Lisa Bishop

Pharmacist and physician views on collaborative practice: Findings from the community pharmaceutical care project

Background: Strong working relationships between pharmacists and physicians are needed to optimize patient care. Understanding attitudes and barriers to collaboration between pharmacists and physicians may help with delivery of primary health care services. The objective of this study was to capture the opinions of family physicians and community pharmacists in Newfoundland and Labrador (NL) regarding collaborative practice. Methods: Two parallel surveys were offered to all community pharmacists and family physicians in NL. Surveys assessed the following: attitudes and experience with collaborative practice, preferred communication methods, perceived role of pharmacists, areas for more collaboration and barriers to collaborative practice. Results for both groups were analyzed separately, with comparisons between groups to compare responses with similar questions. Results: Survey response rates were 78.6% and 7.1% for pharmacists and physicians, respectively. Both groups overwhelmingly agreed that collaborative practice could result in improved patient outcomes and agreed that major barriers were lack of time and compensation and the need to deal with multiple pharmacists/physicians. Physicians indicated they would like more collaboration for insurance approvals and patient counselling, while pharmacists want to assist with identifying and managing patients’ drug-related problems. Both groups want more collaboration to improve patient adherence. Conclusion: Both groups agree that collaborative practice can positively affect patient outcomes and would like more collaboration opportunities. However, physicians and pharmacists disagree about the areas where they would like to collaborate to deliver care. Changes to reimbursement models and infrastructure are needed to facilitate enhanced collaboration between pharmacists and physicians in the community setting.

Interventions performed by community pharmacists in one Canadian province: a cross-sectional study

Purpose Interventions made by pharmacists to resolve issues when filling a prescription ensure the quality, safety, and efficacy of medication therapy for patients. The purpose of this study was to provide a current estimate of the number and types of interventions performed by community pharmacists during processing of prescriptions. This baseline data will provide insight into the factors influencing current practice and areas where pharmacists can redefine and expand their role. Patients and methods A cross-sectional study of community pharmacist interventions was completed. Participants included third-year pharmacy students and their pharmacist preceptor as a data collection team. The team identified all interventions on prescriptions during the hours worked together over a 7-day consecutive period. Full ethics approval was obtained. Results Nine student–pharmacist pairs submitted data from nine pharmacies in rural (n = 3) and urban (n = 6) centers. A total of 125 interventions were documented for 106 patients, with a mean intervention rate of 2.8%. The patients were 48% male, were mostly ≥18 years of age (94%), and 86% had either public or private insurance. Over three-quarters of the interventions (77%) were on new prescriptions. The top four types of problems requiring intervention were related to prescription insurance coverage (18%), drug product not available (16%), dosage too low (16%), and missing prescription information (15%). The prescriber was contacted for 69% of the interventions. Seventy-two percent of prescriptions were changed and by the end of the data collection period, 89% of the problems were resolved. Conclusion Community pharmacists are impacting the care of patients by identifying and resolving problems with prescriptions. Many of the issues identified in this study were related to correcting administrative or technical issues, potentially limiting the time pharmacists can spend on patient-focused activities.

Antibiotic administration longer than eight hours after triage and mortality of community-acquired pneumonia in patients with diabetes mellitus

Studies have established that diabetic patients with community-acquired pneumonia (CAP) may have increased mortality. The primary objective of this study was to investigate if time to first appropriate antibiotic in the emergency department (ED) was associated with in-hospital mortality of CAP in patients with diabetes mellitus (DM). This was a retrospective cohort study of adult diabetic patients who were admitted with CAP. Patients were stratified into two groups: those who received first dose of appropriate antibiotic within 8 hours of triage and those who received it later than 8 hours. A multiple logistic regression analysis was performed. Two hundred six patients were included in the study. Fifty-nine patients (28.6%) had complications of CAP on admission and 31 patients (16%) died. In-hospital mortality was higher in patients who received their initial appropriate antibiotic after 8 hours of triage than those who received it within 8 hours [18 (35.3%), 15 (9.7%), p < 0.0001]. Time to first appropriate antibiotic later than 8 hours of triage was associated with increased in-hospital mortality (OR 4, 95% CI 1.2–13.1, p = 0.02). Antibiotic administration later than 8 hours of triage in the ED was associated with increased in-hospital mortality of CAP among patients with DM.

A Review of Effective Youth Engagement Strategies for Mental Health and Substance Use Interventions

The majority of adult mental health and substance use (MH&SU) conditions emerge in adolescence. Prevention, diagnosis, and treatment programs targeting this age group have a unique opportunity to significantly impact the well-being of the future generation of adults. At the same time, youth are reluctant to seek treatment and have high rates of dropout from interventions. An emphasis on youth engagement in prevention and treatment interventions for MH&SU results in better health outcomes for those youth. This literature review was undertaken to evaluate opportunities to improve youth engagement in MH&SU programs. The intent was to determine best practices in the field that combined community-level improvement in clinical outcomes with proven strategies in engagement enhancement to inform program development at a local level. The results discuss 40 studies, reviews, and program reports demonstrating effective youth engagement. These have been grouped into six themes based on the underlying engagement mechanism: youth participation in program development, parental relationships, technology, the health clinic, school, and social marketing. A broad range of tools are discussed that intervention developers can leverage to improve youth engagement in prevention or treatment programs.

