Humanistic outcomes in the hypertension and COPD arms of a multicenter outcomes study.
ABSTRACT To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD).
Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used.
Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center.
Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents.
Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL.
Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients.
Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model.
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ABSTRACT: Summary Clinical Pharmacy, also called Pharmaceutical care, aims to maximise therapeutic effect, to minimise risk, to minimise cost, and to respect patient choice. North American countries and the United Kingdom have a large experience of pharmaceutical care, and this service is complementary to the activities performed by physicians, nurses, and other healthcare professionals. Experimental studies have shown that clinical pharmacy brings a definite added value in terms of the quality of use of medicines in various settings (hospitals, retail pharmacies, and outpatient clinics. These studies also demonstrate the economical bene- fits of pharmaceutical care. Clinical phar- macy is now under development in Belgium, and the pilot projects launched since 2000 have been well accepted. This has triggered the University Hospitals and the Faculties to launch actions oriented towards both edu- cation and research. Changes introduced in the educational curriculum of pharmacy students make them more alert to their future pharmaceutical care activities. A specific post-graduate program is now developed and implemented in two universities. The profes- sional organizations also organize postgradua- te training in pharmaceutical care. In the near future, an official recognition at the National level will be important to create the necessary framework in which Clinical Pharmacy can develop in Belgium. The combination of our local experience with the demonstrated advantages of Clinical Pharmacy (as seen from foreign studies) makes this project more and more realistic in our country. La pharmacie clinique, encore appelée "soins pharmaceutiques", vise à assurer une thérapie médicamenteuse sûre, efficace, et d'un bon rapport coût/bénéfice, tout en respectant les choix du patient. L'Angleterre, les Etats-Unis et le Canada ont une grande expérience des soins pharmaceutiques. La pharmacie clinique y est un élément complémentaire et souvent jugé essentiel aux soins prodigués par les médecins et le personnel infirmier. Les études montrent que la mise en place de services de pharma - cie clinique apporte une valeur ajoutée réelle tant en milieu hospitalier que dans le cadre des officines ouvertes au public et des consultations pharmaceutiques pour patients ambu -
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ABSTRACT: Integration of pharmacists into primary care general practice clinics has the potential to improve interdisciplinary teamwork and patient care; however this practice is not widespread. The aim of this study was to review the effectiveness of clinical pharmacist services delivered in primary care general practice clinics. A systematic review of English language randomized controlled trials cited in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and International Pharmaceutical Abstracts was conducted. Studies were included if pharmacists had a regular and ongoing relationship with the clinic; delivered an intervention aimed at optimizing prescribing for, and/or medication use by, clinic patients; and were physically present within the clinic for all or part of the intervention, or for communication with staff. The search generated 1484 articles. After removal of duplicates and screening of titles and abstracts against inclusion criteria, 131 articles remained. A total of 38 studies were included in the review and assessed for quality. Seventeen studies had common endpoints (blood pressure, glycosylated hemoglobin, cholesterol and/or Framingham risk score) and were included in meta-analyses. Twenty-nine of the 38 studies recruited patients with specific medical conditions, most commonly cardiovascular disease (15 studies) and/or diabetes (9 studies). The remaining 9 studies recruited patients at general risk of medication misadventure. Pharmacist interventions usually involved medication review (86.8%), with or without other activities delivered collaboratively with the general practitioner (family physician). Positive effects on primary outcomes related to medication use or clinical outcomes were reported in 19 studies, mixed effects in six studies, and no effect in 13 studies. The results of meta-analyses favored the pharmacist intervention, with significant improvements in blood pressure, glycosylated hemoglobin, cholesterol and Framingham risk score in intervention patients compared to control patients. Pharmacists co-located in general practice clinics delivered a range of interventions, with favorable results in various areas of chronic disease management and quality use of medicines.Research in Social and Administrative Pharmacy 10/2013; DOI:10.1016/j.sapharm.2013.08.006 · 2.35 Impact Factor