BACKGROUND/RATIONALE:
VAMCs use various methods to contain costs and manage the medication formulary while maintaining and/or improving quality. These methods include physician education, formularies, involvement of physician champions, academic detailing, and collaborative practice models. VISN 11 has implemented several pharmaceutical programs to reduce medication expenditures by improving the quality, safety and evidence-based prescribing of outpatient pharmaceuticals. However, details regarding the intensity of the methods employed as well as the uptake and effects of these programs are poorly understood.

OBJECTIVE(S):
This proposal will further examine pharmaceutical programs that appear to be particularly effective and estimate the effort to implement key components.

METHODS:
This 5-year multi-method study will be divided into two phases of data collection and analysis. Phase 1 will use qualitative and quantitative methods to identify the types and extent of pharmaceutical strategies used across 7 facilities in VISN 11. Phase 2 will use VA clinical databases to examine patient level outcomes and pharmaceutical utilization to determine the uptake and impact of these programs.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
From phase 1, the application of team building and communication techniques from high reliability organizations may lead to improved patient safety and enhanced medical outcomes within VA primary care. From phase 2, the evaluations suggest that a collaborative care approach for hypertension and dyslipidemia treatment was effective. This model of care management supports the patient aligned care teams (PACT) model within VA primary care and further prospective, controlled studies are needed to confirm the findings.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Russ AL, Zillich AJ, McManus MS, Doebbeling BN, Saleem JJ. A human factors investigation of medication alerts: barriers to prescriber decision-making and clinical workflow. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2009 Nov 14; 2009:548-52. [view]
2. Zillich AJ, Corelli RL, Zbikowski SM, Magnusson LB, Fenlon CM, Prokhorov AV, de Moor C, Hudmon KS. A randomized trial evaluating 2 approaches for promoting pharmacy-based referrals to the tobacco quitline: methods and baseline findings. Research in social & administrative pharmacy : RSAP. 2013 Jan 1; 9(1):27-36. [view]
3. Gonzalvo J, Zillich A. Accuracy of automated community pharmacy-based blood pressure devices. Journal of the American Pharmacists Association : JAPhA. 2011 May 1; 51(3):408-11. [view]
4. Bex SD, Boldt AS, Needham SB, Bolf SM, Walston CM, Ramsey DC, Schmelz AN, Zillich AJ. Effectiveness of a hypertension care management program provided by clinical pharmacists for veterans. Pharmacotherapy. 2011 Jan 1; 31(1):31-8. [view]
5. Smith MC, Boldt AS, Walston CM, Zillich AJ. Effectiveness of a pharmacy care management program for veterans with dyslipidemia. Pharmacotherapy. 2013 Jul 1; 33(7):736-43. [view]
6. Schmelz AN, Nixon B, McDaniel A, Hudmon KS, Zillich AJ. Evaluation of an online tobacco cessation course for health professions students. American Journal of Pharmaceutical Education. 2010 Mar 10; 74(2):36. [view]
7. Zillich AJ, Jaynes HA, Snyder ME, Harrison J, Hudmon KS, de Moor C, French DD. Evaluation of specialized medication packaging combined with medication therapy management: adherence, outcomes, and costs among Medicaid patients. Medical care. 2012 Jun 1; 50(6):485-93. [view]
8. Snyder ME, Zillich AJ, Primack BA, Rice KR, Somma McGivney MA, Pringle JL, Smith RB. Exploring successful community pharmacist-physician collaborative working relationships using mixed methods. Research in social & administrative pharmacy : RSAP. 2010 Dec 1; 6(4):307-23. [view]
9. Russ AL, Zillich AJ, McManus MS, Doebbeling BN, Saleem JJ. Prescribers' interactions with medication alerts at the point of prescribing: A multi-method, in situ investigation of the human-computer interaction. International journal of medical informatics. 2012 Apr 1; 81(4):232-43. [view]
10. Corelli RL, Zillich AJ, de Moor C, Giuliano MR, Arnold J, Fenlon CM, Douglas CL, Magnusson B, Zbikowski SM, Prokhorov AV, Hudmon KS. Recruitment of community pharmacies in a randomized trial to generate patient referrals to the tobacco quitline. Research in social & administrative pharmacy : RSAP. 2013 Jul 1; 9(4):396-404. [view]
11. Doebbeling BN, Zillich AJ. Risk for Non-adherence and Other Drug Therapy problems among ambulatory patients utilizing a safety-net health system. Pharmacotherapy. 2011 Oct 31; 31(10):419e. [view]
12. McBane S, Trewet CB, Havican SN, Kiser K, Klingel C, Riche DM, Sease JM, Nau DP, Zillich AJ. Tenets for developing quality measures for ambulatory clinical pharmacy services. Pharmacotherapy. 2011 Jul 1; 31(7):723. [view]
13. Katz BP, Holmes AM, Stump TE, Downs SM, Zillich AJ, Ackermann RT, Inui TS. The Indiana Chronic Disease Management Program's impact on Medicaid claims: a longitudinal, statewide evaluation. Medical care. 2009 Feb 1; 47(2):154-60. [view]
14. Roth AM, Ackermann RT, Downs SM, Downs AM, Zillich AJ, Holmes AM, Katz BP, Murray MD, Inui TS. The structure and content of telephonic scripts found useful in a Medicaid Chronic Disease Management Program. Chronic Illness. 2010 Jun 1; 6(2):83-8. [view]
15. Zillich AJ, Hudmon KS, Damush T. Tobacco use and cessation among veterans recovering from stroke or TIA: a qualitative assessment and implications for rehabilitation. Topics in Stroke Rehabilitation. 2010 Mar 1; 17(2):140-50. [view]

