This article details a study that was completed in order to study whether or not physicians truly understood how widespread the lack of adherence there was in their particular patient populations. Non adherence is a rampant problem in the elderly population who are the most common patients who have chronic diseases. Diseases such as hypertension, diabetes, and hyperlipidemia require strong adherence in their therapies in order to achieve the most successful results, and patients can quickly slip out of their goal ranges for the management of their symptoms if they are not on top of taking their daily regimens. The focus of the study was to first determine the physicians’ personal perceptions of their populations’ adherence, and then compare them to the actual data of adherence that were provided by the statistical claims.
The study was completed by the distribution of surveys to primary care physicians in a Texan MD-PA plan that was covered by Medicare Part D. The questionnaire was given to these 226 doctors at quarterly meetings and they were asked questions along the line of what percentage of their patients did they believe were adherent in the medication regimens, what income bracket did the most adherent people come from, etc. The study concluded that primary care physicians were equally likely to both underestimate, or overestimate how adherent their population was.
Overall, I do not believe that this article is very important to the field of pharmacy. First off, this is just a qualitative survey that was given to the doctors, so the whole thing was based on personal opinions. Without a source of hard data, this study cannot prove much on its own. I also believe that adherence changes drastically based upon the environment, so completing this survey in only one health system would not provide a good overview for physicians’ opinions on adherence on the grand scale.
J Manag Care Spec Pharm, 2016 Mar;22(3):305-312.
This article details the study of a new electronic system implemented by Sharp Rees-Stealy Medical Group in 2014. In their new system, all incoming refill requests are received electronically and distributed to a more focused, centralized team. With a more centralized team, certain protocols were establish to better organized the incoming prescriptions from the personal care physicians that were sending them. The system was used to store and sort multiple types of information, including things such as dosing adjustment and the coordination between their pharmacy and other mail order pharmacies. In 2014, 302,592 tasks were taking in by the newly implemented system which resulted in 140,350 interventions being completed.
This article is important to the field of pharmacy because efficiency is one of the hallmarks of the practice of pharmacy in a community setting. Taking time out of activities such as taking in and organizing incoming prescriptions opens up for more time for the pharmacists to complete other, more important tasks. This includes the consultation of patients, checking outgoing prescriptions for accuracy, and other services such as providing immunizations. In the results and conclusion portion of the study, it reported that the new electronic system saved the team from 20-30 minutes each day. This might not seem very significant at first, but it opens the door for more time to complete patient-focused activities rather than logistical duties with an extra half-hour for the pharmacist and his or her team.
One question I would have for the team would be how to get more physicians on board to use the system. It would seem that getting them to comply and use the system with all their patients would be the most difficult part of making systems like this be functional and successful.
J Manag Care Spec Pharm, 2016 Mar;22(3):204-208.
This article details a study that was completed involving the collaboration of six separate health care systems in Minnesota. The basis of this study was a qualitative survey which was completed at each site. These qualitative interviews were conducted with individuals who were thought to be essential and involved at the clinics when it came to the implementation and use of medication management services. These interviews were recorded and analyzed to search for certain common thread of thought that served as the data, so to speak, for the experiment. After analysis of the interviews, thirteen themes were determined to be distinct in successful medication management programs. The themes were as follows: “(1) external influences, (2) pharmacists as an untapped resource, (3) principles and professionalism, (4) organizational culture, (5) momentum champions, (6) collaborative relationships, (7) service promotion, (8) team-based care, (9) implementation strategies, (10) overcoming challenges, (11) supportive care model process, (12) measuring and reporting results, and (13) sustainability strategies.”
This study is slightly significant because it tries to bring to light certain aspects of how pharmacists can be more successful in medication therapy management. Over the recent years, the profession has been trying to move away from a product-focused practice to a more patient-centered one, and this may be a good first step to help new pharmacies and pharmacists who want to help try to move the profession to a more promising future.
