Comprehensive health management pharmacist-delivered model: impact on healthcare utilization and costs.

Objectives: To (1) examine the impact of the Comprehensive Health Management Patient Service (CHaMPS) on unplanned hospital admissions and emergency department (ED) visits in patients with chronic conditions, (2) describe the number and type of pharmacist interventions, and (3) determine the cost savings of CHaMPS.

Study Design: Retrospective, cross-sectional design with a matched comparator group.

Methods: CHaMPS integrated pharmacists within family medicine clinics to optimize medication use among patients with chronic conditions.

Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization.

Purpose: The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described.

Methods: Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system.

Population health and medicine: Policy and financial drivers.

Purpose: The financial and policy levers of population health and potential opportunities for pharmacists are described.

Summary: Three long-standing problems drive the focus on population health: (1) the United States suffers far worse population health outcomes compared with those of other developed nations that spend significantly less on healthcare, (2) the U.S.

The ADAPT online education program: A tool for practicing pharmacists delivering patient-centered care.

Objectives: The ADapting pharmacists' skills and Approaches to maximize Patient's drug Therapy effectiveness (ADAPT) e-learning program was developed by a consortium of Canadian pharmacy educators and researchers to prepare practicing pharmacists for patient-centered care. We selected this education program to provide training for pharmacists as the workforce transformation component of a Center for Medicare and Medicaid Innovation project. In this report we share our experiences with this educational program.

Improvements in MBD lab outcomes associated with improved pharmaceutical care in hemodialysis patients.

End stage renal disease (ESRD) patients require a large number of medications and are known to have high rates of nonadherence. It is estimated that >50% of ESRD patients do not take their phosphate binders as prescribed. The renal pharmacy FreseniusRx provides coordinated ESRD medication delivery and adherence support for enrolled patients.

Improving Health of At-Risk Rural Patients project: A collaborative care model.

Purpose: The design elements of the Improving Health of At-Risk Rural Patients (IHARP) care model are described.

Summary: The IHARP project evaluated the clinical, economic, and humanistic outcomes associated with the collaborative care model relative to usual care in the community. The care model was initiated in 22 level 3- certified patient-centered medical homes.

A Novel Education and Training Program to Enhance Student Advocacy.

Objective. To develop and implement a unique student advocacy program to train student pharmacists to be effective advocates for the profession of pharmacy and the patients it serves. Design.

Influence of kidney disease on drug disposition: An assessment of industry studies submitted to the FDA for new chemical entities 1999-2010.

In 1998, the United States Food and Drug Administration (FDA) released the first guidance for industry regarding pharmacokinetic (PK) studies in renally impaired patients. This study aimed to determine if the FDA renal PK guidance influenced the frequency and rigor of renal studies conducted for new chemical entities (NCEs). FDA-approved package inserts (APIs) and clinical pharmacology review documents were analyzed for 194 NCEs approved from 1999 to 2010.

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic.

Background: Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people.

Objectives: To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia.

Doripenem dosing recommendations for critically ill patients receiving continuous renal replacement therapy.

Doripenem dosing regimens for patients receiving continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF) were devised based on an established efficacy criterion (free plasma doripenem concentrations above the minimum inhibitory concentration [fT > MIC] of 1 mg/L for ≥35% of the dosing interval) while maintaining exposure below that with the highest studied dose of 1000 mg infused over 1 hour every 8 hours in healthy subjects. Simulations were utilized to assure ≥90% probability of achieving the efficacy criterion with the recommended doripenem regimens. Inflated intersubject variability of 40% (coefficient of variation) was used for pharmacokinetic parameters (representative of clinical variation) and nonrenal clearance was doubled to account for potential changes with acute renal insufficiency.

A qualitative analysis of perceptions and barriers to therapeutic lifestyle changes among homeless hypertensive patients.

Background: Homeless individuals have higher rates of hypertension when compared to the general population. Therapeutic lifestyle changes (TLCs) have the potential to decrease the morbidity and mortality associated with hypertension, yet TLCs can be difficult for homeless persons to implement because of competing priorities.

Objectives: To identify: (1) Patients' knowledge and perceptions of hypertension and TLCs and (2) Barriers to implementation of TLCs.

Interactive preventive health record to enhance delivery of recommended care: a randomized trial.

Purpose: Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and generates reminders.

Health care reform 2011: opportunities for pharmacists.

The health reforms of the last several years at the federal and state levels have created many opportunities for pharmacists to become actively involved in the direct patient care provision. Indeed, the statutory language in some sections of the Affordable Care Act of 2010 creates expectations of pharmacists that will require practice transformation if we are to arise to accept the responsibilities associated with these expectations. These new opportunities open the door for pharmacists to benefit community-dwelling patients with chronic medical conditions, those with acute/emergent care needs, those experiencing a transition between chronic and acute care and vice versa, as well as others in long-term care settings.

