Objective. To develop, implement, and assess the effectiveness of an online medication therapy management (MTM) program to train pharmacists and pharmacy students in providing MTM services for patients with diabetes and to increase their intent to perform these services.
Design. An online program was created using an Internet-based learning platform to simulate 4 MTM meetings between a pharmacist and a virtual patient diagnosed with diabetes.
Assessment. Eighty students and 42 pharmacists completed the program. After completing the program, scores on post-intervention assessments showed significant improvement in 2 areas: control over performing MTM, and knowledge of how to perform MTM. Students had a significantly less-positive attitude about MTM and a decline in their perception of the social expectation that MTM is part of the practice of pharmacy, while pharmacists’ attitudes did not change significantly in these areas.
Conclusion. This online program using a virtual patient improved both participants’ belief that they have control over performing MTM, and their knowledge of how to perform MTM for diabetic patients, which may increase the likelihood that pharmacists and pharmacy students will perform MTM in the future.
medication therapy management; diabetes; pharmacist; virtual patient; simulation; pharmacy student
Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM.
Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center.
Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively).
Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future.
medication therapy management; advanced pharmacy practice experience; student pharmacists; patient-centered care
Objectives. To evaluate the impact of student pharmacists delivering medication therapy management (MTM) services during an elective advanced pharmacy practice experience (APPE).
Methods. Student pharmacists provided MTM services at community pharmacy APPE sites, documented their recommendations, and then made follow-up telephone calls to patients to determine the impact of the MTM provided. Students were surveyed about the MTM experience.
Results. Forty-seven students provided MTM services to 509 patients over 2 years and identified 704 drug-related problems (average of 1.4 problems per patient). About 53% of patients relayed the recommendations to their physician and 205 (75%) physicians accepted the recommendations. Eighty-eight percent of patients reported feeling better about their medications after receiving MTM services. A majority of the students perceived their provision of MTM services as valuable to their patients.
Conclusions. Providing MTM services to patients in a pharmacy practice setting allowed student pharmacists to apply skills learned in the doctor of pharmacy (PharmD) curriculum.
medication therapy management; experiential education; doctor of pharmacy program; advanced pharmacy practice experience; community pharmacy
To determine the direct financial impact for patients resulting from
Medication Therapy Management (MTM) interventions made by community
pharmacists. Secondary objectives include evaluating the patient and
physician acceptance rates of the community pharmacists' recommended
This was a retrospective observational study conducted at 20 Price Chopper
and Hen House grocery store chain pharmacies in the Kansas City metro area
from January 1, 2010 to December 31, 2010. Study patients were Medicare Part
D beneficiaries eligible for MTM services. The primary outcome was the
change in patient out-of-pocket prescription medication expense as a result
of MTM services.
Of 128 patients included in this study, 68% experienced no out-of-pocket
financial impact on their medication expenses as a result of MTM services. A
total of 27% of the patients realized a cost-savings (USD440.50 per year,
(SD=289.69)) while another 5% of patients saw a cost increase in
out-of-pocket expense (USD255.66 per year, (SD=324.48)). The net financial
impact for all 128 patients who participated in MTM services was an average
savings of USD102.83 per patient per year (SD=269.18, p<0.0001).
Pharmacists attempted a total of 732 recommendations; 391 (53%) were
accepted by both the patient and their prescriber. A total of 341 (47%)
recommendations were not accepted because of patient refusal (290, 85%) or
prescriber refusal (51, 15%).
Patient participation in MTM services reduces patient out-of-pocket
medication expense. However, this savings is driven by only 32% of subjects
who are experiencing a financial impact on out-of-pocket medication expense.
Additionally, the majority of the pharmacists' recommended
interventions (53%) were accepted by patients and prescribers.
Community Pharmacy Services; Medication Therapy Management; Drug Costs; United States
Objective. To measure the impact of medication therapy management (MTM) learning activities on students’ confidence and intention to provide MTM using the Theory of Planned Behavior.
Design. An MTM curriculum combining lecture instruction and active-learning strategies was incorporated into a required pharmacotherapy laboratory course.
Assessment. A validated survey instrument was developed to evaluate student confidence and intent to engage in MTM services using the domains comprising the Theory of Planned Behavior. Confidence scores improved significantly from baseline for all items (p < 0.00), including identification of billable services, documentation, and electronic billing. Mean scores improved significantly for all Theory of Planned Behavior items within the constructs of perceived behavioral control and subjective norms (p < 0.05). At baseline, 42% of students agreed or strongly agreed that they had knowledge and skills to provide MTM. This percentage increased to 82% following completion of the laboratory activities.
