in Malaysia.

title: Documentation Quality in Community Pharmacy: Completeness of Electronic Patient Records After Patients' First Visits
abstract: When patients visit a community pharmacy for the first time, the creation of an electronic patient record (EPR) with relevant and up to date data is a prerequisite for adequate medication surveillance and patient counseling.  To investigate the level of completeness of documentation in the EPR after a patient's first visit to a Dutch community pharmacy.  In each participating pharmacy, newly enlisted <3 mo) patients to whom at least one medication had been dispensed were enrolled in this survey. For each patient who could be interviewed, pharmacy master students used a structured questionnaire to gather relevant, mandatory patient data (ie, basic characteristics, current drugs used, diseases, intolerabilities, specific conditions) and nonmandatory patient data (eg, diagnostic and monitoring data, personal experiences and habits, drug use problems) from the patient's EPR and from a structured telephone interview with the patient. Data retrieved from the patient's EPR were compared with data provided by the patient during the telephone interview.  Of 403 selected patients, 154 (38.2% could be interviewed by telephone. Poor documentation of telephone numbers in the EPR was the main reason for nonresponse (134/249) Interviewers found that 67.7% of prescription drugs, 0% of over the counter drugs, 19.6% of diseases, 3.7% of intolerabilities, and none of the specific conditions reported by patients had been documented in the EPR. Nonmandatory data (personal experiences and habits, drug use problems) reported during the patient interview had not been documented in the EPR.  The EPR after a patient's first visit to the community pharmacy is often incomplete. For new patients, the pharmacist should more proactively and systematically gather patient information, and all relevant information should be recorded, preferably in coded form, in the pharmacy information system to allow more adequate clinical risk management.