Better than an iPad app, a Clinical Pharmacist in your practice
Notice bibliographique
Résumé
Introduction: 2007-09 Hawke’s Bay DHB experienced unsustainable growth in medicine volumes and costs. Analysis showed high levels of polypharmacy and high levels of weekly dispensing, with little evidence of equivalent health gain. Inappropriate polypharmacy is linked with medicine related admissions, falls and other harm for patients 65+.Implementing Practice Change: In 2011 HBDHB employed two clinical pharmacists to integrate into three general practice settings, the aim being to be available on site, to support and influence medicine prescribing behaviours, address polypharmacy, manage patients with complex medicine regimes/adherence issues, and identify sub-optimal medicine related patient outcomes.Aim and Theory of Change: Search of International literature confirmed that while the approach was increasingly supported (UK/Canada), no studies documented the actual gains made or indicated an optimal way of working within general practice. The objective was to show the benefits of having a clinical pharmacist integrated into the general practice team.Targeted Populations and Stakeholders: Three practices with three different targeted populations were chosen for 'proof of concept'. The focus was quality prescribing, and safe and effective use of medicines. Financial savings were not the primary driver.- Practice 1 (175 patients; over 65 years - Aged Related Residential Care(ARRC)Aim: Reducing risk of medicine related harm in patients in ARRC facilities utilising medicine reviews/work with prescribers and ARRC facility staff, and medicine reconciliations during transition between services.- Practice 2 (1200 patients; over 65 years living independently)Aim: Reducing risk of medicine-related harm in community dwelling patients 65+, taking 8+ long term medications utilising medicine review, patient education and medicine reconciliations on discharge from hospital-Practice 3 (7000 patients; high needs/Maori/ Pacific)Aim: Population approach. Focus on Type 2 Diabetes Mellitus to reduce inequity/improve clinical outcomes through optimisation of medicine management and patient education.Highlights: Programme evaluation occurred after two years applying the principles of the Health Quality and Safety Commission’s 'Triple Aim' as a framework for the evaluation. The evaluation, confirmed the service delivered on all three aims:- For the individual: by reducing inappropriate medicines, falls, hospital admissions and increasing patient satisfaction. Medicine changes as a result of medicine review prevented 2 admissions to ARRC.- For the population: by improving equity of access to medicines and pharmacological advice. In practice 3, equity in achievement of hypertension targets amongst patients with diabetes.- Value for money: for the health economy. Year 2 showed a 10.8% reduction in drug costs. A total of $848,000 was attributed to the impact of CPFs – a 4:1 return on Year 2 investment.Transferability: The evaluation confirmed, overwhelming practice and facilitator support for the service continuation, and expansion of the role in the practices. A generic model incorporating aspects from all three patient populations was the agreed approach to integrating clinical pharmacists into general practice.Conclusions: On the basis of overwhelming support for extending the service, the HBDHB has invested in 8FTE practice based clinical pharmacist facilitators across Hawkes Bay, an outstanding result. This innovative service approach is leading the way in New Zealand.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,003 | 0,004 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,199 | 0,136 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».