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Publications (5)34.25 Total impact

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    ABSTRACT: It is not known whether patient outcomes are enhanced by effective pharmacist-patient interactions. To assess the effectiveness of a pharmaceutical care program for patients with asthma or chronic obstructive pulmonary disease (COPD). Randomized controlled trial conducted at 36 community drugstores in Indianapolis, Ind. We enrolled 1113 participants with active COPD or asthma from July 1998 to December 1999. Outcomes were assessed in 947 (85.1%) participants at 6 months and 898 (80.7%) at 12 months. The pharmaceutical care program (n = 447) provided pharmacists with recent patient-specific clinical data (peak expiratory flow rates [PEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. The PEFR monitoring control group (n = 363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n = 303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. Peak expiratory flow rates, breathing-related ED or hospital visits, health-related quality of life (HRQOL), medication compliance, and patient satisfaction. At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P =.02) but not than PEFR monitoring controls (P =.28). There were no significant between-group differences in medication compliance or HRQOL. Asthma patients receiving pharmaceutical care had significantly more breathing-related ED or hospital visits than the usual care group (odds ratio, 2.16; 95% confidence interval, 1.76-2.63; P<.001). Patients receiving pharmaceutical care were more satisfied with their pharmacist than the usual care group (P =.03) and the PEFR monitoring group (P =.001) and were more satisfied with their health care than the usual care group at 6 months only (P =.01). Despite ample opportunities to implement the program, pharmacists accessed patient-specific data only about half of the time and documented actions about half of the time that records were accessed. This pharmaceutical care program increased patients' PEFRs compared with usual care but provided little benefit compared with peak flow monitoring alone. Pharmaceutical care increased patient satisfaction but also increased the amount of breathing-related medical care sought.
    JAMA The Journal of the American Medical Association 11/2002; 288(13):1594-602. · 29.98 Impact Factor
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    ABSTRACT: To describe unexpected challenges and strategies to overcome them when conducting randomized controlled trials (RCT) of health services research interventions in retail pharmacies. Thirty-six retail drug stores in Indianapolis. We conducted an RCT to evaluate the effectiveness of an intervention to increase pharmacists' involvement in caring for customers. We describe: (1) our RCT as originally designed, (2) unexpected challenges we faced; and (3) how we resolved those challenges. Randomized controlled trial. Major modifications in research design were necessitated by factors such as corporate restructuring, heightened sensitivity to patient confidentiality, and difficulties altering employees' behavior. We overcame these barriers by conducting research that is consistent with corporate goals, involving appropriate corporate administrators and technical personnel early in the process, and being flexible. Health services researchers should conduct RCTs in a variety of non-academic practice settings to increase generalizability and better reflect the true impact of interventions. Pragmatic problems, although significant, can be successfully overcome.
    Health Services Research 09/2002; 37(4):1067-77. · 2.29 Impact Factor
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    ABSTRACT: A pharmaceutical care program for patients with reactive airways disease (RAD) is described. A pharmaceutical care program for patients with RAD was developed and implemented at 36 CVS pharmacies. The impact on patient outcomes, pharmacist job satisfaction, and other variables is currently being evaluated in a controlled trial with more than 1100 patient enrollees. Guiding the program are the beliefs that pharmacists must have clinically relevant, patient-specific data to provide appropriate care; that pharmacists must have adequate training to provide pharmaceutical care; that the program must be sensitive to organizational barriers, particularly time demands; and that there must be ongoing support for the program. The program has five components: (1) computer display of patient-specific data for patients enrolled in the study, (2) distribution of tailored patient education materials, (3) use of a resource guide to facilitate the implementation of pharmaceutical care, (4) strategies to reinforce and facilitate the program, and (5) pharmacist training. While developed for community pharmacies, the program is applicable to most ambulatory care pharmacy practices. A pharmaceutical care program for patients with RAD was developed for use in community pharmacies.
