A Pharmacist-Led, Patient-Centered Program Incorporating Motivational Interviewing for Behavior Change to Improve Adherence Rates and Star Ratings in a Medicare Plan.

INTRODUCTION:The Medicare 5-star quality rating system was designed to drive improvements in Medicare quality and to increase accountability among Medicare plans. Medicare star ratings provide significant bonuses for plans that improve medication adherence. Envolve's pharmacy division, Envolve Pharmacy Solutions, which provides services for Medicare Advantage Prescription Drug plans, developed an in-house medication therapy management (MTM) program to improve adherence rates and subsequent star ratings. As part of this program, Envolve invested in motivational interviewing (MI) as a means to improve adherence to antihypertensives, antihyperlipidemics, and antidiabetics but recognized the need for additional staff training to ensure pharmacist success with MI techniques. Thus, Envolve engaged a consultant to help train pharmacists and evaluate the program. This best practices article describes the implementation of an MI program and subsequent changes in patient adherence and star ratings. PROGRAM DESCRIPTION:A pharmacist-led, patient-centered adherence program incorporating MI for behavior change was developed and implemented at Envolve. The program used didactic learning, coaching and skills assessments, and a train-the-trainer (TtT) intervention. This approach resulted in improved adherence rates in all 3 therapeutic classes immediately. In addition, a quality improvement process was incorporated to evaluate the improvements in adherence with this new program over 24 months. OBSERVATIONS:Key findings of the program are as follows: (a) the program increased adherence rates 5-9 percentage points (chi-square tests for all plans and drug classes measured, P < 0.05) over 5 years and improved Medicare star ratings by 1-2 stars; (b) there is a need for support of pharmacy MTM managers to ensure continued success of the program; and (c) there is value in a TtT program for managers that allows them to provide continuous evaluation and feedback to staff for improvement. IMPLICATIONS:Each year, as the Medicare star ratings system matures and plans are held more accountable for improving adherence measures, high star ratings become more difficult to attain. This MI TtT program for pharmacists allows for rapid cycle change in response to these challenges. DISCLOSURES:Funding was provided by Envolve Pharmacy Solutions, which contracted with the University of California, San Francisco (UCSF), School of Pharmacy for the development and implementation of the motivational interviewing and train-the-trainer programs described in this best practices article. Spears, Erkens, and Misquitta are employees of Envolve Pharmacy Solutions. Stebbins and Cutler are faculty in the Department of Clinical Pharmacy at the UCSF School of Pharmacy, who were contracted through Envolve Pharmacy Solutions to provide consulting services for this best practice

INSTRUCTIONAL DESIGN AND ASSESSMENT Peer-to-Peer Interprofessional Health Policy Education for Medicare Part D

Objectives. To determine whether a peer-to-peer education program was an expedient and effective approach to improve knowledge and promote interprofessional communication and collaboration. Design. Trained pharmacy students taught nursing students, medical students, and medical residents about the Medicare Part D prescription drug benefit (Part D), in 1-to 2-hour lectures. Assessment. Learners completed a survey instrument to assess the effectiveness of the presentation and their attitudes toward the peer-to-peer instructional format. Learners strongly or somewhat agreed that the peer-to-peer format was effective in providing Part D education (99%) and promoted interprofessional collaboration (100%). Qualitative data highlighted the program's clinical relevance, value in promoting interprofessional collaboration, and influence on changing views about the roles and contributions of pharmacists. Conclusion. The Part D peer educator program is an innovative way to disseminate contemporary health policy information rapidly, while fostering interprofessional collaboration

The Evolution of Drug Information Services to Asynchronous Delivery of Pharmacist eConsults

Drug information (DI) services provided an avenue to expand the role of pharmacists as the medication experts. The focus of DI has shifted from general questions submitted to DI centers to patient-specific questions that optimize care. One method to increase access to pharmacist expertise is through pharmacy eConsults. Pharmacy eConsults provide specialist care for medically complex patients using a patient-centered, asynchronous approach. The purpose of this article is to describe the evolution of consults from formal drug information services and describe one academic medical center's implementation of a pharmacy eConsult service to provide patient-specific DI

Catherine Ross : Stella Mere

Peck’s essay on Ross’s “Stella Mere” installation – 700 aluminium castings of a starfish arranged in the form of a landscape – and previous stone sculptures underlines the significance of the artist’s choice of subject matter, materials and technique. Peck’s analysis also draws attention to how women’s sculpture challenges the modernist notion of truth-to-materials. Duschenes’ poetic response to “Stella Mere” highlights Ross’s concern for natural rhythms and forms: animals, waves, forests and the earth. Relations between illusion and reality are also discussed. Biographical notes. 5 bibl. ref

A Pharmacist-Led, Patient-Centered Program Incorporating Motivational Interviewing for Behavior Change to Improve Adherence Rates and Star Ratings in a Medicare Plan.

