Pharmacy Practice Outcomes
Prognosis (Greek πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely outcome of one's current standing. When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because previous research found that this proportion of patients died. However, it is much harder to translate this into a prognosis for an individual patient: additional information is needed to determine whether a patient belongs to the 45% who will die, or to the 55% who survive.
Disease and prognostic indicators
Prognostic scoring is also used for cancer outcome predictions. A Manchester score is an indicator of prognosis in small-cell lung cancer. For Non-Hodgkin lymphoma, physicians have developed the International Prognostic Index to predict patient outcome.
Other medical areas where prognostic indicators are used is in Drug-Induced Liver Injury (DILI) (Hy's law) and use of an exercise stress test as a prognostic indicator after myocardial infarction.
End of life
Medical studies have demonstrated that most doctors are overly optimistic when giving prognostic information, that is, they tend to overstate how long a patient might live. For patients who are critically ill, particularly those in an intensive care unit, there are numerical prognostic scoring systems that are more accurate. The most famous of these is the APACHE II scale. However, this scale is most accurate when applied in the seven days prior to a patient's predicted death.
Knowing the prognosis helps determine whether it makes more sense to attempt certain treatments or to withhold them, and thus plays an important role in end-of-life decisions.
Estimator
Estimators that are commonly used to describe prognoses include:
Clinical endpoint
A clinical endpoint is included in the entities of interest in a trial. The results of a clinical trial generally indicate the number of people enrolled who reached the pre-determined clinical endpoint during the study interval compared with the overall number of people who were enrolled. Once a patient reaches the endpoint, he or she is generally excluded from further experimental intervention (the origin of the term endpoint).
For example, a clinical trial investigating the ability of a medication to prevent heart attack might use chest pain as a clinical endpoint. Any patient enrolled in the trial who develops chest pain over the course of the trial, then, would be counted as having reached that clinical endpoint. The results would ultimately reflect the fraction of patients who reached the endpoint of having developed chest pain, compared with the overall number of people enrolled.
When an experiment involves a control group, the proportion of individuals who reach the clinical endpoint after an intervention is compared with the proportion of individuals in the control group who reached the same clinical endpoint, reflecting the ability of the intervention to prevent the endpoint in question.
In clinical cancer research, common endpoints include discovery of local recurrence, discovery of regional metastasis, discovery of distant metastasis, onset of symptoms, hospitalization, increase or decrease in pain medication requirement, onset of toxicity, requirement of salvage chemotherapy, requirement of salvage surgery, requirement of salvage radiotherapy, death from any cause or death from disease. A cancer study may be powered for overall survival, usually indicating time until death from any cause, or disease specific survival, where the endpoint is death from disease or death from toxicity
Physician‐pharmacist collaboration
Health reform has stimulated exploration of innovative care and payment reform models that can improve access to care, provide quality care, contain costs, and afford safe use of medications and other pertinent medication‐related issues. The federal sector has already implemented and embraced such a health care delivery model through physician‐pharmacist collaboration. This collaboration, through extensive performance data, has demonstrated that
patient care services delivered by pharmacists can improve patient outcomes, promote patient involvement, increase cost‐efficiency, and reduce demands affecting the health care system.
For over forty years, federal pharmacists have collaboratively managed disease through medication use, and other cognitive and clinical pharmacy services. Although these models are accepted in the non‐federal sector, utilization is often impeded due to policy, legislation, and compensation barriers that will be discussed in this Report.
An opportunity exists for health leadership and policy makers to support and implement additional, existing and evidence‐based models of cost‐effective pharmacist‐delivered patient care as the following demands within our health system escalate:
Chronic Care. Chronic diseases are the leading causes of death and disability in the United States. Chronic diseases currently affect 45% of the population (133 million Americans), account for 81% of all hospital admissions, 91% of all prescriptions filled, 76% of physician visits, and continues to grow at dramatic rates. Additionally, of all Medicare spending, 99% goes to beneficiaries with chronic disease.
Access to care. Medically underserved patients seeking a health care home and the growth of primary care visits are two components that lead to insufficient time for focused or comprehensive disease or medication management and other related health care issues.
