title: Optimizing finite resources: Pharmacist chart reviews in an outpatient kidney transplant clinic.
abstract: OBJECTIVE
  To determine if a pharmacist-executed comprehensive chart review could serve as sufficient substitution for direct participation during outpatient clinic visits in the postdischarge follow-up treatment of kidney transplant recipients.
  
  
  METHODS
  Retrospective, longitudinal, cross-sectional study.
  
  
  METHODS
  Acute and chronic transplant clinics at the Medical University of South Carolina, Charleston, SC.
  
  
  METHODS
  219 individual kidney transplant recipients.
  
  
  METHODS
  Effectiveness of chart review assessments (with written notes) as compared with in-clinic assessments (with verbal communication with transplant providers followed by documentation by pharmacists). An independent transplant provider graded pharmacist recommendations by severity. All recommendations were compared with the provider's plan to determine if the recommendations were incorporated.
  
  
  RESULTS
  During the 3-month study period, 170 pharmacist chart reviews were written and 175 clinic visits involved direct pharmacist participation. Providers accepted a greater percentage of recommendations that were delivered directly compared with recommendations presented via a note in the patient folder following chart review (92% vs. 28%, respectively; P <0.0001). Directly provided recommendations were also associated with higher severity scores.
  
  
  CONCLUSIONS
  The results of this study suggest that comprehensive chart review by pharmacists prior to patient clinic visits may not be as effective as in-person consultation in communicating recommendations to providers. Further research is needed in similar clinic settings.
authors.affiliation: Solid Organ Transplant Pharmacy Resident, Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC. Electronic address: staino@musc.edu.
authors.forename: Carmelina
authors.initials: C
authors.lastname: Staino
authors.affiliation: Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC.
authors.forename: Nicole
authors.initials: N
authors.lastname: Pilch
authors.affiliation: Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC.
authors.forename: Sweta
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Trobaugh
authors.affiliation: Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC.
authors.forename: James
authors.initials: J
authors.lastname: Fleming
authors.affiliation: Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC.
authors.forename: Holly
authors.initials: H
authors.lastname: Meadows
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: David
authors.initials: D
authors.lastname: Taber
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Titte R
authors.initials: TR
authors.lastname: Srinivas
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Prabhakar
authors.initials: P
authors.lastname: Baliga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008499:Medical Records; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010348:Patient Care Team; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D024382:Professional Role; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013022:South Carolina; D013997:Time Factors; D066027:Transplant Recipients; D055815:Young Adult