Pharmacy practice in Virginia in 2011.

Background: Opportunities for pharmacy practice reform exist at state and national levels. The Virginia Commonwealth University (VCU) School of Pharmacy created a working group to assess these opportunities with a mission to advance pharmacy practice in Virginia.

Objectives: To assess the perceptions of chronic and acute care pharmacy practice and confidence in providing patient care and medication therapy management (MTM) activities and characterize current work activities of pharmacists in Virginia.

Executive summary: The Virginia Commonwealth University pharmacy practice transformation conference.

Pharmacy practice transformation was the focus of an invitational conference held in June 2011 to address the current status of the practice of pharmacy in Virginia and elucidate the consensus on future directions from pharmacists across the commonwealth. The series of presentations provided visionary perspectives on the role that pharmacists can have in the collaborative management of patients with chronic disease states, the optimal pharmacy practice model for direct patient care delivery in acute care settings, and payment for pharmacists' cognitive services, such as medication therapy management (MTM). The discussion groups were structured to have conference participants first identify future goals for pharmacy practice and then consider strategies to achieve these goals.

Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons.

An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need.

Drug dosing consideration in patients with acute and chronic kidney disease-a clinical update from Kidney Disease: Improving Global Outcomes (KDIGO).

Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice. The challenge is how to accurately estimate a patient's kidney function in both acute and chronic kidney disease and determine the influence of renal replacement therapies on drug disposition. Kidney Disease: Improving Global Outcomes (KDIGO) held a conference to investigate these issues and propose recommendations for practitioners, researchers, and those involved in the drug development and regulatory arenas.

Integration of collaborative medication therapy management in a safety net patient-centered medical home.

Objective: To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH).

Setting: Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010.

Practice Description: A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH.

Health Care Policy 2011: implications for pharmacists.

The enactment of the Patient Protection and Affordable Care Act of 2010 set the stage for a new era. The 2010 Congressional election results and recent court rulings challenging the constitutionality of various provisions of the Act suggest that implementation will be anything but straightforward. The proposed changes in health insurance, along with modifications in current reimbursement models, will alter the health-care environment.

Influence of continuous venovenous hemofiltration and continuous venovenous hemodiafiltration on the disposition of doripenem.

The pharmacokinetics, safety, and tolerability of a single 1-hour, 500-mg intravenous infusion of doripenem were assessed in dialysis-dependent subjects with stage 5 chronic kidney disease undergoing continuous renal replacement therapy (CRRT) via 12-hour continuous venovenous hemofiltration (CVVH) (n = 6) or continuous venovenous hemodiafiltration (CVVHDF) (n = 5). Healthy volunteers were also assessed (n = 12). Concentrations of doripenem and the primary metabolite doripenem-M-1 were measured in plasma and ultrafiltrate or ultrafiltrate/dialysate by a validated liquid chromatography-tandem mass spectrometry method.

Health-care reform 2010: how will it impact you and your practice?

There are several transformative features of the 2 landmark health-care reform laws passed by the Congress and signed into law by the President in March. The most critical elements that will impact pharmacists and patients are categorized into 6 key areas in this commentary: health insurance reform; improvements in Medicare and Medicaid; pharmacy practice expansion; health professions education and workforce initiatives; prevention and wellness; and enhanced access to affordable medications. The relevant features of these new opportunities are presented and the implications for pharmacists and their patients are discussed.

Evaluation of renal drug dosing: prescribing information and clinical pharmacist approaches.

Study Objective: To characterize renal function parameters reported in United States Food and Drug Administration-approved prescribing information (package inserts), to compare dosage recommendations for patients with impaired renal function between prescribing information and tertiary drug dosing references, and to evaluate renal function quantification methods most commonly used by clinical pharmacists to develop dosage regimens.

Design: Retrospective analysis and Web-based survey.

Data Sources: Prescribing information for all new molecular entities (NMEs) approved from 1998-2007 in which dosing recommendations were proposed for patients with impaired renal function, drug monographs from four tertiary drug dosing references (Micromedex, Lexi-Comp, Epocrates Rx, and American Hospital Formulary Service [AHFS] Drug Information) for all identified NMEs, and a Web-based survey of 204 nephrology and critical care pharmacy practitioners.

Healthcare reform 2009 and its implications for pharmacists.

The US healthcare system has been widely criticized by many and praised by others for many reasons that are not mutually exclusive. There is no doubt that, compared with our peer industrialized countries, the US ranks near the bottom in many of the benchmark criteria such as life expectancy, infant mortality, and mortality of the population that is amenable to health care. Despite these shortcomings, the US has been a major innovator in healthcare technology including the development of biological and pharmacological drugs.