Journal Other

1. Doebbeling BN, Russ AL, Saleem JJ, Zillich AJ. Computerized Medication Alerts and Prescriber Mental Models: Observing Routine Patient Care. [Abstract]. Human Factors and Ergonomics Society Annual Meeting Proceedings. 2009 Oct 1. [view]
2. Zillich AJ, Jaynes HA, Bex SD, Boldt AS, Ramsey DC, Walston CM, Bravata DM. Does a Pharmacist Care Management Care Management Program Improve Hypertension Outcomes for Veterans? [Abstract]. Pharmacotherapy. 2012 Oct 1; 32(20):205e-205e. [view]
3. Zillich AJ, Jayes HA, Bex SD, Blodt AS, Ramsey DC, Walston CM, Bravata DM. Does a Pharmacist Care Management Program Improve Hypertension Outcomes for Veterans? [Abstract]. Pharmacotherapy. 2012 Jun 1; 32(10):205e. [view]
4. Smith MC, Boldt AS, Walston CM, Zillich AJ. Effectiveness of a Pharmacy Care Management Program for Veterans with Dyslipidemia. [Abstract]. Pharmacotherapy. 2012 Jun 1; 32(10):205e. [view]
5. Frail CK, Synder ME, Jayes HA, Dunham P, Lewis J, Sutherland JM, Zillich AJ. Evaluation of a Telephonic Medication Therapy Management Service in a Home Health Population: An Operational Pilot. [Abstract]. Pharmacotherapy. 2012 Jun 1; 32(10):276e. [view]
6. Zillich AJ, French DD. Evaluation of Specialized Medication Packaging combined with Medication therapy management: adherence, outcomes and costs among Medicaid patients. [Abstract]. Pharmacotherapy. 2011 Oct 31; 31(10):340e. [view]
7. Russ AL, Saleem JJ, Zillich AJ. Qualitative Study of Medication Alerts and Computerized Prescriber Order Entry (CPOE): Opportunities for Pharmacist Consultation at the Point of Prescribing. [Abstract]. Journal of the American Pharmacists Association : JAPhA. 2010 Jan 1; 50(2):284-285. [view]
8. Chen S, Melton BL, Saleem JJ, Johnson E, Weiner M, Russell S, McManus MS, Doebbeling BN, Russ AL. The Effect of Redesigned Computerized Drug-Drug Interaction Alerts on Medication Errors and Prescribing Efficiency. [Abstract]. Value in health : the journal of the International Society for Pharmacoecon. 2013 May 1; 16(3):A13. [view]
9. Melton BL, Russ AL, Zillich AJ, McManus MS, Weiner M. The Reply. The American journal of medicine. 2016 Jul 1; 129(7):e97. [view]
10. Frankel RM, Russ AL, Saleem JJ, Zillich AJ. The Workflow of Computerized Medication Ordering in Primary Care is Not Prescriptive. [Abstract]. Human Factors and Ergonomics Society Annual Meeting Proceedings. 2010 Sep 27; 54(1):840-4. [view]
11. Saleem JJ, Russ AL, Zillich AJ. Usability Testing to Refine a Pharmacogenomic-Guided Warfarin clinical decision support system. [Abstract]. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 2011 Oct 26; 10(2):1888. [view]

