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Author: Deborah S. Ling Publisher: ISBN: Category : Languages : en Pages : 125
Book Description
This dissertation consists of three studies, each applying a different method, to evaluate the use of pharmacists on the primary care team for people with chronic health conditions, such as high blood pressure and diabetes. Pharmacist interventions, also called Medication Therapy Management (MTM) services, are the subject of considerable current debate in health reform policy. Major associations representing pharmacists are advocating for legislation that will establish reimbursement for MTM services for a wide range of chronic conditions. The studies included in this report address unanswered research questions regarding 1) whether enough evidence exists to conclude that MTM services interventions will result in cost savings and significant return on investment, 2) which patient populations might benefit most from MTM services interventions, and 3) what are the challenges associated with the implementation of these types of MTM services in collaborative partnerships with public and private community health entities. The first paper in the trilogy examined the existent literature on the cost-benefits of MTM programs. The findings suggest that existing economic studies of MTM services are lacking in quality and additional high-quality cost-effectiveness research work needs to be completed before there is enough evidence to support reimbursement and policy changes. The second study considered whether different populations of people who have commercial health insurance, Medicare insurance, or Medicaid insurance who take long-term medications were more or less likely to receive medication monitoring. Presumably, those who take long-term medications but may not be receiving proper monitoring could benefit from interventions such as MTM services. Through quantitative regression analysis, it was determined that for populations on widely prescribed medications, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and diuretics - those with commercial insurance were almost three times less likely to be monitored than those with Medicare insurance. Also, significant effects on medication monitoring were found for important patient characteristic covariates including gender - females less likely to be monitored, age - older age associated with lower likelihood of monitoring, and income - higher income associated with higher likelihood of monitoring. The final study examined the efforts of a multi-sector collaborative partnership implementing an MTM services intervention using community pharmacists to assist with treatment of a population of school district employees and their dependents who have diabetes in San Diego, California. Contextual, resource, leadership, and internal conflict factors were evaluated with qualitative analysis to determine their effect on the abilities of the partnership to complete its initiatives. New contributions as a result of this research include developing a cost model to provide MTM services, quantifying relationships between health insurance status and medication monitoring, and revealing practical lessons on implementation of MTM models. This work provides an objective view on these subjects while adding to the growing number of studies on incorporating pharmacists on the primary care team.
Author: Deborah S. Ling Publisher: ISBN: Category : Languages : en Pages : 125
Book Description
This dissertation consists of three studies, each applying a different method, to evaluate the use of pharmacists on the primary care team for people with chronic health conditions, such as high blood pressure and diabetes. Pharmacist interventions, also called Medication Therapy Management (MTM) services, are the subject of considerable current debate in health reform policy. Major associations representing pharmacists are advocating for legislation that will establish reimbursement for MTM services for a wide range of chronic conditions. The studies included in this report address unanswered research questions regarding 1) whether enough evidence exists to conclude that MTM services interventions will result in cost savings and significant return on investment, 2) which patient populations might benefit most from MTM services interventions, and 3) what are the challenges associated with the implementation of these types of MTM services in collaborative partnerships with public and private community health entities. The first paper in the trilogy examined the existent literature on the cost-benefits of MTM programs. The findings suggest that existing economic studies of MTM services are lacking in quality and additional high-quality cost-effectiveness research work needs to be completed before there is enough evidence to support reimbursement and policy changes. The second study considered whether different populations of people who have commercial health insurance, Medicare insurance, or Medicaid insurance who take long-term medications were more or less likely to receive medication monitoring. Presumably, those who take long-term medications but may not be receiving proper monitoring could benefit from interventions such as MTM services. Through quantitative regression analysis, it was determined that for populations on widely prescribed medications, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and diuretics - those with commercial insurance were almost three times less likely to be monitored than those with Medicare insurance. Also, significant effects on medication monitoring were found for important patient characteristic covariates including gender - females less likely to be monitored, age - older age associated with lower likelihood of monitoring, and income - higher income associated with higher likelihood of monitoring. The final study examined the efforts of a multi-sector collaborative partnership implementing an MTM services intervention using community pharmacists to assist with treatment of a population of school district employees and their dependents who have diabetes in San Diego, California. Contextual, resource, leadership, and internal conflict factors were evaluated with qualitative analysis to determine their effect on the abilities of the partnership to complete its initiatives. New contributions as a result of this research include developing a cost model to provide MTM services, quantifying relationships between health insurance status and medication monitoring, and revealing practical lessons on implementation of MTM models. This work provides an objective view on these subjects while adding to the growing number of studies on incorporating pharmacists on the primary care team.
