Preparing for the spread of patient-reported outcomes (PROs) data collection from primary care to community pharmacy: stakeholder insights

Medication non-adherence is a significant public health problem. Patient-reported outcomes (PROs) offer a rich data source to facilitate resolution of medication non-adherence. PatientToc™ is an electronic PRO data collection software originally implemented at primary care practices in California, United States (US). Currently, the use of standardized PRO data collection systems in US community pharmacies is limited. Thus, we are conducting a two-phase evaluation of the spread and scale of PatientToc™ to US Midwestern community pharmacies. This report focuses on the first phase of the evaluation. The objective of this phase was to prepare for implementation of PatientToc™ in community pharmacies by conducting a pre-implementation developmental formative evaluation to (1) identify potential barriers, facilitators, and actionable recommendations to PatientToc™ implementation and (2) create a draft implementation toolkit

Quality of care for older adults with chronic obstructive pulmonary disease and asthma based on comparisons to practice guidelines and smoking status

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to describe the prevalence of respiratory diseases in older adults and compare the demographic, health and smoking characteristics of those with and without these diseases. Furthermore, we evaluate the association between smoking status and patterns in health care and how concordant this care is with guidelines.</p> <p>Methods</p> <p>Using a nationally representative sample of 29,902 older adults who participated in the Medicare Current Beneficiary Survey (1992–2002), we compared guideline recommendations on the treatment and prevention of chronic obstructive pulmonary disease and asthma with survey utilization data, including the use of bronchodilators, spirometry and influenza vaccine.</p> <p>Results</p> <p>26% to 30% of older adults were diagnosed with or self-reported chronic respiratory diseases; however 69% received no pharmacological treatment and 30% of patients reporting use of pharmacological treatments did not receive short-acting bronchodilator inhalers. Current smokers appeared to receive significantly less care for respiratory diseases than non-smokers or former smokers.</p> <p>Conclusion</p> <p>Disparities between recommended and actual care for older adults with chronic lung disease require further research. The needs of older adults with co-morbidities and nicotine addiction deserve special attention in care as well as guideline development and implementation.</p

Experiences Applying Technology to Overcome Common Challenges in Pharmacy Practice-Based Research in the United States

Despite the importance of pharmacy practice-based research in generating knowledge that results in better outcomes for patients, health systems and society alike, common challenges to PPBR persist. Herein, we authors describe PPBR challenges our research teams have encountered, and our experiences using technology-driven solutions to overcome such challenges. Notably, limited financial resources reduce the time available for clinicians and researchers to participate in study activities; therefore, resource allocation must be optimized. We authors have also encountered primary data collection challenges due to unique data needs and data access/ownership issues. Moreover, we have experienced a wide geographic dispersion of study practices and collaborating researchers; a lack of trained, on-site research personnel; and the identification and enrollment of participants meeting study eligibility criteria. To address these PPBR challenges, we authors have begun to turn to technology-driven solutions, as described here

Patient And phaRmacit Telephonic Encounters (PARTE) in an Underserved Rural Population with Asthma: Methods and Rationale

Purpose: Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described. Summary: In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management) for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists’ training, the fidelity and quality of pharmacists’ service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures’ power to provide preliminary patient outcome findings. Conclusion: A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple perspectives of participants, clinicians, and researchers

Health Behavior Change after Blood Pressure Feedback.

Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant's home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure feedback may have promise as part of a multi-method approach involving blood pressure screening and follow up

Prevalence of Obstructive Respiratory Diseases among Older Adults, 1992–2002

<p><b>Copyright information:</b></p><p>Taken from "Quality of care for older adults with chronic obstructive pulmonary disease and asthma based on comparisons to practice guidelines and smoking status"</p><p>http://www.biomedcentral.com/1472-6963/8/144</p><p>BMC Health Services Research 2008;8():144-144.</p><p>Published online 8 Jul 2008</p><p>PMCID:PMC2500012.</p><p></p

Sensitivity analysis: odds ratio of behavior changes by participants’ characteristics in the subsequent examination (diagnosed patients only).

<p>*statistically significant p<0.1</p><p>**p<0.05 compared with reference group, by multiple logistic regression.</p><p>Sensitivity analysis: odds ratio of behavior changes by participants’ characteristics in the subsequent examination (diagnosed patients only).</p