Talya S Burnett Pharm D Pharmacy Resident St Matthews Community Pharmacy Objectives Explore the impact of parkinsonism on disease state management Discuss methods to enhance medication adherence and optimize therapy ID: 737612
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Slide1
Resources for Medication Management
Talya S Burnett, Pharm. D
Pharmacy Resident
St Matthews Community PharmacySlide2
Objectives
Explore the impact of parkinsonism on disease state management
Discuss methods to enhance medication adherence and optimize therapy
Explore the role of the pharmacist in medication adherence and safety
Review programs offered at St Matthews Community Pharmacy to patients in need of thorough medication management
Explore supplemental therapies available to improve cognitive deficitsSlide3
Parkinsonism: Non-motor Symptoms
Forgetfulness, decreased memory
Impaired concentration
Depression, Anxiety, Irritability
Loss of interest/apathy
DelusionsVisual hallucinationsDaytime somnolenceSpeech and swallowing problems
Mov Disord. 2009;24(11):1641-9.Slide4
Increasing medication adherence
Understanding medication indications and potential outcomes of non-adherence
Pill boxes: electronic or manual
Reminders
CaregiverSlide5
Pharmacists’ Role
Drug Regimen Reviews
Interactions
Improving adherence
Optimal therapySlide6
Pharmacist-provided MTMs
Am Pharm Assoc; 2017. Slide7
Pharmacist-provided MTMs
Am Pharm Assoc; 2017. Slide8
Pharmacist-provided MTMs
Am Pharm Assoc; 2017. Slide9
Pharmacists’ Role
Most medication errors occur during transitions of care
Alterations in the healthcare setting changes
Discharge or vacation time
New or additional physician
Refills on medications previously prescribedDuplications in therapy Change in payer status changesNon-adherence Slide10
Pharmacists Drug Regimen Reviews in NC Long Term Care
Consultant pharmacists performed monthly drug regimen reviews
Potentially inappropriate medications in the elderly (Beers Criteria)
Suggestions for more cost effective drugs
Quality Initiatives
Inappropriate drug duration
Therapeutic duplication
Prospective drug review
Clin Ther. 2009;31(9):2018-37.Slide11
Pharmacists Drug Regimen Reviews in NC Long Term Care, cont.
5255 patients available for analysis
Clin Ther. 2009;31(9):2018-37.
Reviews
Review & Recommendation
Review, recommendation, & drug change
Average Cost Reduction
4.4%
6.3%
7.8%
Average Reduction per Member
per Month
$21.36
$30.64
$38.05
P-value
P<0.05
P<0.001
P<0.001Slide12
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study
70 patients diagnosed with Parkinson’s Disease selected to receive 6 monthly MTMs
Data was gathered by clinical pharmacists from:
prescriptions
patient diary and all medicines (over-the-counter and prescription) provided by the patient during the appointment
the medical chart
clinical interviews
questionnaires
Neurol Ther. 2016;5(1):85-99.Slide13
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Classification, type, and frequency of medicine-related problems
Classification
Type
Frequency (%)
Indication
Unnecessary
medication
2
(1.7)
Necessity
of additional medication
16 (13.8)
Effectiveness
Ineffective medication
3 (2.6)
Under dosage
16 (13.8)
Safety
Adverse reaction
19 (16.4)
High dosage
17 (14.6)
Adherence
Non-adherence
43 (37.1)
Total
116 (100.0)