Newspaper Articles

1. Kobylinski AL, Zillich AJ, Russ AL. Redesigning Medication Alerts to Support Prescriber Decision-Making. Topics in Patient Safety (TIPS). 2012 Nov 1: 1: 2. [view]

Center Products

1. Zillich AJ. Invited Speaker, Tobacco Cessation for Veterans Affairs Pharmacy Benefits Management (VA PBM) Clinical Pharmacy Training Program. 2011 Aug 1. [view]

Conference Presentations

1. Russ AL, Zillich AJ, McManus MS, Doebbeling BN, Saleem JJ. 9 Factors that Influence Prescribers' Response to VA Medication Safety Checks at the Point-of-Care. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 14; National Harbor, MD. [view]
2. Doebbeling BN, Russ AL, Saleem JJ, Zillich AJ. A Human Factors Investigation of Medication Alerts: Barriers to Prescriber Decision-Making and Clinical Workflow. Paper presented at: American Medical Informatics Association Annual Symposium; 2009 Nov 18; San Francisco, CA. [view]
3. Doebbeling BN, Zillich AJ, Jaynes HA, Schmelz AN, Gonzalvo JD. A qualitative study of communication between physicians and pharmacists: Implications for Patient Safety. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2010 Apr 28; Minneapolis, MN. [view]
4. Fu SS, Roth C, Battaglia C, Nelson D, Farmer MM, Do T, Goldstein MG, Kavathekar R, Widome R, Hagedorn HJ, Zillich AJ. A Randomized Trial of Two Approaches to Training Veterans Affairs (VA) Medical Home Healthcare Providers on Motivational Interviewing for Tobacco Cessation. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 24; Denver, CO. [view]
5. Zillich AJ. ACCP Practice-Based Research Network Ask the Experts Roundtable. Paper presented at: American College of Clinical Pharmacy Annual Meeting; 2012 Oct 21; Hollywood, FL. [view]
6. Zillich AJ. ACE Inhibitors in Patients with Baseline Kidney Dysfunction...Should they be Prescribed? Paper presented at: American College of Clinical Pharmacy Annual Meeting; 2012 Oct 21; Hollywood, FL. [view]
7. Russ AL, Zillich AJ, Melton B, Spina J, Weiner M, Russell SA, McManus MS, Kobylinski A, Doebbeling BN, Hawsey J, Puleo A, Johnson E, Saleem JJ. Applying Human Factors Principles to Improve Medication Alerts. Paper presented at: American Medical Informatics Association Annual Symposium; 2012 Nov 3; Chicago, IL. [view]
8. Frankel RM, Kobylinski AL, Zillich AJ. Are Pharmacy Schools producing healthcare professionals that will uphold a culture of safety? Poster session presented at: American Society of Health-System Pharmacists Clinical Midyear Meeting; 2011 Dec 10; New Orleans, LA. [view]
9. Zillich AZ. Collaboration Among Physicians and Pharmacists in VA Primary Care. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Indianapolis, IN. [view]
10. Doebbeling BN, Russ AL, Saleem JJ, Zillich AJ. Computerized Medication Alerts and Prescriber Mental Models: Observing Routine Patient Care. Paper presented at: Human Factors and Ergonomics Society Annual Meeting; 2009 Oct 19; San Antonio, TX. [view]
11. Zillich AJ. Do Ask, Do Tell: A Practical Approach to Smoking Cessation. Paper presented at: Michigan Pharmacists Association Annual Convention; 2009 Feb 1; Detroit, MI. [view]
12. Zillich AJ, Jaynes HA, Bex SD, Boldt AS, Ramsey DC, Walston CM, Sutherland JM, Bravata DM. Does a Pharmacist Care Management Program Improve Hypertension Outcomes for Veterans? Paper presented at: American College of Clinical Pharmacy Annual Meeting; 2012 Oct 21; Hollywood, FL. [view]
13. Zillich AJ, Jaynes HA, Bex SD, Blodt AS, Ramsey DC, Walston C, Bravata DM. Does a Pharmacist Care Management Program Improve Hypertension Outcomes in Veterans? Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD. [view]
