Turner Kyle, Buu Jenni, Kuzel Mary, Wagoner Eve Van, Berrett G Benjamin
University of Utah College of Pharmacy and University of Utah Health.
University of Utah Health.
Innov Pharm. 2020 Apr 30;11(2). doi: 10.24926/iip.v11i2.3002. eCollection 2020.
University of Utah Health is an academic health care system that serves residents in Utah and beyond. Clinical pharmacists with the health care system's pharmacy primary care services (PPCS) team provide medication education, population-based care, and medication management through collaborative practice agreements. With the expansion of clinical pharmacist and technician positions and services, the need to measure and assess the impact of pharmacy services and create a value proposition for internal and external stakeholders became an important goal, and the decision was made to better align practices across all PPCS sites. This paper highlights University of Utah Health's approach to implement comprehensive medication management (CMM) across all primary care clinics with embedded clinical pharmacy staff and subsequent evaluation of implementation fidelity.
Implementation of CMM was assisted by participation in the National A3 Collaborative and by using selected principles from the Active Implementation Framework. Stages of implementation included exploration, instillation, and initiating improvement cycles. An implementation team consisting of PPCS employees was created to help with standardization, developing implementation plans, and creating a dissemination strategy for all PPCS team members. The CMM care process was subsequently presented and implemented by clinical pharmacists in primary care clinics. Following implementation, fidelity measures were collected including identification and resolution of medication therapy problems (MTPs) and responses from a questionnaire distributed to the clinical pharmacists to self-report understanding and implementation of CMM key elements. The number and type of MTPs identified were tracked over 18 months.
Within the measurement window, clinical pharmacists identified 17,953 MTPs. Of the total number of MTPs identified, 21% were related to indication, 53% to efficacy, 15% to safety and 11% to adherence. The questionnaire was distributed to clinical pharmacists 9 months after CMM implementation, with a 71% response rate. Pharmacists reported "always" or "often" performing each step in the patient care process as follows: indication (93%), effectiveness (93%), safety (87%), and adherence (93%). Reported barriers to implementation of the CMM include lack of time to complete all aspects of the process efficiently, lack of a standardized format for documentation, and changing practice habits.
Implementation of a CMM process within University of Utah Health's PPCS services with the help of a national collaborative and implementation framework yielded identification of 17,953 MTPs over 18 months and foundational fidelity to core principles.
犹他大学健康中心是一个为犹他州及其他地区居民服务的学术医疗保健系统。该医疗保健系统的药学初级保健服务（PPCS）团队的临床药师通过合作实践协议提供药物教育、基于人群的护理和药物管理。随着临床药师和技术人员职位及服务的扩展，衡量和评估药学服务的影响并为内部和外部利益相关者创造价值主张的需求成为一个重要目标，因此决定在所有PPCS站点更好地统一实践。本文重点介绍了犹他大学健康中心在所有配备嵌入式临床药学人员的初级保健诊所实施全面药物管理（CMM）的方法以及随后对实施保真度的评估。
通过参与国家A3协作并运用主动实施框架中的选定原则来协助实施CMM。实施阶段包括探索、灌输和启动改进周期。成立了一个由PPCS员工组成的实施团队，以帮助进行标准化、制定实施计划并为所有PPCS团队成员制定传播策略。随后，初级保健诊所的临床药师介绍并实施了CMM护理流程。实施后，收集了保真度指标，包括药物治疗问题（MTP）的识别和解决，以及分发给临床药师以自我报告对CMM关键要素的理解和实施情况的问卷的回复。在18个月内跟踪所识别的MTP的数量和类型。
在测量期内，临床药师识别出17953个MTP。在所识别的MTP总数中，21%与适应症相关，53%与疗效相关，15%与安全性相关，11%与依从性相关。在CMM实施9个月后向临床药师发放了问卷，回复率为71%。药师报告在患者护理过程中“总是”或“经常”执行以下每个步骤：适应症（93%）、有效性（93%）、安全性（87%）和依从性（93%）。报告的CMM实施障碍包括缺乏有效完成流程所有方面的时间、缺乏标准化的文档格式以及改变实践习惯。
在国家协作和实施框架的帮助下，犹他大学健康中心的PPCS服务中实施CMM流程，在18个月内识别出17953个MTP，并对核心原则保持了基本保真度。