Neurol Ther. 2016;5(1):85-99.Slide14
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct
Conduct
N (%)
N accepted (%)
N solved (%)
Non-pharmacological treatment guidance
115 (28.5)
74 (64.3)
53
(71.6)
Pharmacological treatment guidance
98 (24.4)
72 (73.5)
60 (83.3)
Rescheduling
55 (13.6)
49 (89.1)
33 (67.3)
Guidance on Parkinson’s Disease
49 (12.1)
36 (73.5)
30 (83.3)
Referral
to specialists
17
(4.2)
8 (47.1)
4 (50.0)
Education for habit changing
13 (3.2)
10 (76.9)
7(70.0)
Addition
of a new medication
12 (3.0)
6 (50.0)
4 (66.7)
Neurol Ther. 2016;5(1):85-99.Slide15
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct
Conduct
N (%)
N accepted (%)
N solved (%)
Non-pharmacological treatment guidance
115 (28.5)
74 (64.3)
53
(71.6)
Pharmacological treatment guidance
98 (24.4)
72 (73.5)
60 (83.3)
Rescheduling
55 (13.6)
49 (89.1)
33 (67.3)
Guidance on Parkinson’s Disease
49 (12.1)
36 (73.5)
30 (83.3)
Referral
to specialists
17
(4.2)
8 (47.1)
4 (50.0)
Education for habit changing
13 (3.2)
10 (76.9)
7(70.0)
Addition
of a new medication
12 (3.0)
6 (50.0)
4 (66.7)
Neurol Ther. 2016;5(1):85-99.Slide16
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct
Conduct
N (%)
N accepted (%)
N solved (%)
Non-pharmacological treatment guidance
115 (28.5)
74 (64.3)
53
(71.6)
Pharmacological treatment guidance
98 (24.4)
72 (73.5)
60 (83.3)
Rescheduling
55 (13.6)
49 (89.1)
33 (67.3)
Guidance on Parkinson’s Disease
49 (12.1)
36 (73.5)
30 (83.3)
Referral
to specialists
17
(4.2)
8 (47.1)
4 (50.0)
Education for habit changing
13 (3.2)
10 (76.9)
7(70.0)
Addition
of a new medication
12 (3.0)
6 (50.0)
4 (66.7)
Neurol Ther. 2016;5(1):85-99.Slide17
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct
Conduct
N (%)
N accepted (%)
N solved (%)
Non-pharmacological treatment guidance
115 (28.5)
74 (64.3)
53
(71.6)
Pharmacological treatment guidance
98 (24.4)
72 (73.5)
60 (83.3)
Rescheduling
55 (13.6)
49 (89.1)
33 (67.3)
Guidance on Parkinson’s Disease
49 (12.1)
36 (73.5)
30 (83.3)
Referral
to specialists
17
(4.2)
8 (47.1)
4 (50.0)
Education for habit changing
13 (3.2)
10 (76.9)
7(70.0)
Addition
of a new medication
12 (3.0)
6 (50.0)
4 (66.7)
Neurol Ther. 2016;5(1):85-99.Slide18
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct, cont.
Conduct
N (%)
N accepted (%)
N solved (%)
Guidance on access to the medication
11 (2.7)
4 (36.4)
3 (75.0)
Medication discontinuation
10 (2.5)
6 (60.0)
6 (100.0)
Guidance on another pathology
7 (1.7)
5 (71.4)
4 (80.0)
Change of medication
6 (1.5)
2 (33.3)
2 (100.0)
Guidance
on the medication use
5 (1.2)
4 (80.0)
4
(100.0)
Change
of dosage
3 (0.7)
3
(100.0)
3 (100.0)
Change of dosage form
3 (0.7)
0 (0.0)
-
Total
404
279
213
Neurol Ther. 2016;5(1):85-99.Slide19
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct, cont.
Conduct
N (%)
N accepted (%)
N solved (%)
Guidance on access to the medication
11 (2.7)
4 (36.4)
3 (75.0)
Medication discontinuation
10 (2.5)
6 (60.0)
6 (100.0)
Guidance on another pathology
7 (1.7)
5 (71.4)
4 (80.0)
Change of medication
6 (1.5)
2 (33.3)
2 (100.0)
Guidance
on the medication use
5 (1.2)
4 (80.0)
4
(100.0)
Change
of dosage
3 (0.7)
3
(100.0)
3 (100.0)
Change of dosage form
3 (0.7)
0 (0.0)
-
Total
404
279
213
Neurol Ther. 2016;5(1):85-99.Slide20
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct, cont.
