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Community pharmacy support in terms of medication reconciliation for patients with CVD and co-morbidities, receiving multiple medications (polypharmacy) before/after discharge from hospital.

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Impact of Community Pharmacy Support in Medical Reconciliation for Patients Suffering from Different Cardiovascular Diseases: A Research Proposal for Reducing the Rate of Adverse Drug Reactions and Medication Errors
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Impact of Community Pharmacy Support in Medical Reconciliation for Patients Suffering from Different Cardiovascular Diseases: A Research Proposal for Reducing the Rate of Adverse Drug Reactions and Medication Errors
Background
Over the past two decades, the incidences of different cardiovascular diseases have increased all across the globe. The rise in various cardiovascular disorders has been attributed to poor lifestyle and improper dietary habits. Management of cardiovascular diseases imposes significant challenges on healthcare professionals. Individuals suffering from cardiovascular disorders are at increased risk of adverse drug reactions and medication errors. Such risks are associated with polypharmacy. Patients suffering from cardiovascular disorders are often prescribed multiple medications and therapeutic interventions (Bates 3-9).
Complying with multiple interventions/medications increases the risk of adverse drug reactions and medications. Moreover, individuals suffering from cardiovascular disorders have to consume high-risk medications. On the other hand, different medications are often under prescribed in a CVD patient. Lack of appropriate dosage titration and inappropriate identification of clinical needs increases the risk of cardiovascular mortality and morbidity.

