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During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies.Copyright © 2022 Elsevier Masson SAS
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Topic significance and study purpose/background/rationale: The current Radiation Oncology electronic health record (EHR) at an Academic Medical Center remains distinct from the EHR in use by other departments. The transplant tracking system used by the Transplant and Cellular Therapy (TCT) division provides additional complexity. The previous system relied on treatment schemas physically signed by the attending, then scanned into the transplant tracking system. Precipitated by the COVID-19 pandemic, entering and verifying chemotherapy admissions moved from paper to the EHR. The transplant coordinator enters and routes the conditioning treatment plans to the physician and clinical pharmacists for verification. The clinical pharmacists integrated dosing into the treatment plans for conditioning regimens. Evaluation within the continuous quality improvement process identified that Radiation Oncology still utilized the transplant tracking system to plan total body irradiation (TBI) dose dates. The limited comfort and ability of Radiation Oncology to view treatment plans was identified as a barrier. To prevent errors, a standardized process to communication within the EHR was developed. Methods, intervention, and analysis: While the conditioning regimen information could be included in the referral order, Radiation Oncology wanted further documentation of physi-cian signatures, particularly to allow for plan alterations. To further document the physician signatures, a standardized note template was developed for the transplant coordinators to utilize in a nursing note. The note summarizes the condi-tioning regimen and radiation dates, then gets automatically routed to the attending physician for co-signature and, if necessary, attestation. Findings and interpretation: The project is ongoing with a goal compliance rate of 100% for adult stem cell recipients undergoing TBI-based conditioning. Discussion and implications: Workarounds open up vulnera-bilities for safety lapses, particularly within a complex health-care system. Utilization of the EHR's full capabilities provides an opportunity to clearly document communicationCopyright © 2023 American Society for Transplantation and Cellular Therapy
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Recipients of a haematopoietic stem cell transplantation (HSCT) may experience issues in medication adherence (MA) when discharged. The primary aim of this review was to describe the oral MA prevalence and the tools used to evaluate it among these patients; the secondary aims were to summarise factors affecting medication non-adherence (MNA), interventions promoting MA, and outcomes of MNA. A systematic review (PROSPERO no. CRD42022315298) was performed by searching the Cumulative Index of Nursing and Allied Health (CINAHL), Cochrane Library, Excerpta Medica dataBASE (EMBASE), PsycINFO, PubMed and Scopus databases, and grey literature up to May 2022 by including (a) adult recipients of allogeneic HSCT, taking oral medications up to 4 years after HSCT; (b) primary studies published in any year and written in any language; (c) with an experimental, quasi-experimental, observational, correlational, and cross-sectional design; and (d) with a low risk of bias. We provide a qualitative narrative synthesis of the extracted data. We included 14 studies with 1049 patients. The median prevalence of MA was 61.8% and it has not decreased over time (immunosuppressors 61.5% [range 31.3-88.8%] and non-immunosuppressors 65.2% [range 48-100%]). Subjective measures of MA have been used most frequently (78.6%) to date. Factors affecting MNA are younger age, higher psychosocial risk, distress, daily immunosuppressors, decreased concomitant therapies, and experiencing more side effects. Four studies reported findings about interventions, all led by pharmacists, with positive effects on MA. Two studies showed an association between MNA and chronic graft-versus-host disease. The variability in adherence rates suggests that the issues are relevant and should be carefully considered in daily practice. MNA has a multifactorial nature and thus requires multidisciplinary care models.
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PURPOSE: This study aimed to evaluate clinical pharmacist's contribution to the pneumococcal vaccination rate by providing education to cancer patients in hospital settings. METHODS: This study was conducted in 2 tertiary-care hospitals' medical oncology outpatient clinics. Patients over 18 years of age and diagnosed with cancer for less than 2 years, in remission stage, and have not previously received the pneumococcal vaccine were included. Patients were randomized to intervention and control groups. The intervention group was provided vaccination education and recommended to receive the PCV13 vaccine. The control group received routine care. Patients' knowledge about pneumonia/pneumococcal vaccine, Vaccine Attitude Examination Scale (VAX) score, and vaccination rates were evaluated at baseline and 3 months after the education. RESULTS: A total of 235 patients (intervention: 117, control: 118) were included. The mean age ± SD was 57.86 ± 11.88 years in the control and 60.68 ± 11.18 years in the intervention groups. The numbers of correct answers about pneumonia/pneumococcal vaccine (p = 0.482) and VAX scores (p = 0.244) of the groups were similar at baseline. After the intervention, the median (IQR) number of correct answers in intervention group [10(3)] was higher than control group [8(4)] (p < 0.001). After the education, the total VAX score (mean ± SD) was less in intervention group (33.09 ± 7.018) than the control group (36.07 ± 6.548) (p = 0.007). Three months after the education, 20.2% of the patients in the intervention and 6.1% in the control groups were vaccinated with pneumococcal vaccine (p = 0.003). CONCLUSIONS: The pneumococcal vaccination rate in cancer patients has increased significantly by the education provided by a clinical pharmacist in hospital settings.