Conduct
N (%)
N accepted (%)
N solved (%)
Guidance on access to the medication
11 (2.7)
4 (36.4)
3 (75.0)
Medication discontinuation
10 (2.5)
6 (60.0)
6 (100.0)
Guidance on another pathology
7 (1.7)
5 (71.4)
4 (80.0)
Change of medication
6 (1.5)
2 (33.3)
2 (100.0)
Guidance
on the medication use
5 (1.2)
4 (80.0)
4
(100.0)
Change
of dosage
3 (0.7)
3
(100.0)
3 (100.0)
Change of dosage form
3 (0.7)
0 (0.0)
-
Total
404
279
213
Neurol Ther. 2016;5(1):85-99.Slide21
Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study, cont.
Pharmaceutical interventions performed, accepted
, and solved by conduct, cont.
Conduct
N (%)
N accepted (%)
N solved (%)
Guidance on access to the medication
11 (2.7)
4 (36.4)
3 (75.0)
Medication discontinuation
10 (2.5)
6 (60.0)
6 (100.0)
Guidance on another pathology
7 (1.7)
5 (71.4)
4 (80.0)
Change of medication
6 (1.5)
2 (33.3)
2 (100.0)
Guidance
on the medication use
5 (1.2)
4 (80.0)
4
(100.0)
Change
of dosage
3 (0.7)
3
(100.0)
3 (100.0)
Change of dosage form
3 (0.7)
0 (0.0)
-
Total
404
279
213
Neurol Ther. 2016;5(1):85-99.Slide22
St Matthews Community Pharmacy
Medication Management ServicesSlide23
St Matthews Community Pharmacy
Med Box
Medications
packaged on a weekly basis and delivered to patients’ homes
Comprehensive medication list
Prospective medication review performed for each medication prior to adding medications to medication list
All medication changes and additions updated in medication box on a continual basis
Ideal for patients with extensive medication lists
Manual or electronic boxes available
Manual allows for more patient controlSlide24
St Matthews Community Pharmacy
Med Sync
Medications refilled together on a monthly basis
Refills are managed at pharmacy
Patient still has control of medication regimen
Slide25
Supplemental Therapies
Integrative Therapeutics
Products
GABA
:
Assists in regulating the brain’s nerve cell functions and supports neurochemical balance.Phosphatidylserine: Supports cognitive function and mental
sharpness
Ele
-Max:
Contains amino acid precursors and nutrients that assist in improving mood
Indicated for patients showing initial symptoms and not currently being treated for PDSlide26
The Patient is Priority!
Patient inclusion in care
Optimal regimens in regards to cost and therapeutic outcomes
Consider caregiver concerns
Cost
EffectivenessIndependence Slide27
Thank YouSlide28
References
Barone P, Antonini A, Colosimo C, et al. The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Mov Disord. 2009;24(11):1641-9.
Foppa AA, Chemello C, Vargas-peláez CM, Farias MR. Medication Therapy Management Service for Patients with Parkinson's Disease: A Before-and-After Study. Neurol Ther. 2016;5(1):85-99.
Khoo, Yarnall AJ, Duncan GW, et al. The spectrum of nonmotor symptoms in early Parkinson disease. Neurology. 2013;80(3):276-81.
Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model.
American Pharmacists Association.
Accessed at:
http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf
. Accessed on 21 Aug 2017.
Non-Motor Symptoms.
National Parkinson Foundation.
Accessed at:
http://www.parkinson.org/understanding-parkinsons/non-motor-symptoms
. Accessed on 30 Sept 2017.
Product Catalog.
Integrative Therapeutics.
Accessed at:
https://www.integrativepro.com/products
. Accessed on 4 Oct 2017.
Trygstad TK, Christensen DB, Wegner SE, Sullivan R, Garmise JM. Analysis of the North Carolina long-term care polypharmacy initiative: a multiple-cohort approach using propensity-score matching for both evaluation and targeting. Clin Ther. 2009;31(9):2018-37.