14. Zillich AJ. Effectiveness of a Collaborative Care Management Program for Veterans with Hypertension. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2010 Apr 29; Minneapolis, MN. [view]
15. Smith MC, Boldt AS, Walston CM, Zillich AJ. Effectiveness of a Pharmacy Care Management Program for Veterans with Dyslipidemia. Poster session presented at: American College of Clinical Pharmacy Annual Meeting; 2012 Oct 21; Hollywood, FL. [view]
16. Frail CK, Snyder ME, Jaynes HA, Dunham P, Lewis J, Sutherland JM, Zillich AJ. Evaluation of a Telephonic Medication Therapy Management Service in a Home Health Population: An Operational Pilot. Poster session presented at: American College of Clinical Pharmacy Annual Meeting; 2012 Oct 21; Hollywood, FL. [view]
17. Zillich AJ. Evaluation of Biostatistical Knowledge in a Cohort of Midwestern Pharmacy Residents. Presented at: Drug Information Association Medical Communications Annual Workshop; 2009 Mar 1; Hilton Head, SC. [view]
18. Zillich AJ. How Physicians and Pharmacists Communicate: Implications for Patient Safety. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2010 Feb 25; San Francisco, CA. [view]
19. Zillich AJ. Implementation of Evidence-Based Strategies for Pharmaceutical Care. Paper presented at: VA HSR&D Career Development Annual Meeting; 2011 Feb 16; National Harbor, MD. [view]
20. Russ AL, Saleem JJ, Zillich AJ. Medication Order Checks: Design Implications for Prescriber Workflow. Poster session presented at: VA Pharmacy Benefits Management Annual Conference; 2010 May 18; Salt Lake City, UT. [view]
21. Zillich AJ. Pharmacy Health Services Research—An Intersection of Mixed Methods and Informatics. Paper presented at: American College of Clinical Pharmacy Practice and Research Spring Forum; 2010 Apr 23; Charlotte, NC. [view]
22. Chen S, Zillich AJ, Melton BL, Saleem JJ, Johnson E, Weiner M, Russell SA, McManus MS, Doebbeling BN, Russ AL. Redesigned Drug-Drug Interaction Alerts Reduced Medication Errors and Improved Prescribing Efficiency. Paper presented at: Great Lakes Pharmacy Resident Annual Conference; 2013 Apr 24; West Lafayette, IN. [view]
23. Doebbeling BN, Zillich AJ. Risk for non-adherence and other drug therapy problems among ambulatory patients utilizing a safety-net health-system. Poster session presented at: American College of Clinical Pharmacy Annual Meeting; 2011 Sep 12; Chicago, IL. [view]
24. Zillich AJ. The ACCP PBRN. Paper presented at: American College of Clinical Pharmacy Annual Meeting; 2011 Oct 20; Buffalo, NY. [view]
25. Chen S, Zillich AJ, Melton BL, Saleem JJ, Johnson E, Weiner M, Russell SA, McManus MS, Doebbeling BN, Russ AL. The Effect of Redesigned Computerized Drug-Drug Interaction Alerts on Medication Errors and Prescribing Efficiency. Poster session presented at: International Society for Pharmacoeconomics and Outcomes Research Annual Meeting; 2013 May 18; New Orleans, LA. [view]
26. Frankel RM, Russ AL, Saleem JJ, Zillich AJ. The Workflow of Computerized Medication Ordering in Primary Care is Not Prescriptive. Paper presented at: Human Factors and Ergonomics Society Annual Meeting; 2010 Sep 27; San Francisco, CA. [view]
27. Zillich AJ, Hudmon KS, Himstreet JE, Belperio PS, Bolduc JA, Cyr M, Jorgensen KR, Pruski DM, Cruz MP, Cushnie S, Jaynes HA, Chen TC. Tobacco Cessation Training for Veterans Affairs Pharmacists: A Clinical Pharmacy Boot Camp. Poster session presented at: American Association of Colleges of Pharmacy Annual Meeting; 2012 Jun 1; Kissimmee, FL. [view]

DRA: Health Systems
DRE: Treatment - Observational
Keywords: none
MeSH Terms: none