AJHP. 2016 ; 73(5) : 307-314
A serious problem that exists today in the world of medicine is bacterial resistance to antibiotics. Particularly resistant and bothersome strains of bacteria are referred to as MDRO’s, or multidrug-resistant organisms. The purpose of this paper was the explain the fact that there is evidence suggesting the usefulness of treating these types of infections with Minocycline in the IV form. The study details how 200 mg of Minocycline was administered to achieve serum concentrations in the body similar to other tetracyclines. The study showed how minocycline treatment was effective in maintaining antimicrobial activity in numerous types of resistant bacterial strains such as Staph infections and gram-negative pathogens.
This article is very important and relevant in the field of pharmacy. The growing threat of resistant bacterial strains can be detrimental to the overall health of the human population if the process of over prescribing antibiotics is not stopped. New studies like this showing that certain drugs are effective at fighting resistant bacterial strains is important because this could lead to more doctors and pharmacists working together to monitor their prescribing habits more closely. If they would switch the therapies they use for each patient so that the entire population is then resistant to a certain drug, then there will be a better chance of not creating resistant bacteria populations.
AJHP. 2016 ; 73(5) : 279-285
At the University of Connecticut Health Center, there has been an increasing correlation between the use of Doxycycline and the development of Acute Pancreatitis. At the health center, there have recently been two patients admitted who had been diagnosed with AP, and a third patient was just taken into the health center for the same reason. Three days before his admission, the 51 year old male had started a regiment of Doxycycline in order to help treat his Lyme Disease. After a week of confusion, fatigue, and other issues, he was admitted to the health center. While there, they discovered that he was having abdominal pains along with extreme tenderness, leading them complete several lab tests, which resulted with the diagnosis of Acute Pancreatitis. The patient was then immediately taken to the ICU where Doxycycline was also immediately discontinued. After additional treatment and the discontinuation of Doxycycline, the patient recovered very quickly, indicated an adverse reaction to the drug.
This article is significant because it demonstrates a very alarming adverse reactions for one of the top drugs currently used in the medical field to treat bacterial infections. Currently in Micromedex, there are no major counseling points or warning about the development of abdominal pain when taking Doxycycline. Even more importantly, under the adverse reactions section, there is no indication for Pancreatitis, meaning this this is a new and developing issue.
One obvious thought that comes up after reading this brief article is whether this side effect is widespread and not just localized in the Connecticut Health center. Further research about the matter could be completed to see if this was a manufacturing issue where that certain batch of Doxycyline was faulty, along with seeing if this adverse effect is occurring in other parts of the country as well.
AJHP. 2016 ; 73(5): 286-291
In 2013, a study began to observe and record the outcomes that a clinical pharmacist would have during an annual visit to a health center. Between October and November of 2013, clinical pharmacists completed medication therapy management type reviews for three-hundred separate patients. During their reviews, they had access to each patients comprehensive charts that included their medication lists and completed multiple duties for the patients that mostly dealt with medication interventions by identifying drug therapy problems and making recommendations to change drug therapy regiments. They were also able to give vaccines to patients on-site during their visits to the clinic. Throughout the course of the study, they pharmacists made 272 referrals, ordered 183 laboratory tests, and completed 182 vaccinations for the patients. These annual wellness services provided by the pharmacists generated more than $22,000 in only one month that the study was completed.
This article is important to the career of pharmacy as a whole because it demonstrates the impact that a pharmacist can have at the patient level. The practice of pharmacy is continually morphing to becoming a more patient-centered practice as opposed to the outdated product-focused practice that only dealt with the dispensing and minimal management of a patient’s medication regiment. The staggering 1608 recommendations made along with the nearly 22,000 dollars in revenue that were generated from the pharmacists’ interventions demonstrates the significant impact that a clinical pharmacist can have if they performed annual rotations at community health centers all over the nation.
On question that I would have for those that ran this study is why they only decided to send the pharmacists and collect data from a single health center. There could be a certain reason why the population they decided to survey was more likely to listen to the pharmacists’ decisions. I believe that this is a good first stepping stone in order to showing the impact of clinical pharmacist completing a medication review in a health center, but this site could have been specially picked because the researchers knew it would produce the best results. In order to further this, all they would have to do is complete the same type of study in multiple areas of the state that covers a wider distribution of the population at large that includes different social status and other factors such as that.
AJHP. 2016 ; 73(4): 225-228