Conclusion. Implementation of simulated MTM activities in a pharmacotherapy laboratory significantly increased knowledge scores, confidence measures, and scores on Theory of Planned Behavior constructs related to perceived behavioral control and subjective norms. Despite these improvements, intention to engage in future MTM services remained unchanged.
medication therapy management; active learning; theory of planned behavior; laboratory course; student confidence; intention
Objective. To determine whether a college of pharmacy curriculum creates a sense of self-efficacy among students with respect to providing medication therapy management (MTM) services.
Methods. An electronic survey instrument was sent to all pharmacy students to elicit information on their perceived confidence in providing MTM services, and the results were reviewed.
Results. Of the 1,160 students targeted, 464 (40%) completed the survey instrument. Responses indicated that overall self-efficacy increased with each successive year of the curriculum that students completed. Fourth-year students completing an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) had significantly higher self-efficacy than did other fourth-year students, whose self-efficacy was similar to that of third-year students.
Conclusion. In this study population, students’ self-efficacy increased with each successive year in pharmacy school, with those who completed an APPE in MTM exhibiting the highest level of self-efficacy. These students may be more likely to pursue MTM opportunities in future careers.
medication therapy management; student self-efficacy; advanced pharmacy practice experience
Objective. To implement and evaluate an introductory pharmacy practice experience (IPPE) based on the medication therapy management (MTM) service model.
Design. Patient Care 2 is an IPPE that introduces third-year pharmacy students to the MTM service model. Students interacted with older adults to identify medication-related problems and develop recommendations using core MTM elements. Course outcome evaluations were based on number of documented medication-related problems, recommendations, and student reviews.
Assessment. Fifty-seven older adults participated in the course. Students identified 52 medication-related problems and 66 medical problems, and documented 233 recommendations relating to health maintenance and wellness, pharmacotherapy, referrals, and education. Students reported having adequate experience performing core MTM elements.
Conclusion. Patient Care 2 may serve as an experiential learning model for pharmacy schools to teach the core elements of MTM and provide patient care services to the community.
medication therapy management; introductory pharmacy practice experience; patient care service learning
To determine the impact of active-learning strategies in a medication therapy management (MTM) elective on pharmacy students' preparedness to participate in real-life MTM counseling sessions.
The elective included active-learning assignments such as patient cases, group discussions, role playing, and use of actual patients to prepare students for MTM services.
A survey was administered before (week 11) and after (week 15) completing a face-to-face comprehensive medication review (CMR) to evaluate achievement of course objectives and students' preparedness to participate in MTM. In the pre-CMR survey, 66.7% of the students strongly agreed that the course prepared them to provide MTM services. In the post-CMR survey, 88.9% of the students strongly agreed (p = 0.046).
The active-learning strategies used in the MTM elective course provided students with the skills necessary to participate in MTM counseling sessions. Face-to-face CMRs better prepared pharmacy students to provide MTM services.
medication therapy management; elective; active learning; comprehensive medication review
The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees.
Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data.
The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed.
Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program.
costs; patient satisfaction; adherence; pharmaceutical care; diabetes
To determine the overall perception and utilization of the pharmacist managed
medication therapy management (MTM) clinic services, by healthcare
professionals in a large, urban, university medical care setting.
This was a cross-sectional, anonymous survey sent to 195 healthcare
professionals, including physicians, nurses, and pharmacists at The
University of Illinois Outpatient Care Center to determine their perception
and utilization of the MTM clinic. The survey consisted of 12 questions and
was delivered through a secure online application.
Sixty-two healthcare professionals (32%) completed the survey. 82% were
familiar with the MTM clinic, and 63% had referred patients to the clinic.
Medication adherence and disease state management was the most common reason
for referral. Lack of knowledge on the appropriate referral procedure was
the prominent reason for not referring patients to the MTM clinic. Of the
providers that were aware of MTM services, 44% rated care as ‘excellent’,
44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic
identified by healthcare providers included in-depth education to patients,
close follow-up, and detailed medication reconciliation provided by MTM
clinic pharmacists. Of those familiar with MTM clinic, recommendations
included; increase marketing efforts to raise awareness of the MTM clinic
service, create collaborative practice agreements between MTM pharmacists
and physicians, and ensure that progress notes are more concise.
In a large, urban, academic institution MTM clinic is perceived as a valuable
resource to optimize patient care by providing patients with in-depth
education as it relates to their prescribed medications and disease states.
