The development and evaluation of an interdisciplinary health training program: a pharmacy perspective

This program integrates training with the clinical interdisciplinary aspects of health care by directly involving pharmacy and other health professional students in an on-going team model of health care delivery. The training program model allows pharmacy students to learn the conceptual basis of team care and to experience directly how this concept is applied in an ambulatory health care setting. Learning strategies include specialty and team delivery of health care, participation in weekly interdisciplinary team training seminars, involvement in problem-solving and other skill building activities, and development of an interdisciplinary team project. Program evaluation results have indicated that students perceive that the interdisciplinary training increased their knowledge and positive attitudes towards interdisciplinary teams. The training also increased their sensitivity to patients, and enhanced the understanding of the problems of delivering health care to an urban community. The results have also shown that through this structured interdisciplinary experience, students reported having a better understanding of the roles of other health professionals and a greater awareness of how these different roles are integrated into a health care team.     

Enhancement of a pharmacy consultation program on a transitional care unit.

The revision and outcomes of a pharmacy consultation program on a transitional care unit (TCU) are described. In 1996, the pharmacy consultation program for the TCU at a 550-bed, tertiary care, community teaching hospital was revised. The changes included increasing the number and depth of medication reviews, mandating pharmacist attendance at interdisciplinary meetings, simplifying the medication review form, and expanding physician education. Data collected during the final two years of the original program (May 1994 to April 1996) and the first two years of the revised program (July 1996 to August 1998) were compared. The number of drug-related problems identified per admission was 0.80 for the revised program (versus 0.32 for the original program), the percentage of patients receiving at least one pharmacy medication review was 99% (versus 70%), the number of pharmacist recommendations made was 726 (versus 140), and the percentage of recommendations accepted was 82% (versus 55%). The program required up to 15 hours of pharmacist time per week. Cost savings were estimated at $15,000 for the first year of the revised program and $23,000 for the second year. Revision of the pharmacy consultation program for a TCU increased the identification of drug-related problems and the number of pharmacist recommendations, helped integrate pharmacists into the interdisciplinary care team, and produced a modest estimated cost savings.     

Development of a pharmacy residency program in home care.

A residency training program developed by a college of pharmacy in conjunction with a home care company is described. The 12-month program is based on the ASHP Residency Learning System and the goal statements and educational objectives of ASHP's accreditation standard for pharmacy practice residency training with emphasis in home care. Establishing the program involved identifying goals, objectives, and learning experiences consistent with the expected outcomes. Specific objectives for meeting goals in four categories--practice foundation skills, direct patient care, drug information and drug policy development, and practice management--were linked to expected program outcomes. Learning experiences that would lead to achievement of the program objectives and outcomes were selected and organized into one- to eight-week rotations (e.g., in acute care, care of pediatric patients, pain management, nutrition, patient education and counseling, and administration and practice management). Throughout the program, residents gain experience in pharmaceutical services and research. Skills in care planning and monitoring are emphasized, as is practicing pharmaceutical care in an interdisciplinary environment. Residents who have completed the program have found employment immediately as pharmacy managers of home infusion centers. Pharmacy residency training in home care provides the experience needed to function as a competent clinician and manager who can identify and solve problems to improve patient care.     

Primary care provider perceptions of an integrated community pharmacy hypertension management program

BackgroundTrained community pharmacists provided hypertension (HTN) management services in collaboration with a patient-centered medical home (PCMH).ObjectiveTo explore primary care provider (PCP) perceptions of a HTN management program in which patients at the PCMH with elevated blood pressure could choose to receive follow-up care with a trained community pharmacist at a chain community pharmacy.MethodsWe conducted informal interviews with 8 PCPs with a range of level of involvement with the collaborative HTN management program to inform the development of a 13-question online survey that was distributed to PCPs at 10 participating Michigan Medicine PCMH clinics. The primary outcome was the percent of PCPs who reported that the program improved their patient’s blood pressure. Secondary outcomes included awareness of the program, alternative follow-up strategies, PCP satisfaction, and barriers to using the program.ResultsA total of 39 PCPs (30.0%) responded to the survey. More than one-half (n = 21 of 39, 53.9%) of respondents reported that at least 1 of their patients had seen a trained community pharmacist for HTN management services. Almost all of these PCPs (n = 19 of 21, 90.5%) reported being satisfied with the program, and 80.9% (n = 17 of 21) agreed that it helped patients improve their blood pressure control. The most common barriers identified were patients preferring to follow up directly with their PCP (n = 18 of 39, 46.2%), PCPs being more comfortable with patients having a visit with an embedded ambulatory care pharmacist (n = 16 of 39, 41.0%), and a lack of written materials to share with patients about the program (n = 15 of 39, 38.5%).ConclusionPCPs who used the integrated community pharmacy HTN management program were satisfied with the program and thought that it resulted in improved blood pressure control. PCPs may benefit from written information to share with their patients as well as education to increase their awareness of the program and its beneficial effect on patient blood pressure.     

