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Contribution of Hospital Pharmacy Residents to Resolution of Drug Therapy Problems for Patients: RES-DTP Study. Manish Khullar Richard Slavik Sean Gorman Nicole Bruchet Sarah Murray Brett Hamilton Dawn Dalen. Background.

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Contribution of Hospital Pharmacy Residents to Resolution of Drug Therapy Problems for Patients: RES-DTP Study

Manish Khullar

Richard Slavik

Sean Gorman

Nicole Bruchet

Sarah Murray

Brett Hamilton

Dawn Dalen

background
Background
  • Clinical pharmacists resolving drug therapy problems (DTPs) for patients improve clinical and health economic outcomes
  • A Canadian National Working Group has recommended 8 clinical pharmacy key performance indicators (cpKPI) to advance pharmacy practice and improve patient care

Makowsky MK, et al. Med Care 2009;47:642-650.

Gillespie U, et al. Arch Intern Med 2009;169:894-900.

background1
Background
  • Performing admission medication reconciliation
  • Participating in inter-professional patient care rounds
  • Initiating a pharmaceutical care plan
  • Resolving drug therapy problems (DTPs)
  • Providing in-person disease and medication education
  • Providing discharge medication education/counseling
  • Performing discharge medication reconciliation
  • Providing bundled, proactive patient care

Fernandes O, et al. Pharmacotherapy 2013; 33(10):e208.

background2
Background

Total DTP

  • Any DTP resolved by a pharmacist

DSEM-DTP

  • DTP resolved for a condition covered in priority disease state education modules (DSEMs)

DSEM-KPI

  • A key pharmacist intervention proven to reduce morbidity, mortality, or health resource utilization for that disease
background3
Background
  • Pharmacist-resolved DTPs is a key clinical performance indicator for IH Pharmacy

Interior Health DTP Tracker Data (Jan 1 – Dec 31, 2013)

rationale
Rationale
  • Resolving impactful DTPs for priority patients is a major professional development goal for the IH Pharmacy Practice Residency Program
  • Limited data suggest that U.S. entry to practice PharmD students and residents may contribute to clinical care during experiential rotations

Mersfelder TL, et al. Pharmacotherapy 2012; 46:541-548.

Taylor CT, et al. Ann Pharmacother2000; 34:843-846.

rationale1
Rationale
  • There are no data on the contribution of Canadian pharmacy practice residents to resolved DTPs during experiential rotations
  • A recently completed IH study identified discordance on the perception of IH resident contributions to DTP resolution
objectives
Objectives
  • To describe the contribution of IH pharmacy practice residents to clinical pharmacy care using resident-resolved DTPs
  • To describe resident satisfaction with tracking their resolved DTPs
methods
Methods

Design

  • Prospective, observational, one group study

Setting

  • Kelowna General Hospital (KGH), Royal Inland Hospital (RIH), Penticton Regional Hospital (PRH), East Kootenay Regional Hospital (EKH) and Kootenay Lake Hospital from Sept 2, 2013 to Jun 13, 2014
methods1
Methods

Inclusion Criteria

  • DTP Tracker data collated from 4 IH pharmacy practice residents after completion of the first 4-week patient care rotation (i.e. Internal Medicine)

Exclusion Criteria

  • DTP Tracker data that is un-interpretable due to manipulation of standard pull-down field options, free text options, incomplete entry of resolved DTPs
methods2
Methods

Primary Outcome

  • Number of resident-resolved DTPs

Secondary Outcomes

  • Number of resident-resolved DSEM-DTPs
  • Number of resident-resolved DSEM-KPIs
  • Progression of resident-resolved DTPs, DSEM-DTPs, and DSEM-KPIs over time
  • Survey feedback from IH pharmacy practice residents on training, usability, efficiency, time of DTP tracking
results
Results

*Interim analysis of 12 clinical rotations (50%) for 4 residents:

Internal Medicine, community medicine, rural medicine (2), ambulatory care (2), nephrology (2), infectious diseases, cardiology (2), critical care

results1
Results

Monthly Counts

#4

#5

#1

#2

#3

#6

Rotation

results2
Results

DTP Tracker Satisfaction Survey

Satisfaction Ratings

Training

Usability

Efficiency

Time

Survey Domains

conclusions
Conclusions
  • IH Pharmacy practice residents are resolving DTPs, DSEM-DTPs, and DSEM-KPIs
  • Resident interventions have increased over time throughout the residency year
  • Resident interventions would be expected to improve clinical and health economic outcomes for patients
  • DTP tracking by residents was well-accepted based on training, usability, efficiency, and time requirements
conclusions1
Conclusions
  • Future research should focus on describing the contribution of IH hospital pharmacists and residents to clinical pharmacy care using the 8 recommended clinical pharmacy key performance indicators (cpKPI)
  • This analysis should provide a more “balanced” dashboard of clinical quality indicators