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Neoplasms , Pharmacists , Humans , Adolescent , Adult , Research Design , Vaccination , Pneumococcal VaccinesABSTRACT
Background: In December 2019, a respiratory illness due to a novel coronavirus, SARS-CoV-2, was first identified in Wuhan, China. SARS-CoV-2, termed COVID-19, is now a worldwide pandemic and has been identified in 216 countries and areas or territories (WHO, 2020). As of May 15th, 2020, there have been more than 4.2 million confirmed cases and 294,190 deaths worldwide. Purpose(s): Ensure patient safety, drug availability, and therapeutic efficacy for all COVID-19 patients. Implement a number of changes to urgently meet the institution's patient care needs. Method(s): Data were collected from a 62-year-old male patient admitted with severe COVID-19 to the intensive care unit in April 2020. The following pharmacy services were then provided: first, constant review and interpretation of new clinical data;second, patient eligibility assessment and obtaining medication through compassionate use protocols;third, evidence-based interventions (e.g. drug-drug interaction, drug-disease interaction, and dose adjustments);fourth, limit unnecessary nebuliser use. Last but not least, educate patients and the public on effective strategies to prevent acquisition and further spread of infection (e.g. social distancing, optimal hand hygiene, and personal protective equipment). Result(s): With standard care and the compassionate use of Hydroxychloroquine, Azithromycin, Zn supplements, and Tocilizumab under close monitoring, the patient successfully recovered and was discharged on May 4th, 2020. Conclusion(s): Pharmacists play a vital role within a multi-disciplinary healthcare team to optimise patient care during this COVID-19 pandemic.
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Background: The experience of clinical pharmacists has been extensively studied these last 30 years but it is rarely described in our region Morocco. We aim through this work to explore the pharmacist's role in a Covid-19 critical care and to share the main drug-related problems and the pharmacist's recommendations. Materials and methods: This study was conducted in a Covid-19 critical care unit in a university-affiliated hospital in Morocco. The pharmacist joined the medical team and provided clinical pharmacy services to all patients admitted from 11th September 2020 to 11th January 2021. The Hatoum scale was used to assess PIs clinical impact. Results and discussion: A total of 362 PIs were performed on 106 critically ill Covid-19 patients. They were mainly represented by dose adjustment, drug discontinuation, treatment recall in 49.4%, 16.8%, and 9.4% of cases, respectively. ATC groups involved in PIs were as follows: J: anti-infective for systemic use (37.3%), B: blood and blood forming organs (18.2%), and P: antiparasitic products, insecticides and repellents (15.5%). The majority of PIs were accepted (90%). Their clinical impact was either significant (64.9%) or very significant (35.1%). Conclusion: The pharmacist was found helpful to manage pharmacotherapy of the Covid-19 population and to intercept medication errors, particularly dosage problems. It is therefore encouraged to expand this practice when possible in other medical units that have a potential of elevated drug errors, and to exploit these services during epidemics. © 2023 Elsevier Masson SAS
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OBJECTIVES: Medication reconciliation is a key point of the v2020 certification. The main objective of this study was to evaluate this activity over one year, including the first epidemic wave at COVID-19. The secondary objectives were to identify the obstacles and levers and to evaluate doctor satisfaction. METHODS: This was a retrospective study of drug reconciliations performed on admission during 12 months of the emergence of COVID-19. Patients aged 65 years and older from orthopedic and visceral surgery, acute hospitalization and conventional medicine units were included. Unintentional discrepancies were analyzed. The obstacles and levers were identified by means of a focus group. Doctors' satisfaction was collected using online quiz. RESULTS: A total of 760 patients were conciliated, of which 27% (n=208) by hospital pharmacy technicians. A decrease in activity was observed during the first epidemic wave. An unintentional discrepancy was found in 77% of patients, and only 48% were corrected by the prescriber. These results were impacted by the pandemic. The pharmaceutical team was mobilized in the logistical management of the crisis, but it was able to adapt in order to perpetuate the activity. Doctors are satisfied with the process. CONCLUSIONS: Medication reconciliation on admission is essential for the prevention of iatrogeny, particularly with the impact of the COVID-19 pandemic in healthcare institutions.
