Effectiveness of a Medication Reconciliation Project Conducted by PharmD Students
Teresa J. LubowskiLaurie M. CroninR. PavelkaLeigh A. Briscoe-DwyerLaurie L. BricelandRobert A. Hamilton
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Keywords:
Pharmaceutical Care
Medication Reconciliation
During patient care rounds with the medical team, pharmacy students have made positive contributions for the benefit of the patient. However, very little has been documented regarding the impact these future healthcare professionals are making while on clinical rotations. The objective of this study was to assess the impact that clinical interventions made by 6th year pharmacy students had on overall patient outcome. Using a special program for a personal digital assistant (PDA), the students daily recorded the pharmacotherapeutic interventions they made. The interventions ranged from dosage adjustments to providing drug information. Data was collected over a 12-week period from various hospitals and clinics in the Jacksonville, Florida area. In total, there were 89 pharmaceutical interventions performed and recorded by the students. Fifty interventions involved drug modification and fifty-four interventions were in regards to drug information and consulting. Of the drug information and consulting interventions, 15 were drug modification. This study shows the impact pharmacy students make in identifying, recommending, and documenting clinical pharmacotherapeutic interventions. Similar to pharmacists, pharmacy students can also have a positive contribution towards patient care.
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Background and objective: Due to drug-related problems (DRPs) that cause both unnecessary suffering and huge costs to society, many patients do not receive the intended beneficial effects of their treatment. Pharmacy practitioners have a key responsibility to respond to these problems, but more knowledge about the expected outcomes of their interventions is needed. The objective of the study was to assess the clinical and economic outcomes of community pharmacy interventions in patient DRPs. Methods: Drug-related problems in 13 different patient groups were identified and classified, according to the Westerlund System, by pharmacy practitioners from 89 Swedish pharmacies in 2006. The cases were documented in the pharmacy software and transferred to the national DRP database. An assessment model was developed and applied by the researchers (a pharmacist and a physician). This assessment was used to conduct a retrospective review by analysing the DRP and intervention documentation, in particular case descriptions from free text fields. Expected clinical patient outcomes of pharmacy interventions were judged in terms of improved therapeutic effects and prevented or relieved adverse drug reactions (ADRs). The review also assessed the expected patient outcomes with regard to initiated or avoided primary care contacts or avoided hospitalisations. The resulting hypothetically avoided direct societal costs and the estimated pharmacy personnel costs were calculated for the study and extrapolated to the Swedish nationwide level on an annual basis, to demonstrate the potential of national cost savings by pharmacy DRP-interventions. Results and discussion: In 358 cases (68%), the pharmacy interventions were judged to have produced an improved therapeutic effect in the patient, and in 172 cases (32%) to have prevented or relieved ADRs. Primary care contacts were initiated for 151 patients (29%), and pharmacy interventions were assessed to have saved 68 (13%) primary care contacts and 16 (3%) future hospitalisations. The potential societal cost savings extrapolated to Sweden at the national level were estimated at € 358 million. This is 37 times the expected pharmacy personnel costs for identifying and responding to the DRPs. Conclusion: Our study demonstrates that community pharmacy interventions in patient DRPs are most likely to lead to favourable clinical and economic outcomes. The convincing cost-benefit ratio should be presented to health care politicians and decision makers to encourage appropriate remuneration for these services.
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The objective of this study was to investigate how well the professional practice of community pharmacy-based pharmaceutical care was being performed in Korea. Current status and problems of the professional practice were investigated using survey questionnaire with ten questions regarding pharmaceutical care service such as DUR, written medication guide, patient consult, and therapeutic monitoring. Three hundred thirty one community pharmacies responded to the survey questionnaire. Of the respondent pharmacies, medium scale pharmacy (30-99 prescriptions daily) accounted for 66.47% followed by large scale (100-199 prescriptions daily), small scale (less than 30 prescriptions daily), and extra-large scale (greater 200 prescriptions daily). Prospective DUR was practiced in less than half of the community pharmacies (45.62%), and written medication guide was provided in only one-third of those (33.84%). Pharmacists average patient consult time was 3-5 minutes in most community pharmacies. Furthermore, 25% of the respondents answered that the time was less than two minutes. Based on this survey results, professional practice of the community pharmacies in Korea appears to be suboptimal in terms of GPP standards jointly announced by FIP and WHO. Therefore, it seems necessary to enforce the GPP accreditation at Korean Pharmaceutical Association level.
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Background: The growing drive in South Africa to contain medicine cost has seen the emergence of postal pharmacy as an alternative mechanism to dispense chronic medicines. Patient satisfaction with pharmaceutical services has received limited attention in South Africa.Aim: The aim of this study was to compare the level of patient satisfaction with pharmaceutical services between postal and community pharmacies.Setting: The research was conducted in the eThekwini Municipality, KwaZulu- Natal Province, South Africa in July and August 2014.Methods: A cross-sectional quantitative study using a randomised, telephonic questionnaire survey was conducted. Selected land telephone numbers were called until a sample size of 250 community pharmacy participants and 125 postal pharmacy participants was obtained.Results: Nine hundred and five telephone calls were made to obtain a sampling frame of 375 (41.44%) respondents, 250 for community and 125 for postal. After adjusting overall satisfaction by removing financial satisfaction, there was no significant difference between satisfaction in the two groups (p = 0.471). Postal pharmacy participants reported a higher level of financial satisfaction (p = 0.001). Community pharmacy participants reported a higher level of satisfaction with counselling or explanation (p = 0.028) and less medicine wastage (p < 0.001).Conclusions: Patient satisfaction with pharmaceutical services provided by either community or postal pharmacy was not significantly different. However, community pharmacies tend to address patients’ specific concerns more effectively. With the move to National Health Insurance, policymakers need to ensure that they provide high-quality pharmaceutical services and are more inclusive of community pharmacies to deliver quality care.
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Patients' opinion about prevalence of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom. The secondary objective was to identify appropriate action(s) to enhance patients' awareness of pharmaceutical services in rural areas.A self-administered, anonymous questionnaire was distributed to patients visiting a community pharmacy in Eye, Suffolk, United Kingdom between July and August, 2015. The main inclusion criterion was living in a rural area. Comparisons were performed using chi-square tests and logistic regression.The study included 103 respondents: 70 women (69.0%) and 33 men (32.0%), aged 16-85 years. Most respondents declared the primary tasks of a community pharmacy were dispensing medicines (86.4% of respondents) and repeat dispensing (72.8% of respondents). Additionally, 23.3% of respondents treated minor ailments at the pharmacy, including bacterial/viral infections, minor injuries, stomach problems, and allergies. The Medicines Use Review service was the only advanced service used in this pharmacy (12.6% of respondents), primarily by men. Younger patients were more familiar with the term of pharmaceutical care (p<0.05; OR=0.33).Only a few pharmaceutical services are utilized by people living in rural areas in the UK, namely prescription dispensing, repeat dispensing, and sale of medications that support self-care for minor ailments. We found an overall poor awareness of the expanded variety of pharmaceutical services encouraged by the community pharmacy contract introduced in the UK in 2005. Therefore, politicians, pharmacists, and pharmacy experts should actively promote these advanced pharmaceutical services in rural areas.
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