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Impact of a Pharmacist-Led Chronic Disease State Management Clinic on Patient Assessment of Chronic Illness Care.

ABSTRACT: Background: The Patient Assessment of Chronic Illness Care (PACIC) tool measures patient satisfaction with chronic disease care. Objective: A modified PACIC tool (PACIC-RxFM) was used to assess patient satisfaction in a pharmacist-led chronic disease state management clinic. The secondary outcome compared satisfaction with pharmacist-led and physician-led visits. Methods: This cross-sectional study surveyed individuals with ≥ 1 chronic disease who saw a pharmacist (pharmacotherapy) or primary care provider (usual care) in the Texas Tech Physicians Family Medicine Clinic. The PACIC-RxFM survey included 15 items rated on a five-point Likert scale (5 = "always satisfied"). Results: A total of 107 patients with no significant differences in demographics or complexity between groups were surveyed. All mean domain scores indicated a high level of satisfaction in the pharmacotherapy group with statements regarding perceptions of care organization and encouragement to go to group classes yielding statistically significantly higher scores than the usual care group. Conclusion: Patients are satisfied with both providers' and pharmacists' involvement in chronic illness care. This involvement leads to significant improvement in patient perception of care organization.

SUBMITTER: Buatois EM

PROVIDER: S-EPMC9184997 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Impact of a Pharmacist-Led Chronic Disease State Management Clinic on Patient Assessment of Chronic Illness Care.

Buatois Emily M EM Covington Les P LP Lopez Nicole D ND Young Rodney B RB MacLaughlin Eric J EJ

Journal of patient experience 20220607

Background: The Patient Assessment of Chronic Illness Care (PACIC) tool measures patient satisfaction with chronic disease care. Objective: A modified PACIC tool (PACIC-RxFM) was used to assess patient satisfaction in a pharmacist-led chronic disease state management clinic. The secondary outcome compared satisfaction with pharmacist-led and physician-led visits. Methods: This cross-sectional study surveyed individuals with ≥ 1 chronic disease who saw a pharmacist (pharmacot ...[more]

PMID: 35694013

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Project description:OBJECTIVES:To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain. DESIGN:An exploratory randomised controlled trial. SETTING:Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3). PARTICIPANTS:Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible. OUTCOME MEASURES:Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months. RESULTS:In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively). CONCLUSIONS:This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required. TRIAL REGISTRATION:www.isrctn.org/ISRCTN06131530. Medical Research Council funding.

Project description:BackgroundAdoption of healthcare technology in the ambulatory care setting is nearly universal. Clinical decision support system (CDSS) technologies improve patient care through the identification of additional care opportunities. With the movement from paper-based to electronic clinical intake forms, the opportunity to improve identification of gaps in care utilizing CDSS in the ambulatory care setting exists.ObjectiveTo evaluate the impact of CDSS-enhanced digital intake forms, with- and without aspects of gamification, on the identification of intervention opportunities in an ambulatory care pharmacy setting.MethodsPatients were invited to complete visit intake paperwork via virtual forms as part of a CDSS-enhanced mobile application designed to identify potential interventions based on patient age, sex, disease state(s), and user-provided information. Patients were randomized to receive optional patient-specific health questions 1) with or 2) without elements of gamification. Gamification elements included trivia questions, fun facts, and the chance to win a prize. A retrospective review was used to assess interventions identified for a random sample of patients seen within the same time frame who did not utilize the mobile application. Interventions were compared across groups utilizing ANOVA. t-tests were used for a subgroup analysis.ResultsFrom January to May 2019, 353 potential interventions were identified for 220 study participants. 0.44 (±0.82), 1.8 (±2.0) and 2.1 (±1.8) interventions per participant were identified for the control, virtual forms, and virtual forms + gamification groups, respectively. Significant differences in intervention identification across groups were found using a one-way ANOVA (F = 17.46, p < .001). Post hoc analysis demonstrated a significant difference in interventions identified for those completing 50-100% (n = 32) and those completing less than 50% (n = 18; p < .001) of the optional health questions in the virtual forms + gamification group.ConclusionsUtilization of CDSS-enhanced clinical intake forms increased identification of potential interventions, though gamification did not significantly impact this identification.

Project description:ImportancePoor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.ObjectiveTo assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.Design, setting, and participantsThis prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.InterventionThe intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.Main outcomes and measuresThe primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.ResultsAmong the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.Conclusions and relevanceThis randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.Trial registrationChinese Clinical Trial Registry Identifier: ChiCTR2000040232.

Project description:BackgroundA cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual pharmacist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communication systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC.MethodsParticipants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively.ResultsPatients (n = 894) were recruited from 30 pharmacies and 82% (n = 732) responded to follow-up. On average, MAS was more costly but also more effective (in terms of symptom resolution and QALY gains) compared to UC. MAS patients (n = 524) gained an additional 0.003 QALYs at an incremental cost of $7.14 (Australian dollars), compared to UC (n = 370) which resulted in an ICER of $2277 (95% CI $681.49-3811.22) per QALY.ConclusionEconomic findings suggest that implementation of MAS within the Australian context is cost effective.Trial registration Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018.

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Impact of a Pharmacist-Led Chronic Disease State Management Clinic on Patient Assessment of Chronic Illness Care.

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Impact of a Pharmacist-Led Chronic Disease State Management Clinic on Patient Assessment of Chronic Illness Care.

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