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Objective: Clinical prognosis of coronavirus disease-19 (COVID-19) may be severe and unexpected. Patients may quickly progress to respiratory failure, infections, multiple organ dysfunction, and sepsis. The main objective of this study is to investigate the drug-related problems of patients with COVID-19 and related factors. Method: A prospective observational study was conducted on patients with COVID-19 between September 2020 and May 2021. Patients' demographics, comorbid diseases, prescribed medicines and laboratory findings were recorded. Drug-related problems (DRPs) were identified by a clinical pharmacist according to recent guidelines, UpToDate® clinical decision support system and evidence-based medicine. Results: The median age of 107 patients was 64 and 50.46% of them were male. The median number of comorbidities was 3 (2-4) per patient. The majority of the patients had at least one comorbidity (88.79%) other than COVID-19 and the most frequent comorbidities were hypertension, diabetes mellitus and coronary artery disease. The total number of DRPs was recorded as 201 and at least one DRP was seen in 75 out of 107 patients. The median number of DRPs was 2 (0-8). In multivariate model, number of comorbidities (odss ratio (OR)=1.952;95% confidence interval (CI)=1.07-3.54, p<0.05, number of medications (OR=1.344;95% CI=1.12-1.61, p<0.001), and serum potassium levels (OR=5.252;95% CI=1.57-17.56, p<0.001) were the factors related with DRP. Conclusion: This study highlights the DRPs and related factors in patients with COVID 19 in hospital settings. Considering unknown features of the infection and multiple medication use, DRPs are likely to occur. It would be beneficial to consider the related factors in order to reduce the number of the DRPs. (English) [ FROM AUTHOR]
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INTRODUCTION: Post Intensive Care Syndrome (PICS) is a new or worsening impairment in physical, cognitive, or mental health following critical illness. Similar to PICS, survivors of critical illness due to COVID-19 may develop Post Acute Sequelae of SARS-CoV-2 Infection (PASC) or Long COVID. ICU recovery centers (ICU-RC) are suggested as an interprofessional approach to treat patients with PICS or PASC. Currently, over 40 different ICU-RC worldwide report having a clinical pharmacist. The purpose of this study was to describe the role of pharmacists in identifying and treating medication-related problems in survivors of critical illness. METHOD(S): This prospective, observational study was conducted in 12 ICU-RC between September 2019 and July 2021. A full medication review comprising of medication reconciliation, a patient interview, and counseling session was conducted by a clinical pharmacist on patients seen at the ICU-RC. Baseline demographic and hospital course data were obtained from the electronic health record and at the ICU-RC appointment. Data are reported using descriptive statistics. RESULT(S): A total of 507 patients were referred to an ICU-RC, of which 474 attended and 472 had a full medication review performed by a pharmacist. 237 (47%) of referred patients had a diagnosis of COVID-19. Pharmacy interventions were made in 397 (84%) patients. The median number of pharmacy interventions per patient was 2 (IQR 1,3). Medications were stopped and started in 124 (26%) and 91 (19%) patients, respectively. There was no difference in median total number of medications prescribed at the start and end of the patient visit (10, IQR = 5, 15). The number of patients that had a dose decreased and a dose increased was 51 (11%) and 43 (9%) patients, respectively. Adverse drug event (ADE) preventive measures were implemented in 115 (24%) patients and ADEs were identified in 69 (15%) patients. Drug interactions were identified in 30 (6%) patients. CONCLUSION(S): Pharmacists play an integral role in ICURC resulting in identification, prevention, and treatment of numerous medication-related problems. This paper should serve as a call to action on the importance of including a pharmacist on the interprofessional team in ICU-RC.
