Development of a Medication-Use Evaluation Template for Andexanet Alfa in the Reversal of Anticoagulation With Factor Xa Inhibitors.

Medication-use evaluations are meant to ensure that medication-use processes are consistent with prevailing standards of care, assure optimal use of therapy, and reduce the risk of medication-related problems. Reversal agents for direct oral anticoagulants are a worthy focus for medication-use evaluations for reasons of efficacy, safety, and cost. A multidisciplinary team of experts developed 2 medication-use evaluation templates illustrating the application of professional society guidelines to the appropriate use of andexanet alfa.

Clinical support role for a pharmacy technician within a primary care resource center.

PURPOSE: The creation of a clinical support role for a pharmacy technician within a primary care resource center is described. SUMMARY: In the Primary Care Resource Center (PCRC) Project, hospital-based care transition coordination hubs staffed by nurses and pharmacist teams were created in 6 independent community hospitals. At the largest site, patient volume for targeted diseases challenged the ability of the PCRC pharmacist to provide expected elements of care to targeted patients. Creation of a new pharmacy technician clinical support role was implemented as a cost-effective option to increase the pharmacist's efficiency. The pharmacist's work processes were reviewed and technical functions identified that could be assigned to a specially trained pharmacy technician under the direction of the PCRC pharmacist. Daily tasks performed by the pharmacy technician included maintenance of the patient roster and pending discharges, retrieval and documentation of pertinent laboratory and diagnostic test information from the patient's medical record, assembly of patient medication education materials, and identification of discrepancies between disparate systems' medication records. In the 6 months after establishing the PCRC pharmacy technician role, the pharmacist's completion of comprehensive medication reviews (CMRs) for target patients increased by 40.5% (p = 0.0223), driven largely by a 42.4% (p < 0.0001) decrease in the time to complete each chart review. CONCLUSION: The addition of a pharmacy technician to augment pharmacist care in a PCRC team extended the reach of the pharmacist and allowed more time for the pharmacist to engage patients. Technician support enabled the pharmacist to complete more CMRs and reduced the time required for chart reviews.

Role of a care transition pharmacist in a primary care resource center.

PURPOSE: The role of a care transition pharmacist (CTP) in a primary care resource center is described. SUMMARY: A CTP role was implemented as part of a primary care resource center team to provide medication therapy management services for patients at high risk for readmission, including patients with chronic obstructive pulmonary disease, with heart failure, or with complex medication regimens and taking more than nine medications. Patients were initially identified upon admission and were seen by the CTP who conducted a medication therapy review, provided patient education, and ensured that any medication-related issues were addressed before discharge. In addition, the CTP followed up with patients by telephone within 72 hours of discharge. CTP interventions included reinforcement of the plan of care (67%), medication-related interventions in which specific issues were addressed (9%), contacting of the physician for treatment plan clarification or care gap (9%), reinforced scheduling of the primary care physician follow-up appointment (8%), and referral of the patient to another caregiver (6%). Patients who received postdischarge follow-up from the CTP were significantly less likely to have an acute care visit within 30 days of discharge compared with patients not contacted by the CTP and had improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. CONCLUSION: Patients discharged from a community hospital who received a follow-up telephone call from a CTP were less likely to be admitted to the hospital or have an emergency department visit within 30 days of an acute care admission. HCAHPS patient satisfaction scores also improved in medication-related and discharge preparation question domains after CTP services were implemented.

Diabetes Ten City Challenge: final economic and clinical results.

OBJECTIVE: To assess the economic and clinical outcomes for the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes. DESIGN: Quasiexperimental observational analysis, pre-post comparison. SETTING: Employers at 10 distinct geographic sites contracting with pharmacy providers in the community setting. PARTICIPANTS: 573 patients with diabetes who had baseline and year 1 medical and pharmacy claims and two or more documented visits with pharmacists. INTERVENTIONS: Community-based pharmacists provided patient self-management care services via scheduled consultations within a collaborative care management model. MAIN OUTCOME MEASURES: Changes in health care costs for employers and beneficiaries and key clinical measures. RESULTS: Average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Statistically significant improvements were observed for key clinical measures, including a mean glycosylated hemoglobin decrease from 7.5% to 7.1% (P = 0.002), a mean low-density lipoprotein cholesterol decrease from 98 to 94 mg/dL (P < 0.001), and a mean systolic blood pressure decrease from 133 to 130 mm Hg (P < 0.001) over a mean of 14.8 months of participation in the program. Between the initial visit and the end of the evaluation period, influenza vaccination rate increased from 32% to 65%, eye examination rate increased from 57% to 81%, and foot examination rate increased from 34% to 74%. CONCLUSION: DTCC successfully implemented an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies. Positive clinical and economic outcomes were identified for 573 patients who participated in the program for at least 1 year, compared with baseline data.