Engaging patients in health research: identifying research priorities through community town halls

BackgroundThe vision of Canada’s Strategy for Patient-Oriented Research is that patients be actively engaged as partners in health research. Support units have been created across Canada to build capacity in patient-oriented research and facilitate its conduct. This study aimed to explore patients’ health research priorities in the province of Newfoundland and Labrador (NL).MethodsEight town halls were held with members of the general public in rural and urban settings across the province. Sessions were a hybrid information-consultation event, with key questions about health research priorities and outcomes guiding the discussion.ResultsSixty eight members of the public attended town hall sessions. A broad range of health experiences in the healthcare system were recounted. Key priorities for the public included access and availability of providers and services, disease prevention and health promotion, and follow-up support and community care. In discussing their health research priorities, participants spontaneously raised a broad range of suggestions for improving the healthcare system in our jurisdiction.ConclusionsPublic research priorities and suggestions for improving the provision of healthcare provide valuable information to guide Support Units’ planning and priority-setting processes. A range of research areas were raised as priorities for patients that are likely comparable to other healthcare systems. These create a number of health research questions that would be in line with public priorities. Findings also provide lessons learned for others and add to the evidence base on patient engagement methods.

Community-Acquired Pneumonia in Patients With Diabetes Mellitus: Predictors of Complications and Length of Hospital Stay

Background: The primary objective of the study was to determine factors associated with complications and length of hospital stay (LOS) in hospitalized adult patients with diabetes along with community‐acquired pneumonia (CAP). CAP is a common infection in patients with diabetes mellitus and is associated with a significant mortality and morbidity. Materials and Methods: This is a retrospective cohort study of 215 adult patients with diabetes who were admitted with CAP. A multivariate logistic and Cox regression analysis were used to assess factors associated with complications and LOS of CAP, respectively. Results: During the follow‐up period from admission until discharge, 94 patients (43.7%) developed complications. Respiratory failure was the most common complication (43.6%). The average LOS of study cohort was 9.47 days. In the multivariate analysis, complications of CAP were associated with time to first dose of appropriate antibiotic therapy >8 hours since triage at emergency department (ED) (odds ratio = 3.16; 95% CI: 1.58‐6.32; P = 0.001) and pneumonia severity index score >90 (odds ratio = 3.52; 95% CI: 1.45‐8.53; P = 0.005). In the multivariate Cox regression analysis, time to first dose of appropriate antibiotic therapy >8 hours since triage at ED (hazard ratio [HR] = 0.56, P = 0.01), pneumonia severity index score >90 (HR = 0.62, P = 0.01), presence of complications (HR = 0.53, P = 0.002), duration of antibiotics (HR = 0.90, P ≤ 0.0001) and duration of symptoms prior presentation to ED (HR = 0.96, P = 0.04) were independently determinants of LOS. Conclusions: Delayed administration of appropriate antibiotic therapy at ED and moderate‐to‐severe pneumonia were associated with both increased risk of complications and prolonged LOS in hospitalized adult patients with diabetes along with CAP.

Community-Acquired Pneumonia in Elderly Patients With Diabetes Mellitus: Outcomes and Time to First Dose of Appropriate Antibiotic Therapy

BackgroundBoth diabetes mellitus (DM) and community-acquired pneumonia (CAP) are prevalent in elderly and are associated with significant morbidity and mortality. The primary objective of this subgroup analysis was to determine risk factors of the inhospital mortality, complication rate, and prolonged length of hospital stay (LOS) of CAP in elderly diabetic patients hospitalized with CAP. MethodsA retrospective cohort study of 157 elderly diabetic patients hospitalized with CAP at 2 tertiary teaching hospitals was carried out. Multivariate logistic and cox regression analyses were used to assess risk factors associated with inhospital mortality, complications, and LOS. ResultsDuring the follow-up period from admission till discharge, 30 (19.1%) patients died and 66 (42%) had complications. Seventeen (56.67%) of the patients who died received their first dose of appropriate antibiotic for CAP longer than 8 hours since triage, whereas 26 (20.47%) of survived patients received their first dose longer than 8 hours of triage at emergency department (ED) (P = <0.0001). Thirteen of 114 (11.4%) patients who received their first appropriate antibiotics in 8 hours or less since triage at ED died, whereas 17 of 43 (39.5%) patients who received their first appropriate antibiotics longer than 8 hours since triage died (P = <0.0001). In the multivariate analysis, time to first dose of appropriate antibiotic therapy longer than 8 hours since triage was associated with increased inhospital mortality (odds ratio, 5.94; 95% confidence interval [95% CI], 2.02–17.43; P = 0.001), complications (odds ratio, 2.90; 95% CI, 1.24–6.79; P = 0.01), and prolonged LOS of CAP (hazard ratio, 0.36; 95% CI, 0.20–0.65; P = 0.001). ConclusionsTime to first dose of appropriate antibiotic therapy longer than 8 hours since triage at ED might be associated with increased morbidity and mortality of CAP in elderly patients with diabetes mellitus.