A cluster randomized trial to evaluate a centralized remote clinical pharmacy service in large, health system primary care clinics.

Background: We developed a remote cardiovascular risk service (CVRS) managed by clinical pharmacists to support primary care teams. The purpose of this study was to examine whether the CVRS could improve guideline adherence in primary care clinics with diverse geographic and patient characteristics.

Methods: This study was a cluster-randomized trial initiated in 20 primary care clinics across the US.

Cost-Effectiveness of a Physician-Pharmacist Collaboration Intervention to Improve Blood Pressure Control.

Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability, lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now (CAPTION) trial randomized 625 patients from 32 medical offices in 15 states.

A Cluster-Randomized Trial of a Centralized Clinical Pharmacy Cardiovascular Risk Service to Improve Guideline Adherence.

Background: Numerous studies have demonstrated the value of including pharmacists in team-based care to improve adherence to cardiovascular (CV) guidelines, medication adherence, and risk factor control. However, there is limited information on whether these models can be successfully implemented more widely in diverse settings and populations. The purpose of this study is to evaluate whether a centralized, web-based cardiovascular risk service (CVRS) managed by clinical pharmacists will improve guideline adherence in multiple primary care medical offices with diverse geographic and patient characteristics.

Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control.

Background: The purpose of this study was to evaluate if a physician/pharmacist collaborative model would be implemented as determined by improved blood pressure (BP) control in primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control could be sustained.

Methods And Results: Prospective, cluster-randomized trial of 32 primary care offices stratified and randomized to control, 9-month intervention (brief), and 24-month intervention (sustained). We enrolled 625 subjects with uncontrolled hypertension; 54% from racial/ethnic minority groups and 50% with diabetes mellitus or chronic kidney disease.

Similar blood pressure values across racial and economic groups: baseline data from a group randomized clinical trial.

This paper examines baseline characteristics from a prospective, cluster-randomized trial in 32 primary care offices. Offices were first stratified by percentage of minorities and level of clinical pharmacy services and then randomized into 1 of 3 study groups. The only differences between randomized arms were for marital status (P=.

Institutional review board barriers and solutions encountered in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now Study: a national multicenter practice-based implementation trial.

Study Objective: To categorize institutional review board (IRB) challenges and solutions encountered in a multicenter practice-based research network (PBRN) study and to assess the impact of IRB requirements on the willingness of individual principal investigators (PIs) to participate in future PBRN studies.

Design: Descriptive analysis of IRB challenges and solutions encountered in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) trial, a multicenter prospective cluster-randomized study conducted by the National Interdisciplinary Primary Care PBRN, and a correlational analysis from a survey of individual site PIs.

Measurements And Main Results: IRB barriers encountered and solutions were categorized for study sites.

Physician-pharmacist co-management and 24-hour blood pressure control.

The objectives of this study were to compare indices of 24-hour blood pressure (BP) following a physician-pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster-randomized clinical trial conducted in 6 family medicine clinics randomized to co-managed (n=3 clinics, 176 patients) or control (n=3 clinics, 198 patients) groups. Mean ambulatory systolic BP (SBP) was significantly lower in the co-managed vs the control group: daytime BP 122.

Using theory to predict implementation of a physician-pharmacist collaborative intervention within a practice-based research network.

Background: Studies have demonstrated that physician/pharmacist collaboration can improve management of chronic conditions.

Objective: The purpose of this study was to determine whether a correlation exists between existing clinical pharmacy services within a practice-based research network (PBRN) and provider attitudes and beliefs regarding implementing a new pharmacy intervention based on the Theory of Planned Behavior (TPB).

Methods: A validated survey was completed by one clinical pharmacist from each office.

Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control.

Study Objective: To compare costs associated with a physician-pharmacist collaborative intervention with costs of usual care.

Design: Cost analysis using health care utilization and outcome data from two prospective, cluster-randomized, controlled clinical trials.

Setting: Eleven community-based medical offices.

Sustained blood pressure control following discontinuation of a pharmacist intervention.

Team-based care can improve hypertension control. The purpose of the present study was to evaluate blood pressure (BP) control 18 months following the discontinuation of a physician-pharmacist collaborative intervention. This was a retrospective analysis of patients who had previously participated in a prospective, cluster randomized, controlled clinical trial.

A cluster-randomized effectiveness trial of a physician-pharmacist collaborative model to improve blood pressure control.

Unlabelled: Numerous studies have demonstrated the value of team-based care to improve blood pressure (BP) control, but there is limited information on whether these models would be adopted in diverse populations. The purpose of this study was to evaluate whether a collaborative model between physicians and pharmacists can improve BP control in multiple primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control can be sustained. This study is a randomized prospective trial in 27 primary care offices first stratified by the percentage of underrepresented minorities and the level of clinical pharmacy services within the office.

Deterioration of blood pressure control after discontinuation of a physician-pharmacist collaborative intervention.

