Term
MTMS
designed to:
services: |
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Definition
- OPTIMIZE THERAPEUTIC OUTCOMES
- IMPROVE MEDICATION USE
- REDUCE the RISK of ADVERSE DRUG EVENTS & drug interactions
- UP PATIENT ADHERENCE
- LOWER overall costs
SERVICES:
-pharmacists can only provide services allowed under their states pharmacy act
- selecting, initiating, modifying or administering medicatrions
- monitoring/evaluating a patient's response tot herapy & providing recommmendations for therapeutic chagnes |
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Term
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Definition
1966 -> 4bil spent on pharm.
2003 - 180 bil (300 bil now)
patients 65+ take 5 drugs a day
66% of patients 65+ have at least 1 chronic med condition & tend to use multiple healtcare providers |
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Term
| Medication Therapy Manage Services |
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Definition
-First time, Medicare will pay for pharmacist's patient care services
MTMS beneficiaries must:
-have multiple chronic illnesses
-take multiple drugs
-be liekkly to incur annual drug costs above a specified level ($4k in 06) (03, approx 16% of Medicare had drug exp. over $4k) |
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Term
| MMA Standard Prescription Drug Coverage |
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Definition
- est monthly premium of $37
- annual deductible at $250
- 25 % copay between 251-2250
- no coverage from 2251-5100 (donught hole)
- 28 rx drug plans in Ohio |
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Term
| Medicare Presription Drug Improvement & modernization Act of 2003 |
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Definition
- addition of prescription drug to benefit under medicare part D (2006)
- opputunities for pharmacists to expand patient care services and receive compensation for this care
-defacto provider status for pharm
-chronic care improvemtn progams |
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Term
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Definition
2003
-pharmacists on General Medicine rounds (henry ford hospital)
-preventable ADE reduced 78%
-reduced ADE's from 26.5 to 5.7/1000 hospital days
150 recommendations/147 were enacted |
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Term
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Definition
1999
- pharmacis participation of ICU team decreased ADE's by 66% (Adverse Drug Events)
-reduced ADEs from 10.4 to 3.5/1000
-annual savings of 270k |
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Term
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Definition
-Improved Perstance & Compliancew w. Therapy
Amer Pharm Assoc
-26 comm based ambulatory care pharmacies
397 patients
93.6% medication thereapy "persistance" over time
90.1% med therapy "compliance" adherent
62.5% reached/maintained NCEP lipid
2-4xs better outcome |
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Term
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Definition
-responsibile provision of drug therapy for the purpose of achieving definite outcome that improve a patient's quality of life
- patient focused, outcomes oriented, pharmacist responsibility, comprehensive drug therapy management |
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Term
Institue of Medicine (IOM)
"To err is human building a safer healt system" |
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Definition
Advisory committee to congress
- IOM quality of health care in amer comm
- 98k/yr in US due to medical errors
Pharm decision support, pharm inclusion on rounds, available patient info, improving patient knowledge of treatment & side effects |
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Term
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Definition
2007
1999-2004 68% increase in deaths from unintentional drug poisoning
among the largest increases: ages 15-24
poisioning 2nd only to motor vehicle accidents as cause of death |
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Term
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Definition
1998
examined all US death certificates 1983-1993
2.57 fold inc. in deaths due to med errors
93 there were 7391 deaths |
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Term
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Definition
1998
serious and fatal ADR's hospital patiens
39 prospective studies
serious ADRs 6.7% (over 2 mil in 94)
fatal ADRs 0.32% (100k patients in 94)
4th-6th leading cause of death over 30 years |
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Term
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Definition
1997
drug related morbidity & mortality in nursing homes
$7.6bil
$1.33 spent on DRP's for every $1.00 spent on drugs |
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Term
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Definition
2000
update on Johnson & Bootman's 1995 estimate
$977mean cost:treatment failure
$1105mean cost: new med problem
$177.4bil in 2000
DOUBLES JOHN & BOOTMAN 1995 |
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Term
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Definition
untreated indications
improper drug selection, subtherapeutic dose, failure to receive drugs, overdose, adverse drug reaction, drug interactions
$76.6 bil/year
diabetes - $45.2 bil
cancer - $100 bil
cardiovascular - $117 bil |
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Term
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Definition
1995
23.4% treatment failures
10.5% new med problems
6.5% both
28% of hospital admissions |
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Term
| Contemporary Ethical Issues |
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Definition
| emergency contraceptives (Plan B), oxycotin addiction, controlled substance in pharm, how to treat pain, conflicts of interests, healt dsparities, marijuana |
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Term
| 4 step model for ethical decision making in pharmacy practice |
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Definition
1 problem indentification
2 develop alternative courses of action
3 select 1 alternative course of action
4 consider objections to alternative selected |
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Term
| Hippocratic Principle v Ohio Pharmacy Practice Act |
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Definition
-doing good/avoiding harm to the patient are the only morally relevant considerations
-corresponding responsibility = equally responsible for the peron's "appropriatenes" = doctor |
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