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Kay M Uttech - One of the best experts on this subject based on the ideXlab platform.
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the cost effectiveness of a Clinical Pharmacist intervention among elderly outpatients
Pharmacotherapy, 1998Co-Authors: Joseph T Hanlon, Morris Weinberger, Gregory P Samsa, Kay M Uttech, Patricia A Cowper, Pamela B Landsman, Kenneth E SchmaderAbstract:: We estimated the cost and cost-effectiveness of a Clinical Pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for 1 year. The intervention Pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.
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a randomized controlled trial of a Clinical Pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy
The American Journal of Medicine, 1996Co-Authors: Joseph T Hanlon, Morris Weinberger, Gregory P Samsa, Kenneth E Schmader, Kay M UttechAbstract:PURPOSE: To evaluate the effect of sustained Clinical Pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (> or = 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A Clinical Pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance and knowledge, number of medications, patient satisfaction, and physician receptivity. RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2%) versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the Clinical Pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001). CONCLUSIONS: This study demonstrates that a Clinical Pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.
Michelle T Martin - One of the best experts on this subject based on the ideXlab platform.
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expanding hepatitis c virus care and cure national experience using a Clinical Pharmacist driven model
Open Forum Infectious Diseases, 2019Co-Authors: David Koren, Michelle T Martin, Autumn Zuckerman, Robyn Teply, Nadia A NabulsiAbstract:BACKGROUND: The US National Viral Hepatitis Action Plan depends on additional providers to expand hepatitis C virus (HCV) treatment capacity in order to achieve elimination goals. Clinical Pharmacists manage treatment and medication within interdisciplinary teams. The study's objective was to determine sustained virologic response (SVR) rates for Clinical Pharmacist-delivered HCV therapy in an open medical system. METHODS: Investigators conducted a multicenter retrospective cohort study of patients initiating direct-acting antivirals from January 1, 2014, through March 12, 2018. Data included demographics, comorbidities, treatment, and Clinical outcomes. The primary outcome of SVR was determined for patients initiating (intent-to-treat) and those who completed (per-protocol) treatment. Chi-square tests were conducted to identify associations between SVR and adverse reactions, drug-drug interactions, and adherence. RESULTS: A total of 1253 patients initiated treatment; 95 were lost to follow-up, and 24 discontinued therapy. SVR rates were 95.1% (1079/1134) per protocol and 86.1% (1079/1253) intent to treat. The mean age (SD) was 57.4 (10.1) years, the mean body mass index (SD) was 28.7 (6.2) kg/m2, 63.9% were male, 53.7% were black, 40.3% were cirrhotic, 88.4% were genotype 1, and 81.6% were treatment-naive. Patients missing ≥1 dose had an SVR of 74.9%; full adherence yielded 90% (P < .0001). CONCLUSIONS: HCV treatment by Clinical Pharmacists in an open medical system resulted in high SVR rates comparable to real-world studies with specialists and nonspecialists. These findings demonstrate the success of a Clinical Pharmacist-delivered method for HCV treatment expansion and elimination.
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patient satisfaction with the Clinical Pharmacist and prescribers during hepatitis c virus management
Journal of Clinical Pharmacy and Therapeutics, 2016Co-Authors: Michelle T Martin, D M FaberAbstract:SummaryWhat is known and objectives Clinical Pharmacists play an important role in the management of patients undergoing hepatitis C virus (HCV) treatment. No satisfaction surveys have been published on Clinical Pharmacist interventions in HCV management. The objective was to evaluate patient satisfaction with Clinical Pharmacist and prescriber services in the HCV patient population at an urban academic hepatology clinic. Methods An anonymous patient satisfaction survey was offered to patients who were initiating or receiving HCV treatment under the care of a Clinical Pharmacist. Survey items assessed demographics and satisfaction with HCV care. Satisfaction was assessed with 17 or 20 Likert-scale questions (1 = poor, 2 = fair, 3 = okay, 4 = good, 5 = great) and two or three open-ended questions. Survey results were analysed via comparative and descriptive statistics. A qualitative content analysis was used for the open-ended survey questions. Results and discussion Sixty-four patients completed 77 (24 Pharmacist and 53 prescriber) patient satisfaction surveys. The mean age was 53 (±9·72) years. Patients reported high levels of satisfaction with the Pharmacist and prescribers. All 24 (100%) patients ranked overall satisfaction with services provided by Pharmacists as ‘great’, and 36 (69%) of 52 patients ranked overall satisfaction with services provided by prescribers as ‘great’. Patients supported the inclusion of a Clinical Pharmacist on health care teams for other disease states. What is new and conclusion Patients reported high levels of satisfaction with the Clinical Pharmacist involved in HCV treatment management at an urban academic medical centre. Clinical Pharmacist services were highly valued and recommended by the patients surveyed. The survey was able to identify areas in need of improvement in the clinic. Clinical Pharmacists play an important role in the treatment and management of HCV. This survey may serve as a model for assessment of satisfaction in other Pharmacist-run clinic settings.
