Impact of a Primary Care Clinical Pharmacist on the Management of Hepatitis C Viral Infection

Interprofessional care including a pharmacist demonstrates a positive trend towards increasing access to care and improving adherence to Hepatitis C management in a primary care setting.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1023/thumbnail.jp

Evaluation of Pharmacist- or Nurse-driven Long-acting Insulin Titration Protocol in Adult Primary Care Patients with Type 2 Diabetes

INTRODUCTION Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol. METHODS This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) \u3e8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was the change in A1C value between pre-protocol enrollment and post-protocol measurement. RESULTS Nurse care managers managed 180 (87.8%) patients while 25 (12.2%) were managed by pharmacists. Patients enrolled in the LAIT protocol experienced a significant decrease in A1C (from 9.97 ± 1.85% pre-referral to 8.60 ± 1.67% post-referral, p DISCUSSION The LAIT protocol was successful in improving glycemic control among patients with T2D. Future enhancements to the protocol could focus on analyzing referral utilization and patient engagement. CONCLUSION The LAIT protocol allows pharmacists and nurse care managers to make a significant contribution toward achieving glycemic goals in those with uncontrolled diabetes

Impact of pharmacist-led medication reconciliation and education at an outpatient dialysis center

Purpose/Background: Patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) are a vulnerable population experiencing high pill burden, low medication adherence rates, multiple comorbidities, and frequent transitions of care. Clinical Pharmacists are highly trained members of the interdisciplinary team who possess the necessary skills to assess and improve drug-related problems in this population. The aim of this study was to evaluate clinical pharmacist integration into an outpatient dialysis center and to determine the impact of pharmacist intervention on medication list accuracy, patient education and adherence to medications used in the management of ESRD. Methods/Approach: The project was conducted at an outpatient dialysis center in Southern Maine. The pharmacist provided clinical services once weekly for 6 months for all patients receiving dialysis. The pharmacist interacted with the patients on three separate, scheduled occasions. The first visit included medication reconciliation, a baseline assessment of adherence using an eight-item questionnaire, and assessment of phosphorus binder understanding using a five-item questionnaire. The second visit focused on education regarding phosphate binders and a review of patients’ other medications. During the third visit, the pharmacist conducted a post-intervention adherence and knowledge assessment of the education provided. Baseline patient demographic information was collected and pre- and post-intervention serum phosphorus levels were recorded along with medication list discrepancies. Patient scores on both the adherence and phosphorus binder understanding questionnaires were assessed. This project was deemed as quality improvement by the Maine Medical Center Institutional Review Board. Results A total of 21 out of 28 eligible patients completed the entire pharmacist pilot program Majority of patients were white and male (88% and 56% respectively) and 48% of patients reported an educational level that was greater than high school. Common comorbid conditions observed included diabetes, hypertension and dyslipidemia. Median time on dialysis was 2 years (range 0.5-10 years). Medication list discrepancies were detected in 100% of patients who completed medication reconciliation by the pharmacist, with a median of 6 discrepancies per patient (range 2-13). For patients who completed the entire program, serum phosphorus levels decreased significantly by a median of -0.40 mg/dL at 1 month post pharmacist intervention (p=0.028). Additionally, the number of patients reporting “never” missing a dose of phosphorus binder in the past week significantly increased after pharmacist intervention (23.8% before and 57.1% after, p= 0.033). There was a statistically significant increase in phosphorus binder education scores after pharmacist intervention (pre median score of 2, post median score of 5, p\u3c0.001). Conclusion Patients receiving medication reconciliation services and medication education from the clinical pharmacist at an outpatient dialysis center experienced decreased serum phosphorus levels, improvements in self-reported phosphorus binder adherence and an improved understanding of their phosphorus binder therapy as evidenced by the improvement in their education scores. Medication list discrepancies were detected in all patients receiving medication reconciliation services by the pharmacist. The evaluation of this clinical pharmacist pilot program demonstrates the positive impact that a pharmacist can have on this patient population

Patient learning about diabetes through group medical visits in Family Medicine

Purpose/Background: Portland Family Medicine (PFM) initiated group medical visits (GMVs) for diabetic patients in January 2019 to deliver evidence-based diabetes care within a supportive environment, promoting patient learning via shared experiences. The existing literature on GMVs for diabetes care consistently shows improvement in clinical outcomes, when compared to traditional primary care models, but we hoped to examine the effectiveness of our interdisciplinary care model at PFM to see if our learning environment would produce similar benefits. Quality improvement data were obtained to assess the effectiveness of the diabetes groups in increasing participants’ knowledge about diabetes, and in improving clinical outcomes. We hypothesized that participants who improved their diabetes knowledge would have the greatest improvement in clinical outcomes. Methods/Approach: Primary care providers from the Portland and Falmouth Family Medicine offices referred patients with uncontrolled diabetes. Groups were led each week by a physician and a clinical pharmacist. During the initial group, patients completed the Michigan Diabetes Research and Training Center’s (MDRTC’s) Diabetes Knowledge Test. This validated, multiple choice question test, assessed patients’ knowledge about diabetes. Patients’ “pre-test” scores from the initial group were compared to a second administration at least 6 weeks later, to assess patient learning through the group visits. Clinical data collected included patient weights, hemoglobin A1c’s, and other blood work, when clinically appropriate. Groups met once weekly for three visits during the first month, then every other week the second month, then monthly. Paired t-tests were used to compare values at pre- and post-intervention time points. Results: For the 24 patients who participated in diabetes GMVs at Portland Family Medicine between January 2019 and January 2020, average A1c dropped from a baseline of 9.8% to 8.1% at three months (p = 0.005). Of the 24 participants, 17 attended four or more diabetes GMVs (retained cohort), while seven attended fewer than four (lost cohort). The “retained” cohort had a statistically significant drop in mean A1c from 9.7%, to 7.5% at three months (p = 0.004). The “lost” cohort’s mean A1c went from 10.1% to 9.9% at three months (n = 4, too small for p-value calculation). Thirteen patients completed the diabetes knowledge post-test, with an average of 64.2% on the pre-test and 66.9% on the post-test, but this was not a statistically significant increase (p = 0.321). Conclusions: After one year of diabetes group visits at Portland Family Medicine, we have seen the improvement in clinical outcomes seen throughout the literature. Our data also suggest that clinical improvement after 3 months, measured by a statistically significant improvement in average A1c, is not related to increased diabetes knowledge, as measured by the MDRTC’s Diabetes Knowledge Test, suggesting participation alone may be more important than knowledge gained. As the sample continues to grow, further research could explore other clinical or utilization outcomes, including diabetes related ED visits or hospitalizations for group participants, medication adherence, exercise capacity, or progression of disease

