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      Advancing Pharmacist Collaborative Care within Academic Health Systems

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          Abstract

          Introduction: The scope of pharmacy practice has evolved over the last few decades to focus on the optimization of medication therapy. Despite this positive impact, the lack of reimbursement remains a significant barrier to the implementation of innovative pharmacist practice models. Summary: We describe the successful development, implementation and outcomes of three types of pharmacist collaborative care models: (1) a pharmacist with physician oversight, (2) pharmacist–interprofessional teams and (3) physician–pharmacist teams. The outcome measurement of these pharmacist care models varied from the design phase to patient volume measurement and to comprehensive quality dashboards. All of these practice models have been successfully funded by affiliated health systems or grants. Conclusions: The expansion of pharmacist services delivered by clinical faculty has several benefits to affiliated health systems: (1) significant improvements in patient care quality, (2) access to experts in specialty areas, and (3) the dissemination of outcomes with national and international recognition, increasing the visibility of the health system.

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          Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials.

          The aim of this study was to determine whether multidisciplinary strategies improve outcomes for heart failure (HF) patients. Because the prognosis of HF remains poor despite pharmacotherapy, there is increasing interest in alternative models of care delivery for these patients. Randomized trials of multidisciplinary management programs in HF were identified by searching electronic databases and bibliographies and via contact with experts. Twenty-nine trials (5,039 patients) were identified but were not pooled, because of considerable heterogeneity. A priori, we divided the interventions into homogeneous groups that were suitable for pooling. Strategies that incorporated follow-up by a specialized multidisciplinary team (either in a clinic or a non-clinic setting) reduced mortality (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.59 to 0.96), HF hospitalizations (RR 0.74, 95% CI 0.63 to 0.87), and all-cause hospitalizations (RR 0.81, 95% CI 0.71 to 0.92). Programs that focused on enhancing patient self-care activities reduced HF hospitalizations (RR 0.66, 95% CI 0.52 to 0.83) and all-cause hospitalizations (RR 0.73, 95% CI 0.57 to 0.93) but had no effect on mortality (RR 1.14, 95% CI 0.67 to 1.94). Strategies that employed telephone contact and advised patients to attend their primary care physician in the event of deterioration reduced HF hospitalizations (RR 0.75, 95% CI 0.57 to 0.99) but not mortality (RR 0.91, 95% CI 0.67 to 1.29) or all-cause hospitalizations (RR 0.98, 95% CI 0.80 to 1.20). In 15 of 18 trials that evaluated cost, multidisciplinary strategies were cost-saving. Multidisciplinary strategies for the management of patients with HF reduce HF hospitalizations. Those programs that involve specialized follow-up by a multidisciplinary team also reduce mortality and all-cause hospitalizations.
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            Physician and pharmacist collaboration to improve blood pressure control.

            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. 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). The study enrolled 402 patients (mean age, 58.3 years) with uncontrolled hypertension. Clinical pharmacists made drug therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. The mean (SD) guideline adherence scores increased from 49.4 (19.3) at baseline to 53.4 (18.1) at 6 months (8.1% increase) in the control group and from 40.4 (22.6) at baseline to 62.8 (13.5) at 6 months (55.4% increase) in the intervention group (P = .09 for adjusted between-group comparison). The mean BP decreased 6.8/4.5 mm Hg in the control group and 20.7/9.7 mm Hg in the intervention group (P < .05 for between-group systolic BP comparison). The adjusted difference in systolic BP was -12.0 (95% confidence interval [CI], -24.0 to 0.0) mm Hg, while the adjusted difference in diastolic BP was -1.8 (95% CI, -11.9 to 8.3) mm Hg. The 24-hour BP levels showed similar effect sizes. Blood pressure was controlled in 29.9% of patients in the control group and in 63.9% of patients in the intervention group (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1; P < .001). A physician and pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates compared with a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management. clinicaltrials.gov Identifier: NCT00201019.
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              A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control.

              This was a prospective, cluster randomized controlled trial in patients with uncontrolled hypertension aged 21 to 85 years (mean, 61 years). Pharmacists made recommendations to physicians for patients in the intervention clinics (n=101) but not patients in the control clinics (n=78). The mean adjusted difference in systolic blood pressure (BP) between the control and intervention groups was 8.7 mm Hg (95% confidence interval [CI], 4.4-12.9), while the difference in diastolic BP was 5.4 mm Hg (CI, 2.8-8.0) at 9 months. The 24-hour BP levels showed similar effects, with a mean systolic BP level that was 8.8 mm Hg lower (CI, 5.0-12.6) and a mean diastolic BP level that was 4.6 mm Hg (CI, 2.4-6.8) lower in the intervention group. BP was controlled in 89.1% of patients in the intervention group and 52.9% in the control group (adjusted odds ratio, 8.9; CI, 3.8-20.7; P<.001). Physician/pharmacist collaboration achieved significantly better mean BP values and overall BP control rates, primarily by intensification of medication therapy and improving patient adherence.
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                Author and article information

                Journal
                Pharmacy (Basel)
                Pharmacy (Basel)
                pharmacy
                Pharmacy: Journal of Pharmacy Education and Practice
                MDPI
                2226-4787
                11 October 2019
                December 2019
                : 7
                : 4
                : 142
                Affiliations
                [1 ]San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, La Jolla, CA 92093, USA; rfsingh@ 123456ucsd.edu (R.F.S.); isaunders@ 123456ucsd.edu (I.S.); fyam@ 123456ucsd.edu (F.K.Y.); jdhirsch@ 123456uci.edu (J.D.H.); slorentz@ 123456ucsd.edu (S.L.); ratayee@ 123456ucsd.edu (R.S.A.); jdma@ 123456ucsd.edu (J.D.M.); smtsunoda@ 123456ucsd.edu (S.M.T.); jnamba@ 123456ucsd.edu (J.N.); cmnatzaganian@ 123456ucsd.edu (C.L.M.); npainter@ 123456ucsd.edu (N.A.P.); Jhwatanabe@ 123456ucsd.edu (J.H.W.); kellylee@ 123456ucsd.edu (K.C.L.); cdaniels@ 123456ucsd.edu (C.E.D.); candismorello@ 123456ucsd.edu (C.M.M.)
                [2 ]San Diego Health System, University of California, La Jolla, CA 92093, USA
                [3 ]Veterans Affairs San Diego Healthcare System, La Jolla, CA 92093, USA
                [4 ]Irvine School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA 92697, USA
                Author notes
                [* ]Correspondence: lawdishu@ 123456ucsd.edu
                Author information
                https://orcid.org/0000-0002-3187-3264
                https://orcid.org/0000-0002-8805-3734
                https://orcid.org/0000-0003-0727-105X
                https://orcid.org/0000-0003-4913-343X
                Article
                pharmacy-07-00142
                10.3390/pharmacy7040142
                6958419
                31614555
                12070f63-9903-4d3d-af14-19bd72eb747c
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 01 May 2019
                : 05 October 2019
                Categories
                Article

                collaborative practice,clinical pharmacy,advanced practice pharmacist provider

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