Patient Care

PCHS is dedicated to deliver pharmaceutical care in innovative and impactful ways. Practice faculty within PCHS lead innovations for delivery of high quality patient centered care and conduct scholarship that impacts the practice of pharmacy and team-based patient care delivery.

Practice Development and Innovation

Practice Development and Innovation

Telephonic Medication Therapy Management

A Randomized, Controlled Pragmatic Trial of Telephonic Medication Therapy Management to Reduce Hospitalization in Home Health Patients

Alan J. Zillich, Margie E. Snyder, Caitlin K. Frail, Julie L. Lewis, Donny Deshotels, Patrick Dunham, Heather A. Jaynes, and Jason M. Sutherland

Objective: To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients.

Setting: Forty randomly selected, geographically diverse home health care centers in the United States.

Design: Two-stage, randomized, controlled trial with 60-day follow-up. All Medicareinsured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTMintervention. TheMTMintervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization. Data Collection. Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients’ baseline risk of hospitalization, number of medications taken daily, and other OASISC data elements.

Principal Findings: A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (AdjustedOR: 1.26, 95 percent CI: 0.89–1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35–10.57, p = .01) compared to the usual care group. Conclusions. This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, theMTMintervention prevented patients from being hospitalized at 60 days. 
© Health Research and Educational Trust
DOI: 10.1111/1475-6773.12176
METHODS ARTICLE

Practice Demonstrations and Evaluation

Practice Demonstrations and Evaluation

Integrating community pharmacists and physicians to improve HIV outcomes

hiv specialistIntegrating community pharmacists and physicians to improve HIV outcomes

There are an estimated 1.2 million HIV-infected persons living in the United States; however, only approximately 40% of are retained in care. This has profound impact on patient and population level HIV prevention and treatment outcomes. Furthermore, due to the growing numbers of persons living with HIV, the demand for HIV care providers is greater than ever, though the HIV workforce appears to be declining. Accordingly, part of the National HIV/AIDS Strategy calls for innovative strategies to diversify and strengthen the HIV provider workforce in order to meet the growing unmet need while improving access to HIV care for those infected. This is of particular importance in communities disproportionately affected by HIV, especially those in medically underserved urban and rural settings. Through provision of pharmaceutical care, pharmacists have long played a key role in optimizing treatment and care for HIV-infected individuals, most often in the setting of specialty HIV clinics. A novel approach to expand the role of pharmacists in the community setting is to develop a patient-centered HIV care model in which community pharmacists provide HIV medication therapy management (MTM) in partnership with medical clinical sites.

This three-year project, initiated through a public-private partnership between the Centers for Disease Control and Prevention (CDC) and Walgreens and led by Dr. Patrick Clay at the University of North Texas Health Science Center, will follow 1,000 HIV-infected participants nationwide, of which at least 15 percent are from rural communities. These participants will be recruited from at least 10 HIV primary care clinics, each of which has partnered with select Walgreens pharmacies where specially trained pharmacists will provide individualized care known as MTM. In addition to standard HIV care by their medical provider, patients enrolled in the study will also receive regularly scheduled MTM visits with the pharmacists over 18-24 months. Pharmacists and medical providers will collaborate to provide HIV treatment and care.

Through development and implementation of this novel patient-centered HIV care model, the project team aims to identify optimal communication patterns between pharmacists and medical providers that increase retention in HIV care, adherence to HIV and non-HIV medication therapy, and HIV viral load suppression, as well as decrease medical care costs.

The project team also includes collaborators from HealthHIV, Northwestern University, University of Nebraska Medical Center, University of Minnesota, University of Kentucky, and the American Pharmacists Association.

PCHS faculty member, Jon Schommer, PhD is conducting the evaluation for this study. 

Funding for this research is through the Centers for Disease Control and Prevention (CDC)

Health Disparities

Health Disparities

The RICH Center Aims to Provide Research Collaborations with Indigenous Entities

As an intercollegiate collaboration between the College of Pharmacy and the College of Medicine on the Duluth campus, RICH aims to provide an interdisciplinary center for research collaborations with Indigenous entities. RICH further aims to foster scholarly works that will identify health barriers and protective factors to increase healthcare equity for Indigenous patients.

Informatics

Informatics

Institute for Health Informatics (IHI)

The Institute for Health Informatics educates students and conducts research in the fields of biomedical and health informatics, focusing on the design, use, and evaluation of information systems that support and improve healthcare while protecting the safety and confidentiality of those who receive that care. It is an interdisciplinary endeavor that encompasses work in a variety of settings from tertiary care hospitals to specialty clinics, mental health facilities, community clinics, nursing homes, and home care agencies.

Disease Treatment

Disease Treatment

Effectiveness and Safety of Medications in Chronic Kidney Disease Patients

cdrgDr. Wendy L. St. Peter has been with the College of Pharmacy since 1988. She was a clinical pharmacy practitioner in nephrology from 1988-1997 at Hennepin County Medical Center. Currently, she is a Professor with the Department of Pharmaceutical Care and Health Systems at the University of Minnesota, College of Pharmacy. Dr. St. Peter is also an investigator with the Chronic Disease Research Group. She has been recognized as a fellow of the American College of Clinical Pharmacy, American Society of Nephrology and National Kidney Foundation.

She is involved in analytical research involving Medicare and other large patient databases with the Chronic Disease Research Group at Hennepin County Medical Center in Minneapolis. Dr. St. Peter served as a Technical Expert Panel (TEP) member for CMS for the ESRD Outpatient Medications Project and the CMS TEP for CKD/ESRD Medication Measures Project. She has provided her expertise to the NKF Kidney Medicare Drugs Awareness and Education Initiative to help address the complexity of Medicare Part D. Her research focuses on optimizing medication use in patients with kidney disease through comparative effectiveness, cost-effectiveness and safety research.