Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)

Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota. Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state. Results: The final analysis included 21 respondents. Size, setting, and time as a certified PCMH varied between practices. PCMHs reported a higher percentage of patients enrolled at lower complexity tiers (35.0 percent at tier I and 40.4 percent enrolled at tier II), with PCMHs with clinical pharmacist services reporting slightly increased frequency of higher complexity patients. The composition of the care team varied from clinic to clinic, but all clinics were multidisciplinary with a mean of 5.8 different provider types listed for each clinic. Physicians were the most common providers of medication management across all settings, and one respondent reported that medication management services are not formally provided in his/her clinic. The presence or absence of a clinical pharmacist did not significantly influence care coordination time dedicated to medication-related activities. Respondents residing in a clinic with clinical pharmacist services reported a high level of satisfaction with pharmacist-provided services. Conclusion: The implementation of the PCMH model in many of the participating clinics was relatively recent and there remains much to be learned regarding the landscape of comprehensive medication management in the PCMH. The reported distribution of patients in complexity tiers suggests that clinics may use different strategies to determine resource allocation. Although the presence of a clinical pharmacist did not influence care coordination time dedicated, care coordinators valued services provided by clinical pharmacists.   Type: Original Researc

Interview with Donald L. Uden

Dr. Donald L. Uden was born in Minneapolis and raised in Coon Rapids, Minnesota. He earned his B.S. in pharmacy in 1975 and Pharm.D. in 1976, both from the University of Minnesota College of Pharmacy. Dr. Uden completed a fellowship in pulmonary medicine and clinical pharmacokinetics at the St. Paul-Ramsey Hospital and Medical Center in 1977. He began working at the Minneapolis Children’s Medical Center in 1979. There he served as Assistant Director of Pharmacy Services from 1979-1980, as Associate Director of Pharmacy Services from 1980-1983, as Director of Pharmacy Services from 1983-1985, and as Director of Research Administration from 1987-1992. Dr. Uden also worked at the St. Paul-Ramsey Medical Center, serving as Director of Clinical Pharmacy from 1985-1987. Dr. Uden returned to the University of Minnesota College of Pharmacy as Instructor of Clinical Pharmacy in 1977. He was promoted to assistant professor in 1981, to associate professor in 1985, and to full professor in 2002. He also served as Associate Dean for Student Services from 2000-2007. Dr. Uden died on March 21, 2020 at the age of 67.Dr. Uden begins his interview by discussing his childhood and high school experience in Coon Rapids, Minnesota. He then reflects on his coming to the University of Minnesota as an undergraduate, his early experiences with pharmacy practice, memorable classes, and his interaction with the medical school. He then describes the development of the Pharm.D. program and changes in the popular image of a pharmacist. He then discusses the significant relationships he formed with Dr. Lawrence Weaver and with peers through the professional fraternity Kappa Psi. He then reflects on his post-graduate work at the St. Paul-Ramsey Medical Center, his increasing involvement with pharmacokinetics, and his growing interest in clinical research. Dr. Uden then describes his time at Minneapolis Children’s Medical Center, his role there as Director of Pharmacy, and his work in pediatric and emergency care. Dr. Uden then discusses his return to the University of Minnesota as a faculty member and reflects on his experience with tenure policies and procedures. He then discusses the growth of clinical pharmacy and the pharmaceutical care movement. He then describes the Pharmacy Rural Education Program (PREP), as well as the development of the Rural Health School and his role as interim director. He then reflects on the deanship of Gilbert Banker, the state of the University of Minnesota College of Pharmacy in the 1990s, and the dynamic between Rho Chi and Lo Chi. Dr. Uden concludes by discussing the Doctor of Pharmacy Program for Practicing Pharmacists (DP4) and reflecting on his experience as Associate Dean of Students

QUALITY & SAFETY in PHARMACY PRACTICE: Book Review

Type: Book Revie

Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)

Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota. Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state. Results: The final analysis included 21 respondents. Size, setting, and time as a certified PCMH varied between practices. PCMHs reported a higher percentage of patients enrolled at lower complexity tiers (35.0 percent at tier I and 40.4 percent enrolled at tier II), with PCMHs with clinical pharmacist services reporting slightly increased frequency of higher complexity patients. The composition of the care team varied from clinic to clinic, but all clinics were multidisciplinary with a mean of 5.8 different provider types listed for each clinic. Physicians were the most common providers of medication management across all settings, and one respondent reported that medication management services are not formally provided in his/her clinic. The presence or absence of a clinical pharmacist did not significantly influence care coordination time dedicated to medication-related activities. Respondents residing in a clinic with clinical pharmacist services reported a high level of satisfaction with pharmacist-provided services. Conclusion: The implementation of the PCMH model in many of the participating clinics was relatively recent and there remains much to be learned regarding the landscape of comprehensive medication management in the PCMH. The reported distribution of patients in complexity tiers suggests that clinics may use different strategies to determine resource allocation. Although the presence of a clinical pharmacist did not influence care coordination time dedicated, care coordinators valued services provided by clinical pharmacists

Predictors of regional establishment success and spread of introduced non-indigenous vertebrates

Aim To provide the first analysis of predictors of both establishment and spread, both within and across taxa, for all vertebrate taxa within a region.We used Florida, USA, as our study system because it has a well-documented history of introduction and invasion, and is a hotspot for biological invasions. Location Florida, USA. Methods We analysed non-indigenous species (NIS) data from peninsular Florida – which included both successful and unsuccessful introductions from all vertebrate classes – to determine the best predictors of both establishment and spread for fish (65 species), herpetofauna (63 species), birds (71 species) and mammals (25 species). We used 10 variables proposed to be associated with the establishment and spread of NIS: body mass, geographic origin, reproductive rate, diet generalism, native-range size, latitude of native range, number of NIS present at date of introduction, presence of NIS congeners, morphological proximity to other NIS (in terms of body mass) and propagule pressure. A multimodel selection process was used with an information-theoretic approach to determine the best fit models for predicting establishment and spread of NIS.We selected a priori plausible predictive models for establishment and spread. Results Large native-range size and small body mass best predicted establishment of non-indigenous herpetofauna. The presence of NIS congeners had the largest positive effect on the establishment of non-indigenous fish. For mammals, the number of NIS present at the time of introduction best explained establishment. No single model best explained bird establishment. For all taxa but birds, the number of NIS present at time of introduction was included in at least one of the best-supported models for explaining spread. Main conclusions Our analyses suggest that predictors of establishment and spread differ across vertebrate taxa at the scale studied. Most predictive variables can be interpreted as measures of competitive interactions among species