Study Objective: To assess blood pressure control after discontinuation of a physician-pharmacist collaborative intervention.

Design: Comparative analysis of data of the patients who received the intervention versus a control group from a prospective, cluster-randomized, 9-month efficacy trial and the same patients' data 18 and 27 months after completion of the trial, abstracted from their medical records.

Setting: Five primary care medical offices operated by a university health system.

Physician and pharmacist collaboration to improve blood pressure control.

Background: Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The objective of this study was to evaluate if a physician and pharmacist collaborative model in community-based medical offices could improve BP control.

Methods: This was a prospective, cluster randomized, controlled clinical trial with clinics randomized to a control group (n = 3) or to an intervention group (n = 3).

Translating research into practice intervention improves management of acute pain in older hip fracture patients.

Objective: To test an interdisciplinary, multifaceted, translating research into practice (TRIP) intervention to (a) promote adoption, by physicians and nurses, of evidence-based (EB) acute pain management practices in hospitalized older adults, (b) decrease barriers to use of EB acute pain management practices, and (c) decrease pain intensity of older hospitalized adults.

Study Design: Experimental design with the hospital as the unit of randomization.

Study Setting: Twelve acute care hospitals in the Midwest.

Effect of evidence-based acute pain management practices on inpatient costs.

Objectives: To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based acute pain management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based acute pain management practices have on inpatient cost.

Data Sources/study Setting: Data from a randomized "translating research into practice" (TRIP) behavioral intervention designed to increase the use of evidence-based acute pain management practices for patients hospitalized with hip fractures.

Study Design: Experimental design and observational "as-treated" and instrumental variable (IV) methods.

Physician adherence to blood pressure guidelines and its effect on seniors.

Study Objective: To compare physician adherence to guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure for patients younger than 65 years of age with those aged 65 years and older, and to analyze whether factor groupings (subsets of criteria used to determine adherence) were predictive of blood pressure control.

Design: Retrospective medical record review.

Setting: Five university-affiliated family medicine and internal medicine outpatient clinics.

Explicit and implicit evaluation of physician adherence to hypertension guidelines.

This study evaluated physician adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) hypertension guidelines in 6 community-based clinics. Explicit review of retrospective medical record data for patients with uncontrolled hypertension measured guideline adherence using 22 criteria. Mean overall guideline adherence was 53.

Measuring adherence to practice guidelines for the management of hypertension: an evaluation of the literature.

Adherence to practice guidelines is frequently used as a measure of quality of care. Numerous studies have evaluated physician adherence to hypertension guidelines by prescription data, physician survey data, or medical record review. However, most have methodological limitations that might underestimate physician adherence.

Evidence-based assessment of acute pain in older adults: current nursing practices and perceived barriers.

Objectives: To report data on current nurse practice behaviors related to evidence-based assessment of acute pain in older adults, perceived stage of adoption of pain assessment practices, and perceptions of barriers to optimal assessment in this population.

Methods: Medical records from 709 older adult patients hospitalized with hip fractures from 12 acute care settings were abstracted for nurse assessment practices during the first 72 hours after admission. Questionnaires sent to nurses on study units regarding perceived stage of adoption and barriers to assessment in older adults.

Challenges of Web-based education in educating nurses about evidence-based acute pain management practices for older adults.

Internet technology holds potential as a valuable educational tool, but several challenges continue to impede its use. This article describes the use of a web-based course to educate staff nurses regarding evidence-based acute pain management practices for older adults. Specific areas highlighted include: the steps involved in creating the web-based course; the materials and support required to disseminate the course; the challenges encountered in promoting use of the course; and responses to and evaluations of the course.

Lack of opioid administration in older hip fracture patients (CE).

As part of a multisite study funded by the Agency for Healthcare Research and Quality, the medical records of older adults with a hip fracture were abstracted for acute pain assessment and treatment practices. Of the 709 records reviewed, 8 patients did not have an opioid administered during the first 72 hours after admission to a non-intensive patient care unit. Using a case study approach, this article examines demographic characteristics, pain assessment, and analgesic administration for these 8 patients to illustrate specific practice problems that occur in managing acute pain in older adults.

Acute pain treatment for older adults hospitalized with hip fracture: current nursing practices and perceived barriers.

This article examines acute pain management practices for patients 65 years of age and older who were hospitalized during 1999 for hip fracture. Data were collected from the medical records of patients (N = 709) admitted to 12 hospitals in the Midwest and from questionnaires on pain practices completed by nurses (N = 172) caring for these patients. The major variables examined were (1).

Assessing and managing acute pain in older adults: a research base to guide practice.

Older adults experiencing acute pain are often underassessed and undertreated. This review summarizes recommendations from an evidence-based practice guideline on acute pain management in older adults. Key areas highlighted are pain assessment and monitoring, patient education, pharmacologic management, and nonpharmacologic management.