Methods and Barriers to Communication Between Pharmacists During Transitions of Care.

Background: Effective communication between pharmacists across healthcare settings is essential to facilitate transitions of care (TOC) and improve patient outcomes. Objective: To explore pharmacists' communication methods and preferences and identify barriers to communication during TOC. Methods: A survey was distributed to a convenience sample of pharmacists in California, Connecticut, Illinois, Massachusetts, New Jersey, and Texas. The survey collected information on pharmacists' demographics, practice settings, and clinical services, and their methods, preferences, and barriers to communication during TOC. Results: A total of 308 responses were included in the analysis. The majority of pharmacists practiced in inpatient pharmacy (39.3%) followed by outpatient community pharmacy (23.4%). About 57.8% of pharmacists reported involvement in TOC services. Among respondents, most reported electronic health record (EHR) as their primary method of communication to receive (66.2%) and send (55.5%) information to perform TOC services. Additionally, EHR was reported as the preferred method of communication to receive (75.4%) and send (75.5%) information during TOC. The primary reasons pharmacists reported not utilizing patient health information were lack of information (38.4%), incorrect information (36.7%), delay in receiving information (36.7%), and lack of time (34.5%). Barriers to providing TOC services included poor communication during handoffs (44.2%) and difficulty obtaining needed patient medical information (43.9%). Conclusion: This study identified methods and barriers to communication between pharmacists during TOC across healthcare settings. This provides an opportunity for future research to develop interventions to improve communication between pharmacists at different practice settings.

Impact of a COPD care bundle on hospital readmission rates.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide and contributes considerably to morbidity and health care costs. In October 2014, the Centers for Medicare and Medicaid Services introduced financial penalties followed by bundled payments for care improvement initiatives in patients hospitalized with COPD. OBJECTIVES: This study seeks to evaluate whether an evidence-based interprofessional COPD care bundle focused on inpatient, transitional, and outpatient care would reduce hospital readmission rates. METHODS: A pre- and postintervention analysis comparing readmission rates after a hospitalization for COPD in subjects who received standard of care versus an interprofessional team-led COPD care bundle was conducted. The primary outcome was 30-day all-cause readmissions; secondary outcomes included 60- and 90-day all-cause readmissions, escalation of pharmacotherapy, interprofessional interventions, and hospital length of stay. RESULTS: A total of 189 subjects were included in the control arm and 127 subjects in the COPD care bundle arm. A reduction in 30-day all-cause readmissions between the control arm and COPD care bundle arm (21.7% vs. 11.8%, P = 0.017) was seen. Similar outcomes were seen in 60-day (18% vs. 8.7%, P = 0.013) and 90-day all-cause readmissions (19.6% vs. 4.7%, P < 0.001). Pharmacists consulted with 68.5% of subjects and assisted with access to outpatient medications in 45.7% of subjects in the COPD care bundle arm. An escalation in maintenance therapy occurred more often in the COPD care bundle arm (22.2% vs. 44.9%, P < 0.001) than the control arm. CONCLUSIONS: An interprofessional team-led COPD care bundle resulted in significant reductions in all-cause hospital readmissions at 30, 60, and 90 days.

Decreasing Hospital Readmissions Utilizing an Evidence-Based COPD Care Bundle.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. METHODS: This single-center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care, while patients in the post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. RESULTS: In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort compared to the pre-intervention cohort, 22.4% vs. 38.3% (p = 0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p < 0.001) and 10.1% vs. 32.2% (p < 0.001), respectively. CONCLUSION: Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.

The Impact of a Home Respiratory Therapist to Reduce 30-Day Readmission Rates for Exacerbation of COPD.

BACKGROUND: In 2015, the Centers for Medicare and Medicaid Services limited payments to hospitals with high readmission rates for patients admitted with COPD exacerbation. Decreasing readmissions in this patient population improves patient health and decreases health care utilization of resources. We hypothesized a COPD disease management program delivered by a respiratory therapist (RT) in the patient's home may reduce readmission rates for COPD exacerbation. METHODS: We performed a pre/post interventional study comparing hospital readmissions for subjects with COPD exacerbation that received standard of care in the home versus an RT-led home COPD disease management program. Subjects discharged home from Atlantic Health System with COPD exacerbation were enrolled in the pre-intervention group. Subsequently, an evidence-based home COPD disease management program was implemented by an RT from At Home Medical in the home. The home COPD Disease Management Program was implemented from April 2017-September 2019, and this served as the post-intervention group. The primary end point was readmission rates at 30 d. Secondary end points included 60-d and 90-d readmission rates. RESULTS: A total of 1,093 participants were included in the study, 658 in the pre-intervention cohort and 435 participants in the post-intervention group. Approximately 22.3% (n = 147) of subjects in the pre-intervention group was readmitted within 30 d of discharge compared to 12.2% (n = 53) in the post-intervention group (P < .001). A reduction in 60-d (33.9% vs 12.0%, P < .001) and 90-d all-cause readmissions (43.5% vs 13.1%, P < .001) was also seen. Participation in the COPD Disease Management Program was significantly associated with decreased 30-, 60-, and 90-d readmission rates adjusting for age, gender, race, ethnicity, and smoking status (odds ratio 0.48 [95% CI 0.33-0.70]; odds ratio 0.26 [95% CI 0.18-0.38]; odds ratio 0.20 [95% CI 0.14-0.27];P < .001, for all 3 readmission rates). CONCLUSIONS: The COPD Disease Management Program is significantly associated with decreased readmission adjusting for demographics and smoking status.

