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1.
Am J Health Syst Pharm ; 76(1): 17-25, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381097

RESUMO

PURPOSE: To evaluate the impact of a pharmacy-directed pain management service (PPMS) designed to optimize analgesic pharmacotherapy, minimize adverse events, and improve patients' experience of pain management. METHODS: A retrospective analysis was conducted to evaluate the PPMS consisting of 3 dedicated pain management clinical pharmacists who perform both consult-based and stewardship functions. Multiple measures of opioid use and associated patient satisfaction outcomes during 3-year periods before and after implementation of the PPMS were compared. RESULTS: Significant decreases in use of institutionally defined high-risk opioid medications (e.g., parenteral hydromorphone, fentanyl, transdermal fentanyl patches), a decrease in total institutional opioid use, increased coanalgesic and adjunctive medication use, and a decrease in rapid response team (RRT) and code blue events associated with opioid-induced oversedation were seen after service implementation. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey domains. CONCLUSION: Our data highlights the impact of a pharmacy directed pain management service on institutional opioid use with available data suggesting improved patient satisfaction scores and indirect cost savings. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated HCAHPS survey pain management domains.


Assuntos
Analgésicos Opioides/uso terapêutico , Conduta do Tratamento Medicamentoso/organização & administração , Manejo da Dor/métodos , Dor/tratamento farmacológico , Farmacêuticos , Adulto , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde , Hospitais Rurais/organização & administração , Hospitais Rurais/estatística & dados numéricos , Humanos , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor/diagnóstico , Medição da Dor , Segurança do Paciente , Satisfação do Paciente , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
2.
Ann Pharmacother ; 36(5): 892-904, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-11978169

RESUMO

OBJECTIVE: To describe the development of a pharmacist-managed lipid clinic within a primary care medical clinic and review its results after approximately 12 months of operation. METHODS: A pharmacist-managed lipid clinic was developed at Naval Medical Center San Diego. Administrative background, treatment algorithm development, operational issues, clinical activities, and barriers to the clinic are discussed. For intermediate outcomes, data from patients who had at least 1 intervention by the pharmacist and 1 follow-up lipid panel were analyzed for medication use, changes in lipid parameters, and percent reaching the low-density-lipoprotein (LDL) target goal. Modified National Cholesterol Education Program-Adult Treatment Panel II guidelines were used to determine the LDL goal. RESULTS: Following approximately 12 months of operation, the clinic received 204 referrals and consisted of 146 active patients. A brief study was conducted to assess clinical outcomes. Of 115 patients who were seen in the clinic and met inclusion criteria, 57% were receiving treatment with a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) and 17% were receiving fibrates; 17% of the patients were not receiving lipid-lowering medications. Relative to baseline, LDL cholesterol concentrations decreased 20%, high-density-lipoprotein cholesterol increased 11%, and triglycerides decreased 19%. Overall, LDL goals were reached in 77% of the patients. LDL goals were attained by 63%, 79%, and 93% of patients with targets of <100, <130, and <160 mg/dL, respectively. Results are compared with other studies regarding lipid goal attainment. CONCLUSIONS: A pharmacist-managed lipid clinic can be developed and integrated into a primary care medical clinic. Pharmacists can effectively manage lipid-lowering therapy, helping to achieve LDL goals.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , LDL-Colesterol/sangue , Farmacêuticos/organização & administração , Administração Farmacêutica/métodos , Algoritmos , Monitoramento de Medicamentos/métodos , Controle de Formulários e Registros/organização & administração , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta , Resultado do Tratamento , Carga de Trabalho
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