The pharmacy as part of an integrated hospital information system: a focus on benefits

An integrated hospital information system benefits not only the pharmacy but also each department within a hospital, including the physician and patient. The Composite Health Care System (CHCS) is a fully integrated healthcare information system that has been developed for the Department of Defense's medical treatment facilities. CHCS provides modules for Patient Administration, Patient Appointment Scheduling, Radiology, Laboratory, Pharmacy, and Physician/Nursing Order Entry and Results Retrieval, which serve to integrate inpatient wards, clinical services, administrative departments, and remote outpatient clinics. CHCS provides an integrated patient profile to care givers throughout the medical facility, improving the quality of their clinical decisions. The integrated hospital information system also helps to coordinate the delivery of patient care and automates many interdepartmental transactions, which allows for more efficient use of resources and increases the turnaround time for delivery of services. This article focuses on the system's pharmacy component to demonstrate the benefits realized with an integrated hospital information system.     

The challenge of health care developments for hospital pharmacy

The traditional role of hospital pharmacists in drug analysis and drug compounding broadened to a patient-oriented approach during the sixties and seventies. The clinical pharmacy concept was adopted. This practice includes daily-prepared total parenteral nutrition and chemotherapy, sophisticated analgesic systems, individualized drug distribution and specific information. The hospital pharmacy provides aseptic procedures as well as specialized logistics. Clinical pharmacy practice concentrates on tailor-made pharmaceutical care. As home health care usually deals with therapeutic modalities, this approach offers great possibilities for highly skilled out-patient care. Financial and legal interferences and the traditional gap between in-patient care and out-patient care must be removed. Home health care challenges the hospital pharmacists to place his knowledge and abilities at the diposal of this new type of patient care.     

The economic impact of a college of pharmacy

Objectives

To quantify the dollar value of economic returns to a community when a college of pharmacy attains its fourfold mission of research, service, patient care, and education.

Methods

United States Bureau of Economic Analyses (BEA) RIMS II input/output analysis and data from student and faculty surveys were used to quantify the economic impact of the University of Tennessee''s College of Pharmacy (UTCOP).

Results

The UTCOP''s revenue of $22.4 million resulted in an indirect output impact of over $29.2 million, for a total impact of nearly $51.6 million in output (production of goods and services), while supporting 617.4 jobs and total earnings of $18.5 million during the 2004-2005 school year.

Conclusions

Demonstrating the economic value of colleges of pharmacy is critical when seeking support from state legislators, foundations, government agencies, professional associations, and industry. Based on this study, UTCOP was able to report that every dollar the state invests in UTCOP yields an estimated net return on investment of $27.90.     

An economic evaluation of the costs and benefits of heparin rationalisation in a hospital pharmacy

AIM: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs. METHODS: A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service. RESULTS: Total annual cost was estimated to be pounds sterling 3.2 m (single LMWH), pounds sterling 4.4 m (UFH only) and pounds sterling 3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest CONCLUSION: Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.     

The Asheville Project: factors associated with outcomes of a community pharmacy diabetes care program

OBJECTIVE: To assess the importance of environment, patient characteristics, and health behavior in explaining differences in clinical, economic, and humanistic outcomes of pharmaceutical care services (PCS) for patients with diabetes. DESIGN: Quasi-experimental, pre-post cohort-with-comparison group study using multivariate logistic regression. SETTING: Twelve community pharmacies in Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS: Eighty-five patients with diabetes who were employees, dependents, or retirees from two self-insured employers; community pharmacists who completed a diabetes certificate program and received reimbursement for PCS. INTERVENTIONS: Scheduled consultations with pharmacists involving education and training, assessment, monitoring, follow-up, and referral. MAIN OUTCOME MEASURES: Change in glycosylated hemoglobin (A1c) value, diabetes diagnosis and all-diagnosis utilization and cost of medical care, quality of life, and satisfaction with pharmacy services. RESULTS: The strongest predictors of improvement in A1c following PCS were the patient characteristics baseline glycemic control and type 1 diabetes. All patients with type 1 diabetes had reduced their A1c concentrations at follow-up. Patients in one employer group (an environmental characteristic) were significantly more likely to have a 10% reduction in diabetes diagnosis costs, compared with employees in the other group. They were also more likely to report improved satisfaction with pharmacy services. No other statistically significant relationships were found. CONCLUSION: The greatest improvement in A1c occurred among patients with type 1 diabetes and/or higher baseline A1c concentrations. When controlling for other factors, PCS did not emerge as a significant factor in lowering A1c, but it was imprecisely measured, and our proxy measure did not capture the full complement of PCS provided to patients. Success in terms of cost savings and patient satisfaction differed by employer group.