Class of 2013 Abstract / Specific Aims: To compare the Comprehensive Medication Review (CMR) rate for Workflow Model #1 (used in 2010) to the CMR rate for Workflow Model #2 (used in 2011) at the Medication Management Center (MMC). Methods: A retrospective database analysis was completed in which Comprehensive Medication Review (CMR) completion rates for 2010 and 2011 were assessed. Comparison included only Center for Medicare and Medicaid Services (CMS) contracts that the Medication Management Center (MMC) provided Medication Therapy Management (MTM) services for both in 2010 and 2011. Data was used to determine the effect a process change had on CMR participation rate at the MMC and best practices for improving the rate of Medication Therapy Management Program (MTMP) beneficiaries participating in a CMR. Main Results: In 2010, patient participation and response to a CMR offer letter was low (0.2%). The changes in process yielded an increase in the CMR completion rate (6.93%); this in turn yielded higher performance measurements for prescription drug plans. Conclusion: Workflow modifications, including a pro-active secondary CMR offer, led to a marked increase in member participation and CMR rates. Patients are more apt to consent to a CMR if they are called for a specific medication related problem. It is recommended to continue to convert TMR calls to CMRs whenever possible, monitor CMR rates at least quarterly, and make cold calls where needed to increase CMR percentages.

Medication complexity and nonadherence are significant risk factors for avoidable hospitalizations and health care spending for older adults in the United States. However, limited empirical research has investigated pharmacist-run telephonic medication management programs as a potential solution to the problem of reducing medication complexity while improving medication adherence. This quantitative study employed the behavioral change model to analyze archival data from a sample of 1,148 participants, examining the relationship of a pharmacist-run telephonic consulting program on medication adherence and medication complexity for one pharmacy benefit management firm's Medicare Part D recipients. The primary research questions investigated the relationship of medication therapy management programs to medication adherence and complexity. Data were assessed using correlation and regression analysis to determine the association between receiving pharmacist counseling, medication adherence, and medication complexity, and to assess the strength of any relationships identified. No linear relationship was found between pharmacists' counseling, medication complexity, and medication adherence. However, the study found a weak correlation between medication complexity and comorbidities, and between medication complexity and medication adherence. This study promotes positive social change by identifying information that can be used to reduce pharmaceutical industry liability by improving proper management of medications, by reducing the burden of comorbidities related to poor management of chronic disease, and streamlining health services and improving their outcom

OBJECTIVE: To develop, validate and apply a scale to measure patient satisfaction in a randomised controlled trial of community pharmacy service. METHODS: Published scales were reviewed to inform development of the patient satisfaction scale. Questionnaires were sent to patients in the control (n=500) and intervention (n=941) groups of a randomised controlled trial of community pharmacy-led management of coronary heart disease at baseline and 12-month follow-up. Any underlying main factors were assessed with exploratory factor analysis. Reliability and construct validity were tested. The 15-item scale was used to compare patient satisfaction across arms with their most recent pharmacy visit. RESULTS: Response rates were 92% (461/500) for control and 96% (903/941) for intervention groups at baseline and 85% control (399/472) and intervention (810/941) at follow-up. At baseline satisfaction was very similar in the intervention and control groups (median scores of 42). At follow-up mean satisfaction had significantly improved for the intervention compared with the control (median scores of 46 compared with 43; P<0.01); intervention females were more likely to be satisfied with the service than males (49 compared with 44; P<0.01). Three main factors explained the majority of the data variance. Cronbach's alpha was 0.7-0.9 for both groups over time for all factors and total scale. An increase in the overall satisfaction corresponding to a decrease in subjects wanting that particular service to be provided during their next visit indicated construct validity of the scale. CONCLUSION: A new scale of patient satisfaction with community pharmacy services was developed and shown to be reliable and valid. Its application showed increased satisfaction in the intervention group receiving a new pharmacy service.