Provider workforce. The primary care workforce may not be able to meet the demands of increased access to care. Physician shortages and maldistribution of health care providers impact how we address this issue. The proportion of newly graduated U.S. medical students who choose primary care as a career has declined by 50% since 1997. Currently, it is estimated that over 56 million Americans lack adequate access (not coverage) to primary
health care because of shortages of primary care physicians in their communities. As millions of new beneficiaries enter the health care system, the situation will most likely worsen.
Outcomes Related Websites
A Program Guide for Public Health - Centers for Disease
CDC - DHDSP - Heart Disease Facts
CDC Heart Disease Fact Sheet - Centers for Disease
CDC - DHDSP - Heart Disease Facts and Statistics
Clinical Decision Support Systems (CDSS)
Clinical Pharmacists in Emergency Medicine - Advances in Patient
FASTSTATS - Deaths and Mortality - Centers for Disease
Medication Therapy Management in Pharmacy Practice: Core
Collaborative Practice Agreements and Pharmacists' Patient
Heart Disease - Centers for Disease Control and Prevent
Improving Patient and Health System Outcomes through Advanced Pharmacy Practice
Program-Level, Ability-Based Outcomes for PharmD
Improving Patient and Health System Outcomes
The Medication Adherence Project (MAP). Toolkit
Stanford Hospital and Clinics Pharmacy Services
Scope of contemporary pharmacy practice: Roles, responsibilities
Ability of pharmacy clinical decision-support software to alert users
Users' Guides to Evidence-Based Practice
The Science and Art of Mapping Risk-Benefit Analyses in Clinical
What is Clinical Informatics? | HIMSS
Clinical Surveillance: Clinical Decision-Support Systems in ... - ProCE
USF College of Pharmacy » Pharmacogenomics: Why Pharmacists?
Knowledge is power: Evidence-based clinical decisions lead
Right Care Initiative-Promising Best Practices
UpToDate: Evidence-Based Clinical Decision Support
Various resources available to help you make the right
Pharmacy Exceptions and Appeals for Healthcare Providers
Clinical Pharmacy, Pharmaceutical Care, and the Quality
Prognosis (Greek πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely outcome of one's current standing. When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because previous research found that this proportion of patients died. However, it is much harder to translate this into a prognosis for an individual patient: additional information is needed to determine whether a patient belongs to the 45% who will die, or to the 55% who survive.
Disease and prognostic indicators
Prognostic scoring is also used for cancer outcome predictions. A Manchester score is an indicator of prognosis in small-cell lung cancer. For Non-Hodgkin lymphoma, physicians have developed the International Prognostic Index to predict patient outcome.
Other medical areas where prognostic indicators are used is in Drug-Induced Liver Injury (DILI) (Hy's law) and use of an exercise stress test as a prognostic indicator after myocardial infarction.
End of life
Medical studies have demonstrated that most doctors are overly optimistic when giving prognostic information, that is, they tend to overstate how long a patient might live. For patients who are critically ill, particularly those in an intensive care unit, there are numerical prognostic scoring systems that are more accurate. The most famous of these is the APACHE II scale. However, this scale is most accurate when applied in the seven days prior to a patient's predicted death.
Knowing the prognosis helps determine whether it makes more sense to attempt certain treatments or to withhold them, and thus plays an important role in end-of-life decisions.
Estimator
Estimators that are commonly used to describe prognoses include:
- Progression-free survival - the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse.
- Survival rate - indicating the percentage of people in a study or treatment group who are alive for a given period of time after diagnosis.
- Survival time - the remaining duration of life. If not otherwise specified, it generally starts from the time of diagnosis.
Clinical endpoint
A clinical endpoint is included in the entities of interest in a trial. The results of a clinical trial generally indicate the number of people enrolled who reached the pre-determined clinical endpoint during the study interval compared with the overall number of people who were enrolled. Once a patient reaches the endpoint, he or she is generally excluded from further experimental intervention (the origin of the term endpoint).
For example, a clinical trial investigating the ability of a medication to prevent heart attack might use chest pain as a clinical endpoint. Any patient enrolled in the trial who develops chest pain over the course of the trial, then, would be counted as having reached that clinical endpoint. The results would ultimately reflect the fraction of patients who reached the endpoint of having developed chest pain, compared with the overall number of people enrolled.
