ABSTRACT
OBJECTIVE: Patients prescribed psychotropic medications within primary care are at risk of suboptimal monitoring. It is unknown whether pharmacists can improve medication safety through targeted monitoring of at risk populations. Access Community Health Centers implemented a quality improvement pilot project that included pharmacists on an integrated care team to provide medication reviews for patients. Aims were to determine whether inclusion of a pharmacist performing medication reviews within a primary care behavioral health (PCBH) practice is feasible and facilitates safe medication use. METHOD: Pharmacists performed medication reviews of the electronic health record for patients referred for psychiatry consultation. Reviews were performed 1-3 months following consultation and focused on medications with known suboptimal monitoring rates. Reviews were documented within the EHR and routed to the primary care provider. Primary outcome measures were change in percentage up-to-date on monitoring and AIMS assessment, and at risk of experiencing drug interaction(s) between baseline and 3 months postreview. Secondary outcome was provider opinion of medication reviews collected via electronic survey. RESULTS: Reviews were performed for 144 patients. Three months postreview, percentage up-to-date on recommended monitoring increased 18% (p = .0001), at risk for drug interaction decreased 20% (p < .0001), and up-to-date on AIMS decreased 12% (p = .2113). The majority of surveyed providers wanted medication reviews to continue. CONCLUSION: Pharmacist population-level monitoring within an integrated care team is feasible and associated with improved safety monitoring of psychotropic medications. Results identify key areas for improvement that other clinics considering integration of similar pharmacy services should consider. (PsycINFO Database Record
Subject(s)
Pharmacists/standards , Pharmacological Phenomena , Safety Management/methods , Adolescent , Adult , Child , Female , Humans , Middle Aged , Pharmacists/psychology , Primary Health Care/methods , Psychotropic Drugs/adverse effects , Psychotropic Drugs/therapeutic use , Referral and Consultation/standards , Safety Management/standardsSubject(s)
Contraceptives, Oral/therapeutic use , Menstruation Disturbances , Metformin/therapeutic use , Polycystic Ovary Syndrome/complications , Comparative Effectiveness Research , Evidence-Based Practice , Female , Humans , Hypoglycemic Agents/therapeutic use , Insulin Resistance/physiology , Menstruation Disturbances/drug therapy , Menstruation Disturbances/etiology , Review Literature as TopicABSTRACT
OBJECTIVE: Primary, to evaluate the usefulness of a comprehensive medication review (CMR) process in screening for adverse drug event (ADE) risk and to measure the impact of pharmacist recommendations; secondary, to evaluate whether screening tools assist in detecting ADEs. DESIGN: Nonrandomized, prospective pre/post pilot study. SETTING: Wisconsin-based community pharmacy affiliated with a two-campus retirement facility serving independently living older adults. PARTICIPANTS: Sixty-nine older adults responded to the initial call for participation in the ADE screening (mean age 84 years, mean daily medications: 13.7). Thirty-nine older adults (mean age 86 years, mean daily medications: 13.8) participated in both pre/post pilot study phases. INTERVENTION: Each participant received a CMR, including self-identified geriatric syndromes and St. Louis University Memory Screen (SLUMS) assessment. Recommendation letters included lifestyle changes to reduce medication use. A three-month follow-up call gathered current medication lists and recommendation acceptance rates. Repeat screenings were also conducted. MAIN OUTCOME MEASURE(S): Number of ADEs identified, recommendation acceptance rates, medication-related changes. Secondary measures: self-reported geriatric syndromes, SLUMS scores associated with ADE identification, screening tools associated with ADE identification. RESULTS: Pharmacist-initiated CMRs resulted in a high rate of discontinued nonsteroidal anti-inflammatory drugs (NSAIDs) and overall reduction in the number of scheduled medications. Participants with a positive ADE history were significantly more likely to report a suspected current ADE. Pharmacists incorporated nonpharmacologic interventions for reported geriatric syndromes, with high participant acceptance rates. In isolated cases, cognition was measurably improved with discontinuation of a targeted medication. CONCLUSIONS: Pharmacist-provided CMR services should be comprehensive, including patient's self-report of ADEs and history of ADEs. Pharmacist intervention can minimize prescription medication use, reducing the risk of ADEs.