<p><b>Background</b><br></p> <p>More than 90% of individuals aged 65 years or older in the United States (US) are taking at least one prescription medication, and more than 40% are taking five or more prescription medications. The potential for non-adherence and risk of medication therapy problems (MTPs) increases with the use of multiple medications. To enhance patient understanding of appropriate medication use, improve medication adherence, and reduce MTPs, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Prescription Drug (Part D) policy; however, “best practices” for achieving positive MTM outcomes are not well understood.</p><p><br></p> <p> </p> <p><b>Objectives</b></p> <p>This study had two objectives. The first objective was to identify and explain reasons for concordance and discordance between a) consistently high, moderate, and low performing pharmacies and b) pharmacies that improve or worsen in performance overtime. The second objective was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on widely accepted MTM quality measures. </p><p><br></p> <p> </p> <p><b>Methods</b></p> <p>This comparative mixed-methods, case study design incorporated two complementary conceptual models. First, an adaptation of the Positive Deviance (PD) model explains reasons for deviations in MTM quality measure performance among community pharmacies and informs study design. Second, the Chronic Care Model (CCM) guided data collection and analysis. Data consisted of pharmacy/staff demographics and staff interviews. When appropriate, quantitative and qualitative data were analyzed within and across pharmacy MTM performance (i.e., high, moderate, low) or change-in-performance (i.e., consistent, improved, worsened) categories using descriptive statistics and cross-tabulation respectively. MTM performance component measures used to evaluate and rank pharmacy MTM performance mirrored measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 CMS Medicare Part D Plan’ Star Rating measures. This study was approved by the Institutional Review Board for the Purdue University Human Research Protection Program. </p><p><br></p> <p> </p> <p><b>Results </b></p> <p>Across the sample of eligible pharmacies (N = 56), MTM performance composite scores varied by 21.3%. Of the five component scores, the <i>Comprehensive Medication Review (CMR)</i> component score had the highest percent variation (88.3%). Pharmacy staff at 13 pharmacies of the 18 pharmacies selected as case study sites participated in interviews, yielding a 72.2% case pharmacy participation rate. Of the 13 pharmacies, five were categorized as high performers, four were moderate performers, and four were low performers. Of the 39 pharmacy staff approached across all pharmacies, 25 participated in interviews, yielding a 64.1% participation rate. Interviewees included 11 pharmacists, 11 technicians and three student interns. Eight strategies were hypothesized as positively (7) or negatively (1) contributing to pharmacies’ MTM performance. Hypotheses generated were organized by CCM elements and included: <i>Delivery System Design (DSD)</i> – Having a high degree of technician involvement with MTM activities; Inability to meet cultural, linguistic, and socioeconomic needs of patients (negative); Having sufficient capacity to provide CMRs to patients in person compared to telephone alone; Pharmacy staff placing high priority on addressing MTM activities<i>; Clinical Information Systems (CIS) </i>– Faxing adherence-related MTP recommendations and calling providers on indication-related MTP recommendations; Technicians’ use of CISs to collect/document information for pharmacists; Using maximum number of available CISs to identify eligible MTM patients; <i>Health System Organizations (HSO) </i>– Strong pharmacist-provider relationships and trust. No hypotheses were generated for the remaining three CCM elements.</p><p><br></p> <p> </p> <p><b>Conclusions </b></p> <p></p>A total of eight strategies were hypothesized as contributing to community pharmacies’ ability to achieve high performance on MTM quality measures. Notable strategies were related to three of the six chronic care model elements. Future research should engage stakeholders to assist with prioritizing hypotheses to be statistically tested in a larger representative sample of pharmacies.