These identified benefits of MTM clinic lead to frequent patient referrals
specifically for aid with medication adherence and disease state
Medication Therapy Management; Professional Practice; Academic Medical Centers; Personal Satisfaction; Attitude of Health Personnel; Pharmacists; United States
Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques.
Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services.
A mailing survey was used to elicit Tennessee (US) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2,000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness-to-accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA.
Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates.
Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15 to $50 and patients' willingness-to-pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services.
Medication therapy management services; contingent valuation; pharmacists; compensation; willingness to accept
A pharmacist-delivered, outpatient-focused medication therapy management (MTM) program is using a remote blood glucose (BG) meter upload device to provide better care and to improve outcomes for its patients with diabetes. Sharing uploaded BG meter data, presented in easily comprehensible graphs and charts, enables patients, caregivers, and the medical team to better understand how the patients’ diabetes care is progressing.
Pharmacists are becoming increasingly more active in helping to manage patients’ complex medication regimens in an effort to help detect and avoid medication-related problems. Working together with patients and their physicians as part of an interdisciplinary health care team, pharmacists are helping to improve medication outcomes. This article focuses on two case studies highlighting the Diabetes Monitoring Program, one component of the Meridian Pharmacology Institute MTM service, and discusses the clinical application of a unique BG meter upload device.
blood glucose meter upload device; clinical pharmacist; diabetes monitoring program; medication compliance; medication therapy management; Metriklink; pharmacist
To develop and implement a medication therapy management (MTM) curriculum and assess students' skills and attitudes after the provision of MTM services to faculty and staff members.
Third-year students enrolled in a pharmaceutical care laboratory course received lectures and participated in MTM activities in preparation for an MTM encounter. Students conduced MTM sessions with university faculty and staff members, providing comprehensive medication review, blood pressure checks, and optional blood glucose and cholesterol (total cholesterol and HDL) screenings.
A faculty-developed rubric was used to evaluate students' ability to explain MTM to the participant and address medication-related problems. Students' responses on pre- and post-encounter survey instruments showed their confidence to provide MTM services, communicate with participants and other health care providers, and provide point-of-care screening services had increased.
Incorporating MTM into an existing laboratory course increased students' confidence and perceived ability to provide MTM services.
medication therapy management; medication review; patient-centered care
The pressures driving the need for an expanded practice scope in community pharmacy have been building for the past 2 decades. Many pharmacists have chosen to embrace the pharmaceutical care model in their practice sites to meet patient and healthcare system needs. The potential for medication therapy management (MTM) services provide an additional career opportunity for pharmacy graduates. Colleges of pharmacy offer advanced pharmacy practice experiences (APPEs) in the community setting that are designed to prepare students for these opportunities. These sites provide students with the opportunity to observe the integration of pharmaceutical care activities into community practice. Although developing an APPE site is challenging, serving as a preceptor benefits the students, the site, and the patients served. Therefore, colleges of pharmacy and community pharmacists are collaborating to increase the number of APPE sites to prepare pharmacy students for practice today and tomorrow.
curriculum; advanced pharmacy practice experience; community pharmacy; preceptor
Objective. To determine the impact of an elective course on pharmacy students’ perceptions, knowledge, and confidence regarding Medicare Part D, medication therapy management (MTM), and immunizations.
Design. Thirty-three pharmacy students were enrolled in a Medicare Part D elective course that included both classroom instruction and experiential training.
Assessment. Students’ self-reported confidence in and knowledge of Part D significantly improved upon course completion. End-of-course student perceptions about the relative importance of various aspects of MTM interventions and their confidence in performing MTM services significantly improved from those at the beginning of the course. Students’ confidence in performing immunizations also increased significantly from the start of the course.
Conclusion. A classroom course covering Medicare Part D with an experiential requirement serving beneficiaries can improve students’ attitudes and knowledge about Medicare Part D and their confidence in providing related services to beneficiaries in the community.
Medicare Part D; medication therapy management; student attitudes; experiential learning
The quality of pharmacologic care provided to older adults is less than optimal. Medication therapy management (MTM) programs delivered to older adults in the ambulatory care setting may improve the quality of medication use for these individuals.
We conducted focus groups with older adults and primary care physicians to explore: (1) older adults' experiences working with a clinical pharmacist in managing medications, (2) physician perspectives on the role of clinical pharmacists in facilitating medication management, and (3) key attributes of an effective MTM program and potential barriers from both patient and provider perspectives.
Five focus groups (4 with older adults, 1 with primary care physicians) were conducted by a trained moderator using a semi-structured interview guide. Each participant completed a demographic questionnaire. Sessions were recorded, transcribed verbatim, and analyzed using qualitative analysis software for theme identification.
