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4012 Positive Deviants for Medication Therapy Management: A Mixed-Methods Comparative Case Study of Community Pharmacy Practices
- Omolola A Adeoye-Olatunde, Leslie M. Lake, Karen S. Hudmon, Alan J. Zillich, Margie E. Snyder
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue s1 / June 2020
- Published online by Cambridge University Press:
- 29 July 2020, pp. 142-143
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OBJECTIVES/GOALS: To optimize medication use in older adults, Medication Therapy Management (MTM) was launched as part of Medicare Prescription Drug (Part D) policy. The objective of this study was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on policy relevant MTM quality measures. METHODS/STUDY POPULATION: This mixed-methods comparative case study design incorporated two conceptual models; the Positive Deviance model and Chronic Care Model. The study population consisted of pharmacy staff employed by a Midwestern division of a national supermarket-community pharmacy chain. Data consisted of semi-structured interviews and demographics. Qualitative and quantitative data were analyzed abductively or using descriptive statistics, respectively. Case comparisons were synthesized using the Framework Method. MTM quality measures used to evaluate participant pharmacies’ MTM performance mirrored quality measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 Medicare Part D Plan’ Star Rating measures. RESULTS/ANTICIPATED RESULTS: Staff at 13 of the 18 selected pharmacies (72.2%) participated in interviews. Interviewees included 11 pharmacists, 11 technicians and three student interns. Strategies hypothesized as contributing to MTM performance included: 1. Strong pharmacist-provider relationships and trust, 2. Inability to meet patients’ cultural, linguistic, and socioeconomic needs (negatively contributing), 3. Technician involvement in MTM, 4. Providing comprehensive medication reviews in person vs. phone alone, 5. Placing high priority on MTM, 6. Using maximum number of clinical information systems (CISs) to identify eligible patients. 7. Technicians using CISs to collect information for pharmacists, 8. Faxing prescribers adherence medication therapy problems (MTPs) and calling on indication MTPs. DISCUSSION/SIGNIFICANCE OF IMPACT: Our study resulted in eight strategies hypothesized to contribute to community pharmacy performance on MTM quality measures. To inform MTM policy recommendations, future research should engage stakeholders to assist with prioritizing hypotheses to be tested in a larger representative sample of pharmacies. CONFLICT OF INTEREST DESCRIPTION: This research was supported, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by grant number TL1TR001107 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. Dr. Adeoye-Olatunde is a part-time employee and Dr. Lake is a full-time employee at the Midwestern division, national supermarket-community pharmacy chain, where study procedures were conducted. Dr. Snyder reports personal fees from Westat, Inc., outside the submitted work.
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. 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- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Even a theory-theory needs information processing: ToMM, an alternative theory-theory of the child's theory of mind
- Alan M. Leslie, Tim P. German, Francesca G. Happé
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- Journal:
- Behavioral and Brain Sciences / Volume 16 / Issue 1 / March 1993
- Published online by Cambridge University Press:
- 04 February 2010, pp. 56-57
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Contributors
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- By Osvaldo P. Almeida, Rebecca Anglin, Vivek Benegal, Margaret N. Berry, Nash N. Boutros, Henry Brodaty, Alan S. Brown, Monte S. Buchsbaum, William Burke, Kim Burns, Stanley V. Catts, Vibeke S. Catts, Jennifer M. Connolly, David L. Copolov, Louisa Degenhardt, Stewart L. Einfeld, Anthony Feinstein, Matt P. Galloway, Bangalore N. Gangadhar, Wayne Hall, Malcolm Hopwood, Michael D. Jibson, Ripu D. Jindal, David J. Kavanagh, Sophie Kavanagh, Matcheri S. Keshavan, Ennapadam S. Krishnamoorthy, Rajeev Kumar, Alexander F. Kurz, Nicola T. Lautenschlager, Edward C. Lauterbach, Leslie Lester-Burns, Lyn-May Lim, Jeffrey C. L. Looi, Michael Mazurek, Serge A. Mitelman, Ramon Mocellin, Bryan Mowry, Kim T. Mueser, Anand K. Pandurangi, Eric M. Pihlgren, Seethalakshmi Ramanathan, Patricia I. Rosebush, Perminder S. Sachdev, Richard D. Sanders, Vandana Shashi, Arabella Smith, Sergio E. Starkstein, Ezra S. Susser, Rajiv Tandon, Jagadisha Thirthalli, Bruce J. Tonge, Julian Trollor, Dennis Velakoulis, Mark Walterfang, Jane Zhang
- Edited by Perminder S. Sachdev, University of New South Wales, Sydney, Matcheri S. Keshavan
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- Secondary Schizophrenia
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- 05 August 2011
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- 04 February 2010, pp vii-xii
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- By Annie S. Anderson, James Barry, Eve Blair, Laura Brown, Sirinuch Chomtho, Rana Conway, Adrienne Cullum, Alan T. Davis, Mary Fewtrell, Lorraine Gambling, Y. Ingrid Goh, William W. Hay, William C. Heird, Louise Kenny, Christopher H. Knight, Wing Yee Kwong, Barbara Luke, Harry J. McArdle, Fergus McCarthy, Karin B. Michels, Ian M. Morison, Leslie Myatt, James D. Paauw, Theresa Powell, Shobha Rao, Tim Regnault, Wolf Reik, Jacques Rigo, Paul Rozance, Thibault Senterre, Kevin D. Sinclair, Alison C. Tse, Wendy L. Wrieden, Chittaranjan Yajnik
- Edited by Michael E. Symonds, University of Nottingham, Margaret M. Ramsay, University of Nottingham
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- Maternal-Fetal Nutrition During Pregnancy and Lactation
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- 26 February 2010
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- 28 January 2010, pp vi-viii
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Mind and Emotion. By G. Mandler. (Pp. 280; $14.50.) Robert E. Krieger: Melbourne, Florida. 1982.