Maurilio De Souza Cazarim - One of the best experts on this subject based on the ideXlab platform.
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analysis of Clinical Pharmacist interventions in the neurology unit of a brazilian tertiary teaching hospital
PLOS ONE, 2019Co-Authors: Joao Paulo Vilela Rodrigues, Fabiana Marques, Ana Maria Rosa Freato Goncalves, Marilia Silveira De Almeida Campos, Tiago Marques Dos Reis, Manuela Roque Siani Morelo, Andrea Fontoura, Beatriz Maria Pereira Girolineto, Helen Palmira Miranda De Camargo Souza, Maurilio De Souza CazarimAbstract:It is estimated that around five to 10.0% of hospital admissions occur due to Clinical conditions resulting from pharmacotherapy. Clinical Pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by Clinical Pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be Clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the Clinical Pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.
J M Gatell - One of the best experts on this subject based on the ideXlab platform.
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evaluation of antiretroviral related errors and interventions by the Clinical Pharmacist in hospitalized hiv infected patients
Hiv Medicine, 2011Co-Authors: E Carcelero, Montserrat Tuset, Maria Martin, E De Lazzari, C Codina, J M Miro, J M GatellAbstract:Results The prescriptions for 247 admissions (189 patients) were reviewed. Sixty antiretroviral-related problems were identified in 41 patients (21.7%). The most common problem was contraindicated combinations (n 5 20; 33.3%), followed by incorrect dose (n 5 10; 16.7%), dose omission (n 5 9; 15%), lack of dosage reduction in patients with renal or hepatic impairment (n 5 6; 10% and n 5 1; 1.7%, respectively), omission of an antiretroviral (n 5 6; 10%), addition of an alternative antiretroviral (n 5 5; 8.3%) and incorrect schedule according to outpatient treatment (n 5 3; 5%). Fifteen out of 20 errors were made during admission. A multivariate analysis showed that factors associated with an increased risk of antiretroviral-related problems included renal impairment [odds ratio (OR) 3.95; 95% confidence interval (CI) 1.39–11.23], treatment with atazanavir (OR 3.53; 95% CI 1.61–7.76) and admission to a unit other than an infectious diseases unit (OR 2.50; 95% CI 1.28– 4.88). Use of a nonnucleoside reverse transcriptase inhibitor was a protective factor (OR 0.33; 95% CI 0.13–0.81). Ninety-two per cent of the Pharmacist’s interventions were accepted. Conclusion Antiretroviral-related errors affected more than one-in-five patients. The most common causes of error were contraindicated or not recommended drug–drug combinations and dose-related errors. A Clinical Pharmacist trained in HIV pharmacotherapy could help to detect errors and reduce the duration of their effect.
Kenneth E Schmader - One of the best experts on this subject based on the ideXlab platform.
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the cost effectiveness of a Clinical Pharmacist intervention among elderly outpatients
Pharmacotherapy, 1998Co-Authors: Joseph T Hanlon, Morris Weinberger, Gregory P Samsa, Kay M Uttech, Patricia A Cowper, Pamela B Landsman, Kenneth E SchmaderAbstract:: We estimated the cost and cost-effectiveness of a Clinical Pharmacist intervention known to improve the appropriateness of drug prescribing. Elderly veteran outpatients prescribed at least five drugs were randomized to an intervention (105 patients) or control (103) group and followed for 1 year. The intervention Pharmacist provided advice to patients and their physicians during all general medicine visits. Mean fixed and variable costs/intervention patient were $36 and $84, respectively Health services use and costs were comparable between groups. Intervention costs ranged from $7.50-30/patient/unit change in drug appropriateness. The cost to improve the appropriateness of drug prescribing is thus relatively low.
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a randomized controlled trial of a Clinical Pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy
The American Journal of Medicine, 1996Co-Authors: Joseph T Hanlon, Morris Weinberger, Gregory P Samsa, Kenneth E Schmader, Kay M UttechAbstract:PURPOSE: To evaluate the effect of sustained Clinical Pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (> or = 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A Clinical Pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance and knowledge, number of medications, patient satisfaction, and physician receptivity. RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2%) versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the Clinical Pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001). CONCLUSIONS: This study demonstrates that a Clinical Pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.