Twenty-eight older adults and 8 physicians participated. Older adults valued the professional, trusting nature of their interactions with the pharmacist. They found the clinical pharmacist to be a useful resource, thorough, personable, and a valuable team member. Physicians believe the clinical pharmacist fills a unique role as a specialized practitioner, contributing meaningfully to patient care. Physicians emphasized the importance of effective communication, pharmacist's access to the medical record, and a mutually-trusting relationship as key attributes of a program. Potential barriers to an effective program include poor communication and lack of familiarity with the patient's history. The lack of a sustainable reimbursement model was cited as a barrier to widespread implementation of MTM.
This study provides information to assist pharmacists in designing MTM programs in the ambulatory setting. Key attributes of an effective program include one that is comprehensive, addressing all medication-related needs over time. The clinical pharmacist's ability to build trusting relationships with both patients and providers is essential.
older adults; medication management; focus groups; collaborative practice; pharmacists
To implement and assess a medication therapy management (MTM) training program for pharmacy students using the MirixaPro (Mirixa Corporation, Reston, VA) platform and case studies.
Students received lectures introducing MTM and were given a demonstration of the MirixaPro platform. They were divided into teams and assigned cases and times to interview patients portrayed by faculty members. Using the MirixaPro system, students performed 2 comprehensive medication reviews during the semester, recording the patient's current medications, indications, side effects, allergies, health conditions, and laboratory test recommendations and developed a personal medication record and medication action plan.
Based on a rubric with a rating scale of 0-10, campus and distance pathway students received mean scores ranging from 6.3-7.4 for their performance on the second MTM exercise, an increase of 47%-54% over the first MTM exercise. In qualitative assessments, the majority of students believed that their confidence in providing MTM was enhanced by the activity, while faculty members recognized the advantage of using MirixaPro, which allowed students to experience what is required in processing a pharmacist led, billable MTM encounter.
Use of the MirixaPro system and patient cases provides students with a “hands-on” experience that may encourage them to promote MTM during their APPEs and provide MTM services as practicing pharmacists.
medication therapy management (MTM); Web-based technology; active learning; patient simulation; case-based learning
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
Pharmacists; Physicians; Collaborative working relationships; Pharmacist-physician collaborative index; Community
To examine PharmD students' knowledge about Medicare Part D and their attitudes toward and intention to provide Medicare medication therapy management services (MTMS).
Fourth-professional year students were given a self-administered survey instrument that assessed: (1) knowledge about Medicare Part D; (2) attitudes, perceived behavioral control, subjective norms, and intention to provide Medicare MTMS; and (3) demographic and experience information.
Ninety-five students responded for a response rate of 94%. Students showed good basic knowledge about Medicare Part D, with a mean score of 94%. Almost 60% of students agreed that they intended to provide Medicare MTMS, but agreement dropped to 37% when they were asked if they were willing to take initiative to provide MTMS.
The lack of willingness to take initiative to provide Medicare MTMS suggests that colleges and schools of pharmacy must strengthen efforts to encourage students to take on the role of service provider.
Medicare Part D; medication therapy management; assessment; theory of planned behavior
Adherence to a biologic treatment regimen is essential for tracking efficacy and justifying its cost. That’s where medication therapy management services come in.
Pharmacists are providing medication therapy management (MTM) services for patients taking biologics, although studies to demonstrate its cost-effectiveness are lacking. Is this the best way to ensure that high-cost, high-impact biologics are used correctly?
The number of patients with cardiovascular and kidney disease in the United States continues to grow as the population ages, increasing the demand on the health care system and its providers. Many patients develop chronic conditions in which optimization of care is labor intensive, specifically hypertension, hyperlipidemia, diabetes, heart failure, and chronic kidney disease. Therefore, innovative and collaborative approaches to health care are warranted. Several team-based health care models have evolved and are gaining popularity, including the Patient-Centered Medical Home (PCMH) and Medication Therapy Management (MTM). Team-based care is widely supported in the literature, demonstrating significant improvement in cardiovascular and renal outcomes. This article will review the premises of PCMH and MTM, review the evidence and roles for team-based care specific to cardiovascular and renal outcomes, and introduce fundamentals to implement collaborative practice focusing on pharmacist-provider teams.
Collaboration; Team-based care; Cardiovascular outcomes; Renal outcomes; Pharmacist; Patient-Centered Medical Home; Medication Therapy Management
Although community pharmacists in the United Kingdom are expected to assess elderly patients' needs for additional support in managing their medicines, there is limited data on potentially useful assessment tools. We sought to evaluate a 13-item assessment instrument among community dwelling elderly patients, 65 years and above. The instrument is composed of a cognitive risk sub-scale of 6 items and a physical risk sub-scale of 7 items.