Author: Henri Richard Manasse Publisher: ASHP ISBN: 1585280895 Category : Medical Languages : en Pages : 394
Book Description
Medication safety is the most challenging goal for pharmacy practice and patient safety professionals in all health care facilities. This book serves as an essential reference guide for planning and implementing a medication safety program. Written by nationally-recognized experts, Medication Safety: A Guide for Health Care Facilities provides a comprehensive analysis of principles and practices associated with the prevention and identification of medication errors, as well as interdisciplinary, facility-wide recommendations for achieving medication safety in all settings. This book is divided into four sections so users can easily find the information they need: the Importance of Medication Safety, the Medication Safety Team, Building a Safe Medication Use System, and Measuring Medication Safety.
Author: Meera Viswanathan Publisher: ISBN: Category : Languages : en Pages :
Book Description
OBJECTIVES: To describe intervention components and implementation features (Key Question [KQ]1) for outpatient medication therapy management (MTM) interventions with comprehensive medication review, followup, education, and care coordination; assess the effectiveness of these MTM interventions on intermediate, patient-centered, or resource utilization outcomes (KQ 2); identify intervention features (KQ 3) and patient characteristics (KQ 4) that moderate the effect of an intervention on outcomes; and assess harms associated with interventions (KQ 5). DATA SOURCES: MEDLINE(r), Cochrane Library, International Pharmaceutical Abstracts, gray literature, additional studies from reference lists and technical experts REVIEW METHODS: Two trained reviewers selected, extracted data from, and rated the risk of bias of relevant trials and cohort studies. We used random-effects models to estimate pooled effects for outcomes with three or more similar studies with a low or medium risk of bias. For other outcomes, we synthesized the data qualitatively. RESULTS: We included 44 eligible studies (21 randomized controlled trials, 4 controlled clinical trials, and 19 cohort studies) reported in 61 articles, described in detail in the report (KQ 1). Evidence was insufficient on the effect of outpatient MTM interventions on most outcomes (KQ 2). In a few instances, described below, the evidence led us to conclude benefit or lack of benefit. Specifically, we found evidence that MTM results in improvement when compared with usual care for some measures of medication adherence and appropriateness; medication dosing; health plan expenditures on medication costs; and, for patients with diabetes, the proportion hospitalized and costs of hospitalization. Similarly, we conclude, based on a low strength of evidence, that MTM confers no benefit for patient satisfaction and most measures of health-related quality of life. We found evidence on five intervention components and intervention features (KQ 3). One study provided information on each feature and yielded insufficient evidence for most outcomes, with the following two exceptions. An MTM program with pharmacist access to brief clinical summaries from the medical record reduces the mean number of adverse drug events when compared with a basic MTM program without such access (low strength of evidence). Community pharmacists increase the generic dispensing ratio more than call-center-based pharmacists (low strength of evidence). We found no relevant studies on patient characteristics moderating the effect of MTM interventions (KQ 4). Similarly, the evidence on harms associated with MTM was limited to one study on inconvenience and was rated as insufficient (KQ 5). CONCLUSIONS: The evidence base offers low evidence of benefit for a limited number of intermediate and health utilization outcomes. We graded the evidence as insufficient for most other outcomes because of inconsistency in direction, magnitude, and precision, rather than lack of evidence. Wide variations in populations and interventions, both within and across studies, likely explain these inconsistencies. Given the widespread implementation of MTM and urgent need for actionable information, optimal investments in new research require a process of research prioritization in which the value of information from each proposed study is carefully considered. Studies designed to identify causal relationships between MTM interventions and their outcomes require adequate controls for confounding but may offer limited information on the factors that explain program success or failure. Studies designed to explore the reasons for program success or failure using qualitative or single-arm designs may offer hypotheses-generating rather than hypotheses-confirming insights on MTM effectiveness. New research, regardless of specific focus, will likely continue to find inconsistent results until underlying sources of heterogeneity are accounted for.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309101476 Category : Medical Languages : en Pages : 481
Book Description
In 1996 the Institute of Medicine launched the Quality Chasm Series, a series of reports focused on assessing and improving the nation's quality of health care. Preventing Medication Errors is the newest volume in the series. Responding to the key messages in earlier volumes of the seriesâ€"To Err Is Human (2000), Crossing the Quality Chasm (2001), and Patient Safety (2004)â€"this book sets forth an agenda for improving the safety of medication use. It begins by providing an overview of the system for drug development, regulation, distribution, and use. Preventing Medication Errors also examines the peer-reviewed literature on the incidence and the cost of medication errors and the effectiveness of error prevention strategies. Presenting data that will foster the reduction of medication errors, the book provides action agendas detailing the measures needed to improve the safety of medication use in both the short- and long-term. Patients, primary health care providers, health care organizations, purchasers of group health care, legislators, and those affiliated with providing medications and medication- related products and services will benefit from this guide to reducing medication errors.