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INTRODUCTION: Prior to the COVID-19 pandemic, telecritical care (TCC) pharmacists evaluated patients at multiple ICUs across this healthcare system using clinical decision support (CDSS) alerts for abnormal laboratory values. To increase provider capacity for higher acuity activities, a critical care pharmacist emergency protocol (CCPEP) was enacted, allowing TCC pharmacists to manage therapy in multiple domains. The purpose of this review was to characterize TCC pharmacist interventions prior to and after CCPEP implementation. METHOD(S): This multi-center, multi-ICU, retrospective observational quality improvement project evaluated TCC pharmacist interventions documented from September 1, 2019, through November 30, 2019 (pre-CCPEP) compared with September 1, 2020, through November 30, 2020 (post- CCPEP). Descriptive statistics were reported. RESULT(S): In the pre-CCPEP period, 1448 interventions were performed in 655 unique patients (mean 2.2 interventions/patient) across 10 ICUs as compared to 2115 interventions in 861 unique patients (mean 2.5 interventions/ patient) across 8 ICUs post-CCPEP, a 46.1% increase in the total number of interventions. Glycemic control interventions decreased from 38.7% to 26.4% of interventions, while medication management interventions increased from 28.3% to 41.3% from the pre- to post-CCPEP period, respectively. In medication management, sedation and analgesia interventions increased from 57 (13.9%) in the pre- CCPEP period to 251 (28.8%) in the post-CCPEP period, cardiovascular medication recommendations decreased from 60 (14.6%) to 50 (5.7%), and gastrointestinal agent recommendations increased from 8 (2%) to 68 (7.8%). Electrolyte management, venous thromboembolism prophylaxis, and stress ulcer prophylaxis intervention rates remained similar. CONCLUSION(S): Implementation of a CCPEP facilitated more interventions by TCC pharmacists than CDSS review alone, especially in general medication management. Increased sedation and analgesia interventions in the post-CCPEP period suggest enhanced complexity of recommendations. More patients were intervened on in the post-CCPEP period with more interventions per patient, which may be due to increased census and acuity in addition to the CCPEP. Future directions include pursuing clinical pharmacist practitioner status in the TCC space.
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Background. Increased antibiotic usage during the COVID-19 pandemic and resultant infection control measures derailed the existing antimicrobial stewardship program which involved in person post prescription review and feedback. We performed a time series analysis using Procalcitonin as a tool for a remotely delivered antimicrobial stewardship program by a clinical pharmacist. Methods. This study was conducted in a tertiary care 3500 bedded teaching hospital in southern India. In the baseline phase, all COVID-19 in-patients receiving antibiotics > 48 hours were screened via the electronic records by a pharmacist and antimicrobial consumption indices like days of therapy (DOT) and length of therapy (LOT) were measured. In the intervention phase, if a patient was on antimicrobials, then a PCT was sent. An alert was sent to the treating team based on the procalcitonin levels and a screening of electronic records by a clinical pharmacist to either continue/ de-escalate or discontinue an antibiotic under supervision of an Infectious Diseases physician. Figure 1 Guideline for continuing or stopping antibiotics based on procalcitonin levels Figure 2 Guideline for continuing or stopping antibiotics based on procalcitonin levels Study Flow Results. About 481 patients were enrolled in the pre intervention phase of the study from July to October 2020 (peak of the pandemic) and 90 patients in the intervention phase December 2020 - March 2021 (decline of the pandemic. The baseline characteristics are shown in Figure3. The DOT/1000 patient days (PD) for all antibiotics was 9269 (DOT-6915) in the baseline and 2032 (DOT-886) in the intervention arm. The total length of therapy (LOT) for antimicrobial consumption significantly reduced from 3779 in the pre-intervention phase to 657 in the intervention phase (Figure 4). Out of the 90 recommendations given in the intervention phase, 82 (91.1%) were accepted by the treating team. For Azithromycin and Doxycycline, DOT significantly reduced from 3319 to 486 per 1000 PD and 602 to 158 per 1000 PD respectively. The DOT of the reserve antibiotics according to the WHO AWaRe classification like Polymyxins and Carbapenems decreased from 323 to 67 and 777 to 443 per 1000 PD days in the intervention phase. Conclusion. This study demonstrated the utility of a novel biomarker driven antimicrobial stewardship strategy by clinical pharmacists during the COVID pandemic when access to patients was restricted to both infection control physicians and pharmacists.