The instrument was administered to elderly patients in a survey performed in a community to the west of Glasgow, Scotland. The survey recruited 37 participants, 31 from 4 community pharmacies and 6 patients whose medication management tasks were managed by the West Glasgow Community Health and Care Partnership (managed patients). Community pharmacists independently rated 29 of the 37 participants' comprehension of, and dexterity in handling their medicines. We assessed scale reliability, convergent validity and criterion validity. In sub-analyses, we assessed differences in scores between the managed patients and those recruited from the community pharmacies, and between multi-compartment compliance aid users and non-users. The instrument showed satisfactory internal consistency (Cronbach's alpha of 0.792 for 13-item scale). There was significant strong negative correlation between the cognitive risk sub-scores and community pharmacists' assessment of comprehension (ρ = -0.546, p = 0.0038); and physical risk sub-scores and community pharmacists' assessment of dexterity (ρ = -0.491, p = 0.0093). The Area Under the Receiver Operator Characteristic Curve (AUC ± SE; 95%CI) showed that the instrument had good discriminatory capacity (0.86 ± 0.07; 0.68, 0.96). The best cut-off (sensitivity, specificity) was ≥4 (65%, 100%). In the sub-analyses, managed patients had significantly higher cognitive risk sub-scores (6.5 versus 4.0, p = 0.0461) compared to non-managed patients. There was a significant difference in total risk score (4 versus 2, p = 0.0135) and cognitive risk sub-score (4 versus 1.5, p = 0.0029) between users and non-users of multi-compartment compliance aids.
This instrument shows potential for use in identifying elderly patients who may have problems managing their own medicines in the community setting. However, more robust validity and reliability assessments are needed prior to introduction of the tool into routine practice.
Background: No randomised studies have addressed whether self-management for asthma can be successfully delivered by community pharmacists. Most randomised trials of asthma self-management have recruited participants from secondary care; there is uncertainty regarding its effectiveness in primary care. A randomised controlled study was undertaken to determine whether a community pharmacist could improve asthma control using self-management advice for individuals recruited during attendance at a community pharmacy.
Methods: Twenty four adults attending a community pharmacy in Tower Hamlets, east London for routine asthma medication were randomised into two groups: the intervention group received self-management advice from the pharmacist with weekly telephone follow up for 3 months and the control group received no input from the pharmacist. Participants self-completed the North of England asthma symptom scale at baseline and 3 months later.
Results: The groups were well matched at baseline for demographic characteristics and mean (SD) symptom scores (26.3 (4.8) and 27.8 (3.7) in the intervention and control groups, respectively). Symptom scores improved in the intervention group and marginally worsened in the control group to 20.3 (4.2) and 28.1 (3.5), respectively (p<0.001; difference adjusted for baseline scores = 7.0 (95% CI 4.4 to 9.5).
Conclusions: A self-management programme delivered by a community pharmacist can improve asthma control in individuals recruited at a community pharmacy. Further studies should attempt to confirm these findings using larger samples and a wider range of outcome measures.
To evaluate the impact of a tobacco cessation training program on pharmacists' confidence, skills, and practice-change behaviors.
Wisconsin during 2002–2003.
25 community pharmacists.
A continuing education training program was developed and implemented using home and live training components consisting of the national tobacco cessation guidelines, including the 5A's counseling process. The home study component included lectures and readings in CD-ROM format. Consistent with self-efficacy theory, the live training was based on exercises that included modeling, rehearsal, and feedback to learners.
Main outcome measures
Knowledge assessment, pre- and postsurveys assessing confidence and skill levels, and service provision indicators.
Self-efficacy and perceived ability to counsel patients to quit using tobacco improved significantly after the combined program. No significant change in confidence or perceived skills occurred following home study alone, suggesting value in using a combination of teaching strategies (problem solving, modeling, rehearsal, and feedback). Of participants, 92% received a passing knowledge score and 75% attempted to implement a tobacco cessation service posttraining; more than 50% assisted patients up to 1 year posttraining. A relationship between self-efficacy and service provision was found when practice settings were considered.
This program increased pharmacists' knowledge and self-efficacy to counsel patients on tobacco use. Further, the majority of pharmacy participants attempted to implement a tobacco cessation service.
Self-efficacy; continuing education; counseling (patient); tobacco cessation
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.
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.
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.
pharmaceutical care; pharmacy; medications; Canada; prescriptions; drug-related problems