Greater Expectations for Pharmaceutical Value: Better Care, Healthier People, Smarter Spending

Type: Commentar

Drug Therapy Problems in NCAA Division I-A Minnesota Gopher Student-Athletes

As with all competitive sports, in NCAA Division I-A athletics it is important to maximize controllable factors in order for each athlete to compete at his or her best. One important and controllable factor that has the potential for improvement is the athlete’s medication experience. When medications are used to treat the correct condition, administered at the right time, and with the correct dose, they have the potential to improve outcomes and enhance athletic performance. As an example, it is essential that a soccer player who has asthma is using the correct inhaler, at the correct time, with proper technique, and with the correct number of puffs in order to support breathing and improve oxygen transportation during a game. Ineffective and unsafe use of medications can lead to serious disease-related events and also prevent an athlete from achieving their performance goals when they are not being used correctly. The goal of this project was to explore the presence and extent of drug therapy problems (DTPs) among a college athlete population. Within the 10 student-athletes who were interviewed, there were a total of 36 drug therapy problems identified, many of which were tied to a lack of understanding for their own medication regimen. This project suggests that medication-related needs may not be appropriately addressed among the college athlete population. The addition of a pharmacist on the athletic healthcare team would ensure appropriate medication use and optimization for health outcomes and overall athletic performance.   Article Type: Original Researc

An Evaluation of the Distribution, Scope, and Impact of Community Pharmacy Foundation Grants Completed by Academic Principal Investigators between 2002 and 2014

Objective: From a total of 107 grants, a subset evaluation of 58 grants awarded to and completed by pharmacy faculty by the Community Pharmacy Foundation (CPF) from 2002 through 2014 was conducted to: (a) evaluate the representativeness across principal investigator (PI) academic institutions, (b) compare the scope of CPF grants completed by academic PIs across time, and (c) compare the impact of CPF grants completed by academic PIs across time. Methods: Quantitative data for all 107 CPF grants awarded between 2002 and 2014 were obtained from the CPF website and CPF personnel. Qualitative ethnographic data was generated from principal investigator (PI) interviews by email communications. All 107 grants, including a subset of 58 grants awarded to pharmacy faculty, were analyzed and compared between ‘Initial Years’ (2002-2008) and ‘Recent Years’ (2009-2014) using descriptive statistics for quantitative data and an extraction of dominant themes from PI reflections for qualitative data. Results: In the initial years (2002-2008), 54% of grants awarded to pharmacy faculty were from public academic institutions. This proportion increased to 80% in recent years (2009-2014). In recent years, pharmacy faculty projects were increasingly focused on higher AHRQ Impact Categories, such as changing policies and programs, clinical care and practice patterns, and health outcomes (AHRQ Impact Levels 2-4), rather than simply adding to the knowledge base (Impact Level 1). Academic investigators reported that funding positively influenced practice development (59%), promotion & advancement (59%), and expanded collaborations (38%). Diverse geographic representation of funding recipients was achieved. Conclusions: CPF funding has been invaluable for investigators seeking experience securing grant funding. And the impact of CPF funding has transitioned from studies that add to the knowledge base only, toward studies that effect actual health outcomes or that profoundly change practice. Conflict of Interest Anne Marie Kondic is Executive Director and Grants Administrator for the Community Pharmacy Foundation.   Type: Original Researc

Comparing the Research Contributions of Community Pharmacy Foundation Funding on Practice Innovation Between Non-Academics and Academics

