Impact of a Pharmacist-driven Spirometry Clinic Service within a Community Family Health Center: A 5-year Retrospective Review.

OBJECTIVE: This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center. METHODS: This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives. FINDINGS: Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; P = 0.024 and 76.3 years vs. 54.6 years; P < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity (r = -0.3593, P = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines. CONCLUSION: A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.

A systematic review of pharmacists performing obstructive sleep apnea screening services.

Background Obstructive sleep apnea (OSA) is a chronic sleep disorder associated with a varying degree of upper airway collapse during sleep. Left untreated, OSA can lead to the development of cardiovascular disease including risk of stroke and increased mortality. Pharmacists are the most accessible and underutilized healthcare resource in the community and can have a significant role in screening patients for OSA. The result may include an expedited referral to the patient's general practitioners or sleep disorder specialists for further diagnostic assessment and therapeutic intervention. Aim of the review The primary aim of this review was to identify the current published evidence of pharmacists providing OSA screening services in a community pharmacy setting. Methods A literature search was conducted to identify evidence of pharmacists providing OSA screening services. The literature search including five databases [PubMed, (1946-January 2015), Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical Abstracts (1970 to January 2015), Cochrane Database of Systematic Reviews and Google Scholar] with search terms of ("pharmacist or pharmacy") AND ("obstructive sleep apnea") AND ("sleep disorders") AND ("continuous positive airway pressure-CPAP") were used. Articles were limited to English and reported in humans. Results A total of seven publications (four Australia, two Switzerland and one France) were selected and evaluated. Pharmacists utilized validated screening tools in 6/7 (86 %) of clinical studies to assist in the identification of patients with sleep disorders in community pharmacies. A total of 1701 pharmacies encompassing 9177 patients were screened in the clinical studies. Pharmacists were able to identify between 21.4 and 67 % of patients that were at risk for developing OSA or required a referral to a general practitioner or sleep disorder specialist for further diagnostic testing. Conclusion Studies assessing the role of pharmacists performing OSA screening services remains limited due to the small number of studies available and differences in methodological assessment. More qualitative studies including randomized controlled trials are needed to better identify the value of pharmacists providing this novel service.

Pharmacists performing quality spirometry testing: an evidence based review.

BACKGROUND: The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines. AIM OF THE REVIEW: The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed. METHODS: A literature search was conducted using five databases [PubMed (1946-January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information. RESULTS: Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100%) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99% consistent with published data. CONCLUSION: Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by pharmacists and to measure health outcomes of the pulmonary patient.

A collaborative approach to achieving NCQA PCMH recognition within family medicine residency practices.

BACKGROUND AND OBJECTIVES: The Pennsylvania Academy of Family Physicians (PAFP) developed a statewide Residency Program Collaborative (RPC) to facilitate family medicine residency practices in Pennsylvania becoming recognized patient-centered medical homes (PCMHs). This report outlines the methods and a brief evaluation of the RPC, which included 20 residency practices. Participants attended tri-annual learning sessions and monthly conference calls, received physician faculty mentorship, and reported clinical quality data monthly on diabetes and ischemic vascular disease. METHODS: Two years after the start of the RPC, surveys were sent to residents, staff, providers, and administrators at participating practices to measure attendance and usefulness of collaborative sessions, mentors, and monthly reports. Evaluators also mapped the RPC curriculum to the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies. RESULTS: All 20 participating practices achieved National Committee for Quality Assurance (NCQA) PCMH recognition, with 17 attaining Level 3 recognition. A total of 295 surveys were collected (92 residents, 71 faculty, and 132 office staff/administrators). Survey data showed higher collaborative attendance for residents and faculty compared to office staff/administrators (~84% versus 45%). No differences were noted between resident and faculty respondents regarding perceived helpfulness of collaborative sessions (6.3 and 6.5, respectively), mentors (6.6 and 6.2) and monthly reports (6.4 and 6.5), with both groups rating these components more highly than staff/administrators (5.3, 5.3, and 5.4 for each category). CONCLUSIONS: Learning collaboratives can assist residency practices in achieving PCMH recognition while concurrently providing an educational framework aligned with residency program Core Competencies. The RPC intervention, including learning sessions, monthly conference calls, data reporting, and faculty mentors, also can effectively guide residency practices in the PCMH transformation process and can serve as a means to experientially imbue future family physicians with the attitudes and skills to create and effectively operate their practices under PCMH principles.

Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office / Evaluación de una clínica de espirometría dirigida por un farmacéutico en la consulta de un médico general

Objective: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians office Methods: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceutical interventions. Abnormal spirometry was identified as an obstructive and/or restrictive defect. Results: Sixty-five patients with a primary diagnosis of cough, shortness of breath, or diagnosis of asthma or chronic obstructive pulmonary disease were referred to the spirometry clinic for evaluation. A total of 51 (32 patients with normal spirometry, 19 abnormal spirometry) completed their scheduled appointment. Calculated lung age was lower in normal spirometry (58.1; SD=20 yrs) than abnormal spirometry (78.2; SD=7.5 yrs, p<0.001). Smoking pack years was also lower in normal spirometry (14.4; SD=10.7 yrs) than abnormal spirometry (32.7; SD=19.5 yrs, p=0.004). Resting oxygen saturation of the arterial blood (SaO2) was higher in normal spirometry than abnormal spirometry (98.1% vs 96.5%, p=0.016). Mean change in the forced expiratory volume in one second (FEV1) after administration of bronchodilator was greater in patients with abnormal spirometry compared with normal spirometry (10.9% vs 4.1%, p<0.001). Spirometry testing assisted in addition, discontinuation or altering pulmonary drug regimens in 41/51 patients (80%) and the need for further diagnostic testing or physician referral in 14/51 patients (27.4%). Conclusion: Implementation of a pharmacist-driven spirometry clinic is a value-added service that can be integrated with other clinical pharmacy services within the ambulatory care setting. Further studies are needed to determine the role of pharmacists in performing spirometry testing and measuring performance outcomes of the pulmonary patient (AU)

Objetivo: Evaluar el valor añadido de un servicio dirigido por un farmacéutico de una clínica rápida de espirometría para cuantificar las anomalías respiratorias en una consulta de un médico general. Métodos: Este estudio de cohorte prospectiva fue un análisis de los pacientes referidos por un médico que visitaron nuestra clínica de espirometría durante 2008-2010 debido a síntomas o enfermedad pulmonar. Después de la espirometría, se recogieron retrospectivamente los datos demográficos de los pacientes, los resultados de la espirometría y las intervenciones farmacéuticas. Se identificó una espirometría anormal cuando había una obstrucción o un defecto restrictivo. Resultados: 65 pacientes con diagnostico primario de tos, dificultad de respiratoria, o diagnóstico de asma o enfermedad pulmonar obstructiva crónica fueron referidos a la clínica de espirometría para evaluación. Un total de 51 pacientes (32 con espirometría normal y 19 con anomalías espirométricas) completó el esquema de citas. La edad pulmonar calculada fue menor en las espirometrías normales (58,1; DE=20 años) que en las anormales (78,2; DE=7,5 años; p<0,001). Los años de fumador fueron también menores en las espirometrías normales (14,4; DE=10,7 años) que en las anormales (32,7; DE=19,5 años; p=0,004). La saturación en reposo de oxígeno en la sangre arterial (SaO2) era superior en las espirometrías normales que en las anormales (98,1% vs. 96,5%, p=0,016). El cabio medio en el volumen espiratorio forzado en un segundo (FEV1) después de la administración de un broncodilatador fue mayor en pacientes con espirometría anormal comparado con las normales (10,9% vs. 4,1%; p<0,001). La espirometría ayudó en la adición, discontinuación o alteración de los tratamientos pulmonares en 41/51 pacientes (80%) y en la necesidad de pruebas posteriores o derivación al médico en 14/51 pacientes (24,4%). Conclusión: La implantación de una clínica espirométrica dirigida por un farmacéutico es un servicio de valor añadido que puede integrarse con otros servicios de farmacia clínica en los ambulatorios. Se necesitan más estudios para determinar el papel del farmacéutico realizando espirometrías y midiendo el funcionamiento de los resultados en salud de los pacientes pulmonaes (AU)

Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office.

OBJECTIVE: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians office. METHODS: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceutical interventions. Abnormal spirometry was identified as an obstructive and/or restrictive defect. RESULTS: Sixty-five patients with a primary diagnosis of cough, shortness of breath, or diagnosis of asthma or chronic obstructive pulmonary disease were referred to the spirometry clinic for evaluation. A total of 51 (32 patients with normal spirometry, 19 abnormal spirometry) completed their scheduled appointment. Calculated lung age was lower in normal spirometry (58.1; SD=20 yrs) than abnormal spirometry (78.2; SD=7.5 yrs, p<0.001). Smoking pack years was also lower in normal spirometry (14.4; SD=10.7 yrs) than abnormal spirometry (32.7; SD=19.5 yrs, p=0.004). Resting oxygen saturation of the arterial blood (SaO2) was higher in normal spirometry than abnormal spirometry (98.1% vs 96.5%, p=0.016). Mean change in the forced expiratory volume in one second (FEV1) after administration of bronchodilator was greater in patients with abnormal spirometry compared with normal spirometry (10.9% vs 4.1%, p<0.001). Spirometry testing assisted in addition, discontinuation or altering pulmonary drug regimens in 41/51 patients (80%) and the need for further diagnostic testing or physician referral in 14/51 patients (27.4%). CONCLUSIONS: Implementation of a pharmacist-driven spirometry clinic is a value-added service that can be integrated with other clinical pharmacy services within the ambulatory care setting. Further studies are needed to determine the role of pharmacists in performing spirometry testing and measuring performance outcomes of the pulmonary patient.