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INTRODUCTION: This study assessed student perception in treating chronic disease states before and after taking an ambulatory care didactic elective and the impact on performance within a fourth-year ambulatory care advanced pharmacy practice experience (APPE). METHODS: Assessment of student perceptions was evaluated in students taking the Fall 2016 and Spring 2017 elective offering by completing an 11-item electronic survey prior to the first lecture of the course and after the last lecture of the course. A retrospective assessment of student performance in the APPE compared students that had taken the elective to those that had not over a two-and-one-half year period. Data collected included the students' final APPE experiential and required examination grade. RESULTS: In all but one survey question, student perceptions significantly improved upon completion of the elective. Student ambulatory care APPE final experiential grades were higher in students who had taken the elective compared to those that had not (90.3% vs. 88.9%, respectively, pâ¯=â¯0.04) as were APPE examination scores (78.0% vs. 74.0%, respectively, pâ¯=â¯0.01). DISCUSSION AND CONCLUSIONS: Student perception in key ambulatory care concepts, disease states, and drug knowledge improved after taking the ambulatory care elective. Student ambulatory care APPE performance was also mildly improved as a result of taking the elective compared to those who did not take the course. This is the first study to evaluate subsequent performance in an APPE as a result of taking an elective ambulatory care course and can serve as a template for other research in elective assessment.
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Instituciones de Atención Ambulatoria , Curriculum/normas , Evaluación Educacional/estadística & datos numéricos , Percepción , Estudiantes de Farmacia/psicología , Curriculum/tendencias , Educación en Farmacia/métodos , Educación en Farmacia/normas , Evaluación Educacional/métodos , Humanos , Estudios Retrospectivos , Estudiantes de Farmacia/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new pharmacotherapeutic class for the treatment of Type 2 Diabetes Mellitus (T2DM). OBJECTIVE: To evaluate beneficial effects of the SGLT2 inhibitors on metabolic, cardiovascular, and renal outcomes. METHODS: A Pub-Med search (1966 to July 2017) was performed of published English articles using keywords sodium-glucose co-transporter 2 inhibitors, canagliflozin, dapagliflozin, and empagliflozin. A review of literature citations provided further references. The search identified 17 clinical trials and 2 meta-analyses with outcomes of weight loss and blood pressure reduction with dapagliflozin, canagliflozin, or empagliflozin. Three randomized trials focused on either empagliflozin or canagliflozin and reduction of cardiovascular disease and progression of renal disease. RESULTS: SGLT2 inhibitors have a beneficial profile in the treatment of T2DM. They have evidence of reducing weight between 2.9 kilograms when used as monotherapy to 4.7 kilograms when used in combination with metformin, and reducing systolic blood pressure between 3 to 5 mmHg and reducing diastolic blood pressure approximately 2 mmHg. To date, reduction of cardiovascular events was seen specifically with empagliflozin in patients with T2DM and a history of cardiovascular disease. In the same population, empagliflozin was associated with slowing the progression of kidney disease. Moreover, patients with increased risk of cardiovascular disease treated with canagliflozin have decreased risk of death from cardiovascular causes, nonfatal MI, or nonfatal stroke. Data regarding these outcomes with dapagliflozin are underway. CONCLUSION: SGLT2 inhibitors demonstrate some positive metabolic effects. In addition, empagliflozin specifically has demonstrated reduction in cardiovascular events and delay in the progression of kidney disease in patients with T2DM and a history of cardiovascular disease. Further data is needed to assess if this is a class effect.
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Compuestos de Bencidrilo/uso terapéutico , Enfermedades Cardiovasculares/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/uso terapéutico , Enfermedades Renales/complicaciones , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Enfermedades Cardiovasculares/mortalidad , Hemoglobina Glucada/análisis , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Pérdida de Peso/efectos de los fármacosRESUMEN
Interprofessional education (IPE) is an important component of healthcare professional curriculum in order to optimally prepare students for their roles as part of the healthcare team. Integrating IPE activities into direct patient care in the primary care clinic setting can help improve perceptions and student understanding of other healthcare professionals' responsibilities in this ever-evolving practice setting. This report describes the implementation of an interprofessional clinic including a variety of healthcare professionals and students in the context of the Medicare Annual Wellness Visits (AWV). Design of the clinic and general roles of the professionals in optimising preventive care are described. Student perceptions of IPE and their knowledge of other healthcare professionals were also surveyed. Student knowledge of other professionals mildly improved. Student perception of actual cooperation and interprofessional interaction statistically improved, while perception of interprofessional learning slightly worsened. Utilising Medicare AWVs can be a way for various professionals to improve IPE in the primary care setting.
