ABSTRACT
Background: Clinical pharmacy services improve several patient chronic disease outcomes. This review evaluates a pharmacist-led chronic care management (CCM) program partnered with a health system for patient outcomes and sustainability. Methods: A mixed methods evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was completed. Patient A1c and blood pressure readings were retrospectively collected from the electronic health record from August 2018-April 2022. Patients that completed >4 CCM visits with a diagnosis of diabetes and/or hypertension were included. Results: 557 patients enrolled, 53 had uncontrolled systolic blood pressure (SBP), SBP >130 mmHg. Average SBP at baseline was 141.0 mmHg and average SBP at 6 months was 130.2 mmHg, (P < .001). 76 patients had uncontrolled diabetes, A1c > 7%. Average A1c at baseline = 9.1% and average A1c at 6 months = 8.3%, (P < .001). 4464 CCM visits with 247 disease-state targeted patients were completed over 44-month with a 100% adoption rate across clinic locations. Implementation facilitators included patient medication cost concerns, disease burden, provider revenue generation, CCM dedicated software, streamlined call process, and remote EMR access. Implementation barriers included provider discomfort "selling the program," potential patient costs, unclear need from patient, pharmacists not considered providers, pharmacist cost, multi-platform software, reprioritized stakeholder support, and lack of partner site diversification. Program maintenance showed revenue generation was $5925.31-$8879.89 from August 2021-May 2022 and profitability was $3385.61-$1614.23. Conclusion: This study provides lessons learned, strategies for implementation, and ideas for process efficiencies leading to maintenance of a telehealth pharmacist-led CCM service.
ABSTRACT
Assessment of locomotor function of rodents may be supplemented using electrophysiological tests which monitor the integrity of ascending and descending tracts as well as the focal circuitry of the spinal cord in non-sedated rodents. Magnetically induced SSEPs (M-SSEPs) were elicited in rats by activating the hindpaw using magnetic stimulation (MS). M-SSEP response latencies were slightly longer than those elicited by electrical stimulation. M-SSEPs were eliminated following selective dorsal column lacerations of the spinal cord, indicating that they were transmitted via this tract. Magnetically induced motor evoked potentials (M-MEPs) were elicited in mice following transcranial MS and recorded from the gastrocnemius muscles. M-MEPs performed on myelin deficient mice demonstrated longer onset latencies and smaller amplitudes than in wild-type mice. Magnetically induced H-reflexes (MH-reflexes) which assess local circuitry in the lumbosacral area of the spinal cord were performed in rats. This response disappeared following an L3 contusion spinal cord injury, however, kainic acid (KA) injection at L3, known to selectively destroy interneurons, caused a shorter latency and an increase in the amplitude of the MH-reflex. M-SSEPs and MH-reflexes in rats and M-MEPs in mice compliment locomotor evaluation in assessing the functional integrity of the spinal cord under normal and pathological conditions in the non-sedated animal.