O uso de medicamentos atualmente vem sendo considerado como fator de risco para saúde, pois são empregados com freqüência de forma inadequada acarretando conseqüências indesejáveis aos usuários. Diante disso, atualmente, o foco dos sistemas de saúde e órgãos reguladores tem sido promover o uso racional dos medicamentos e garantir a segurança no consumo. Nesse contexto, o agente comunitário de saúde (ACS) tem na sua rotineira visita domiciliar um espaço importante a ser explorado para orientação sobre o uso correto da farmacoterapia. Desse modo, o objetivo desse estudo foi analisar as atividades e os conhecimentos dos ACS referentes à orientação da comunidade sobre o uso correto e racional de medicamentos. Foi realizado um estudo do tipo survey exploratório junto a 95 ACS atuantes no Distrito de Saúde Oeste de Ribeirão Preto-SP no período de novembro de 2007 a fevereiro de 2008. A coleta de dados envolveu a aplicação do instrumento de coleta de dados aos 95 ACS para caracterização da população e avaliação dos conhecimentos sobre a farmacoterapia. Além disso, foram feitas observações diretas não-participantes das visitas domiciliares realizados por 8 ACS. A análise dos resultados revelou que a média de idade dos ACS foi de 37,9 ± 8,3 anos, 96,8% deles são do gênero feminino, 71,6% possuem ensino médio completo, 76,8% não participaram de curso de capacitação sobre farmacoterapia e 83,2% utilizam as bulas dos medicamentos como fonte de informação. A maioria dos ACS informaram que os idosos (80,0%) são os usuários que com mais frequência solicitam informação sobre a terapia medicamentosa. O uso de medicamentos em horário inadequado, automedicação e não adesão ao tratamentos foram citadas, respectivamente, por 64, 63 e 55 ACS como as situações de risco já identificadas por eles durante as visitas domiciliares. A média de acertos dos ACS no instrumento de avaliação dos conhecimentos sobre uso correto de medicamentos foi de 8,2 ± 1,3 e não houve associação estatisticamente significante (p>0.05) entre o índice de acerto e participação em cursos de capacitação sobre medicamentos, grau de escolaridade, idade e tempo de trabalho na função de ACS. As principais atividades desenvolvidas pelos ACS nas 91 visitas domiciliares observadas foram relacionadas à verificação e/ou orientação sobre o medicamento ou sobre a utilização de serviços de saúde. Entre as atividades de verificação e/ ou orientação sobre a farmacoterapia houve destaque para as ações relacionadas ao levantamento/ avaliação do perfil de utilização dos medicamentos. Conclui-se que é preciso desenvolver competências nos ACS por meio de programas de educação permanente que promovam uma transformação nas práticas desses profissionais para que atuem, juntamente com a equipe de saúde da família, na promoção do uso racional de medicamentos. / Medicine use is nowadays considered as a risk factor for health, for they are often used in a wrong way, which has bad consequences to users. So that, the current focus of Health Systems and management organs has been to promote a rational use of medicines, in order to ensure safety for consumption. In this context, the Health Community Agent (HCA) has an important field to be exploited in his routine of home visiting in order to guide the pharmacotherapy correct use. So that, the aim of this study was to analyze HCA activities and knowledge concerning to guiding population to use medicines in a proper and rational way. It was done a survey exploratory study with 95 HCA who worked in West Health District of Ribeirão Preto- SP from November, 2007 to February, 2008. Data collect involved the application of questionnaires to 95 HCA in order to characterize the population and to evaluate his knowledge on pharmacotherapy. Direct Non Participant observations were made during home visiting done by 8 HCA. The analysis showed that the middle age of the HCA was 37,9 ± 8,3 years old. From them, 98% are women; 71.6% have studied till the secondary course; 76;8 did not participate of Pharmacotherapy Courses and 83,2% use the medicine leaflets as information sources. Most of the HCA informed that old patients (80%) are the most frequent users who ask for information on medicine therapy. Medicine use in inadequate time, self medication and not adhesion to treatment were pointed, respectively, by 64, 63 and 55 HCA as risk situations identified by them during their home visits. The average of HCA hits in the questionnaire was of 8,2 ± 1,3 and there was no association statically significant (p>0.05) between the rate of hits and participation in pharmacotherapy capacitating courses, level of schooling, age and time of work as HCA. The main activities developed by the HCA during their home visits were related to the verification and/or guiding on medicines or on health services utilization. Among the verifying activities and/or guiding on pharmacotherapy, there was emphasis on actions related to the profile of medicine using. The main conclusion is that there is a demand to developing competences in HCA, by means of Permanent Capacity Programs that can promote a change in the practice of these professionals, in order they work together the Family Health team, to improve the rational use of medicines.