Pharmacologic Management of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune inflammatory disease of the joints, which can result in permanent cartilage and bone damage. Although the exact cause of RA is unknown, there are many risk factors that have been associated with RA. When RA occurs, the immune system mistakenly attacks healthy synovial and connective tissue. Available treatment options work to reduce inflammation or slow the disease progression. The American College of Rheumatology published guidelines for the treatment of rheumatoid arthritis in 2015, with an update expected in late 2019/early 2020. Nonpharmacologic therapy for patients with RA includes rest, occupational and physical therapy, and weight reduction and use of assistive devices, as necessary. Pharmacologic options include nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs, antitumor necrosis factor agents, and interleukin receptor antagonists.

Incorporation of a multi-modal interactive exercise on student pharmacists' perceptions of lifestyle modification in weight loss promotion.

BACKGROUND AND PURPOSE: The purpose of this project was to evaluate the impact of a calorie tracking and dietary modification activity on students' perceptions of the challenges associated with weight loss. EDUCATIONAL ACTIVITY AND SETTING: Students maintained a two-day paper calorie log, then received a weight management lecture, followed by four additional days of calorie tracking using a mobile application. Demographics, self-evaluation of obesity-related knowledge, perceptions on weight loss difficulties, utility of mobile technology, and overall program value were evaluated. FINDINGS: A total of 79% of students completed all three surveys (n = 150). Students' perceptions regarding their knowledge and comfort with respect to weight loss counseling and dietary modification strategies increased following the lecture and mobile technology-based calorie counting activity. Seventy-eight percent of students either agreed or strongly agreed that this activity was valuable to their professional development while 86% of students agreed or strongly agreed this activity helped them understand the challenges faced by patients trying to lose weight. DISCUSSION: Student attitudes regarding weight loss, including nutritional tracking, and comfort in establishing a weight loss goal, as well as student's perceived knowledge of the types of dietary fats and empathy, all significantly improved over the course of activity participation. SUMMARY: This activity improved student pharmacists' understanding of lifestyle modifications necessary for weight loss, exposed them to novel technologies available to help support patient's weight loss attempts, and provided them with first-hand experience in tracking calories.

Effect of Nursing Education on Optimization of Medication Reconciliation in the Pediatric Emergency Department.

OBJECTIVE: This study was conducted to evaluate the impact of education on optimizing medication histories in a single-center pediatric emergency department. METHODS: This was a prospective, 2-phase study of 200 patients ages 21 years and younger who presented to the pediatric emergency department in January and February 2017. In phase I of the study, 100 patients were interviewed by both a nurse and a pharmacist. Between phases I and II, the pharmacist educated each nurse and disseminated standardized education materials. In phase II, 100 additional patients were interviewed by both a nurse and a pharmacist. Discrepancies were quantified in both phases of the study. The primary outcome was the distribution of total discrepancies in medications identified. Total discrepancies were defined as a composite of medication name, dose, route, frequency, and time of last dose. RESULTS: A total of 200 medication histories were collected over phases I and II. In phase I (n = 79), the pharmacist identified 185 medications, 88 of which were also identified by the nurse. In phase II (n = 82), the pharmacist identified 180 medications, 95 of which were also identified by the nurse. The distribution of discrepancies per patient and per medication was significantly reduced in regard to dose, route, and frequency documentation. CONCLUSION: Although improvement was observed, barriers beyond a knowledge deficit exist to limit accuracy of medication histories collected by nurses.

Long-Acting Bronchodilator Use in the Management of Stable COPD.