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Personal de Salud/educación , Relaciones Interprofesionales , Medicare , Visita a Consultorio Médico , Grupo de Atención al Paciente , Atención Primaria de Salud , Humanos , Estados UnidosRESUMEN
Metformin is considered an initial drug of choice for type 2 diabetes mellitus by leading recommendations. When contraindications to its use exist or patients cannot tolerate it due to adverse effects, clinicians have a variety of other classes of agents to treat hyperglycemia associated with type 2 diabetes mellitus. Each class of agent has its own benefit and safety profile. There are numerous factors to consider when selecting another agent in lieu of metformin including, but not limited to, overall efficacy in A1c reduction, adverse effect profile, cost, and patient preference. The number of factors influencing the decision process presents challenges and often no one specific agent is ideal. Each pharmacotherapeutic class of agents alternative to metformin for the treatment of hyperglycemia in type 2 diabetes mellitus as initial monotherapy is reviewed.
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The American College of Clinical Pharmacy (ACCP) Ambulatory Care Practice Research Network (PRN) considers the role of clinical pharmacists to be fundamental to the success of the Patient-Centered Medical Home (PCMH) model. Within the PCMH, pharmacists can improve the health of populations by participating in activities that optimize medication management. Multiple published articles support clinical pharmacist involvement in the PCMH with regard to promotion of team-based care, enhanced access, care coordination, and improved quality and safety of care. A survey of clinical pharmacist members of ACCP who operate in such a model depict a variety of activities, with some members pioneering new and innovative ways to practice clinical pharmacy. Although this is a significant opportunity for pharmacists in the primary care setting, a unified vision of pharmacy services is needed. It is our hope that with continued efforts focused on obtaining national provider status, clinical pharmacy can use the PCMH model to solidify the future of primary care pharmacy. The following is an opinion statement of the ACCP Ambulatory Care PRN regarding the vital role of clinical pharmacists in the PCMH.
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Atención Ambulatoria/métodos , Atención Dirigida al Paciente/métodos , Farmacéuticos , Servicio de Farmacia en Hospital/métodos , Rol Profesional , Atención Ambulatoria/normas , Humanos , Grupo de Atención al Paciente/normas , Atención Dirigida al Paciente/normas , Farmacéuticos/normas , Servicio de Farmacia en Hospital/normas , Estados UnidosRESUMEN
OBJECTIVES: To evaluate whether the direct renin inhibitor, aliskiren, has a more favorable effect compared to amlodipine on atherosclerotic biomarkers in patients with stable coronary artery disease and diabetes currently receiving standard secondary prevention therapy. METHODS: A total of 38 patients were randomly assigned initially to either aliskiren (150 mg daily) or amlodipine (5 mg daily) for 2 weeks after which the dose of either medication was increased to its maximum daily dose for 4 additional weeks. Baseline and 6-week blood samples were analyzed for changes from baseline and between treatment groups for vascular and intracellular cell adhesion molecule, C-reactive protein, nitric oxide, plasminogen activator inhibitor 1, 8-isoprostane, and thiobarbituric acid reactive substances. RESULTS: Thirty-one patients completed the study. More of the dropouts occurred in patients receiving aliskiren. Systolic blood pressure decreased in both treatment arms with no differences between the groups being noted. Plasminogen activator inhibitor 1, nitric oxide, and C-reactive protein concentrations increased in both groups from baseline but changes from baseline or between groups were not significant. Vascular and intracellular cell adhesion molecule, thiobarbituric acid reactive substances, and isoprostane concentrations decreased in each treatment arm from baseline, but these changes were not significant and no differences were noted between the groups. CONCLUSIONS: Treatment with either aliskiren or amlodipine did not significantly alter surrogate biomarkers of atherosclerosis in patients with both diabetes and established cardiovascular disease already receiving appropriate secondary cardiovascular prevention therapy. The study is limited in its size and duration to see an effect.
