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Pharmacist clinic assessment

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Then, we go to our final step.
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Step 3: Assessment. Once you set up your clinics, you need pharmacists to provide the service. And, you also require a lot of supports from other departments. And, it all takes money. So, you need a performance assessments. So, if you set up clinics, my suggestion is that you need a short-term outcomes, which is you can have achievement in 6 to 12 months. And, I suggest you have surrogate markers. For example, in anticoagulation clinics, you may have TTR% as your surrogate. For clinics focusing on diabetic management, you can choose HbA1c as your surrogate. And, lipid profile is also a good surrogate because once you have your test done, and you will get the data.
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And, you can compare the drug profile before and after your intervention.
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This is our service outcome in the first year. We compared the patients’ outcome before and after six months after pharmacist intervention. So, you can see that, before the pharmacist intervention, the TTR before the six months is only 39%. But after we intervention, the TTR% increase to 49.3. And, for the thromboembolic events, for the warfarin-related emergency department visits, for the hospitalization. It all decreased significantly. However, you have notice that the minor bleeding increase slightly, it may be due to that we do the documentation very followlly and detail so, the minor bleeding events may increase. You can see that major bleeding events decrease from 4 event to 0 event.
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You can do it as a short-term outcome measure and if you can provide your performance outcome to your hospital management department, it will give a very persuasive evidence that the pharmacist-manage anticoagulation clinic does do their job.
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However, for long-term outcomes, we will talk about the disease control and management. You may want to discuss about change in morbidity or mortality, or your service will reduce frequency of cardiovascular events, or decrease number of emergency department visits or hospitalizations. All this long-term outcome you may come up with a pharmacal economy issue, you can prove that through your pharmacy clinics, you can have cost-effective and you can provide patient have better pharmacotherapy and have less adverse side-effect.
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So, this is international, prospective, controlled study. It is a clinic focus on NOACs only. And, this name of the trial is IMPACT-AF. It’s talking about a pharmacist clinic only focus on NOACs and what is their contribution. The primary outcome is talking about the medication treatment plan. Because if you have bleeding event, sever bleeding event patient tend to quit the anticoagulant treatment. So, you can see that if you have pharmacist clinic service, the patient will stay in the anticoagulant plan. However, if you don’t have the pharmacist service, most patients just intented not to have anticoagulant, which will increase the stroke rate.
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And, there is another secondary outcome. It prove that under the intervention of pharmacist, the stroke rate does reduce. And, it is a long-term outcome and it also a very persuasive data for that clinics does do their job and doing very good because if the patient have stroke attack, they may increase their hospitalization rate, and they may not take care of themselves and it will increase a lot of burden in the family financial.
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So, after we talk about the literature review and see through the most of successful models and remarkable models in the literature review. Then we go to how to set up a pharmacist clinics by step one, two, three. Then, we have to know that once you set up a clinic, and you already prove that your clinics did provide patient a better pharmacotherapy then the next job you have to do is to reimagining clinics, try to expanding and remodeling your service through times because once again, medication advance with time, you need to keep up with time, try to adjust your service through keep yourself the most updated days so that you can have your patient under the best management.
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I’m glad to be here to share the idea of setting up pharmacist clinics and thank you for your time to listen to this lecture.

Ms Wung explains the importance and methods of assessment. She will use her example in the TVGH and another case study. She then briefly explains what to do after a successful model has been created before concluding the activity.

Key concepts

Assessment is important to secure future funding.

Both short-term and long-term surrogate markers need to be studied.

In anticoagulation clinics, TTR% is a short-term surrogate. For clinics focusing on diabetic management, HbA1c is a possible surrogate. Drug profiles before and after intervention can also be used to assess the clinic’s success.

At TVGH anticoagulation clinics, the average patient TTR% before treatment is 39% but increases to 49.3% after the intervention. Though the frequency of minor bleeding events increased slightly, major bleeding events decrease from 4 to 0.

Long-term impacts include disease control and management. Possible surrogates are morbidity or mortality. Or if the services reduce the frequency of cardiovascular events, ER visits, or hospitalizations.

Case study:

This is a clinic focusing on NOACs only, the name of the trial is IMPACT-AF. After evaluation, it was discovered that with the pharmacist clinic, fewer patients quit anticoagulant treatment due to bleeding events.

Secondly, the frequency of strokes reduced. This is a long-term outcome and is very persuasive evidence, proving the positive impact of pharmacist clinics.

As mentioned at the start of this week, pharmacist clinics need to keep up with the times. Pharmacists need to continue reimaging and remodeling the clinic to keep patients under the best, up-to-date care. They can also consider expanding the model to serve a wider range of patients.

Share and learn:

  • Besides applying for funding, how else are assessments important?

  • In your opinion, how effective will directly transferring a successful model to a different setting be?

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