OBJECTIVE: To review the management of chronic obstructive pulmonary disease (COPD), with a focus on updated information regarding the use of long-acting bronchodilators in the prevention of exacerbations and outcomes associated with this disease. DATA SOURCES: A literature search of the MEDLINE databases through November 2017 was conducted. All published articles regarding use of bronchodilator therapy in the management of COPD were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. STUDY SELECTION AND DATA EXTRACTION: Available English-language data from reviews, abstracts, presentations, and clinical trials of the treatment of stable COPD with bronchodilator therapy in humans were reviewed; relevant clinical data were selected and included. DATA SYNTHESIS: COPD is a prevalent medical condition worldwide that results in functional impairment, and worsened quality of life and overall health status. Numerous treatment options are available; the rationale for the optimal agents to utilize in a particular patient case is dependent on a multitude of patient-specific factors and severity of disease. In this review, a discussion of the role of long-acting bronchodilators, including long-acting ß agonists and long-acting muscarinic antagonists will be explored. Additionally, an update on the roles of novel delivery devices for delivering respiratory medications in this medical condition will be described. CONCLUSION: Although numerous treatment options are available, management of COPD remains a clinical challenge. Long-acting bronchodilators represent a significant class of medications that have the potential to reduce exacerbations and related hospitalizations and improve overall health outcomes.

Heart Failure: A Class Review of Pharmacotherapy.

A recent guideline update for the treatment of heart failure has created the need for a new look at the medication classes and trials related to the disease. The authors focus on pharmacological options available for treating the problem.

Targeting Interleukin-5 in Patients With Severe Eosinophilic Asthma: A Clinical Review.

Interleukin-5 (IL-5) is known to play a major role in the growth, differentiation, recruitment, and activation of eosinophils. The authors review the efficacy and safety of two IL-5-targeting agents used in the treatment of eosinophilic asthma.

Exploring Transitional Care: Evidence-Based Strategies for Improving Provider Communication and Reducing Readmissions.

The coordination of care as patients move from one health care setting to another is crucial to treatment, but breakdowns in the process lead to poor transitions, fragmented care, hospital readmissions, and increased costs. This article discusses evidence-based strategies for improving communication and reducing readmissions.

Empagliflozin: a sodium-glucose cotransporter 2 inhibitor for treatment of type 2 diabetes.

PURPOSE: The pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effects, dosage and administration, and drug-drug interactions of empagliflozin are reviewed. SUMMARY: Empagliflozin is a direct inhibitor of sodium-glucose cotransporter 2 (SGLT2), which acts to lower the renal threshold and increase urinary glucose excretion. SGLT2 is found in the proximal tubules of the kidneys and reabsorbs about 90% of the filtered glucose. Because the mechanism of action of empagliflozin is not insulin dependent or insulin sensitive, it may be used in patients at different stages of diabetes with nonfunctional or impaired pancreatic ß cells. Furthermore, empagliflozin can be used with other antidiabetic drugs due to its lack of any additive hypoglycemic effects. Long-term efficacy studies revealed significant reductions with empagliflozin in glycosylated hemoglobin (HbA1c) values at week 78 compared with placebo. Secondary endpoints in clinical trials showed improvements in lowering blood pressure and reductions in body weight. The risk:benefit ratio must be assessed for empagliflozin as the safety profile includes an increase in urinary and genital infections. CONCLUSION: Empagliflozin has shown efficacy in lowering HbA1c and blood glucose levels both as monotherapy and as an add-on to existing therapy. Despite the drug's promising outlook, empagliflozin also leads to common but serious adverse events not seen with other classes of antihyperglycemic agents. Considering the current data on its efficacy and its safety profile, empagliflozin can be used as a second- or third-line agent in treating diabetes.

Evaluating the Potential Impact of Pharmacist Counseling on Medication Adherence Using a Simulation Activity.

OBJECTIVE: To evaluate the impact of counseling in a simulated medication adherence activity. DESIGN: Students were randomized into 2 groups: patient medication monograph only (PMMO) and patient medication monograph with counseling (PMMC). Both groups received a fictitious medication and monograph. Additionally, the PMMC group received brief counseling. A multiple-choice, paper-based survey instrument was used to evaluate simulated food-drug interactions, adherence, and perceptions regarding the activity's value and impact on understanding adherence challenges. ASSESSMENT: Ninety-two students participated (PMMC, n=45; and PMMO, n=47). Overall, a significantly higher incidence of simulated food-drug interactions occurred in the PMMO group (30%) vs the PMMC group (22%) (p=0.02). Doses taken without simulated food-drug interactions were comparable: 46.2% (PMCC) vs 41.9% (PMMO) (p=0.19). The average number of missed doses were 3.2 (PMMC) vs 2.8 (PMMO) (p=0.55). Approximately 70% of the students found the activity to be valuable and 89% believed it helped them better understand adherence challenges. CONCLUSION: This activity demonstrated the challenges and important role of counseling in medication adherence.