    American Journal of Health-System Pharmacy 06/2001; 58(9):791-6. · 1.98 Impact Factor
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    ABSTRACT: Objetivo. Determinar si en pacientes con enfermedades respiratorias como asma o enfermedad pulmonar obstructiva crónica (EPOC) un programa de atención farmacéutica (AF) desde la oficina de farmacia contribuye a mejorar su clínica y calidad de vida. Diseño. Ensayo clínico con asignación aleatoria de oficinas de farmacia en tres grupos: atención farmacéutica, autocontrol con peak-flow y sin intervención. Emplazamiento. Treinta y seis oficinas de farmacia de Indianápolis (EE.UU.) en colaboración con la Universidad de Medicina de Indiana. Población de estudio. Se incluyeron 1.113 pacientes de Medicaid con asma o EPOC (desde julio de 1998 a diciembre de 1999). Los criterios de inclusión fueron los siguientes: mayor de 18 años, enfermedad documentada, en tratamiento farmacológico para asma o EPOC, asiduidad a la farmacia, no residencia de ancianos, no tener importantes dificultades de visión, audición o comunicación verbal y firmar un consentimiento escrito para participar en el estudio. Intervención. El grupo intervención de AF (n = 447 pacientes, 185 EPOC y 262 asma) incluía un programa de formación, un programa informático específico para el estudio, materiales escritos, guía de apoyo y entrenamiento. Al grupo de autocontrol con peak-flow (363 pacientes, 315 EPOC y 296 asma) no se realizaba seguimiento de AF y el tercer grupo no recibió peak-flow ni AF (303 pacientes, 138 EPOC y 165 asma). Mensualmente, se realizaba una entrevista telefónica y se completaba con entrevistas cara a cara a los 6 y 12 meses. Medición del resultado. Flujo espiratorio máximo (FEM), calidad de vida determinada por modelos específicos para asma y EPOC (HRQOL), visitas a urgencias relacionadas con problemas respiratorios, cumplimiento terapéutico y satisfacción del usuario. Resultados principales. De 14.195 personas finalmente se incluyeron 1.113. A los 6 meses seguían en el estudio 947 pacientes y 898 al año. Evolución del FEM(%): grupo de AF (basal, 63,8 ± 21,6; a los 6 meses, 65,5 ± 19,5; al año, 65,5 ± 19,5), autocontrol con peak-flow (basal, 61,2 ± 22,0; a los 6 meses, 65,1 ± 21,3; al año, 64,2 ± 21,5) y control (basal, 60,4 ± 22, 0; a los 6 meses, 60,5 ± 21,4; al año, 61,6 ± 22,6). No se encontraron diferencias significativas en los resultados del test de calidad de vida ni en los pacientes con asma o EPOC. En todos los grupos se observó una mejora de la puntuación a lo largo del estudio. El cumplimiento farmacológico fue mejorando en los 3 grupos, sin diferencias significativas. Los pacientes con asma pertenecientes al grupo de atención farmacéutica acudieron un mayor número de veces a urgencias (odds ratio [OR] = 2,16; IC del 95%, 1,76-2,63; p < 0,001). Los pacientes mostraron más satisfacción con sus resultados en salud en el grupo de atención farmacéutica que en el resto. Conclusión. La mejoría en el FEM es similar en pacientes que siguen el programa de AF y los que se autocontrolan con el peak-flow respecto a un grupo control, aunque la mejora en calidad de vida es similar en todos los grupos. Fuentes de financiación. Beca de la Agency for Healthcare Research and Quality and the Health Services Research and Development (HSR&D).
    FMC - Formación Médica Continuada en Atención Primaria 10(3):229.
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    ABSTRACT: To discuss with pharmacists and patients with reactive airways disease their beliefs about pharmaceutical care and the pharmacist's role in health care, obstacles to providing pharmaceutical care in community pharmacies, and strategies to overcome these obstacles. Two focus groups of patients, two focus groups of pharmacists. Thirteen patients with reactive airways disease and 11 chain pharmacists. Qualitative reports on the pharmacist's role in health care delivery and obstacles to implementing pharmaceutical care programs. Pharmacists wished to provide pharmaceutical care, and patients were supportive of pharmacists' involvement in their health care. Both viewed counseling as an important role for pharmacists and believed that pharmacists should work with patients' physicians. Reported obstacles included lack of time, inadequate privacy, and pharmacists' lack of direct access to patients' physicians. Pharmacists and patients believed pharmacists should have access to patient-specific clinical data. Focus groups provided valuable information for designing pragmatic pharmaceutical care. The obstacles and possible solutions identified through the discussions represent fertile ground for designing innovative pharmaceutical care programs.
    Journal of the American Pharmaceutical Association 41(6):850-5.