Kaiser Permanente Colorado, Aurora, Colorado.
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.
Am J Pharm Educ. 2019 Jun;83(5):6759. doi: 10.5688/ajpe6759.
To assess the value of an advanced pharmacy practice experience in which students engaged in population health management (PHM) activities for a managed care setting. Students were provided with a list of patients, trained on the requirements for each PHM activity and completed them independently. The students reviewed the electronic record for each patient on their list to identify those who were non-adherent to dual antiplatelet therapy (DAPT) within one year of coronary stent placement, non-adherent to beta blockers (BB) within six months post-acute myocardial infarction, or with renal dysfunction and requiring dose adjustment of lipid-lowering therapy. Students coded each intervention based on predefined categories such as patient education, medication discontinuation, or medication reconciliation, and then if necessary were reviewed with the pharmacy preceptor. The primary investigator determined the intervention to be either actionable or non-actionable. The primary outcome was the proportion and type of interventions made by each student. The secondary outcome was clinical pharmacist time offset. A retrospective, data-only pilot study was conducted to determine the outcomes from the program over four years. Forty-six students made 3,774 interventions over the study period, 37% of which were categorized as actionable. The most common actionable interventions were providing patient education (52%), verifying prescription adherence (23%), and medication therapy adjustment (10.5%). Over the study period, an estimated 765.6 hours of clinical pharmacist time was offset, or approximately 191.4 hours per academic year. This study demonstrated that a population health management approach can be used successfully within an APPE. This approach can result in offset pharmacist time for precepting organizations, while offering meaningful clinical interventions for patients and learning opportunities for students.
评估学生在管理式医疗环境中参与人群健康管理 (PHM) 活动的高级药学实践经验的价值。学生收到了一份患者名单，接受了每项 PHM 活动的要求培训，并独立完成了这些活动。学生审查了名单上每位患者的电子记录，以确定在冠状动脉支架置入后一年内未坚持双联抗血小板治疗 (DAPT)、急性心肌梗死后六个月内未坚持使用β受体阻滞剂 (BB)、或肾功能不全且需要调整降脂治疗剂量的患者。学生根据预定义类别对每项干预措施进行编码，例如患者教育、药物停用或药物重整，然后如有必要与药房导师一起审查。主要研究者确定干预措施是否可采取行动。主要结果是每个学生采取的干预措施的比例和类型。次要结果是临床药师时间偏移。进行了一项回顾性、仅数据的试点研究，以在四年内确定该计划的结果。46 名学生在研究期间共进行了 3774 次干预，其中 37%被归类为可采取行动。最常见的可采取行动的干预措施是提供患者教育（52%）、验证处方依从性（23%）和药物治疗调整（10.5%）。在研究期间，估计有 765.6 小时的临床药师时间被抵消，即每个学年约 191.4 小时。这项研究表明，人群健康管理方法可以在 APPE 中成功使用。这种方法可以为指导组织节省药剂师时间，同时为患者提供有意义的临床干预措施，并为学生提供学习机会。
