OBJECTIVE:To compare medication adherence calculated from four different data sources including a pill count and self-report obtained during a home medication history, as well as calculations based on refill frequency derived from a provincial prescription claims database (manual and electronic).DESIGN:Baseline medication adherence was collected as part of a prospective, randomized, controlled study. Mean medication adherence results obtained from the four data sources were compared using repeated-measures ANOVA followed by a Tukey's multiple range test.SETTING:A pharmacy consultation service located at an interdisciplinary wellness center for noninstitutionalized elderly.PATIENTS:65 years or older, noninstitutionalized, taking one or more prescribed or nonprescribed medications. Clients would either present to the wellness center or be referred by the Provincial Home Care program.RESULTS:When calculated from self-report or manual or electronic prescription claims data, mean percent adherence by drug was ...

Pill Count, Self-Report, and Pharmacy Claims Data to Measure Medication Adherence in the Elderly

Background:Prescription claims data have been used to estimate refill medication adherence through calculations of cumulative medication acquisition (CMA) and cumulative medication gap (CMG) values. Few studies have assessed the validity of these calculated rates.Objectives:We sought to assess the v

Validity of a Prescription Claims Database to Estimate Medication Adherence in Older Persons

Documentation of clinical services within health care systems has become increasingly significant because greater amounts of information are now required by accrediting agencies, third-party payers, researchers, and others in their evaluation of patient care and because of the increasing emphasis on patient outcomes. Given the multiple users who depend on health care information in the patient record, it is imperative that clinical nutrition practitioners implement a standardized nutrition care process and language to document comprehensively and communicate meaningful information concerning their role in improving patient outcomes. A body of work has led to the development and adoption of a standardized nutrition care process for the dietetics profession. A standardized nutrition care process consistent with the scientific method and a standardized language are two essential components required to articulate a conceptual model for clinical nutrition practice and documentation and distinguish clinical dietetics' unique body of knowledge. The conceptual model serves as an organizing framework to standardize and guide nutrition practitioners' clinical judgments or critical thinking processes and document information linking nutrition care to patient outcomes.

A Standardized Nutrition Care Process and Language Are Essential Components of a Conceptual Model to Guide and Document Nutrition Care and Patient Outcomes

Objective To compare documentation of two groups of clinical nutrition practitioners for evidence of the nutrition care process. Design This study used a comparative descriptive design. A retrospective chart review was conducted on all nutrition documentation in closed patient records. Documentation of two groups of nutrition practitioners (institution A=practitioners who received initial orientation and routine reinforcement in use of nutrition care process standards; institution B=practitioners who received orientation in use of a further assessment and medical nutrition therapy intervention procedure) was compared for evidence of a six-step nutrition care process. Sample/Setting The sample consisted of randomly selected patient records (N=60). A total of 15 oncology and 15 chronic renal failure patient records from each of two Midwestern tertiary-care hospitals were reviewed. Main Outcome Measures Outcome measures were number of nutrition care process steps documented, appropriate relationships among documented steps in the nutrition care process, and the number of complete, incomplete, and interrupted chains. Statistical Analyses Two-sample t tests and χ 2 analyses were used. Results Nutrition practitioners at institution A documented approximately three times as many nutrition care process steps per patient per chain that demonstrated appropriate relationships as did nutrition practitioners at institution B (2.69±1.15 and 0.80±0.62, respectively [mean±standard deviation]) ( P Conclusions Nutrition practitioners with orientation to nutrition care process standards documented more related nutrition care process steps than practitioners without this orientation. Providing nutrition practitioners with ongoing education and clinical experiences in use and documentation of the nutrition care process and a standardized language may be indicated to increase the number of completed nutrition care process chains and improve documentation of nutrition care and patient outcomes.

https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1018&context=nutritionfacpub

Orientation to nutrition care process standards improves nutrition care documentation by nutrition practitioners.

Background The extant literature reveals a lack of psychometrically validated tools measuring patient satisfaction with pharmacist clinical services. The Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0) was developed to address this need using a mixed methods approach. Objective To assess the psychometric properties of the PSPSQ 2.0, an instrument developed to measure patient satisfaction with clinical services provided by pharmacists. Methods Validation studies were conducted in two Veterans Affairs (VA)-based and two community-based (diabetes and psychiatric care) disease management/medication therapy management clinics. The PSPSQ 2.0 consisted of 22-items related to three domains identified as quality of care, patient-pharmacist relationship and overall satisfaction using a 4-point, Likert-type scale. It was administered to participants following their session with a pharmacist at the clinics. Collected data were analyzed for descriptive statistics, internal consistency, and validity using exploratory factor analysis. Results A total of 149 patients completed the survey. Patients from VA clinics were on average 61 years old, mostly white (63%), and predominantly male (95%). Patients from non-VA clinics were on average 47 years old, mostly White (47%) and male (53%). Non-VA patients mostly had Medicaid (42%) and commercial health insurance (31%), whereas VA patients retained benefits with the US Department of Veterans Affairs. Reliability of the scale using internal consistency metrics revealed a Cronbach's alpha of 0.98, 0.98 and 0.95 for VA, diabetes, and psychiatric care clinics, respectively, whereas the Cronbach's alpha for the pooled sample was 0.96. Factor analyses resulted in a three-factor solution accounting for 91% and 69% variance for diabetes and psychiatric care clinics, respectively; however, VA clinics and pooled sample yielded only 2-factor solution with 80% and 66% variance, respectively, with more items loading on patient-pharmacist relationship domain. Conclusions The results suggest that the PSPSQ 2.0 can serve as a reliable and valid tool for measuring patient satisfaction with pharmacists providing clinical services in VA- and non-VA settings upon further validation.

Development and validation of PSPSQ 2.0 measuring patient satisfaction with pharmacist services.

Understanding the important aspects of measuring outcomes will prepare pharmacists for changes in the marketplace and help them to assess the results of studies that will appear in subsequent issues of the Journal of the American Pharmaceutical Association and the research journals of other health services professions. In any evaluation of quality, all three quality measures (structure, process, and outcomes) must be considered. No one measure, in isolation, can describe the quality of care provided. Thus, the best patient care will come from health care practitioners who document structure, process, and outcomes and who evaluate these measures to provide appropriate care. The pharmacist cannot dispense prescriptions or provide pharmaceutical care without a pharmacy, drug inventory, or patient profiles, all of which are important structural inputs. The pharmacist takes a medication history, monitors the drug regimen, and counsels the patient on the appropriate way to use the treatment, all vital process activities. The objective of these inputs and actions is to improve the health status of the patient. Outcomes, therefore, are the intended endpoints of care, and occasional unintended effects (e.g., adverse drug reactions) as well. The future of pharmacy rests on demonstrating the positive effect of pharmaceutical care on patient outcomes. Pharmacists have always been part of the system of checks and balances in health care delivery. As the provision of health services changes, opportunities to assess the process and structure of care and to document patient outcomes will increase. Pharmacists are well positioned to intervene in patient care, but if they do not demonstrate the value of pharmacy services, they will face competition from alternative providers. Some have even suggested less expensive alternatives to having pharmacists dispense medications. Pharmacists must establish that their role goes beyond dispensing to include cognitive services such as compliance programs, screening services, glucose monitoring, and disease management programs. Pharmacists must document their role and its effects on patient outcomes.

What are outcomes

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