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Coding accuracy of administrative drug claims in the Ontario Drug Benefit database.

https://arctichealth.org/en/permalink/ahliterature184346
Source
Can J Clin Pharmacol. 2003;10(2):67-71
Publication Type
Article
Date
2003
Author
Adrian R Levy
Bernie J O'Brien
Connie Sellors
Paul Grootendorst
Donald Willison
Author Affiliation
Centre for Health Evaluation & Outcome Sciences, St Paul's Hospital, Vancouver, Canada. alevy@cheos.ubc.ca
Source
Can J Clin Pharmacol. 2003;10(2):67-71
Date
2003
Language
English
Publication Type
Article
Keywords
Clinical Pharmacy Information Systems - standards
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Humans
Insurance Claim Review
Medical Audit
Ontario
Pharmacies - standards
Retrospective Studies
Sensitivity and specificity
Abstract
Every year in Ontario, the records of over 42 million prescriptions dispensed to persons eligible for Ontario Drug Benefit (ODB) benefits are transmitted to a central database. The ODB database is the second largest database of medications in Canada, containing records on almost half of all medications dispensed in Ontario. There is no information about the reliability of the coding on the ODB drug claims database and, therefore, the objective of this study was to estimate the reliability of coding of the Drug Identification Number, and the date, quantity and duration of the dispensation on claims sent to the ODB.
To meet this objective, approximately 100 randomly selected prescriptions dispensed from each of 50 pharmacies in southern Ontario between July 1, 1998 and December 31, 1999 were audited. For each claim, the written information on the prescription was compared with the electronic information submitted to the ODB database. Logistic regression was used to test the association between coding errors and the location, owner affiliation, and productivity of each pharmacy (defined as the annual volume of dispensations divided by the annual number of hours worked by all pharmacists and pharmacy assistants).
Of the 183 pharmacies owners invited to participate, consent to abstract information was obtained in 50, yielding a participation rate of 27%. Of the 5155 dispensed prescriptions, 37 errors were found, yielding an overall error rate of 0.7% (95% CI 0.5% to 0.9%). None of the characteristics of pharmacies that were examined (location, owner affiliation, productivity) was associated with coding errors.
Pharmacists almost always dispense the medication that is prescribed and this information is reliably transmitted to the ODB drug claims database. This means that any conclusions drawn by researchers using these data are not likely to be compromised by low coding reliability.
PubMed ID
12879144 View in PubMed
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Collaboration between community pharmacists and family physicians: lessons learned from the Seniors Medication Assessment Research Trial.

https://arctichealth.org/en/permalink/ahliterature182758
Source
J Am Pharm Assoc (2003). 2003 Sep-Oct;43(5):566-72
Publication Type
Article
Author
Michelle Howard
Kristina Trim
Christel Woodward
Lisa Dolovich
Connie Sellors
Janusz Kaczorowski
John Sellors
Author Affiliation
Department of Family Medicine, McMaster University, HSC 2V10, Hamilton, Ontario, Canada. mhoward@mcmaster.ca
Source
J Am Pharm Assoc (2003). 2003 Sep-Oct;43(5):566-72
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Family Practice
Geriatrics
Health Services Research
Humans
Interprofessional Relations
Ontario
Pharmacists
Abstract
To learn about the experiences of specially trained expanded role pharmacists (ERPs) and family physicians in a program in which they worked together to optimize drug therapy for elderly patients (aged 65 and older) and to identify shortcomings of the program, obstacles to its implementation, and strategies to overcome these obstacles.
Qualitative opinion analysis.
Six family physicians and six community-based ERPs who had participated in a randomized controlled trial (Seniors Medication Assessment Research Trial [SMART]).
In-depth interviews.
Themes that emerged from the interviews regarding the strengths and weaknesses of and ways to improve the program.
ERPs and physicians differed in their perceptions of appropriate roles for ERPs. ERPs saw the program as an opportunity to take on new professional roles. Physicians appreciated the information they received from ERPs about their patients' adherence and use of nonprescription medications, but they did not want ERPs to directly counsel their patients. Some physicians questioned the value of the program for some patients, since the inclusion criteria for patients were broad and not all patients meeting the criteria needed intense interventions by ERPs. Both ERPs and physicians identified the need to refine the referral process and to work out professional role relationships and ongoing collaboration more fully. If the program were to be implemented as a routine service, physicians were concerned about the demands on their staff and office space and the need for an external compensation mechanism.
Issues to be addressed for future programs include clarification of the roles of pharmacist and physician when the professionals work together, targeting of appropriate patients for the program, identification of a more efficient way to deliver recommendations, and development of an appropriate compensation mechanism.
PubMed ID
14626748 View in PubMed
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Integrating pharmacists into family practice teams: physicians' perspectives on collaborative care.

