Integration of a Pharmacist into a Stroke Prevention Clinic Team: Results
During the study period, the pharmacist initiated 432 interventions during 153 patient encounters, which represented an average of 2.8 interventions per encounter. The most common interventions were medication counselling, medication reconciliation or follow-up, recommending initiation of pharmacotherapy, and preventing or resolving adverse drug reactions (Figure 1).
Table 2. Outcomes Targeted by Pharmacist Interventions
|
|
|
|
Clinical |
|
|
Cure a disease |
2 (0.2) |
|
Eliminate or reduce signs or symptoms |
37 (4.4) |
|
Arrest or slow a disease process |
9 (1.1) |
|
Prevent a disease or symptom |
390 (46.7) |
|
Achieve desired alterations |
|
|
in physiologic processes |
|
|
(e.g., normalized electrolytes) |
110 (13.2) |
|
Humanistic |
|
|
Improvement in physical, mental, or |
|
|
social function or satisfaction with care |
286 (34.3) |
A total of 835 proposed patient outcomes were associated with the pharmacist’s interventions, representing an average of 1.9 outcomes per intervention. The main outcome type targeted by the pharmacist was prevention of a disease or symptom (Table 2). The physicians accepted most of the pharmacist’s suggestions (Figure 2). No significant trend in the rejection rate was noted during the study period. Apcalis Oral Jelly
Figure 1. Number of pharmacist interventions according to nature of drug-related problem. Reconciliation included medication reconciliation activities.
Patient flow in the clinic was reappraised during the study period, and usual practice was altered early in the study period. Rather then being followed for 6 months, patients are now seen for an initial appointment with limited follow-up (usually one visit). This change reflected typical neurology practice in the DTHR, whereby the patient has an initial consultation for diagnosis, with management of chronic diseases and risk factors being performed by general practitioners. However, the number of pharmacist activities continued to increase over the study period (data not shown).
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Figure 2. Proportion of pharmacist interventions accepted by prescriber. Interventions that did not require physician acceptance were classified as “not applicable”.