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Background: The experience of clinical pharmacists has been extensively studied these last 30 years but it is rarely described in our region Morocco. We aim through this work to explore the pharmacist's role in a Covid-19 critical care and to share the main drug-related problems and the pharmacist's recommendations. Materials and methods: This study was conducted in a Covid-19 critical care unit in a university-affiliated hospital in Morocco. The pharmacist joined the medical team and provided clinical pharmacy services to all patients admitted from 11th September 2020 to 11th January 2021. The Hatoum scale was used to assess PIs clinical impact. Results and discussion: A total of 362 PIs were performed on 106 critically ill Covid-19 patients. They were mainly represented by dose adjustment, drug discontinuation, treatment recall in 49.4%, 16.8%, and 9.4% of cases, respectively. ATC groups involved in PIs were as follows : J anti-infective for systemic use (37.3%), B blood and blood forming organs (18.2%), and P antiparasitic products, insecticides and repellents (15.5%). The majority of PIs were accepted (90%). Their clinical impact was either significant (64.9%) or very significant (35.1%). Conclusion: The pharmacist was found helpful to manage pharmacotherapy of the Covid-19 population and to intercept medication errors, particularly dosage problems. It is therefore encouraged to expand this practice when possible in other medical units that have a potential of elevated drug errors, and to exploit these services during epidemics. Résumé Introduction : L'expérience des pharmaciens cliniciens a été largement étudiée ces 30 dernières années mais elle est rarement décrite au Maroc. Nous visons à travers ce travail à partager les principaux problèmes médicamenteux ainsi que les recommandations élaborées par le pharmacien. Matériels et méthodes : Cette étude a été menée dans une unité de soins critiques Covid-19 dans un hôpital universitaire au Maroc. Le pharmacien a rejoint l'équipe médicale et a fourni des services de pharmacie clinique à tous les patients admis du 11 septembre 2020 au 11 janvier 2021. L'échelle de Hatoum a été utilisée pour évaluer l'impact clinique des IP. Résultats et discussion : Un total de 362 IP a été réalisées sur 106 patients Covid-19 gravement malades. Ces IP sont représentées principalement par l'adaptation posologique, l'arrêt du traitement, le rappel du traitement dans 49,4%, 16,8% et 9,4% des cas, respectivement. Les groupes ATC impliqués dans les IP étaient les suivants : anti-infectieux à usage systémique (37,3%), sang et organes hématopoiétiques (18,2%), et antiparasitaires, insecticides et répulsifs (15,5%). La majorité des IP ont été acceptées (90%). Leur impact clinique était soit significatif (64,9 %) soit très significatif (35,1 %). Conclusion : Le pharmacien a été jugé utile pour gérer la pharmacothérapie de la population Covid-19 et pour intercepter les erreurs de médication, en particulier les problèmes de dosage. Il est donc encouragé d'étendre cette pratique lorsque cela est possible dans d'autres unités médicales qui ont un potentiel d'erreurs médicamenteuses élevé.
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Introduction: The early use of sotrovimab has been approved in patients over 12 years of age and weighting more than 40kg, who are at risk of developing severe COVID-19. Although sotrovimab is the only monoclonal Antibody (mAb) effective against the "Omicron" variant of concern, data on its use in the paediatric population are still scarce. Herein, we present a case series of seven immunocompromised children younger than 12 years old, treated with sotrovimab at the University Hospital of Padua in 2022, proposing a readjusted formula for dosage calculation according to weight. Case: Two patients recently underwent solid organ transplantation, three had an onco-hematological disease, and two suffered a rare autoimmune disease. Five patients were older than 8 years old, while the remaining were 3 years and 10 months old, respectively. We adapted the Clark's rule by adjusting the original reference weight of 68kg to 40kg. The final formula was: (Patient's weight/40kg) x Adult Dose = Pediatric Dosage. While for four patients weighing approximately 40kg (+/- 4kg), sotrovimab was given at the standard dosage of 500mg, the others of 16, 13, and 8.5kg received 190mg, 150mg, and 100mg of mAb, respectively. Discussion(s): No patients experienced any adverse event and all resolved their SARS-Cov2-symptoms within three days, confirming the safety and effectiveness of the recalculated dosages. For the first time, we report a renewed intuitive model of mAb's dosage calculation, which allows the dose to be tailored to the patient according to weight. We chose to revise Clark's rule rather than other unvalidated methods because of its reliability and ease of use. Conclusion(s): Clinical pharmacist's skills are important in the review of off-label therapies, ensuring safe dosing even when evidence is lacking or limited. Although further pharmacokinetic analysis is needed, Clark's pharmacist-revised formula is a quick and safe way to modulate dosing for patients under 40kg.
