Comparing Diagnosis and Treatment of Pulmonary Hypertension Patients at a Pulmonary Hypertension Center versus Community Centers

Once patients are diagnosed with pulmonary hypertension it is important to identify the correct diagnostic group as it will have implications on the disease state management. Pulmonary hypertension is increasingly diagnosed and treated in general medical practices; however, evidence-based guidelines recommend evaluation and treatment in pulmonary hypertension centers for accurate diagnosis and appropriate treatment recommendations. We conducted a retrospective cohort study of 509 random patients 18 years and older who were evaluated in our pulmonary hypertension clinic from January 2005 to December 2018. 68.4% (n = 348) had their diagnostic group clarified or changed. Pulmonary hypertension was deemed an incorrect diagnosis in 12.4% (n = 63). A total of 114 patients (22.4%) had been initiated on pulmonary hypertension specific treatment prior to presentation. Pulmonary hypertension specific medication was stopped in 57 (50.0%) cases. The estimated monthly saving of the stopped medication based on wholesale acquisition costs was USD 396,988.05–419,641.05, a monthly saving of USD 6964.70–7362.12 per patient. Evaluation outside of a pulmonary hypertension center may lead to misdiagnosis and inappropriate or inadequate treatment. Pulmonary arterial hypertension directed therapy improves median survival, but inappropriate therapy may cause harm; therefore, patients benefit from a specialized center with multiple resources to secure an accurate diagnosis and tailored treatment for their condition.

Effect of Visit Frequency of Pharmacist-Led Diabetes Medication Management Program

Background: Pharmacists have a positive effect on clinical outcomes in chronic disease state management, however, few studies have evaluated the effect that frequency of visits may have on diabetes biomarkers such as hemoglobin A1c and blood pressure readings. Methods: Under the medication management program (MMP), patients with diabetes were seen monthly by pharmacists until early 2015, when time between visits was increased to every 3 months. A retrospective chart review was conducted to evaluate the primary outcome of the percent change in hemoglobin A1c and blood pressure after the change in visit frequency. Results: In the 303 patients enrolled, no statistical difference existed between the pre and post average A1c (p-value = 0.10). The intermediate average A1c was statistically lower from the preintervention mean A1c (p-value = 0.001) but not from the postintervention mean A1c (p-value = 0.30). No statistical differences were seen between systolic blood pressure and diastolic blood pressure. Conclusion: Patients who have been seen by a clinical pharmacist more frequently (every month or every other month) for several years may be able to maintain their reduction in A1c with less-frequent visits (every 3 to 6 months).

Rural Physician-Pharmacist Collaborative Practice Agreements Managing Patients in Supportive Living and Assisted Living Memory Care Facilities

Setting: Supportive living and assisted living memory care facilities in a rural West-Central Illinois county. Objectives: 1) Evaluate the impact of active pharmacist participation on patient care for residents living in supportive and assisted living facilities, 2) demonstrate feasibility and financial sustainability of rural community pharmacists providing disease state management services, 3) create processes for best practice to expand the clinical role of the community pharmacist Design: Case study. Interventions: Participating residents received disease state management services provided by a community pharmacist as outlined through collaborative practice agreements with local physicians. The disease states managed included hypertension, hyperlipidemia, diabetes mellitus, and warfarin anticoagulation therapy. The pharmacist completed an initial chart review, initial face-to-face visit, subsequent monthly chart reviews, and monthly face-to-face visits with each resident. Results: During the 6-month period of community pharmacist management, 86 face-to-face visits were completed to deliver a median of 5 visits per resident. The pharmacist identified 23 drug therapy problems with recommended solutions communicated to the resident’s primary care provider. Providers accepted 19 of these recommendations, reflecting an 82.6% acceptance rate. Conclusions: Community pharmacists can feasibly implement enhanced clinical services to assist with disease state management of supportive living and assisted living residents in collaboration with physicians. Pharmacists can provide clinical assessment, education and effective communication to optimize medication management and utilization. Article Type: Case Study

Pediatric-to-adult healthcare transitions: Current challenges and recommended practices

Purpose An overview of the pediatric-to-adult healthcare transition (HCT) process, including stakeholders, challenges, and fundamental components that present opportunities for pharmacists and pharmacy technicians, is provided. Summary Pediatric-to-adult HCT programs should be longitudinal in nature, be patient focused, and be coproduced by patients, caregivers, and care team members. Educational components of HCT programs should include knowledge and skills in disease state management and self-care; safe and effective use of medications, as well as other treatment modalities; and healthcare system navigation, including insurance issues. Interprofessional involvement in HCT is encouraged; however, roles for each discipline involved are not clearly delineated in current guidelines or literature. Possible influencing elements in achieving successful pediatric-to-adult HCT outcomes include those that are related to patient and/or caregiver factors, clinician awareness, availability of resources, and ability to achieve financial sustainability. Conclusion The use of structured pediatric-to-adult HCT programs is currently recommended to optimize patient and health-system outcomes. Given the importance of medication-related knowledge and healthcare system navigation skills to successful care transitions, there are opportunities for pharmacists and pharmacy technicians to contribute to HCT programs.

Ohio Community Pharmacist Interest and Participation in Community-Clinical Linkages

Background: Community-clinical linkages have been promoted as a means to improve population health. The community pharmacy is an ideal location for these partnerships to occur due to the expertise of the community pharmacist. While the need for these partnerships exists, there are limited data regarding community pharmacists’ current participation in such programs. Objective: The purpose of this analysis was to assess Ohio community pharmacists’ involvement and interest in community-clinical linkages. Methods: An electronic survey tool containing 26 questions was developed to assess Ohio community pharmacists’ participation in community-clinical linkages and interest to develop such partnerships. The tool was sent via email to a random sample of 500 pharmacists registered in Ohio and practicing in a community setting. Chi-square or Fisher exact nonparametric statistical tests were used as appropriate to identify whether there were any significant differences in current partnership or interest to partner with a prescriber who refers patients to their community pharmacy based on education (Bachelor of Science or Doctor of Pharmacy degree) or pharmacy location (urban, suburban, or rural). Results: Nine emails were undeliverable, leaving a sample of 491 pharmacists. Ninety-three (19%) responded to the survey. Sixteen respondents (17%) indicated that they currently partner with a prescriber who refers patients to their pharmacy for assistance with medications or chronic disease state management; this practice was more often reported in urban settings (p=0.022). Of those not currently participating in such a partnership, 53 (57%) were interested in developing one. Thirty-two respondents (34%) reported providing referrals for at least 1 type of screening or counseling service. For some types of services, pharmacists reported that they provide the service in the pharmacy and/or were interested to develop the service in the pharmacy rather than provide a referral. However, for any given service there were a number of pharmacists who expressed interest in providing referrals although they were not currently doing so. Conclusion: This sample of Ohio community pharmacists reported limited participation in community-clinical linkages but interest to develop them. Further studies should explore the pharmacists’ role and impact in such programs. Article Type: Original Research