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Amidas/uso terapéutico , Amlodipino/uso terapéutico , Aterosclerosis/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Fumaratos/uso terapéutico , Anciano , Amidas/farmacología , Amlodipino/farmacología , Aterosclerosis/patología , Biomarcadores/metabolismo , Presión Sanguínea/efectos de los fármacos , Enfermedad de la Arteria Coronaria/patología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Estudios de Seguimiento , Fumaratos/farmacología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Renina/antagonistas & inhibidoresRESUMEN
The glucagon-like peptide-1 receptor agonists, exenatide and liraglutide, offer a unique mechanism in the treatment of type 2 diabetes mellitus (T2DM) as part of the incretin system. Their mechanism of action is to increase insulin secretion, decrease glucagon release, reduce food intake, and slow gastric emptying. They target postprandial blood glucose values and have some effect on fasting levels as well. In addition, they promote weight loss and may help to preserve ß-cell function, both major problems in T2DM patients. Changes in hemoglobin A1c are similar to those produced by other T2DM agents, including thiazolidinediones, low-dose metformin, and sulfonylureas, and better than those caused by α-reductase inhibitors and dipeptidyl peptidase-4 inhibitors. These agents have been safely studied in combination with metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin therapy. Overall, data are limited for head-to-head comparisons, but it appears that liraglutide may have better efficacy and tolerability compared with exenatide; however, more studies are needed. They are overall well tolerated, with the main adverse events being similar to those with metformin (gastrointestinal intolerances that are transient and dose dependent). However, patients must be monitored for pancreatitis as a rare but possible side effect. For T2DM patients willing to use an injectable agent, exenatide and liraglutide offer another therapeutic option to control hyperglycemia with the potential for weight loss and may be combined with other agents safely.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptido 1 Similar al Glucagón/análogos & derivados , Péptido 1 Similar al Glucagón/efectos de los fármacos , Hipoglucemiantes/farmacología , Péptidos/farmacología , Receptores de Glucagón/agonistas , Ponzoñas/farmacología , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/sangre , Quimioterapia Combinada , Exenatida , Femenino , Péptido 1 Similar al Glucagón/farmacología , Receptor del Péptido 1 Similar al Glucagón , Hemoglobina Glucada/efectos de los fármacos , Humanos , Liraglutida , Masculino , Resultado del TratamientoRESUMEN
Dipeptidyl peptidase -4 inhibitors represent a novel way to augment the incretin system and one of the newest class of medications in the treatment of type 2 diabetes mellitus. Their mechanism of action is to decrease the inactivation of glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide, both of which are involved in maintaining euglycemia subsequent to carbohydrate intake. Currently investigated agents include sitagliptin, vildagliptin, saxagliptin, linagliptin, and alogliptin. Each agent has been shown to provide significant improvements in glycemic control compared to placebo. They are effective when added to other oral diabetes agents and in the cases of sitagliptin, vildagliptin, and alogliptin in addition to insulin. These agents may not provide as significant improvement in glucose concentrations as some other medications including metformin, thiazolidinediones, or glucagon-like peptide 1 agonists. The lack of head to head clinical data comparing the various dipeptidyl peptidase 4 inhibitors does not allow for specific recommendations if one agent is more effective or safer than another within the class. Their side effect profile suggests they are very well tolerated and have few drug interactions. For patients with mildly elevated glucose concentrations, they are therapeutic options in both drug-naive patients as well as those not optimally controlled on other diabetes medications.