- Alan M. Leslie
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- Psychological Medicine / Volume 14 / Issue 1 / February 1984
- Published online by Cambridge University Press:
- 09 July 2009, pp. 239-241
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Autism and ostensive communication: The relevance of metarepresentation
- Alan M. Leslie, Francesca Happé
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- Development and Psychopathology / Volume 1 / Issue 3 / July 1989
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- 31 October 2008, pp. 205-212
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Recent empirical and theoretical work on both normal and pathological development has led to the formulation of the metarepresentational conjecture for autism. This account of autistic development links the core impairments in imaginative abilities, communicative skills, and social competence to dysfunction of a single set of underlying cognitive mechanisms. In this context, Mundy and Sigman (1989) argue that the impairment of early gestural communication in autism cannot be accounted for by the metarepresentational theory. On the contrary, this early communication impairment in autism is highly consistent with a faulty theory-of-mind module. In normal development, this module is available from around the first year to handle estensive communication – shared pretense being a prime, though slightly later, example. We briefly consider the role in communication of perceptual processes that may trigger metarepresentation. This early theory-of-mind module, with its metarepresentational processes, provides the specific developmental basis for later versions of the child's theory of mind.
Impact of the San Diego County Firestorm on Emergency Medical Services
- Gary M. Vilke, Alan M. Smith, Barbara M. Stepanski, Leslie Upledger Ray, Patricia A. Murrin, Theodore C. Chan
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- Journal:
- Prehospital and Disaster Medicine / Volume 21 / Issue 5 / October 2006
- Published online by Cambridge University Press:
- 28 June 2012, pp. 353-358
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- October 2006
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Background:
In October 2003, San Diego County, California, USA, experienced the worst firestormin recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.
Methods:A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.
Results:During the firestorm, fire consumed >380,000 acres (>938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.
Conclusion:Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, therewere a number of lessons learned that can be used in future events.
No (social) construction without (meta-)representation: Modular mechanisms as a basis for the capacity to acquire an understanding of mind
- Tim P. German, Alan M. Leslie
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- Journal:
- Behavioral and Brain Sciences / Volume 27 / Issue 1 / February 2004
- Published online by Cambridge University Press:
- 01 February 2004, pp. 106-107
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Theories that propose a modular basis for developing a “theory of mind” have no problem accommodating social interaction or social environment factors into either the learning process, or into the genotypes underlying the growth of the neurocognitive modules. Instead, they can offer models which constrain and hence explain the mechanisms through which variations in social interaction affect development. Cognitive models of both competence and performance are critical to evaluating the basis of correlations between variations in social interaction and performance on mental state reasoning tasks.
5 - ToMM, ToBY, and Agency: Core architecture and domain specificity
- Edited by Lawrence A. Hirschfeld, University of Michigan, Ann Arbor, Susan A. Gelman, University of Michigan, Ann Arbor
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- Mapping the Mind
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- 04 August 2010
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- 29 April 1994, pp 119-148
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Summary
Our understanding of Agency is, in part, the result of domain-specific learning. The nature of this domain-specific learning needs to be understood in relation to the organization of information processing in the infant. As a result of adaptive evolution, the infant is a specialized processor of information with an architecture that (in part) reflects properties of the world. On this assumption, it should be possible to establish links between properties of the world, processing subsystems specialized for tracking those properties, and domains of knowledge. It is argued in the case of Agency that three main classes of world properties are reflected in three corresponding processing subsystems producing three distinct levels of knowledge. These three related triples are, respectively, mechanical Agency, actional Agency, and attitudinal Agency. Each of these three linked property classes, processing subsystems, and knowledge levels are discussed in turn but the focus will be mainly on mechanical Agency. In developing these ideas this discussion deals more generally with the nature of early mechanical understanding and its relation to conceptual development. A number of the ideas put forward in Leslie (1988) are revised and extended.
One lesson of cognitive science is that different types of knowledge often have different locations within the global organization of human information processing. In development, different types of commonsense knowledge may originate from different locations in core cognitive architecture. Early mechanical understanding and the notion of Agency can be studied within such a framework.