https://arctichealth.org/en/permalink/ahliterature153719
Source
Can Fam Physician. 2008 Dec;54(12):1714-1717.e5
Publication Type
Article
Date
Dec-2008
Author
Kevin Pottie
Barbara Farrell
Susan Haydt
Lisa Dolovich
Connie Sellors
Natalie Kennie
William Hogg
Carmel M Martin
Author Affiliation
Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada. kpottie@uottawa.ca
Source
Can Fam Physician. 2008 Dec;54(12):1714-1717.e5
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Delivery of Health Care, Integrated - organization & administration
Family Practice - organization & administration
Female
Humans
Interdisciplinary Communication
Interprofessional Relations
Male
Ontario
Pharmaceutical Services - organization & administration
Questionnaires
Retrospective Studies
Abstract
To explore family physicians' perspectives on collaborative practice 12 months after pharmacists were integrated into their family practices.
Qualitative design using focus groups followed by semistructured interviews.
Seven physician-led group family practices in urban, suburban, and semirural Ontario communities.
Twelve purposively selected family physicians participating in the IMPACT (Integrating family Medicine and Pharmacy to Advance primary Care Therapeutics) project.
We conducted 4 exploratory focus groups to gather information on collaborative practice issues in order to construct our interview guide. We later interviewed 12 physicians 1 year into the integration process. Focus groups and interviews were audiotaped and transcribed verbatim. Four researchers used immersion and crystallization techniques to identify codes for the data and thematic editing to distil participants' perspectives on physician-pharmacist collaborative practice. FINDINGS The focus groups revealed concerns relating to operational efficiencies, medicolegal implications, effects on patient-physician relationships, and work satisfaction. The follow-up semistructured interviews revealed ongoing operational challenges, but several issues had resolved and clinical and practice-level benefits surfaced. Clinical benefits included having colleagues to provide reliable drug information, gaining fresh perspectives, and having increased security in prescribing. Practice-level benefits included group education, liaison with community pharmacies, and an enhanced sense of team. Persistent operational challenges included finding time to learn about pharmacists' role and skills and insufficient space in practices to accommodate both professionals.
Physicians' perspectives on collaborative practice 12 months after pharmacists were integrated into their family practices were positive overall. Some ongoing operational challenges remained. Several of the early concerns about collaborative practice had been resolved as physicians discovered the benefits of working with pharmacists, such as increased security in prescribing.
Notes
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Cites: Soc Sci Med. 2001 Oct;53(7):943-5511522139
Cites: CMAJ. 2003 Jul 8;169(1):17-2212847034
PubMed ID
19074716 View in PubMed
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Narrative reports to monitor and evaluate the integration of pharmacists into family practice settings.

https://arctichealth.org/en/permalink/ahliterature158321
Source
Ann Fam Med. 2008 Mar-Apr;6(2):161-5
Publication Type
Article
Author
Kevin Pottie
Susan Haydt
Barbara Farrell
Lisa Dolovich
Connie Sellors
William Hogg
Author Affiliation
Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada. kpottie@uottawa.ca
Source
Ann Fam Med. 2008 Mar-Apr;6(2):161-5
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Group Practice
Health Plan Implementation - methods
Humans
Interdisciplinary Communication
Medication Therapy Management - organization & administration
Ontario
Organizational Innovation
Patient Care Team - organization & administration
Pharmacists
Primary Health Care - methods - organization & administration
Process Assessment (Health Care) - methods
Abstract
Narratives can capture unfolding events and negotiation of roles and thus can help to evaluate interventions in interdisciplinary health care teams. We describe a practical qualitative method, the narrative report, and its role in evaluating implementation research.
We used narrative reports as a means to evaluate an intervention to integrate pharmacists into group family practices. The pharmacists submitted 63 written narrative reports during a 1-year period. Our interdisciplinary research team analyzed these reports to monitor the progress of the implementation, to identify pharmacists' needs, and to capture elements of the integration process.
The monthly narrative reports allowed the research team to document early learning and calibrate the program in terms of clinical support, adapting roles, and realigning expectations. The reports helped the research team stay in tune with practice-related implementation challenges, and the preliminary summary of narrative findings provided a forum for sharing innovations among the integrating pharmacists.
The narrative report can be a successful qualitative tool to track and evaluate the early stages of an intervention in the context of evolving primary health care teams.
Notes
Cites: J Pers. 1991 Sep;59(3):575-6071960643
Cites: West J Nurs Res. 1994 Aug;16(4):414-257941487
Cites: Clin Pharmacol Ther. 2008 Jun;83(6):913-718388882
Cites: Qual Saf Health Care. 2005 Dec;14(6):443-916326792
Cites: Milbank Q. 2004;82(4):581-62915595944
PubMed ID
18332409 View in PubMed
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Pharmacist's identity development within multidisciplinary primary health care teams in Ontario; qualitative results from the IMPACT project.