Objective: Evaluate and compare the research contributions of Community Pharmacy Foundation (CPF) funding on community pharmacy practice innovation between non-academic and academic principal investigators (PIs) with respect to the following measurements: 1) “Pharmacy Practice Activity Classifications” (PPAC); 2) CPF “Coordinated Use of Medications”; and 3) CPF Investigator Impact. Methods: Quantitative data for all 124 CPF-funded grants awarded from 2002-2016 were obtained from the CPF website and personnel, while ethnographic qualitative data was generated from queries of PIs. Grant categorization was conducted by researchers serving as judges trained on the rules and procedures for coding. A threshold level of 90% agreement in scores of independent judging was established a priori. Findings were summarized and groups were compared using descriptive statistics for quantitative data and a thematic analysis of PI ethnographic reflections for qualitative data. Results: There were no differences between non-academic and academic PI groups for Coordinated Use of Medications and PPAC domains, but non-academics contributed more to two dispensing-related PPAC subclasses: ‘Preparing the Product’ (10% vs. 2%) and ‘Delivering the Medication or Device’ (13% vs. 2%). Analysis of investigator reflections revealed similarities between groups regarding impact on practice innovations, expanded collaborations, new practice tools, and patient-care financing models. Conclusions: CPF funding contributed new knowledge and resources for expanding and enhancing practice innovations as shown by quantitative (PPAC & Coordinated Use of Medications) and qualitative (PI impact) measures. Similarities between PI groups suggest that the CPF has established a funding niche with unique diversity of practice innovation opportunities. This investigation’s findings may be useful to the CPF’s continuous quality improvement efforts, as well as future grant applicants to assess research gaps in the medication use process and develop sustainable, transferable, and replicable patient-care innovations in community pharmacy practice. Conflict of Interest This program evaluation analysis was funded by the Community Pharmacy Foundation (CPF). Co-author Anne Marie Kondic is Executive Director and Grants Administrator for the Community Pharmacy Foundation. The ideas articulated in the manuscript are those of the authors to characterize historical CPF grant funding and do not necessarily indicate or impact future funding priorities.   Type: Original Researc

Evaluation of a Consumer-Generated Marketing Plan for Medication Therapy Management Services

The purpose of this project was to utilize a consumer-directed, care model redesign methodology to develop and evaluate a marketing plan for medication therapy management services (MTMS) provided in community pharmacies. This was accomplished through a six-step process: (1) application of "design thinking" for eliciting consumer input on redesigning MTMS and marketing approaches, (2) exploratory research, (3) focus group analysis, (4) marketing plan development, (5) marketing plan implementation, and (6) marketing plan evaluation. The findings showed that the application of "design thinking" and focus group analysis was useful for creating a consumer-directed marketing plan for medication therapy management services (MTMS). Implementation and evaluation of the MTMS Marketing Plan revealed that the most successful pharmacies were those that had established business associate agreements with the medical clinics closest to their site of practice, including access to electronic health records. This "virtual electronic presence" of pharmacists in the medical care system was highly consistent with the consumer demand we uncovered for a visible relationship between pharmacists, physicians and other health care providers.   Type: Original Researc

Integrating Medication Therapy Management (MTM) Services Provided by Community Pharmacists into a Community-Based Accountable Care Organization (ACO)

(1) Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM) services provided by community pharmacists into the clinical care teams and the health information technology (HIT) infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO). (2) Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO) model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3) Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4) Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements

Integrating Medication Therapy Management (MTM) Services Provided by Community Pharmacists into a Community-Based Accountable Care Organization (ACO)

(1) Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM) services provided by community pharmacists into the clinical care teams and the health information technology (HIT) infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO). (2) Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO) model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3) Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4) Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements

Selected Presentations Use of a Student-Driven, University-Based Pharmaceutical Care Clinic to Define the Highest Standards of Patient Care

PROLOGUE The goal of this educational strategy is preparation of pharmacy students to care for patients at the highest level possible in terms of a complete and comprehensive pharmaceutical care practice. Pharmacy students' abilities to provide direct patient care utilizing the pharmaceutical care process are evaluated. This educational strategy is designed for third professional year pharmacy students, although other pharmacy students also participate in the patient care process as care plan team members. A university dental clinic model has been adapted to create a functional structure for the egress of patients through this Pharmaceutical Care Clinic. Patient care process criteria developed by experienced pharmaceutical care practitioners are an important focus of students' performance evaluation. Patients receiving care in this clinic also evaluate student performance with a patient-as-the-expert strategy utilized in medicine. Patients receiving care in this clinic have, on average, 5.2 medical conditions, take 7.8 active medications/remedies, and have 2.6 drug therapy problems per patient (level four on the resource-based relative value scale). Patient care process criteria utilized to assess student performance can also be applied to evaluation of a student's performance in experiential clerkship rotations. Future plans include utilizing this clinic strategy to also define pharmaceutical care compensation standards