Medicaid reimbursement for pharmacist services: A strategy for the pharmacy profession.

PURPOSE: Reimbursement for pharmacist services is complex due to a different set of rules for each payer. State legislatures, regulators, and professional licensing bodies have expanded the scope of practice for pharmacists in many states, representing a significant opportunity for third-party payers, including the Centers for Medicare and Medicaid Services, to enable and expand patient access to, and receipt of, care from pharmacists. This paper will introduce the term "other licensed practitioner" and describe how a state Medicaid program may include covered services provided by a pharmacist practitioner using the Medicaid state plan amendment process. SUMMARY: In recent years, states have made great strides in training and educating high-quality pharmacist practitioners, expanding the scope of practice in all states, incorporating a credentialing and privileging process, and expanding the use of collaborative practice agreements with physicians and nurse practitioners. Pharmacists are well-positioned, essential members of the healthcare team, providing a spectrum of clinical and prevention services that increase access to care and improve health outcomes. CONCLUSION: A broad coalition of stakeholders including states, the federal government, pharmacy organizations, and other parts of the health ecosystem, working together, can better address the health needs of a state and its Medicaid beneficiaries. Pharmacist practitioners across different settings of care can augment public health efforts, as well as primary and specialty care practices. State efforts should include enrollment and reimbursement of pharmacist practitioners as Medicaid providers for pertinent Medicaid-covered services.

Características clínico-funcionais de idosos com osteoartrose de joelhos / Clinical and functional characteristics of elderly people with knee osteoarthrosis

O objetivo deste estudo, de cunho empírico analítico do tipodescritivo exploratório, foi observar as características clínicofuncionaisde 15 idosos com diagnóstico médico de osteoartrose de joelho, com idade ≥ a 60 anos, de ambos os gêneros, voluntários,moradores de Florianópolis, selecionados de forma não probabilística intencional. Utilizou-se a escala linear de dor e o questionário de McGill para verificar a intensidade e a qualidade da dor e ainda as medidas do ângulo “Q” e das amplitudes ativa e passiva de flexão e extensão do joelho de cada um dos sujeitos. Observou-se, pormeio de estatística descritiva, que a média de peso dos sujeitos foide 76,8 kg, caracterizando-os como idosos com excesso de peso, já que a média da altura do grupo foi de 1,50 m. A mediana da intensidade da dor foi de 7,5 (S = 2,94) com média do número de descritores de qualidade de dor de 19. Esses parâmetros de alta intensidade da dor, somados a mediana das medidas do ângulo “Q”do joelho (21 graus), o quartil superior de 23 graus, e a média defl exão ativa de 111 graus e extensão ativa de 170 graus, caracterizam o grupo, como sujeitos que apresentam alteração postural e funcional mecânica desta articulação, com riscos de comprometera sua independência funcional, limitando-os significativamente na habilidade individual de levantar de uma cadeira, permanecer em pé confortavelmente, caminhar, subir e descer escadas. Identificar as alterações posturais, funcionais e de dor causadas por esta patologia é deveras relevante, possibilitando desta forma, a utilização destas medidas clínico-funcionais como parâmetro para o estudodos efeitos de tratamentos de correção e prevenção da evolução das deformidades posturais e da mecânica articular do joelho de idosos com osteoartrose de joelhos.

This descriptive exploratory study aimed at observing clinical and functional characteristics of 15 elderly people diagnosed withknee osteoarthrosis, aged ≥ 60 years, both genders, voluntaries,residents in Florianópolis selected by nonprobability sampling. The linear scale of pain and the McGill questionnaire were used to verify the intensity and quality of pain, and also measurement of “Q” angle and active and passive amplitude of flexion and extension movement of the knee in each subject. It was observed through descriptive statistic that subjects mean weight was 76.8 kg, characterizing then as overweight elderly people, since mean height of the group was 1.50 m. The median pain intensity score was 7.5 (S = 2.94),and mean descriptors of pain quality was 19. These high intensity parameters of pain added up to the median of “Q”angles (21°), the superior quartile (23°) and mean of active fl exion (111°) and theactive extension (170°) showed that the group had knee postural and mechanical functional alterations, with risks to compromise their functional independence, limiting significantly their individualability to stand up from the chair, stand comfortably, walk, go upand down the stairs. To identify the postural, functional and painalterations caused by this pathology is indeed relevant, allowingthe use of clinical and functional measurements as a parameterfor the study of effects of corrective treatments and prevention of postural deformities and mechanical knee alterations of elderly with osteoarthritis of the knee.

Estudo do padrão postural de jogadores de futebol da categoria infantil / Study of postural pattern in infantile category of soccer players

Levantar um referencial teórico sobre cadeias musculares e analisar o padrão postural, segundo as cadeias musculares, de jogadores de futebol da categoria infantil, relacionando-os aos movimentos repetitivos inerentes a prática dessa atividade, foram os objetivos desse trabalho. Foram estudados 22 jogadores com idade de 15 anos, pertencentes ao quadro do Sport Club Internacional, Porto Alegre, RS. As posturas foram analisadas através de fotografias e comparadas aos padrões ideais de postura. Os movimentos repetitivos foram observados através do acompanhamento dos treinos habituais realizados pela equipe, relacionando-os com a musculatura mais utilizada, sob a ótica das cadeias musculares. As variáveis idade, peso, posição em que joga, presença de lesões no joelho e prática de outra atividade física também foram consideradas, e seus valores foram obtidos através de entrevista não estruturada com os indivíduos estudados. Observou-se que existe uma alteração do padrão postural nos joelhos dos jogadores em flexo e varo, devido a maior utilização das cadeias de abertura e flexão pela sobreprogramação dessas cadeias nos movimentos repetitivos de chute durante os treinos. Outras alterações posturais na região do quadril, pés, coluna vertebral e ombros também analisados não revelaram um padrão consistente. Essas alterações posturais variaram de jogador para jogador, não se observando uma sobreprogramação das cadeias nessas outras articulações. As variáveis altura, peso, idade e prática de outras atividades desportivas não influenciaram o padrão postural dos jogadores observados.

The aim of this study was to raise theoretical reference about muscular chains and to analyses the postural pattern, according to the muscular chain, of the soccer players of the infantile category; to bring into relation with repetitive movements inherent to the practice of this activity. Twenty-two players were studied, with the age of 15, belonging to Sport Club Internacional, Porto Alegre, RS. The postures were analyzed through pictures and they were compared to the ideal model pattern of posture. The repetitive movements were observed through accompanying the habitual training accomplished by the team, relating them with the more utilized musculature, under muscular chain optic. The variables age, weight, soccer position, presence of the knee lesions and practice of another physical activity were also considered, and their values were obtained through the no structured interview with the group studied. It was observed that there is modification of the postural pattern on the knee in flex and varo, due to a higher utilization of the opening and flexion chain by the over programming of these chains during the repetitive movements of the kick in the practice of the soccer. Another postural modification on the hip, foot, vertebral column and shoulders also analyzed did not revealed a consistent pattern. These postural modifications diversified from player to player, not observing an overprogramming of the chains on those joints. The variables, height, weight, age and practice of another sport activity did not influence the postural pattern observed on the players.