Objective: To perform a systematic review to identify health outcomes related to medication regimen complexity as measured by the Medication Regimen Complexity Index (MRCI) instrument. Data Sources...

https://journals.sagepub.com/doi/pdf/10.1177/1060028018773691

Medication Regimen Complexity Measured by MRCI: A Systematic Review to Identify Health Outcomes.

Aims
The aims were to assess the impact of a medication review with follow-up (MRF) service provided in community pharmacy to aged polypharmacy patients on the number of medication-related hospital admissions and to estimate the effect on hospital costs

Methods
This was a sub-analysis of a cluster randomized controlled trials carried out in 178 community pharmacies in Spain Pharmacies in the intervention group (IG) provided a comprehensive medication review during 6 months Pharmacists in the comparison group (CG) delivered usual care For the purposes of this sub-analysis, an expert panel of three internal medicine specialists screened the hospitalizations occurring during the main study, in order to identify medication-related hospitalizations Inter-rater reliability was measured using Fleiss's kappa Hospital costs were calculated using diagnosis related groups

Results
One thousand four hundred and three patients were included in the main study and they had 83 hospitalizations Forty-two hospitalizations (506%) were medicine-related, with a substantial level of agreement among the experts (kappa = 065, 95% CI 052, 078, P < 001) The number of medication-related hospitalizations was significantly lower in patients receiving MRF (IG 11, GC 31, P = 0042) The probability of being hospitalized was 37 times higher in the CG (odds ratio 37, 95% CI 12, 113, P = 0021) Costs for a medicine-related hospitalization were €6672 Medication-related hospitalization costs were lower for patients receiving MRF [IG: €94 (SD 917); CG: €301 (SD 2102); 95% CI 359, 3780, P = 0018]

Conclusion
MRF provided by community pharmacists might be an effective strategy to balance the assurance of the benefit from medications and the avoidance of medication-related hospitalizations in aged patients using polypharmacy

/pdf/the-impact-of-a-medication-review-with-follow-up-service-on-21lic7syou.pdf

The impact of a medication review with follow-up service on hospital admissions in aged polypharmacy patients.

Pharmacist-led medication review services are recognized as a key to medicines management. This case study describes the implementation process of a medication review with follow-up service in a community pharmacy setting and evaluates its initial outcomes. An implementation-effectiveness hybrid study was undertaken in a community pharmacy setting. The implementation process was divided into four different phases: Exploration and adoption, program installation, initial implementation, and full operation. A core set of implementation outcomes was measured, including penetration, implementation costs, feasibility, fidelity, acceptability, appropriateness and efficiency. The penetration rate of the service was nearly 62.5%, and the implementation costs were 57,359.67€. There was a high retention-participation rate of patients. For every month of service provision, there was a 1.27 increase in the number of patients requesting the service, compared to the number of patients being offered the service. The time spent on service provision was 171.7 min per patient. Average patient satisfaction with the service was 4.82 (SD: 0.39, scale 1–5), and the acceptance rate of care plans by patients and general medical practitioners were 96.99% and 96.46%, respectively. There were 408 negative outcomes associated with the use of medications were identified during the study (3.09 per patient), of which 96.3% were resolved. The average time per patient spent on service provision significantly decreased along the 18 months of service provision. This case report can assist individual pharmacists and professional organizations interested in implementing evidence-based services by offering an example on how to approach the implementation process in a systematic way.

/pdf/evaluation-of-the-implementation-process-and-outcomes-of-a-37eu1sdhew.pdf

Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report

Introduction Medication review (MR) is a pharmacy practice conducted in different settings that has a positive impact on patient health outcomes. In this context, systematic reviews on MR have restricted the assessment of this practice using criteria such as methodological quality, practice settings, and patient outcomes. Therefore, expanding research on this subject is necessary to facilitate the understanding of the effectiveness of MR and the comparison of its results. Aim To examine the panorama of systematic reviews on pharmacist-participated MR in different practice settings. Methods A literature search was undertaken in Biblioteca Virtual em Saude (BVS), Embase, PubMed, Scopus, The Cochrane Library, and Web of Science databases through January 2018 using keywords for "medication review", "systematic review", and "pharmacist". Two independents investigators screened titles, abstracts, full texts; assessed methodological quality; and, extracted data from the included reviews. Results Seventeen systematic reviews were included, of which sixteen presented low to moderate methodological quality. Most of reviews were conducted in Europe (n = 7), included controlled primary studies (n = 16), elderly patients (n = 9), and long-term care facilities (n = 8). Seven reviews addressed MR as an intervention and thirteen reviews cited collaboration between physicians and pharmacists in the practice of MR. In addition, thirteen terminologies for MR were used and the main objective was to identify and solve drug-related problems and/or optimize the drug use (n = 11). Conclusion There is considerable heterogeneity in practice settings, population, definitions, terminologies, and approach of MR as well as poor description of patient care process in the systematic reviews. These facts may limit the comparison, summarization and understanding of the results of MR. Furthermore, the methodological quality of most systematic reviews was below ideal. Thus, international agreement on the MR process is necessary to assess, compare and optimize the quality of care provided.