When an experiment involves a control group, the proportion of individuals who reach the clinical endpoint after an intervention is compared with the proportion of individuals in the control group who reached the same clinical endpoint, reflecting the ability of the intervention to prevent the endpoint in question.
In clinical cancer research, common endpoints include discovery of local recurrence, discovery of regional metastasis, discovery of distant metastasis, onset of symptoms, hospitalization, increase or decrease in pain medication requirement, onset of toxicity, requirement of salvage chemotherapy, requirement of salvage surgery, requirement of salvage radiotherapy, death from any cause or death from disease. A cancer study may be powered for overall survival, usually indicating time until death from any cause, or disease specific survival, where the endpoint is death from disease or death from toxicity
Physician‐pharmacist collaboration
Health reform has stimulated exploration of innovative care and payment reform models that can improve access to care, provide quality care, contain costs, and afford safe use of medications and other pertinent medication‐related issues. The federal sector has already implemented and embraced such a health care delivery model through physician‐pharmacist collaboration. This collaboration, through extensive performance data, has demonstrated that
patient care services delivered by pharmacists can improve patient outcomes, promote patient involvement, increase cost‐efficiency, and reduce demands affecting the health care system.
For over forty years, federal pharmacists have collaboratively managed disease through medication use, and other cognitive and clinical pharmacy services. Although these models are accepted in the non‐federal sector, utilization is often impeded due to policy, legislation, and compensation barriers that will be discussed in this Report.
An opportunity exists for health leadership and policy makers to support and implement additional, existing and evidence‐based models of cost‐effective pharmacist‐delivered patient care as the following demands within our health system escalate:
Chronic Care. Chronic diseases are the leading causes of death and disability in the United States. Chronic diseases currently affect 45% of the population (133 million Americans), account for 81% of all hospital admissions, 91% of all prescriptions filled, 76% of physician visits, and continues to grow at dramatic rates. Additionally, of all Medicare spending, 99% goes to beneficiaries with chronic disease.
Access to care. Medically underserved patients seeking a health care home and the growth of primary care visits are two components that lead to insufficient time for focused or comprehensive disease or medication management and other related health care issues.
Provider workforce. The primary care workforce may not be able to meet the demands of increased access to care. Physician shortages and maldistribution of health care providers impact how we address this issue. The proportion of newly graduated U.S. medical students who choose primary care as a career has declined by 50% since 1997. Currently, it is estimated that over 56 million Americans lack adequate access (not coverage) to primary
health care because of shortages of primary care physicians in their communities. As millions of new beneficiaries enter the health care system, the situation will most likely worsen.
Outcomes Related Websites
A Program Guide for Public Health - Centers for Disease
CDC - DHDSP - Heart Disease Facts
CDC Heart Disease Fact Sheet - Centers for Disease
CDC - DHDSP - Heart Disease Facts and Statistics
Clinical Decision Support Systems (CDSS)
Clinical Pharmacists in Emergency Medicine - Advances in Patient
FASTSTATS - Deaths and Mortality - Centers for Disease
Medication Therapy Management in Pharmacy Practice: Core
Collaborative Practice Agreements and Pharmacists' Patient
Heart Disease - Centers for Disease Control and Prevent
Improving Patient and Health System Outcomes through Advanced Pharmacy Practice
Program-Level, Ability-Based Outcomes for PharmD
Improving Patient and Health System Outcomes
The Medication Adherence Project (MAP). Toolkit
Stanford Hospital and Clinics Pharmacy Services
Scope of contemporary pharmacy practice: Roles, responsibilities
Ability of pharmacy clinical decision-support software to alert users
Users' Guides to Evidence-Based Practice
The Science and Art of Mapping Risk-Benefit Analyses in Clinical
What is Clinical Informatics? | HIMSS
Clinical Surveillance: Clinical Decision-Support Systems in ... - ProCE
USF College of Pharmacy » Pharmacogenomics: Why Pharmacists?
Knowledge is power: Evidence-based clinical decisions lead
Right Care Initiative-Promising Best Practices
UpToDate: Evidence-Based Clinical Decision Support
Various resources available to help you make the right
Pharmacy Exceptions and Appeals for Healthcare Providers
Clinical Pharmacy, Pharmaceutical Care, and the Quality