The Diabetes Ten City Challenge: interim clinical and humanistic outcomes of a multisite community pharmacy diabetes care program.

OBJECTIVE: To assess clinical and humanistic outcomes 1 year after initiating the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes. DESIGN: Interim observational analysis of deidentified aggregate data from participating employer clients. SETTING: 29 employers at 10 distinct geographic sites contracting for patient care services with pharmacy providers in the community setting. PARTICIPANTS: 914 patients with diabetes covered by self-insured employers' health plans who received 3 or more months of pharmacist care and had an initial glycosylated hemoglobin (A1C) measurement. Community-based pharmacists were trained in a diabetes certificate program and reimbursed for clinical services. INTERVENTIONS: Community-based pharmacists provided patient care services using scheduled consultations, clinical goal setting, a validated patient self-management program tool, and health status monitoring within a collaborative care management model. MAIN OUTCOME MEASURES: Changes in key direct and surrogate outcomes, including glycosylated hemoglobin (A1C), low-density lipoprotein (LDL) cholesterol., blood pressure measurements, and body mass index; influenza vaccinations; foot examinations; eye examinations; numbers of patients with goals for nutrition, exercise, and weight; and patient satisfaction. RESULTS: At initial visit compared with 1 year, mean A1C decreased from 7.6% to 7.2%, mean LDL cholesterol decreased from 96 to 93 mg/dL, and mean systolic blood pressure decreased from 131 to 129 mm Hg. Increases were seen for influenza vaccination rate (from 43% to 61%), eye examination rate (from 60% to 77%), and foot examination rate (from 38% to 68%) for the initial visit to the end of the analysis period. For all patients in DTCC, those who perceived that their overall diabetes care was very good to excellent increased from 39% to 87%. Overall, 97.5% reported being very satisfied or satisfied with the diabetes care provided by pharmacists. CONCLUSION: Employers demonstrated a willingness to offer a voluntary health benefit to employees and their dependents with diabetes that uses pharmacists to help participants achieve self-management goals. Patients participating in the first year of DTCC had measurable improvement in clinical indicators of diabetes management, higher rates of self-management goal setting, and increased satisfaction with diabetes care. Based on results of previous studies, these positive trends are expected to drive a corresponding decline in projected total direct patient medical costs.

Multidisciplinary team for enhancing care for patients with acute myocardial infarction or heart failure.

PURPOSE: Pharmacists' involvement in a disease management program for the improvement of care of patients with acute myocardial infarction (MI) or heart failure (HF) is described. SUMMARY: Beginning in 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented evidence-based measures in several performance areas, including MI and HF. In 2003, a multidisciplinary team consisting of physicians, clinical pharmacists, nurses, cardiac rehabilitation specialists, nutrition specialists, and case managers was established at Allegheny General Hospital. As of January 2004, hospitals were required to select three core measure sets in order to meet JCAHO accreditation requirements. Pharmacists provided medication evaluation and education for patients in an effort to augment adherence with the JCAHO core measures. These services were facilitated by pharmacists' participation in the development of preprinted orders, clinical pathways, patient-evaluation forms, and written educational materials. Patients targeted for intervention were admitted with a principal diagnosis of MI or HF. JCAHO core measure data for MI and HF were presented from first quarter (Q1) fiscal year (FY) 2005 through Q1 FY 2006. For MI, a consistent improvement in performance to 100% was demonstrated for four of the six criteria. For HF, increases were demonstrated for left ventricular (LV) function assessment, angiotensin-converting-enzyme inhibitor for LV systolic dysfunction, and smoking-cessation counseling. Despite documentation issues regarding discharge instructions, results overall compared favorably with the referenced standard. CONCLUSION: A multidisciplinary team that included pharmacists improved JCAHO core measures for hospitalized patients with MI or HF.