PURPOSE: Transitional care for adolescents with complex diseases, who are entering adulthood, is challenging. The purpose of this study is to quantify the disease and medication burden of this population, who are transitioning though an interdisciplinary specialty clinic. METHODS: This study is a retrospective observational study of all patients seen in a transitional care clinic between July 2012 and March 2015. The main outcomes assessed included disease state and medication burden. Descriptive statistics, along with the paired t-test and McNemar’s test, were used. RESULTS: The study cohort included 216 patients. The median patient age was 20.7 years, and the median number of clinic encounters was 6. Patients had at least 1 of 8 primary diagnoses. On average, patients took medications from 5 classes and used 3 dose forms. Among 163 patients who had medication reconciliation performed, the average number of medication classes increased by 0.44±1.53 ( p = 0.0003). There was an average increase of 3.70%(SD±36.31%; p = 0.27) in the number of required medication lab assessments ordered for patients who had medication reconciliation performed. CONCLUSION: There is a high disease and medication burden among adolescent patients with complex disease states who are to transition to adult care.

Purpose The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research. Method The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies' quality. Results The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5-15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students' educational outcomes related to SUDs and/or interprofessionalism. Conclusions Interprofessional SUD educational interventions improved health professions students' knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students' behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.

Purpose Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. Summary The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. Conclusion Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.

Journal Article The Cleveland Clinic Pharmacy Population Health Management Summit Get access Scott J. Knoer, M.S., Pharm.D., FASHP, Scott J. Knoer, M.S., Pharm.D., FASHP Cleveland Clinic, Cleveland, OH Address correspondence to Dr. Knoer (knoers@ccf.org). Search for other works by this author on: Oxford Academic Google Scholar Meghan D. Swarthout, Pharm.D., M.B.A., BCPS, Meghan D. Swarthout, Pharm.D., M.B.A., BCPS Ambulatory and Care Transitions, The Johns Hopkins Hospital, Baltimore, MD Search for other works by this author on: Oxford Academic Google Scholar Erick Sokn, Pharm.D., M.S., BCPS, Erick Sokn, Pharm.D., M.S., BCPS Transitions of Care, Cleveland Clinic, Cleveland, OH Search for other works by this author on: Oxford Academic Google Scholar Nirav Vakharia, M.D., Nirav Vakharia, M.D. Cleveland Clinic, Cleveland, OH Search for other works by this author on: Oxford Academic Google Scholar Trista Pfeiffenberger, Pharm.D., M.S., Trista Pfeiffenberger, Pharm.D., M.S. Network Pharmacy Programs, Community Care of North Carolina, Raleigh, NC Search for other works by this author on: Oxford Academic Google Scholar Gerard A. Greskovic, B.S.Pharm., CACP, CDE, Gerard A. Greskovic, B.S.Pharm., CACP, CDE Ambulatory Clinical Pharmacy Programs, Geisinger Health System, Danville, PA Search for other works by this author on: Oxford Academic Google Scholar Lindsey R. Kelley, Pharm.D., M.S., Lindsey R. Kelley, Pharm.D., M.S. Ambulatory Pharmacy Services, Michigan Medicine, Ann Arbor, MI Search for other works by this author on: Oxford Academic Google Scholar Amy Thompson, Pharm.D., BCACP, CDE, Amy Thompson, Pharm.D., BCACP, CDE Innovations and Partnerships, University of Michigan, Ann Arbor, MI Search for other works by this author on: Oxford Academic Google Scholar Thomas S. Achey, Pharm.D., M.S., BCPS, Thomas S. Achey, Pharm.D., M.S., BCPS Inpatient Pharmacy Services, Duke University Hospital, Durham, NC Search for other works by this author on: Oxford Academic Google Scholar Samuel V. Calabrese, M.B.A., B.S.Pharm., FASHP Samuel V. Calabrese, M.B.A., B.S.Pharm., FASHP Cleveland Clinic, Cleveland, OH Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 75, Issue 18, 15 September 2018, Pages 1421–1429, https://doi.org/10.2146/ajhp180081 Published: 15 September 2018

Background Asthma exacerbations leading to ED visits are prevalent (1 in 5 children/ year), associated with significant morbidity, health care utilization and even mortality. Among multiple predictors, recent exacerbation history is the strongest predictor of future exacerbations. This provides a window of opportunity to identify and educate high-risk asthmatics to reduce further exacerbation. Local problem At baseline, in our system, 52% of asthmatics did not have an assigned asthma severity in the problem list and there were 222 Emergency Department (ED) visits among high-risk asthmatics over a year. Objectives To improve classification of asthma into its severity in …

PURPOSEPharmacists' involvement in a population health initiative focused on chronic disease management is described.SUMMARYGeisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients.CONCLUSIONThe Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes.