Contribution of Hospital Pharmacy Residents to Resolution of Drug Therapy

Problems for Patients: RES-DTP Study

Manish KhullarRichard SlavikSean Gorman

Nicole BruchetSarah Murray

Brett HamiltonDawn Dalen

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.

Background

1.Performing admission medication reconciliation2.Participating in inter-professional patient care rounds3.Initiating a pharmaceutical care plan4.Resolving drug therapy problems (DTPs)5.Providing in-person disease and medication education6.Providing discharge medication education/counseling7.Performing discharge medication reconciliation8.Providing bundled, proactive patient care

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

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

Background

• Pharmacist-resolved DTPs is a key clinical performance indicator for IH Pharmacy

Outcome Number (%)Total DTP 29,909

DSEM-DTP 12,017 (40%)

DSEM-KPI 7,448 (25%)

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

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 Pharmacother 2000; 34:843-846.

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

• 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

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

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

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

Outcome Number (%)

1° Total DTP 581

2° DSEM-DTP 298 (51%)

2° DSEM-KPI 241 (42%)

*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

Results

Series10

50100150200250300350400

Total DTP DSEM-DTP DSEM-KPI

#1

Mon

thly

Cou

nts

Rotation#2 #3 #4 #5 #6

Results

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q101

2

3

4

5

Survey Domains

Satis

facti

on R

ating

s

Training Usability Efficiency Time

DTP Tracker Satisfaction Survey

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

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

Questions