JEANETTE WAXMONSKY, PhD
University of Colorado

Shared medical appointments (SMAs) for patients with diabetes are an evidence-based and potentially efficient approach to provide self-management education and support in a group setting. For sustainability planning, we evaluated personnel time and other costs for delivering diabetes SMAs in primary care.

Twenty two practices were randomized and trained to deliver standardized or patient-driven models of diabetes SMAs in a comparative effectiveness study. Both models included six two-hour sessions using the Targeted Training in Illness Management curriculum for groups of approximately 5-15 patients. Standardized SMAs were delivered by a health educator with accompanying prescribing provider visits. Patient-driven SMAs further incorporated behavioral health providers, peer mentors, and patient-led topic prioritization (expected to yield better value albeit with higher costs).

Practices were surveyed regarding personnel time for SMA delivery and support and additional resources needed (e.g., travel, materials, overhead) for start-up (prior to first cohort), and initial delivery phases (after completing first cohort).

Starting-up standardized and patient-driven SMA models required similar amount of personnel time on average (46 vs. 45 hrs.). Delivering patient-driven SMAs on average required more personnel hours (75 hours) than standardized SMAs (50 hours). Other costs for patient-driven SMAs on average were higher for both start-up ($957 vs. $1,717) and initial delivery ($137 vs. $177). Overall, hours and other costs varied greatly by practice, as indicated by wide ranges reported in both hours spent (min = 12 hrs., max = 135 hrs.) and other costs (min = $0, max = $802).

Reported costs of delivering diabetes SMAs varied considerably among practices, both in personnel time and other expenditures. As expected, delivering a model with a larger team involved more hours during implementation than an approach with fewer personnel, plus modest increases in other costs. Practices seeking to implement diabetes SMAs should consider what elements of SMAs are most important to their patients and the resources required relative to reimbursement for each model.

SHARON LANG, BA
Brown University School of Public Health

Promotion of evidence-based practices (EBPs) often hinges upon training workshops designed to help counselors deliver EBPs with fidelity. The COVID-19 pandemic necessitated a rapid shift from in-person to virtual workshop training, yet the relative effectiveness and cost-effectiveness of these modalities is unknown. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) is an ongoing cluster-randomized hybrid type 3 trial examining strategies to implement contingency management (CM), a behavioral EBP, across opioid treatment programs. Counselors from the first cohort received in-person workshop training, whereas counselors from the second cohort received virtual workshop training. The shift to virtual training as a response to federal guidelines of social distancing presented a rare opportunity to compare the modalities. This study compared the effectiveness and cost-effectiveness of in-person and virtual training workshops for equipping opioid treatment program staff to implement contingency management.

The first cohort consisted of 26 counselors from eight opioid treatment programs, and the second cohort consisted of 31 counselors from 10 opioid treatment programs. All opioid treatment programs were located throughout the New England area, and the research study was based at Brown University in Rhode Island.

Counselors submitted post-training role-plays that were rated by independent coders for both readiness and proficiency to deliver CM. Per-clinician costs were estimated for the two modalities. Adjusted differences between cohorts were estimated using ordinary least squares, and an incremental cost effectiveness ratio was calculated to specify cost differences across cohorts.

Attainment rates of the readiness and proficiency benchmarks were higher in the virtual than in-person condition, though these differences were not statistically significant. Aggregated costs showed a $399 difference in per-clinician cost favoring virtual workshop training. Due to its lower cost and comparable effectiveness, the virtual modality was the dominant strategy.

Our findings support the utility and effectiveness of virtual workshop training and may inform the delivery of workshop training for other EBPs post-pandemic.

ANJU SAHAY, PhD
Dept. of Veterans Affairs

The focus of the Department of Veteran Affairs’ (VA) Center for Inpatient Medication Safety (CIMS) is to reduce medication errors for hospitalized Veterans. For the VA and the Defense Health Agency, the Joint Patient Safety Reporting (JPSR) system standardizes event capture and data management of medical errors and near misses. In collaboration with the VA Office of Pharmacy Benefits Management Services (PBM), we are interested in understanding how VA pharmacists use JPSR at their sites to monitor, track and report medication error related adverse events and/or close calls.

Pharmacists at all the VA sites.

In November 2021, jointly CIMS and PBM conducted a web-based survey. VISN (Regional) Pharmacy Executives at 18 VISNs were emailed a survey weblink to forward to the Chiefs of Pharmacy at all the sites within their own VISN who, in turn, identified a pharmacist with knowledge of the JPSR system at their site to complete the survey. The goal of the survey was to understand how pharmacists perceived the use of JPSR to report medication adverse events and/or close calls. Survey response rate was 67.12% (N=98).

A majority of the respondents (pharmacists) self-reported their primary role as Pharmacy Manager (49.5%), Patient/Medication Safety Pharmacist (21.6%), Clinical Pharmacy Specialist (8.2%), Chief of Pharmacy (6.2%), Quality Management Pharmacist (3.1%), Staff Pharmacist (2.1%), and Pharmacoeconomist (2.1%). Remaining pharmacists (7.2%) identified themselves singularly (1.0%) in each of the remaining 7 primary roles. Almost all the pharmacists (96.0%) reported that they and/or other pharmacist(s) use JPSR to report medication adverse events and/or close calls. The remaining pharmacists did not use (2.0%) and did not know (2.0%) about the use of JPSR. Regarding how often JPSR medication adverse event reports and/or close calls were reviewed by the Pharmacy Service at their site, respondents stated that these reports are reviewed: daily (34.9%), weekly (28.9%), bi-weekly (1.2%), monthly (32.6%), quarterly (1.2%) and never (1.2%). In general, to understand medication adverse events and/or close calls these pharmacists considered the JPSR reports as useful with responses ranging from quite useful (61.3%), somewhat useful (34.4%) to not useful (4.3%). Focusing on those pharmacists (96.0%) who responded that they and/or other pharmacists use JPSR to report medication adverse events and/or close calls, we found that reporting of medication error related adverse events occurred often (67.8%), sometimes (25.6%), and rarely (6.7%). Similarly, reporting of close calls in JPSR occurred often (53.9%), sometimes (34.9%) and rarely (11.2%).

Pharmacists perceive the JPSR system as valuable and useful to report medication error related adverse events and/or close calls to manage medication safety for Veterans.