Author: Vikram Patel Publisher: World Bank Publications ISBN: 1464804281 Category : Medical Languages : en Pages : 307
Book Description
Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 0309459575 Category : Medical Languages : en Pages : 483
Book Description
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 0309671035 Category : Social Science Languages : en Pages : 317
Book Description
Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.
Author: David H. Peters Publisher: World Health Organization ISBN: 9241506210 Category : Medical Languages : en Pages : 69
Book Description
Interest in implementation research is growing, largely in recognition of the contribution it can make to maximizing the beneficial impact of health interventions. As a relatively new and, until recently, rather neglected field within the health sector, implementation research is something of an unknown quantity for many. There is therefore a need for greater clarity about what exactly implementation research is, and what it can offer. This Guide is designed to provide that clarity. Intended to support those conducting implementation research, those with responsibility for implementing programs, and those who have an interest in both, the Guide provides an introduction to basic implementation research concepts and language, briefly outlines what it involves, and describes the many opportunities that it presents. The main aim of the Guide is to boost implementation research capacity as well as demand for implementation research that is aligned with need, and that is of particular relevance to health systems in low- and middle-income countries (LMICs). Research on implementation requires the engagement of diverse stakeholders and multiple disciplines in order to address the complex implementation challenges they face. For this reason, the Guide is intended for a variety of actors who contribute to and/or are impacted by implementation research. This includes the decision-makers responsible for designing policies and managing programs whose decisions shape implementation and scale-up processes, as well as the practitioners and front-line workers who ultimately implement these decisions along with researchers from different disciplines who bring expertise in systematically collecting and analyzing information to inform implementation questions. The opening chapters (1-4) make the case for why implementation research is important to decision-making. They offer a workable definition of implementation research and illustrate the relevance of research to problems that are often considered to be simply administrative and provide examples of how such problems can be framed as implementation research questions. The early chapters also deal with the conduct of implementation research, emphasizing the importance of collaboration and discussing the role of implementers in the planning and designing of studies, the collection and analysis of data, as well as in the dissemination and use of results. The second half of the Guide (5-7) detail the various methods and study designs that can be used to carry out implementation research, and, using examples, illustrates the application of quantitative, qualitative, and mixed-method designs to answer complex questions related to implementation and scale-up. It offers guidance on conceptualizing an implementation research study from the identification of the problem, development of research questions, identification of implementation outcomes and variables, as well as the selection of the study design and methods while also addressing important questions of rigor.
Author: Mevhibe Hocaoglu Publisher: Frontiers Media SA ISBN: 2832552501 Category : Medical Languages : en Pages : 213
Book Description
It is estimated that at least 60% of persons dying have a prolonged advanced illness. The need for palliative and end-of-life care will increase due to the rapidly aging world population and the increase of multiple long-term conditions. For these reasons, palliative care is an integral part of public health and public health strategies. Palliative care as holistic person-centered care and has played a critical role in the recent public health emergency of the COVID-19 pandemic. There is a close association between public health, health promotion, and palliative care, and this research topic will highlight this association. Through a series of multi-disciplinary articles, we will explore public health in the context of life-limiting illnesses contributing to shaping person-centered care, including palliative, end-of-life, and rehabilitation. This research topic will discuss advanced and life-limiting illness as a public health challenge and explore the role of palliative and end-of-life care including rehabilitation in shaping person-centered care.
Author: Deborah S. Ling
Author: Deborah S. Ling
Author: Vince Deguzman
Author: Henri Richard Manasse
Author: Meera Viswanathan
Author: Institute of Medicine
Author: Vikram Patel
Author: National Academies of Sciences, Engineering, and Medicine
Author: National Academies of Sciences, Engineering, and Medicine
Author: David H. Peters
Author: Mevhibe Hocaoglu