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1.
JMIR Res Protoc ; 8(10): e13821, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573933

RESUMO

BACKGROUND: Medication errors, adverse drug events, and nonadherence lead to increased health care utilization and increased risk of adverse clinical outcomes, including graft loss, in solid organ transplant recipients. Veterans living with organ transplants represent a population that is at substantial risk for medication safety events and fragmented care coordination issues. To improve medication safety and long-term clinical outcomes in veteran transplant patients, interventions should address interorganizational system failures and provider-level and patient-level factors. OBJECTIVE: This study aims to measure the clinical and economic effectiveness of a pharmacist-led, technology-enabled intervention, compared with usual care, in veteran organ transplant recipients. METHODS: This is a 24-month prospective, parallel-arm, cluster-randomized, controlled multicenter study. The pharmacist-led intervention uses an innovative dashboard system to improve medication safety and health outcomes, compared with usual posttransplant care. Pharmacists at 10 study sites will be consented into this study before undergoing randomization, and 5 sites will then be randomized to each study arm. Approximately, 1600 veteran transplant patients will be included in the assessment of the primary outcome across the 10 sites. RESULTS: This study is ongoing. Institutional review board approval was received in October 2018 and the study opened in March 2019. To date there are no findings from this study, as the delivery of the intervention is scheduled to occur over a 24-month period. The first results are expected to be submitted for publication in August 2021. CONCLUSIONS: With this report, we describe the study design, methods, and outcome measures that will be used in this ongoing clinical trial. Successful completion of the Improving Transplant Medication Safety through a Technology and Pharmacist Intervention study will provide empirical evidence of the effectiveness of a feasible and scalable technology-enabled intervention on improving medication safety and costs. CLINICAL TRIAL: ClinicalTrials.gov NCT03860818; https://clinicaltrials.gov/ct2/show/NCT03860818. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13821.

2.
Prog Cardiovasc Dis ; 60(2): 249-258, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28826670

RESUMO

OBJECTIVE: To perform a pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients. BACKGROUND: Transitions of care in HF should include: medication reconciliation, multidisciplinary care, early post-discharge follow-up, and prompt intervention on HF signs and symptoms. We hypothesized that combining these elements with optimization of medications would impact outcomes. METHODS: In the SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC), patients were seen by a clinical pharmacist trained in HF. The pharmacist performed medication reconciliation, a basic physical exam, and a HF symptom history. Medications were adjusted by the clinical pharmacist or medical provider. Data were retrospectively collected for a quality improvement evaluation of this novel clinic on medication discrepancies, medications optimized, and 30-day readmissions. Descriptive statistics and paired t-tests were used for medication doses. RESULTS: All patients (n=135) had a diagnosis of HF, 59% were recently discharged. The mean time from discharge to the clinic appointment was 10±6days, and the 30day all-cause readmission rate was 9%. Medication discrepancies were detected in 53% of patients. Medications were optimized in 70%, most frequently beta blockers, ace inhibitors, and diuretics. In patients with an ejection fraction ≤40%, significantly higher doses of beta blockers and ace inhibitors were prescribed after the clinic visit. CONCLUSION: The HF MRTCC identified and corrected numerous medication discrepancies, up-titrated medications, and was associated with a 30-day readmission rate of 9%. These encouraging pilot results are hypothesis-generating and warrant further controlled trials.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Reconciliação de Medicamentos/organização & administração , Alta do Paciente , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Cuidado Transicional/organização & administração , Idoso , Idoso de 80 Anos ou mais , Fármacos Cardiovasculares/efeitos adversos , Cálculos da Dosagem de Medicamento , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Prescrição Inadequada , Liderança , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Exame Físico , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Estudos Retrospectivos , Fatores de Tempo
3.
Pharmacotherapy ; 33(5): 529-48, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23649813

RESUMO

Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. The goals of this paper are to outline potential roles for clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by clinical pharmacists, to recommend minimum training for clinical pharmacists engaged in HF care, and to suggest financial strategies to support clinical pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Positive outcomes associated with clinical pharmacist activities support the value of making this resource available to HF teams.

4.
J Card Fail ; 19(5): 354-69, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23663818

RESUMO

BACKGROUND: Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. METHODS AND RESULTS: The goals of this paper are to outline potential roles for clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by clinical pharmacists, to recommend minimum training for clinical pharmacists engaged in HF care, and to suggest financial strategies to support clinical pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. CONCLUSIONS: Positive outcomes associated with clinical pharmacist activities support the value of making this resource available to HF teams.


Assuntos
Insuficiência Cardíaca/terapia , Equipe de Assistência ao Paciente , Farmacêuticos , Serviço de Farmácia Hospitalar , Custos de Medicamentos , Serviços de Informação sobre Medicamentos , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Educação de Pós-Graduação em Farmácia , Transplante de Coração , Humanos , Assistência Médica , Medicare , Adesão à Medicação , Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos , Conduta do Tratamento Medicamentoso/economia , Ambulatório Hospitalar , Alta do Paciente , Educação de Pacientes como Assunto , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Estados Unidos
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