https://arctichealth.org/en/permalink/ahliterature146919
Source
Res Social Adm Pharm. 2009 Dec;5(4):319-26
Publication Type
Article
Date
Dec-2009
Author
Kevin Pottie
Susan Haydt
Barbara Farrell
Natalie Kennie
Connie Sellors
Carmel Martin
Lisa Dolovich
Author Affiliation
Department of Family Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
Source
Res Social Adm Pharm. 2009 Dec;5(4):319-26
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Community Pharmacy Services - organization & administration - trends
Drug Therapy - standards - trends
Family Practice - organization & administration - trends
Humans
Interprofessional Relations
Mentors
Ontario
Patient Care Team - organization & administration - trends
Pharmacists - trends
Physicians
Primary Health Care - organization & administration - trends
Professional Role
Abstract
Multidisciplinary team development generates changes in roles, responsibilities, and identities of individual health care providers. The Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) project introduced pharmacists into family practice teams across Ontario, Canada, to provide medication assessments, drug information, and academic detailing and to develop office system enhancements to improve drug therapy.
To analyze pharmacists' narrative accounts during early integration to study identity development within emerging team-based care.
Qualitative design using 63 pharmacist narrative reports of pharmacists' experiences over a 9-month integration period. Four independent researchers with varied professional backgrounds used immersion and crystallization to identify codes and iterative grounded theory to determine and debate process and content themes relevant to identity development.
The pharmacists' narratives spoke of the daily experiences of integrating into a family practice setting: feeling valued and contributing concretely to patient care; feeling underutilized; feeling like a nuisance, or feeling as though working too slowly. Pharmacist mentors helped deal with uncertainty and complexity of care. Pharmacists perceived that complementary clinical contributions enhanced their status with physicians and motivated pharmacists to take on new responsibilities. Changes in perspective, clinic-relevant skill development, and a new sense of professionalism signaled an emerging pharmacist family practice identity.
Pharmacists found that the integration into team-based primary health care provided both challenges and fresh opportunities. Pharmacists' professional identities evolved in relation to valued role models, emerging practice-level opportunities, and their patient-related contributions.
Notes
Comment In: Res Social Adm Pharm. 2009 Dec;5(4):302-419962673
PubMed ID
19962675 View in PubMed
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Prescribing of potentially inappropriate medications to elderly people.

https://arctichealth.org/en/permalink/ahliterature180227
Source
Fam Pract. 2004 Jun;21(3):244-7
Publication Type
Article
Date
Jun-2004
Author
Michelle Howard
Lisa Dolovich
Janusz Kaczorowski
Connie Sellors
John Sellors
Author Affiliation
Departments of Family Medicine, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada. mhoward@mcmaster.ca
Source
Fam Pract. 2004 Jun;21(3):244-7
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Benzodiazepines - therapeutic use
Cross-Sectional Studies
Family Practice
Female
Geriatrics
Humans
Male
Medication Errors - statistics & numerical data
Ontario - epidemiology
Prevalence
Abstract
To estimate the prevalence and predictors of medications deemed potentially inappropriate for the elderly among family physicians' patients aged 65 and older (seniors) taking multiple prescribed medications.
Forty-eight randomly selected family practices in 16 towns and cities in Southern Ontario, Canada and 889 of their senior patients were recruited into a randomized trial. We conducted a cross-sectional analysis of prescription insurance data from the provincial universal prescription insurance database over 12 months, from the 777 seniors who completed the trial and agreed to have their data released. The prevalence and patient and physician predictors of use of a potentially inappropriate medication (PIM), as defined by published widely accepted criteria, were examined.
The median number of prescriptions filled was 24. Nearly one-fifth (16.3%) of the seniors received at least one prescription for a PIM, with short-acting benzodiazepine prescriptions for longer than 30 days (6.4%) and oxybutynin (3.7%) being the types prescribed most frequently. In univariate and multiple variable analyses, women were found to be statistically significantly more likely to be prescribed a PIM (adjusted OR = 1.6; 95% confidence interval = 1.0-2.4). Age, education, self-rated health, number of health conditions, and number of prescriptions were not associated with PIM use. Physician gender, family medicine certification status, and time since graduation were not significantly associated with PIM prescribing.
Prescribing of PIMs, especially of short-acting benzodiazepines was common in seniors taking multiple medications. Interventions to reduce use of PIM, especially long-term benzodiazepines, are important in primary care.
PubMed ID
15128683 View in PubMed
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A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients.

https://arctichealth.org/en/permalink/ahliterature184610
Source
CMAJ. 2003 Jul 8;169(1):17-22
Publication Type
Article
Date
Jul-8-2003
Author
John Sellors
Janusz Kaczorowski
Connie Sellors
Lisa Dolovich
Christel Woodward
Andrew Willan
Ron Goeree
Roxanne Cosby
Kristina Trim
Rolf Sebaldt
Michelle Howard
Linda Hardcastle
Jeff Poston
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton, Ont.
Source
CMAJ. 2003 Jul 8;169(1):17-22
Date
Jul-8-2003
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Community Pharmacy Services - organization & administration
Cooperative Behavior
Drug Costs - statistics & numerical data
Female
Health Care Costs - statistics & numerical data
Health Services Research
Humans
Interprofessional Relations
Male
Ontario
Outcome and Process Assessment (Health Care) - organization & administration
Patient care team
Pharmacists - organization & administration - psychology
Physicians, Family - organization & administration - psychology
Primary Health Care - organization & administration
Program Evaluation
Referral and Consultation - organization & administration
Abstract
Pharmacists can improve patient outcomes in institutional and pharmacy settings, but little is known about their effectiveness as consultants to primary care physicians. We examined whether an intervention by a specially trained pharmacist could reduce the number of daily medication units taken by elderly patients, as well as costs and health care use.
We conducted a randomized controlled trial in family practices in 24 sites in Ontario. We randomly allocated 48 randomly selected family physicians (69.6% participation rate) to the intervention or the control arm, along with 889 (69.5% participation rate) of their randomly selected community-dwelling, elderly patients who were taking 5 or more medications daily. In the intervention group, pharmacists conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems. Process outcomes included the number of drug-related problems identified among the senior citizens in the intervention arm and the proportion of recommendations implemented by the physicians.
After 5 months, seniors in the intervention and control groups were taking a mean of 12.4 and 12.2 medication units per day respectively (p = 0.50). There were no statistically significant differences in health care use or costs between groups. A mean of 2.5 drug-related problems per senior was identified in the intervention arm. Physicians implemented or attempted to implement 72.3% (790/1093) of the recommendations.
The intervention did not have a significant effect on patient outcomes. However, physicians were receptive to the recommendations to resolve drug-related problems, suggesting that collaboration between physicians and pharmacists is feasible.
Notes
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Comment In: CMAJ. 2003 Jul 8;169(1):30-112847036
PubMed ID
12847034 View in PubMed
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Recruiting family physicians and patients for a clinical trial: lessons learned.

https://arctichealth.org/en/permalink/ahliterature191738
Source
Fam Pract. 2002 Feb;19(1):99-104
Publication Type
Article
Date
Feb-2002
Author
John Sellors
Roxanne Cosby
Kristina Trim
Janusz Kaczorowski
Michelle Howard
Linda Hardcastle
Connie Sellors
Christel Woodward
Author Affiliation
Department of Family Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Source
Fam Pract. 2002 Feb;19(1):99-104
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Aged
Family Practice
Female
Humans
Male
Ontario
Patient Selection
Randomized Controlled Trials as Topic
Abstract
The randomized controlled trial (RCT) is the most definitive tool for evaluating an intervention. However, methodological deficiencies may limit the internal or external validity of the RCT.
Our aim was to describe the tactics used and the resources required randomly to select and recruit family physicians (FPs) and their patients aged 65 and older (seniors) for a community-based cluster RCT in primary care.
We randomly selected 48 FPs in 24 urban and rural sites in Southern Ontario, and 889 of their community-dwelling seniors (approximately 20 per FP) taking five or more medications daily. To accomplish this, the principal investigator (an FP) contacted the eligible FPs. The participating FPs' office staff then generated and contacted the roster of eligible seniors, with support provided by the research staff.
Of the 163 randomly selected FPs telephoned, 94 were ineligible and 48 (69.6%) of the remaining 69 participated. The rosters were generated with the assistance of the research staff (taking 1.5-8.0 hours) in each of the 48 practices, using electronic appointment records (n = 26), electronic billing records (n = 17), electronic medical records (n = 2) or written charts or file cards (n = 3). Of the 2078 seniors approached, 799 were ineligible and 889 (69.5%) of the remaining 1279 participated. Seniors' refusal rates among practices ranged from 4.8 to 62.3%.
Recruitment of a representative sample and generalizability of results are possible in RCTs in primary care. Involvement of an FP in physician recruitment and clinical research nurses who provided assistance to office staff were keys to success.
PubMed ID
11818358 View in PubMed
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8 records – page 1 of 1.