Evaluating the role and value of a clinical pharmacist in a concierge primary care clinic.

OBJECTIVE: To understand the perceived role and value of the clinical pharmacist in a southern Arizona concierge primary care practice (CPCP) by employees. METHODS: Semistructured face-to-face interviews were conducted with health care team members employed by the CPCP site in December 2019 and January 2020 for this study. The interviews were audio recorded, transcribed, and thematically analyzed using an inductive approach with ATLAS.ti (version 7). A qualitative assessment was performed by 2 independent reviewers to identify the themes, which included clinical, economic, and humanistic outcomes. RESULTS: Eleven CPCP employees were interviewed: physicians (n = 2), a nurse practitioner (n = 1), medical assistants (n = 4), and administrative staff (n = 4). The perceived role and value of the clinical pharmacist in this CPCP varied by employee position; yet, all expressed the pharmacist's positive impact on patient care. Five themes were identified. The most common pharmacist roles identified included providing medication knowledge to providers, preventing abuse of controlled substances, monitoring clinical response to medications and adverse drug events, aiding in prior authorizations, educating patients, and providing patient-centered care. CONCLUSION: These results demonstrate that the integration of a clinical pharmacist into a CPCP can be valuable. This study highlights that the pharmacist was positively received by the physicians and staff. This further supports the value of the pharmacist as a key interprofessional health care team member. Further study is warranted to assess the longitudinal impact of pharmacists' services in a CPCP.

Impact of Pharmacist-Led Drug Therapy Management Services on HbA1c Values in a Predominantly Hispanic Population Visiting an Outpatient Endocrinology Clinic.

PURPOSE: To assess the impact pharmacists have on improving glycemic control among predominantly Hispanic diabetic patients visiting an endocrinology clinic in South Texas. Pharmacists were recently integrated into this clinic to be part of a collaborative team. METHODS: This study follows a retrospective cohort design. All patients received diabetic care from endocrinologists, and some received pharmacist-led drug therapy management (PDTM). Patients with ≥1 PDTM were categorized as the intervention group and those without PDTM as the standard of care (SOC) group. The outcome variables were the mean absolute change in glycosylated hemoglobin (HbA1c) from baseline and the proportion of patients at goal HbA1c (<7%) postintervention. RESULTS: Data were collected from 222 patients (n = 120 SOC patients, n = 102 PDTM patients). The mean age was 61 ± 14 years, 136 (61%) were female, and 197 (89%) were Hispanic. The mean absolute change in HbA1c was -1.3%. In the adjusted model, the mean absolute change in HbA1c in the PDTM compared to the SOC group was not significant (-0.1% ± 0.2%; P < .74), and concurrent interventions from registered dieticians (RDs) and licensed professional counselors (LPC) were identified as effect modifiers of the association. The stratum specific analysis identified the greatest decrease in HbA1c when the three interventions (ie, PDTM, RD, and LPC) coincided (-1.0% ± 0.3%; P < .01). Postintervention, 25% of those who received PDTM achieved an HbA1c<7% as compared to 19% in the SOC group. CONCLUSION: The clinical importance of pharmacists is enhanced when integrated with behavioral modifying programs to achieve additional improvement in HbA1c.

Extracorporeal membrane oxygenation: successful bridge to pediatric heart transplantation.

Since the year 2000, extracorporeal membrane oxygenation (ECMO) support for cardiac failure has been employed in the post operative care of children at the Centro Cardiovascular de Puerto Rico y el Caribe. Our experience with the application of ECMO had been limited to circulatory support after repair of congenital cardiac lesions. We report the first case in Puerto Rico where ECMO was used successfully as bridge to pediatric heart transplantation.

Dengue in children: critical points in management

Dengue fever (DF) is endemic and occasionally epidemic in many tropical and subtropical areas inhabited by the mosquito vector Aedes aegypti. Infection with Dengue may present with varied clinical manifestations. Significant morbidity and mortality can result if early recognition and monitoring of its severe forms (DHF and DSS) is not done and if appropriate medical intervention is delayed. This article reviews several critical points in the basic evaluation and management of dengue in the pediatric age group and present our current approach in the form of a therapeutic algorithm.