O uso de medicamentos atualmente vem sendo considerado como fator de risco para saúde, pois são empregados com freqüência de forma inadequada acarretando conseqüências indesejáveis aos usuários. Diante disso, atualmente, o foco dos sistemas de saúde e órgãos reguladores tem sido promover o uso racional dos medicamentos e garantir a segurança no consumo. Nesse contexto, o agente comunitário de saúde (ACS) tem na sua rotineira visita domiciliar um espaço importante a ser explorado para orientação sobre o uso correto da farmacoterapia. Desse modo, o objetivo desse estudo foi analisar as atividades e os conhecimentos dos ACS referentes à orientação da comunidade sobre o uso correto e racional de medicamentos. Foi realizado um estudo do tipo survey exploratório junto a 95 ACS atuantes no Distrito de Saúde Oeste de Ribeirão Preto-SP no período de novembro de 2007 a fevereiro de 2008. A coleta de dados envolveu a aplicação do instrumento de coleta de dados aos 95 ACS para caracterização da população e avaliação dos conhecimentos sobre a farmacoterapia. Além disso, foram feitas observações diretas não-participantes das visitas domiciliares realizados por 8 ACS. A análise dos resultados revelou que a média de idade dos ACS foi de 37,9 ± 8,3 anos, 96,8% deles são do gênero feminino, 71,6% possuem ensino médio completo, 76,8% não participaram de curso de capacitação sobre farmacoterapia e 83,2% utilizam as bulas dos medicamentos como fonte de informação. A maioria dos ACS informaram que os idosos (80,0%) são os usuários que com mais frequência solicitam informação sobre a terapia medicamentosa. O uso de medicamentos em horário inadequado, automedicação e não adesão ao tratamentos foram citadas, respectivamente, por 64, 63 e 55 ACS como as situações de risco já identificadas por eles durante as visitas domiciliares. A média de acertos dos ACS no instrumento de avaliação dos conhecimentos sobre uso correto de medicamentos foi de 8,2 ± 1,3 e não houve associação estatisticamente significante (p>0.05) entre o índice de acerto e participação em cursos de capacitação sobre medicamentos, grau de escolaridade, idade e tempo de trabalho na função de ACS. As principais atividades desenvolvidas pelos ACS nas 91 visitas domiciliares observadas foram relacionadas à verificação e/ou orientação sobre o medicamento ou sobre a utilização de serviços de saúde. Entre as atividades de verificação e/ ou orientação sobre a farmacoterapia houve destaque para as ações relacionadas ao levantamento/ avaliação do perfil de utilização dos medicamentos. Conclui-se que é preciso desenvolver competências nos ACS por meio de programas de educação permanente que promovam uma transformação nas práticas desses profissionais para que atuem, juntamente com a equipe de saúde da família, na promoção do uso racional de medicamentos. / Medicine use is nowadays considered as a risk factor for health, for they are often used in a wrong way, which has bad consequences to users. So that, the current focus of Health Systems and management organs has been to promote a rational use of medicines, in order to ensure safety for consumption. In this context, the Health Community Agent (HCA) has an important field to be exploited in his routine of home visiting in order to guide the pharmacotherapy correct use. So that, the aim of this study was to analyze HCA activities and knowledge concerning to guiding population to use medicines in a proper and rational way. It was done a survey exploratory study with 95 HCA who worked in West Health District of Ribeirão Preto- SP from November, 2007 to February, 2008. Data collect involved the application of questionnaires to 95 HCA in order to characterize the population and to evaluate his knowledge on pharmacotherapy. Direct Non Participant observations were made during home visiting done by 8 HCA. The analysis showed that the middle age of the HCA was 37,9 ± 8,3 years old. From them, 98% are women; 71.6% have studied till the secondary course; 76;8 did not participate of Pharmacotherapy Courses and 83,2% use the medicine leaflets as information sources. Most of the HCA informed that old patients (80%) are the most frequent users who ask for information on medicine therapy. Medicine use in inadequate time, self medication and not adhesion to treatment were pointed, respectively, by 64, 63 and 55 HCA as risk situations identified by them during their home visits. The average of HCA hits in the questionnaire was of 8,2 ± 1,3 and there was no association statically significant (p>0.05) between the rate of hits and participation in pharmacotherapy capacitating courses, level of schooling, age and time of work as HCA. The main activities developed by the HCA during their home visits were related to the verification and/or guiding on medicines or on health services utilization. Among the verifying activities and/or guiding on pharmacotherapy, there was emphasis on actions related to the profile of medicine using. The main conclusion is that there is a demand to developing competences in HCA, by means of Permanent Capacity Programs that can promote a change in the practice of these professionals, in order they work together the Family Health team, to improve the rational use of medicines.