INTRODUCTION: The Medicare 5-star quality rating system was designed to drive improvements in Medicare quality and to increase accountability among Medicare plans. Medicare star ratings provide significant bonuses for plans that improve medication adherence. Envolves pharmacy division, Envolve Pharmacy Solutions, which provides services for Medicare Advantage Prescription Drug plans, developed an in-house medication therapy management (MTM) program to improve adherence rates and subsequent star ratings. As part of this program, Envolve invested in motivational interviewing (MI) as a means to improve adherence to antihypertensives, antihyperlipidemics, and antidiabetics but recognized the need for additional staff training to ensure pharmacist success with MI techniques. Thus, Envolve engaged a consultant to help train pharmacists and evaluate the program. This best practices article describes the implementation of an MI program and subsequent changes in patient adherence and star ratings. PROGRAM DESCRIPTION: A pharmacist-led, patient-centered adherence program incorporating MI for behavior change was developed and implemented at Envolve. The program used didactic learning, coaching and skills assessments, and a train-the-trainer (TtT) intervention. This approach resulted in improved adherence rates in all 3 therapeutic classes immediately. In addition, a quality improvement process was incorporated to evaluate the improvements in adherence with this new program over 24 months. OBSERVATIONS: Key findings of the program are as follows: (a) the program increased adherence rates 5-9 percentage points (chi-square tests for all plans and drug classes measured, P < 0.05) over 5 years and improved Medicare star ratings by 1-2 stars; (b) there is a need for support of pharmacy MTM managers to ensure continued success of the program; and (c) there is value in a TtT program for managers that allows them to provide continuous evaluation and feedback to staff for improvement. IMPLICATIONS: Each year, as the Medicare star ratings system matures and plans are held more accountable for improving adherence measures, high star ratings become more difficult to attain. This MI TtT program for pharmacists allows for rapid cycle change in response to these challenges. DISCLOSURES: Funding was provided by Envolve Pharmacy Solutions, which contracted with the University of California, San Francisco (UCSF), School of Pharmacy for the development and implementation of the motivational interviewing and train-the-trainer programs described in this best practices article. Spears, Erkens, and Misquitta are employees of Envolve Pharmacy Solutions. Stebbins and Cutler are faculty in the Department of Clinical Pharmacy at the UCSF School of Pharmacy, who were contracted through Envolve Pharmacy Solutions to provide consulting services for this best practice

David Kramer : Heaven on Earth

This catalogue features scripts and stills from eight videos by Kramer, as well as documentation of various installations. Both Stebbins and Viveros-Fauné, suggest the artist's work provides a critique of consumer culture. They also comment on the “loser” persona that Kramer perpetuates in his work – a persona that often reassembles the pathetic cast-offs of consumerism. Biographical notes

Pharmacy students teaching prescribers strategies to lower prescription drug costs for underserved patients.

BACKGROUND: The rising costs of health care and, in particular, prescription drugs remains a challenge. Health professionals ability to promote cost-effective prescription drug use is critical, yet this subject is not included consistently in the curriculum of most health professional schools. As experts in prescription drug selection, use, and cost, pharmacists are in a unique position to help manage prescription drug regimens for the best therapeutic outcome, while also helping to keep patients out-of-pocket (OOP) prescription drug costs low. In addition to promoting interprofessional collaboration, pharmacy student-led lectures may provide an effective means to teach prescription drug cost-savings strategies to other health professional students and current prescribers. OBJECTIVE: To describe and evaluate the impact of a 60- to 90-minute standardized, case-based lecture on prescribers attitudes and knowledge about drug cost-containment strategies. METHODS: Four trained pharmacy students delivered a lecture that focused on strategies to help underserved patients with their OOP prescription drug costs. This lecture was given to health professional students and prescribers across disciplines. For purposes of this study, underserved patients included those with no drug insurance, those with limited financial resources who were unable to pay for their prescription drugs, and those whose drug insurance had significant gaps in coverage (e.g., Medicare Part D patients). Lectures targeted future and current prescribers and were delivered in multiple settings (e.g., residents seminars, medical grand rounds, required health policy courses for medical and nursing students). Pretest/posttest surveys were administered to assess the impact of the lecture on learners (a) knowledge of strategies to improve underserved patients access to needed prescription drugs; (b) willingness to address and discuss cost issues with patients; (c) likelihood of collaborating with other health care professionals; and (d) perception of pharmacists as patient advocates. The survey collected demographic information about learners and assessed their knowledge through 5 case-based, multiple-choice questions. The survey also asked learners to rate their agreement with 5 statements using a 4-point Likert rating scale (4 = strongly agree to 1 = strongly disagree). To control for potential test-retest bias for the case-based knowledge questions, an alternate version of the pretest/posttest survey was developed without the pretest knowledge questions included. Learners received either 1 of the 2 surveys randomly before the lecture began and were instructed to complete the pretest portion of the survey before the start of the lecture and to complete the posttest portion of the survey at the conclusion of the lecture. RESULTS: From October 2010 to June 2012, trained pharmacy students delivered 19 presentations to 626 learners from other health professions. Compared with the baseline, there was a statistically significant increase in the proportion of correct answers for each knowledge-based question after delivery of the lecture (overall significance P less than 0.001). Furthermore, there was a significant increase in the proportion of learners responding that they were more confident in their ability to select prescription drug cost-saving strategies; more likely to consult with other providers to lower OOP prescription drug costs; more likely to consider costs when making prescribing decisions; and more likely to ask their patients about prescription drug affordability (overall significance of P less than 0.05). In addition, after the lecture, more learners felt that pharmacists were patient advocates. Finally, 96% of learners felt that the lecture promoted interprofessional collaboration and would recommend it to other health care professionals. CONCLUSIONS: This study demonstrates that a single lecture given by pharmacy students to other health care professional students and current prescribers can improve knowledge of prescription drug cost-saving strategies targeted toward vulnerable patient populations and may increase the likelihood of collaboration between prescribers and pharmacists. The format of this lecture is an efficient and effective way to disseminate important and timely policy information to health care professionals

