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Pharmacist clinics based on specified health conditions

Then, we go to the next models which also one class of drug model. It is an antidepressant medication, and the pharmacist clinics try to improve the medication adherence here. And, we have to notice that the short-term surrogate is not that optimal for this case. So, although it improved that after pharmacists’ intervention, the medication adherence is improved, but the treatment outcome, the long-term outcome need to be analyzed furthermore to prove the pharmacists’ contribution.
Then we move on to the next model, which is one health condition. In this case, it’s a pharmacist clinics for diabetes care, so, if you want to set up a clinics for one health condition, you need to prepare the pharmacists for know more about the disease. And in this case, it has a very good short-term measurement, which is HbA1c. So, in this case, people who enrolled to this pharmacist clinics, have a great outcome because the HbA1c decrease significantly. This is a very successful case, and the diabetes care is already become a wide spreading model in this world. And in Taiwan, the diabetes care already have the joint-care network in Taiwan.
So, not only pharmacists, the nutritionist and nurses are also join as a joint clinics, that you can have the patient under a good control.
Then, we go to another case of one health condition model, which is asthma education. In this paper, it showed you that if you want to set up a pharmacist clinics focusing on asthma education. Then, you need to prepare the education material and it will show you how to do it rationally and you can go through the detail in this paper and you will know that once you want to set up a clinic focusing on one health condition, how much you have to do to prepare the pharmacists.
Then, this is another case of one health condition. It is a pharmacist clinics focusing on heart failure postdischarge clinic. For heart failure patient and the advanced heart failure patient, it may have the readmission very frequently. So, these clinics are focusing on this charge patient and try to maintain them in ambulatory care. And, the short-term outcome measure is 30 days death and all-cause mortality. And in this case, the clinics showing that they significantly improved the survival rates of these kinds of patients. So, it is a case that they are focusing on postdischarge patients and keep them in ambulatory care. It will reduce the costs of medication expenses.
So, It is a very exciting case that the pharmacist does help to do the cost-effective service.
Then, we come to a more complicated model, which is numerous condition. In this case, the pharmacist clinics is focusing on geriatric population. They will review the aged people who has 5 or more medication and doing the comprehensive medication review. And, what they do is use the STOP or START Criteria to survey all these medications and try to find the potential inappropriate drugs and try to adjust the medication plan. And, in this case, they significantly reduce the medication-related problem. However, the short-term outcome cannot directly reflect to the long-term treatment outcome, so, in this case, what we learned is about the choose of surrogate.
Because if your surrogate cannot directly reflect to the outcome of the treatment, then you have to do a bridge study, showing that your short-term surrogate does reflect the outcome for the long-term. For example, the mortality rate or the life quality so on and so forth. And ,also I have to mention that because the pharmacists have to deal with numerous conditions, and numerous types of drug. So, you need to have your pharmacists training in the vary followed ways, so, the pharmacists can handle any kinds of condition
The last is the electronic communication models. Telemedicine is the newly developed service model. And, the pharmacist clinics also apply this kind of service model and it already have systemic review showing that at least 5 models of electronic communication showing that the pharmacist clinics using the telephone only does have positive effect of the disease control. So, it comes a good signs that you don’t have actually have a clinic office and sit in here. Actually, you only need an office and a telephone line, then you can do your pharmacist clinics.
So, here we come to Taipei Veterans General Hospital. We have 3 pharmacist clinics. One is anticoagulation clinics. It is a one class of drug model and once the patient enroll to our service plane, the patient can choose to have face-to-face service or we contact the patient by phone so, we also imply an electronic communication models in our clinics. The second clinic is transplant clinic. It’s focusing on immune person drug management, and it is one health condition model. And, the third pharmacist clinics is medication therapy clinic. It deals with numerous conditions, So, it’s a numerous conditions model.

Ms Wung gives another example of one class of drug clinic, before moving onto the other models. She also introduces the 3 specified pharmacist clinics in her hospital.

Key concepts

One class of drug model:

  • Antidepressant medication clinic. At this clinic, pharmacist aims to improve drug adherence. Though they are successful in achieving that, the long-term treatment outcome needs to be monitored analyzed to prove the pharmacists’ contribution to patient health.

One health condition model:

For this model, the pharmacists need to be specialized in the target disease/health condition. Ms Wung will explain 3 cases as examples: clinics for diabetes care, asthma education, and heart failure post-discharge clinic.

Numerous condition model:

Clinics focusing on geriatric care. Pharmacists perform comprehensive medication reviews for the elderly with 5 or more medications. They use the STOP or START criteria to survey the medications and identify potential inappropriate drugs. However, the short-term outcome cannot directly reflect the long-term treatment outcome.

Electronic communication models:

Telemedicine. It is already proven that telemedicine has positive effects on disease control. This also greatly increases the flexibility of both pharmacists and patients.

In Taipei Veterans General Hospital, we have 3 pharmacist clinics.

  • Anticoagulation clinic (one class of drug model): It is a “one class of drug model” and once the patient enrolls in our service plane, the patient can choose to have face-to-face service or we contact the patient by phone. We also imply an electronic communication model in our clinics.

  • Transplant clinic (one health condition model) It’s focusing on immune person drug management, and it is one health condition model.

  • Medication therapy clinic (numerous conditions model) It deals with numerous conditions, So, it’s a numerous conditions model.

Share and learn:

  • What do you think are the benefits of having pharmacist clinics on top of physician clinics?
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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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