No description available.

The Patient Protection and Affordable Care Act (PPACA) represents one of the most significant pieces of legislation in the history of United States healthcare. The PPACA has two main goals: to increase the insured patient population in the US and to reduce the overall cost while improving the quality of healthcare in the US. To accomplish the latter goal, healthcare providers are experiencing a movement toward integrated, team-oriented models that place increasing accountability on the providers and institutions. At the same time, these integrative models emphasize effective preventive care, which is critical in reducing the country’s overall healthcare costs. As more health care institutions and providers across the country adopt the healthcare reform models of the Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs) directly under the PPACA, the demand for pharmacists is increasing. In addition, the role of the pharmacist through Medication Therapy Management (MTM) is growing as more public and private sectors adopt MTM and its standards are being used as the medication-related cornerstone for the ACOs. There is a call for lower costs and higher quality outcomes in healthcare, and the pharmacists are increasingly integrated into direct patient care and medication management. The newly integrated responsibilities of the pharmacist are numerous and almost limitless. The roleof pharmacists is expanding, and as many studies suggest, their contributions produce auspicious results.

Les pharmaciens communautaires ont accès en tout temps aux informations concernant les renouvellements d’ordonnance et ont une interaction fréquente avec les patients. Ils sont donc les professionnels de la santé les mieux placés pour intervenir auprès des patients non adhérents à leurs médicaments. Il serait donc pertinent de développer un outil électronique d’aide à la prise en charge des patients non adhérents aux médicaments à usage chronique (e-AdPharm) adapté aux besoins des pharmaciens. Pour ce faire, ce projet a été mené selon un devis mixte. Dans un premier temps, un sondage a été acheminé aux pharmaciens communautaires du Québec afin d’obtenir un portrait global de leur pratique concernant la mesure de l’adhésion et des interventions réalisées auprès des patients pour optimiser l’adhésion. Les résultats du sondage nous indiquent que la méthode la plus utilisée pour identifier les patients non adhérents est le nombre de jours de retard entre les renouvellements, alors que les principales barrières rencontrées pour mesurer l’adhésion sont le manque de temps et le manque d’information sur les ordonnances. La principale intervention réalisée auprès des patients non adhérents est le conseil verbal et les principales barrières pour intervenir sont la réaction négative du patient et le manque de temps. Dans un deuxième temps, quatre groupes de discussion ont été organisés afin de questionner les pharmaciens communautaires sur le développement d’un prototype d’outil électronique pour la prise en charge de l’adhésion. Les pharmaciens souhaitent que l’adhésion soit mesurée sous forme de pourcentage et présentée dans un tableau utilisant un code de couleurs déterminé selon le niveau d’adhésion. Ils ont aussi manifesté un grand intérêt pour l’ajout d’une section permettant le suivi de l’adhésion, incluant un horizon temporel des interventions réalisées et à faire et les causes de la non-adhésion. / Community pharmacists have direct access at all times to prescription refills information and have regular interactions with their patients. Therefore, they are in a unique position to promote optimal medication use. It would therefore be relevant to develop an electronic tool adapted to pharmacists’ needs (e-AdPharm) to provide medication adherence support to patients treated for chronic diseases. This project was conducted according to a mixed study design. First, an invitation to complete a web-based survey was published online through different platforms to describe how community pharmacists in Quebec identify non-adherent patients, monitor medication use, and promote optimal medication adherence. The survey results show that the most common method to identify non-adherent patients was to check gaps between prescription refills whereas the most common barriers to identifying non-adherent patients were lack of time and lack of prescriptions and refills information. The most common intervention to promote adherence was patients’ counselling whereas the most common barriers to intervene were anticipation of a negative reaction from patients and lack of time. Second, four focus groups were organized to design a prototype of an electronic tool adapted to community pharmacists’ needs to provide medication adherence support to patients. Pharmacists wanted a table displaying medication adherence measures for chronic conditions with a color code representing adherence level. They also stressed the importance to have a structured section enabling them to continuously document the interventions made, needs for patients’ follow-ups and non-adherence causes.

No description available.