Pharmacy Students Teaching Prescribers Strategies to Lower Prescription Drug Costs for Underserved Patients

BACKGROUND: The rising costs of health care and, in particular, prescription drugs remains a challenge. Health professionals ability to promote cost-effective prescription drug use is critical, yet this subject is not included consistently in the curriculum of most health professional schools. As experts in prescription drug selection, use, and cost, pharmacists are in a unique position to help manage prescription drug regimens for the best therapeutic outcome, while also helping to keep patients out-of-pocket (OOP) prescription drug costs low. In addition to promoting interprofessional collaboration, pharmacy student-led lectures may provide an effective means to teach prescription drug cost-savings strategies to other health professional students and current prescribers. OBJECTIVE: To describe and evaluate the impact of a 60- to 90-minute standardized, case-based lecture on prescribers attitudes and knowledge about drug cost-containment strategies. METHODS: Four trained pharmacy students delivered a lecture that focused on strategies to help underserved patients with their OOP prescription drug costs. This lecture was given to health professional students and prescribers across disciplines. For purposes of this study, underserved patients included those with no drug insurance, those with limited financial resources who were unable to pay for their prescription drugs, and those whose drug insurance had significant gaps in coverage (e.g., Medicare Part D patients). Lectures targeted future and current prescribers and were delivered in multiple settings (e.g., residents seminars, medical grand rounds, required health policy courses for medical and nursing students). Pretest/posttest surveys were administered to assess the impact of the lecture on learners (a) knowledge of strategies to improve underserved patients access to needed prescription drugs; (b) willingness to address and discuss cost issues with patients; (c) likelihood of collaborating with other health care professionals; and (d) perception of pharmacists as patient advocates. The survey collected demographic information about learners and assessed their knowledge through 5 case-based, multiple-choice questions. The survey also asked learners to rate their agreement with 5 statements using a 4-point Likert rating scale (4 = strongly agree to 1 = strongly disagree). To control for potential test-retest bias for the case-based knowledge questions, an alternate version of the pretest/posttest survey was developed without the pretest knowledge questions included. Learners received either 1 of the 2 surveys randomly before the lecture began and were instructed to complete the pretest portion of the survey before the start of the lecture and to complete the posttest portion of the survey at the conclusion of the lecture. RESULTS: From October 2010 to June 2012, trained pharmacy students delivered 19 presentations to 626 learners from other health professions. Compared with the baseline, there was a statistically significant increase in the proportion of correct answers for each knowledge-based question after delivery of the lecture (overall significance P less than 0.001). Furthermore, there was a significant increase in the proportion of learners responding that they were more confident in their ability to select prescription drug cost-saving strategies; more likely to consult with other providers to lower OOP prescription drug costs; more likely to consider costs when making prescribing decisions; and more likely to ask their patients about prescription drug affordability (overall significance of P less than 0.05). In addition, after the lecture, more learners felt that pharmacists were patient advocates. Finally, 96% of learners felt that the lecture promoted interprofessional collaboration and would recommend it to other health care professionals. CONCLUSIONS: This study demonstrates that a single lecture given by pharmacy students to other health care professional students and current prescribers can improve knowledge of prescription drug cost-saving strategies targeted toward vulnerable patient populations and may increase the likelihood of collaboration between prescribers and pharmacists. The format of this lecture is an efficient and effective way to disseminate important and timely policy information to health care professionals