Sharon B.S. Gatewood

Integration of collaborative medication therapy management in a safety net patient-centered medical home.

OBJECTIVE To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH). SETTING Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010. PRACTICE DESCRIPTION A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up. PRACTICE INNOVATION CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals. MAIN OUTCOME MEASURES Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations. RESULTS Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted. CONCLUSION Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

Implementation of a comprehensive pretravel health program in a supermarket chain pharmacy

OBJECTIVE To describe the procedures for implementing a comprehensive pretravel health program in a supermarket chain pharmacy. SETTING Central Virginia (Richmond, Fredericksburg, Williamsburg, and Roanoke) between 2000 and 2008. PRACTICE DESCRIPTION Ukrops is a local supermarket chain with 29 stores, 20 of which have pharmacies. Ukrops Pharmacy offers enhanced patient care services, including medication therapy management, wellness services, diabetes education and management, smoking cessation, and immunizations. PRACTICE INNOVATION Comprehensive pretravel health program. MAIN OUTCOME MEASURES Number of patients participating in the pretravel health program and number of vaccinations administered by pharmacists. RESULTS An average of 1,000 patients per year participate in the pretravel health program, and approximately 1,900 vaccines are administered each year. CONCLUSION A comprehensive pretravel program is a successful service in a supermarket chain pharmacy. It provides another option for travelers seeking pretravel health care.

Keeping Up-to-Date on Immunizations: A Framework and Review for Pharmacists

OBJECTIVE To provide a framework for keeping current in the immunizations field; an update on changes in adult and pediatric vaccine delivery since 2003; and an update on new immunization guidelines, new approved vaccines, and changes in uses for current vaccines. DATA SOURCES Published guidelines identified from the Centers for Disease Control National Immunization Program Web site. In addition, published articles were identified through Medline (January 2003-November 2005) using specific vaccine names as search terms. Additional sources were identified from the bibliographies of retrieved articles. STUDY SELECTION By the authors. DATA EXTRACTION By the authors. DATA SYNTHESIS To implement the immunization services now permitted under law in 44 states, many pharmacists receive initial training through the American Pharmacists Association Pharmacy-Based Immunization Delivery CERTIFICATE PROGRAM. To remain up-to-date in this field, pharmacists can apply the process described in this article, which includes regular monitoring of the Web site and publications of the Centers for Disease Control and Prevention and participation in one or more listservs. Specific information is presented on new vaccines marketed in the United States since 2003 along with updates on standards for adult and adolescent immunizations and changes in guidelines during this time frame. CONCLUSION As increasingly committed health professionals in the immunizations field, pharmacists are responsible for keeping updated on the constantly changing recommendations for vaccines and related products. By incorporating the recent information presented in this article and applying the process described for tracking changes in this field, pharmacists can fulfill their emerging vaccine-related roles on the health care team.

The relationship between medication-related problems and behavioural health condition among patients served by a health care for the homeless centre

Objectives  To evaluate the association between behavioural health conditions and the presence of a medication‐related problem (MRP) and the association between the type of MRP and the presence of a dual diagnosis.

Medication reconciliation campaign in a clinic for homeless patients

Patients commonly see multiple health care providers, obtain prescribed medications from more than one pharmacy, and transition between inpatient and outpatient settings, all of which can lead to inaccurate medication information and, ultimately, medication errors.[1][1]–[4][2] In fact, it has

Medication reconciliation: an important piece of the medication puzzle.

Medication errors continue to cause significant morbidity and mortality. This, in turn, costs the health care system millions of dollars each year in preventable costs. Medication reconciliation, an important piece of medication therapy management (MTM), is vital to reducing medication errors. By verifying, clarifying, and reconciling medications at each point of care, pharmacists can play a vital role in improving health care and lowering costs. This case study describes an MTM session with a 66-year-old Caucasian female who is referred by the nurse practitioner in the clinic for pharmacist services. The patient has a history of portal hypertension, alcoholic liver damage, and chronic obstructive pulmonary disease. After obtaining a detailed history, the pharmacist identified significant medication-related problems including polypharmacy, nonadherence, drug-alcohol interactions, and inappropriate use of medication. After discussions with the patient and her nurse practitioner, a medication plan was created for the patient to follow.

Public attitudes and beliefs about Virginia community pharmacists dispensing and administering naloxone

OBJECTIVES To determine awareness concerning naloxone and perceived severity of opioid overdose, to identify attitudes and beliefs concerning naloxone, and to assess perceived benefits and barriers related to naloxone dispensed and administered by community pharmacists. METHODS The project was conducted in 3 phases. Phase 1 consisted of survey development and pretesting to identify unclear questions. The survey used principles of the health belief model, focusing on perceived severity of opioid overdose, perceived barriers and benefits to community pharmacists dispensing and administering naloxone, naloxone awareness, sources of health information, and attitudes and beliefs about naloxone. Question types were 5-point Likert response scale with several multiple choice and dichotomous questions. In phase 2, the paper-based survey was distributed to adults in the Richmond area from December 2016 to June 2017. Phase 3 consisted of data analysis using descriptive statistics. RESULTS One hundred twenty-nine individuals with a mean age of 35.4 years (56.7% male and 44.4% white) completed the survey. Opioid overdose was identified as a serious problem in the Richmond area and the United States by 71.9% and 81.3% of respondents, respectively. Among respondents, 39.5% had heard of naloxone before the survey. Most respondents were comfortable with a community pharmacist dispensing and administering naloxone (66.4% and 64.0%, respectively). Of the 31 respondents who were not comfortable with pharmacists dispensing or administering naloxone, 18 respondents identified promoting drug abuse and misuse and 12 respondents identified promoting reckless behavior as a perceived barrier. CONCLUSIONS While most survey respondents were not aware of naloxone before completing the survey, the majority were in favor of community pharmacists in Virginia dispensing and administering naloxone. The most commonly identified concern is that pharmacists dispensing naloxone would promote drug abuse and misuse, which should be addressed with patient education.

Concordance of Pharmacist Assessment of Medication Nonadherence With a Self-Report Medication Adherence Scale

Objective: To evaluate the concordance of the Modified Morisky Scale (MMS) with a pharmacist assessment of medication adherence during a medication review. Methods: This retrospective study examined the electronic medical records (EMRs) of patients ≥18 years who received a medication review by a pharmacist from October 2008 to September 2009 at a homeless behavioral health clinic. In addition to the 6-item MMS, adherence was assessed using the first 4 items of the MMS, which comprise the original Morisky Scale. A final pharmacist assessment of adherence based upon the medication review was documented in the EMR. The McNemar test was used to assess the agreement between the MMS (6 and 4 items) and the pharmacist assessment of medication adherence. Results: A total of 288 patients were eligible for the study, which included 449 medication reviews. Nonadherence was identified in 61.7% and 49.7% of medication reviews using the 6 and 4 items of the MMS. The pharmacist assessment determined nonadherence in 23.8% of medication reviews. There were significant differences between the pharmacist adherence assessment and the 6 (P < .0001) and 4 (P < .0001) items of the MMS. Conclusion: A combination of methods including self-report and pharmacist assessment may provide the greatest insight into adherence.