The Impact of an InterprofessionalEducation Curriculum on Medical, Pharmacy and Social Work Students’ Interdisciplinary Perceptions and Teamwork

Purpose: To assess the impact of a Maine Medical Center Dept. of Family Medicine interprofessional education curriculum on student perceptions of competency and autonomy within their own profession, on attitudes toward the contributions and value of other disciplines and individual self-assessment of skills required to work effectively on an IP team. Background: Interprofessional (IP) collaboration among a variety of health care disciplines has been found to be effective in improving patient health outcomes, reducing medical errors, decreasing readmission rates and enhancing patient satisfaction. Efforts are being focused globally on training health care professionals to work in collaborative practices through interprofessional education (IPE). Student participant satisfaction, attitudes and reactions to IPE have been well-studied. To add to the literature, we were interested in assessing the impact of a Maine Medical Center Family Medicine IPE curriculum on student perceptions of competency and autonomy within their own profession, on attitudes toward the contributions and value of other disciplines and individual self-assessment of skills required to work effectively on an IP team. Methods: From October 2014 to December 2018, social work, pharmacy and medical students worked as an IP team involving inpatient, outpatient and home visit experiences. Students completed two validated surveys pre- and post- their interprofessional education (IPE) rotation: the Interdisciplinary Education Perception Scale (IEPS) and the Teams Skills Scale (TSS). Paired t-test analyses were conducted on individual pre- and post-survey scores. Results: 27 (77%) of the 35 participating students completed pre- and post- surveys. Significant differences were found between student pre-IEPS mean scores (4.98) and post-IEPS mean scores (5.29), with a mean difference in matched pairs of 0.31 (p \u3c 0.0009, n = 27). Students reported significant differences in individual pre-TSS mean scores (3.52) and post-TSS mean scores (4.31), with a mean difference in matched pairs of 0.79 (p \u3c 0.0001, n = 27). Discussion: Our findings demonstrate that an integrated IPE curriculum involving teaching and team experiences across inpatient, outpatient and home settings had a positive impact on students’ overall IP teamwork perceptions, attitudes and self-assessed skills. Strong administrative support and faculty IP training and buy-in were essential to overcome the predicted challenges of implementing a curriculum with students from different professions, developmental stages, and rotation schedules. Future studies would benefit from increasing the number of students from all professional groups and recruiting multiple sites. Collecting additional demographic information would allow for analysis and understanding about such factors as the impact of gender or previous IPE experience on the impact of the IPE curriculum. Conclusion: This study provides evidence that an IPE curriculum, taught by IP faculty, with experiences across inpatient, outpatient and home settings, where students learn with, from, and about each other, has a positive impact on IP attitudes, perceptions and self-assessed teamwork skills of students from the professions of medicine, pharmacy and social work

Integrating Interprofessional Case Scenarios, Allied Embedded Actors, and Teaching Into Formative Observed Structured Clinical Exams.

BACKGROUND AND OBJECTIVES: Interprofessional education is a critical component of medical student training, yet it is often difficult to implement. Medical students who learn with, from, and about learners from other disciplines have been shown to create more effective and safe health care teams. The investigators wanted to know how participating in two interprofessional observed structured clinical exams (OSCEs) at Tufts University School of Medicine (TUSM) would affect changes in medical students\u27 attitudes and values in interprofessional teamwork. METHODS: For the academic years 2017 and 2018, two interprofessional case scenarios were integrated into OSCEs for third-year medical students at TUSM, with an allied embedded actor (AEA) playing a social worker to an end-of-life scenario, and an AEA playing the role of a pharmacy student added to a chronic pain scenario. Students participated in didactic training about interprofessional teamwork and received structured feedback regarding interprofessional competencies following simulation cases. Changes in interprofessional knowledge and attitudes were assessed by comparing student pre- and postscenario mean scores on the Interprofessional Socialization and Valuing Scale (ISVS-21, a 21-item scale survey), with students rating themselves on a Likert scale from 1 (not at all) to 7 (to a very great extent). We performed paired t-test analysis on individual pre- and post-ISVS-21 means. RESULTS: Three hundred fifty-three of the 417 participating medical students fully completed pre- and postsurveys. Students reported significant changes in interprofessional knowledge and attitudes (mean change=1.3, P CONCLUSIONS: Placing interprofessional cases involving AEAs into OSCE events is easily replicated, and positively impacts students\u27 attitudes and values in interprofessional knowledge