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Moreover, a lack of awareness and inadequate knowledge in healthcare consumers leads to reduced compliance with prescribed therapeutic interventions. Therefore, patients suffering from different cardiovascular diseases are prone to negative health outcomes (Bates 3-9).
Team-based approaches have been recognized for the management of cardiovascular disorders (Coleman 549-555). Physicians, nurses, pharmacists and allied healthcare professionals should exhibit effective teamwork for reducing the morbidity and mortality in patients suffering from cardiovascular disorders. As a result, the American College of Cardiology has also recognized the role of clinical pharmacists in reducing the complications associated with the management of CVD patients. Moreover, it is also felt that clinical pharmacists are often underutilized in delivering healthcare services to concerned stakeholders (Coleman 549-555). Clinical pharmacists have the requisite skills and knowledge for reducing the prevalence of complications associated with the management of cardiovascular diseases. Moreover, these individuals could be adequately trained for imparting healthcare knowledge to the healthcare consumers. Clinical pharmacy services include management of complex medications and polypharmacy, provision of transitional care related with medications and patient education services (Coleman 549-555).
Purpose of the Study and Problem Statement
Medication errors are quite common during prescription and administration of drugs. Medication errors are considered both costly and harmful. Approximately, 40% medication errors are attributed to the inadequate reconciliation of medications during transitional care (Boockvar at al. 236-243). Medication reconciliation is defined as a conscientious, patient-centric, inter-professional process that aims for optimal management of medications. Transitional care refers to the continuity of care while a patient shifts between different stages of a disease or between different healthcare settings (Karapinar & Terry 32-33). Prevalence of medication discrepancies is quite high during transitions of care. Such discrepancies have been documented while a patient shifts from a hospital or long-term care facilities to community settings. Moreover, medication errors and adverse drug reactions are also evident while a patient shifts from inpatient settings to outpatient (Karapinar & Terry 32-33). Studies have indicated that the prevalence of post-hospitalization adverse events is as high as 19%. The majority of such adverse events have been attributed to medication errors during transitional care. Hence, community pharmacists have a major role to play in reducing the prevalence of adverse drug reactions and medication errors in through appropriate medication reconciliation (Terry et al. 22).
Objectives and Theoretical Framework for the Proposed Study
The present research proposal would explore the potential of a novel medication reconciliation process for preventing the prevalence of medication errors and comorbidity in individuals suffering from different cardiovascular disorders. Patients suffering from cardiovascular disorders are often on polypharmacy. Polypharmacy is a significant risk factor for increasing the prevalence of medication errors. Community pharmacists should be competent in guiding and imparting awareness on polypharmacy amongst concerned stakeholders (Terry et al. 1). Moreover, individuals suffering from cardiovascular disorders are also affected by comorbid disorders. Hence, appropriate medication reconciliation is essential for reducing the prevalence and incidence of different comorbid disorders. This is the guiding philosophy of the proposed research (Coleman 549-555).
The findings of the proposed research may be useful in reducing the prevalence of medication errors and adverse drug reactions during transitional care in individuals suffering from cardiovascular disorders. According to IHI (2001), effective medication reconciliation depends on three strategies (Bates 3-9). Firstly, it is important to create an accurate and complete list of current medications. Secondly, medication regimes should be checked for appropriateness. Finally, the reason for a change of medication should be documented. These three steps are essential before dispensing medications to concerned stakeholders (Kim & Flanders 1).
Materials and Methodology
Study Design
The proposed research would be conducted as a prospective randomized cross-sectional study. The study would implement a mixed methodology approach. Hence, both qualitative and quantitative variables would be explored in the study. The study participants would include community pharmacists and patients suffering from cardiovascular disorders. The community pharmacists would be selected from four different counties in the state of Arizona. Study participants with a history of cardiovascular disorder would be randomly selected for the study. However, purposive sampling would be deployed for selecting the study participants. Individuals during the transitional phase of care (which means patients should be discharged from hospital settings to the community settings within one week on the date of participating in the study).
Procedure
The study would be conducted in two phases. During the first phase, the knowledge of community pharmacists would be evaluated through a structured interview. The structured interview would appraise the skills of community pharmacists. The structured interview would be followed by a phase of observation. The observation phase would explore whether the pharmacists can holistically appraise the prescription of an individual, whether they can acknowledge the appropriateness and change of medications or change of therapeutic interventions. The observation phase would also explore the interpersonal relation and quality of communication between the community pharmacist and the concerned patient. Simultaneously, the subjective responses of different patients would also be collected. The subjective responses would portray the sense of well-being, the degree of compliance with therapeutic interventions, difficulty or stress in managing polypharmacy and desire to visit the same community pharmacy for the 2nd time. The 2nd phase of the study would involve training of community pharmacists associated with translational care and medication reconciliation. Based on the responses of study participants the community pharmacists would be trained and sensitized on the importance of medication reconciliation. An on-the-job- training program would be implemented across study participants (community pharmacists). The training program would aim to improve the knowledge and skills of pharmacists in extending translational care. Skills like person-centric care, evidence-based knowledge on cardiovascular disorders and identification of drug-drug interactions would be reciprocated to the study participants. During the third phase of the study, the procedure implemented during the first phase would be repeated. The skills and competence of community pharmacists would be evaluated on a 10-point scale. The scale would be based on various subjective and objective ratings. On the other hand, issues like compliance, the number of medication errors, and the number of adverse drug reactions and frequency of clinical exigencies would be considered as the objective end points for the study.
Research Questions and Hypothesis Testing
The study would explore different questions. The major research questions the study would aim to address are:
Whether community pharmacists are competent in extending translational care in individuals suffering from cardiovascular disorders? (Terry et al. 22)
Ho= Community pharmacists are not competent in extending translational care in individuals suffering from cardiovascular disorders (p>0.05).
Ha= Community pharmacists are competent in extending translational care in individuals suffering from cardiovascular disorders (p<0.05)
Whether the proposed training program was effective in improving the skills of medication reconciliation amongst community pharmacists? (Kim & Flanders 1)
Ho= Proposed training program was ineffective in improving the skills of medication reconciliation amongst community pharmacists (p>0.05).
Ha= Proposed training program was effective in improving the skills of medication reconciliation amongst community pharmacists (p<0.05)
Whether the prevalence of medication errors and clinical emergencies were reduced after implementation of the proposed training program?
Ho= Prevalence of medication errors and clinical emergencies were not significantly reduced after implementation of the proposed training program (p>0.05).
Ha= Prevalence of medication errors and clinical emergencies were significantly reduced after implementation of the proposed training program (p<0.05).
Statistical tests and Statistical Software
The present study would implement different statistical tests of inference. Correlation analysis, logistic regression analysis and chi-square tests of comparison would be implemented for extrapolating the findings of the study. All statistical analysis for the present study would be conducted through SPSS software (version 17).
Timeframe and Cost Implications of the Study
The timeframe for the present study is broadly estimated to be one year. Phase-1 would be conducted for two months; Phase-2 would be conducted for the next three months and Phase-3 would be conducted for three months. Four months would be required for preparing the final dissertation work along with statistical interpretation of the findings. The cost implications would involve traveling allowance and use of online and offline services.
Proposed Outcomes of the Study
The findings of the proposed research may be useful in reducing the prevalence of medication errors and adverse drug reactions during transitional care in individuals suffering from cardiovascular disorders.
References
Bates DW.  Preventing medication errors: a summary. American Journal of Health-System Pharmacy;2007; 64(14 Suppl 9): 3-9
Boockvar KS, Carlson LaCorte H, Giambanco V, Fridman B, Siu A. Medication reconciliation for reducing drug-discrepancy adverse events. American Journal of Geriatric Pharmacotherapy 2006; 4(3): 236-243
Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. Journal of the American Geriatrics Society 2003; 51(4): 549-555
Karapinar F, Terry DRP. Medication reconciliation : a necessity for continuity of care (EAHP 16th Congress Report).European Journal of Hospital Pharmacy: Practice 2011; 17: 32-33
Kim CS, Flanders SA. Transitions of care. Annals of Internal Medicine 2013; 158(5.1):1
Terry DRP, Sinclair AG, Marriott JF, Wilson KA. Problems dispensing hospital prescriptions in community pharmacy: a survey of primary-care pharmacists. Arch Dis Child.2011; 96: 1
Terry DRP, Solanki GA, Sinclair AG, Marriott JF, Wilson KA. Medicines reconciliation on admission – don’t forget the children. Br J Clin Pharm. 2009; 1: 22

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