manish khullar richard slavik sean gorman nicole bruchet sarah murray brett hamilton dawn dalen
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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. - PowerPoint PPT PresentationTRANSCRIPT
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 DTP 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 uninterpretable or incomplete
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 on resident satisfaction with
training, usability, efficiency, and 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), cardiology (3), 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