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Introduction: Underserved populations are 40% more likely to have hypertension and three times more likely to die from heart diseases due to uncontrolled blood pressure (BP). Disrupted access to care from the COVID-19 pandemic further puts these populations at higher risks of complications. A C-RPM for hypertension was established in response to this threat. Research Question or Hypothesis: Will C-RPM promote timely BP control among underserved patients during the COVID19 pandemic? Study Design: A retrospective, single-arm observational study conducted in two federally qualified health center sites. Method(s): All adult patients with uncontrolled BP (>=140/90) who received physician or nurse practitioner referral to participate in CRPM were included. Patients who failed to use BP device independently were excluded. All participants received a BP device that transmitted their BP measurements to the institution electronic health records. Clinical pharmacists, under a collaborative practice agreement, followed the readings and provided dose adjustments via telemedicine. Patient demographics were collected at baseline and BP readings were tracked daily for the first three months. Descriptive analysis, ASCVD risk calculator and paired t-test were used accordingly. Result(s): Between August and December 2021, 89 patients were referred, of which 70 (78.7%) monitored BP daily while 19 (21.3%) were lost to follow up. The average age of the patients was 60.8 years with majority being Hispanic (76.4%), female (63%), and diagnosed with type 2 diabetes (52.8%). The average BP improved from 163/82 at baseline to 132/71 at three months (p<0.001) with an average ASCVD risk score reduction of 25%. Approximately 76% achieved BP target (<140/90) within three months. BP of those lost to follow up maintained uncontrolled over the three months. Conclusion(s): C-RPM achieved clinically meaningful and timely improvement in BP control and cardiovascular risks among underserved patients, bypassing the threat of care access disruption due to the COVID19 pandemic.
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Service or Program: The Community Outreach Intervention Projects (COIP) Mobile Unit is a unique collaboration between a community harm reduction program, an opioid treatment program, and mobile medical unit organization. The goal is to provide medication-assisted recovery (MAR) via low-threshold buprenorphine initiation, methadone referral, and primary care with harm reduction services to reach people who use drugs, are at risk for overdose, and/or could benefit. from medical care in Chicago. The interprofessional team consists of physicians, clinical pharmacists, peer recovery specialists, and outreach workers. Clinical pharmacists are integral to this operation by providing COVID vaccinations, testing, medication inductions and counseling, and wound care. Justification/Documentation: A chart review was conducted for patients seen by the COIP Mobile Unit between June 1, 2021 and January 31, 2022 to describe services provided. A total of 398 unique patients were seen across 565 visits. Of the visits, 70% (n=398) and 30% (n=167) were initial and follow-up visits, respectively. Most visits provided one service (84%, n=477) versus two or more (16%, n=88). The typical patient was Black (65%), male (66%), and 46 years old (mean). The most common service provided was COVID-19 vaccination (43%, n=244) followed by MAR (25%, n=143), COVID-19 testing (14%, n=81), wound care (11%, n=63), medication refill (7%, n=41), and vitals assessment (2%, n=13). Adaptability: The unit adjusts its service location based on monthly overdose data from the Chicago Department of Public Health to meet the patients where they are. The outreach model employed is an Indigenous Leader Outreach Model that hires from the target population for shared experience and enhanced value. This model can be adopted by other street medicine teams to further integrate into high need areas. Significance: The COIP Mobile Unit is an innovative, interprofessional harm reduction program increasing access to MAR and primary care in a street medicine environment with integrated clinical pharmacy services.
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During the exceptional health crisis caused by the COVID-19 pandemic, a program of telepharmacy consultations, associated with dematerialized dispensing of treatments with delivery to the home or drive, was set up by the pharmacy department of our institution. The system has concerned 25 % of the ambulatory dispensations of the PUI over the period of the first containment, and allowed 351 patients to avoid coming to the hospital pharmacy, while maintaining a quality pharmaceutical service. Although certain limitations were identified, such as access to technology or the increase in dedicated pharmaceutical time, this system, appreciated by patients and physicians, has enabled a privileged relationship to be maintained with many patients. Expert clinical pharmacists now also perform PT, and treatments are now sent to patient's pharmacies. Copyright © 2022 Elsevier Masson SAS