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0210312&type=printable

Pharmacist-participated medication review in different practice settings: Service or intervention? An overview of systematic reviews

Part 1. What is Pharmaceutical Care -- Definitions of pharmaceutical care and related concepts -- The role of drug-related problems -- Part 2. Pharmaceutical care processes -- Role of the patient -- Counseling and instructing patients -- The role of Adherence in Pharmaceutical Care -- Interprofessional communication -- Medication reconciliation and review -- Documenting pharmaceutical care -- Quality control: Standards, Guidelines and Protocols -- Structure, process, outcome and their indicators -- Economical, Clinical and Humanistic outcomes -- Core Outcomes Sets -- Part 3. Pharmaceutical care around the world -- Pharmaceutical Care in the North America -- Pharmaceutical Care in Europe -- Pharmaceutical Care in New Zealand and Australia -- Pharmaceutical Care in Latin America -- Pharmaceutical Care in Asia -- Part 4. Implementing Pharmaceutical care in different settings -- Implementation strategies and the role of the audience -- Implementation in the community setting -- Implementation in Nursing homes -- Implementation in Hospitals and clinics -- Part 5. Delivering pharmaceutical care in practice -- Dispensing new and repeat prescriptions -- OTC medication and pharmaceutical care -- Care around Medical devices -- Health promotion and disease prevention -- Part 6. Pharmaceutical care for specific patient groups -- PhC in the aged -- PhC and Asthma and COPD -- PhC and Diabetes -- PhC and Cardiovascular diseases -- PhC and Anticoagulation -- PhC and Pediatrics -- Pharmaceutical care for cancer outpatients -- PhC and Viral diseases (HIV and Hepatitis C) -- Part 7. Remuneration of pharmaceutical care -- Basic functioning of health care systems -- Payment methods in health care systems -- How to determine the price of a service -- Overview of different services being paid worldwide -- Paying for Pharmaceutical Care -- Part 8. Teaching pharmaceutical care -- Teaching pharmaceutical care in university -- Teaching pharmaceutical care to pharmacists and other health care professionals.

The Pharmacist Guide to Implementing Pharmaceutical Care

Background Despite many research studies demonstrating the benefit in clinical, economic, and humanistic outcomes of professional pharmacy services, there is a paucity of evidence when these services become incorporated into the usual practice of a community pharmacy. Objective The objective of the present study was to evaluate the clinical, economic, and humanistic impact of a pharmacist-conducted medication review with follow-up following 18 months implementation. Setting Community pharmacies in Spain. Method The study used an effectiveness-implementation hybrid design. During the follow-up, patients attended the pharmacy on a monthly basis and received the medication review with follow-up service. Main outcome measure Economic, clinical, and humanistic measures were used to assess the impact of the service. Results 132 patients received the service. During the 18 months of follow-up, 408 negative outcomes related to medicines (which are uncontrolled health problems) were identified, of which 393 were resolved. The average number of medicines used by patients significantly decreased from 6.1 (SD: 2.9) to 3.3 (SD: 2.2). A significant decrease was also observed in hospitalizations [OR = 0.31 (IC 95 % = 0.10–0.99)] and in emergency department visits [OR = 0.16 (IC 95 % = 0.05–0.55); p = 0.001]. A general trend to increase all quality of life domains was observed over time. The higher increase was observed in the construct health transition [mean increase: 30.7 (SD: 25.4)], followed by bodily pain [mean increase: 22.3 (SD: 25.4)], and general health [mean increase: 20.7 (SD: 23.7)]. Medication knowledge significantly increased in terms of aggregated domains of dose, frequency, drug indication [from 8.9 (SD: 17.5) to 87.9 (SD: 25.0)], and dose and frequency [from 9.3 (SD: 17.9) to 92.5 (22.1)]. Although a slight improvement was observed in terms of drug indication, this increase was not statistically significant. 68 out of 132 patients (51.5 %) were non-adherent to their treatment. This number decreased to 1 (0.8 %) after the follow-up [OR = 0.007 (IC 95 %: 0.001–0.053) p < 0.001]. Conclusion A community pharmacy based medication review with follow-up service delivered by a trained pharmacist, has positive effects across clinical, economic, and humanistic outcomes. These results are consistent with previous studies. Incorporating community pharmacists into the multidisciplinary team is a reliable solution to improve health care.

Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes

Aims: A Web based research was desgined in 2006 to search for Pharmacy Practice, Social and Administrative Pharmacy departements in all Pharmacy Schools in the world. Material and Methods: The International Federation Pharmacy list of all Faculty of Pharmacy in the world was used. The key words used were: Pharmacy Practice, Social Pharmacy and Administrative Pharmacy in different languages: English, Spanish and Portuguese. Results: 718 Faculties of Pharmacy were identified, 192 reaching the inclusion criteria. 83 out of them had a PPD with a key word in their web site. In Oceania there were 9 PPD, in Asia 8 and in Europe 22. In America 43, all of them located in North America while in Africa there was only one university with a PPD. Conclusions: The biggest rate of implementation of PPD happens in well developed countries. They are autonomous, independent from other departments and with a multidisciplinary structure.

/pdf/departamentos-de-practica-farmaceutica-en-el-mundo-en-2006-1coft932st.pdf

Carla Castrillon Ocampo

Papers

Implementation of medication review with follow-up in a Spanish community pharmacy and its achieved outcomes

Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report

Departamentos de práctica farmacéutica en el mundo, en 2006