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Glucemia/metabolismo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Péptido 1 Similar al Glucagón/sangre , Adamantano/análogos & derivados , Adamantano/farmacología , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/sangre , Dipéptidos/farmacología , Inhibidores de la Dipeptidil-Peptidasa IV/farmacología , Interacciones Farmacológicas , Femenino , Péptido 1 Similar al Glucagón/efectos de los fármacos , Humanos , Linagliptina , Masculino , Nitrilos/farmacología , Piperidinas/farmacología , Purinas/farmacología , Pirazinas/farmacología , Pirrolidinas/farmacología , Quinazolinas/farmacología , Fosfato de Sitagliptina , Resultado del Tratamiento , Triazoles/farmacología , Uracilo/análogos & derivados , Uracilo/farmacología , VildagliptinaRESUMEN
Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy. Objective: The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population. Methods: A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59) to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg) in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58) in the same clinical setting. Results: The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077) and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153) were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013) but a higher frequency of clinic visits (10.7 versus 3.45, p<0.0001) in the cardiologist-pharmacist care model compared to usual care. The number of antihypertensive agents used did not change over the time period evaluated. Conclusion: This study suggests a team-based approach to hypertensive care using a collaborative cardiologist-pharmacist care model improves blood pressure from baseline in a high cardiac risk patient population and was more likely to obtain more stringent blood pressure goals than usual care (AU)
La gestión de la terapéutica en colaboración con los médicos utilizando farmacéuticos clínicos para ayudar con la medicación de pacientes con hipertensión ha demostrado mejorar el control de la presión arterial. Con las recomendaciones de menores presiones arteriales para los pacientes con enfermedad coronaria, un modelo de colaborativo cardiólogo-farmacéutico puede ser un método novedoso de conseguir resultados terapéuticos más rigurosos. Objetivo: El propósito de este proyecto fue evaluar este tipo de cuidados en una población de pacientes en alto riesgo cardiovascular. Métodos: Un estudio de cohorte retrospectiva (n=59) determinó la capacidad de que un modelo de cuidados cardiólogo-farmacéutico baje la presión arterial y alcance los objetivos de presión arterial (<130 mmHg) en pacientes con o en riesgo de enfermedad coronaria comparado con el cuidados normales de un cardiólogo (n=58) en el mismo establecimiento clínico. Resultados: El modelo de cuidados cardiólogo-farmacéutico mostró un mayor porcentaje de pacientes alcanzando su objetivo de presión arterial comparado con el cuidado del cardiólogo solo, 49,2% vs 31,0%, respectivamente, p=0,0456. Se encontraron mayores reducciones de presión arterial sistólica (-22 mmHg vs. -12 mmHg, p=0.0077) y presión de pulso (-15 mmHg vs. -7 mmHg, p=0.0153) en el modelo de cuidados cardiólogo-farmacéutico. No se encontraron diferencias en la presión arterial diastólica. Hubo menor duración del seguimiento (7.0 vs. 13.2 meses, p=0.0013) pero mayor frecuencia de visitas a la clínica (10.7 vs. 3.45, p<0.0001) en el modelo colaborativo comparado con el cardiólogo solo. El número de antihipertensivos utilizado no cambió durante el periodo evaluado. Conclusión: Este estudio sugiere que un abordaje de los cuidados de la hipertensión en equipo usando un modelo de cuidados colaborativo cardiólogo-farmacéutico mejora la presión arterial en una población de pacientes en riesgo cardiaco elevado, y alcanzó los objetivos de presión arterial más rigurosamente que la atención normal (AU)
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Humanos , Masculino , Femenino , Atención a la Salud/organización & administración , Factores de Riesgo , Fármacos Cardiovasculares/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/prevención & control , Farmacéuticos/ética , Farmacéuticos , Servicios Farmacéuticos/ética , Presión Arterial , Hipertensión/tratamiento farmacológico , 16359/políticas , Estudios de Cohortes , Estudios Retrospectivos , Estados Unidos/epidemiología , Hipertensión/prevención & controlRESUMEN
UNLABELLED: Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy. OBJECTIVE: The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population. METHODS: A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59) to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg) in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58) in the same clinical setting. RESULTS: The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077) and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153) were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013) but a higher frequency of clinic visits (10.7 versus 3.45, p<0.0001) in the cardiologist-pharmacist care model compared to usual care. The number of antihypertensive agents used did not change over the time period evaluated. CONCLUSIONS: This study suggests a team-based approach to hypertensive care using a collaborative cardiologist-pharmacist care model improves blood pressure from baseline in a high cardiac risk patient population and was more likely to obtain more stringent blood pressure goals than usual care.
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Patients with type 2 diabetes and their physicians are often reluctant to begin insulin therapy--despite evidence of its efficacy. Here's help in overcoming this other form of "insulin resistance."
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Cumplimiento de la Medicación , Educación del Paciente como Asunto , Medicina Familiar y Comunitaria , Conocimientos, Actitudes y Práctica en Salud , Humanos , Relaciones Médico-Paciente , Estados UnidosRESUMEN
STUDY OBJECTIVE: To determine whether controlling systolic blood pressure (SBP), pulse pressure, and heart rate in the outpatient setting is associated with decreased hospital utilization in patients with heart failure and preserved ejection fraction (PEF). DESIGN: Retrospective medical record review. SETTING: University-affiliated medical center and outpatient clinics. PATIENTS: One hundred forty adults admitted between January 1, 2003, and October 31, 2005, for an exacerbation of heart failure with PEF and followed for 2 years after their index admission. MEASUREMENTS AND MAIN RESULTS: Outpatient SBP, pulse pressure, and heart rate, and the percentage of clinic visits for which patients had each vital sign at a certain level were used for correlations and comparisons. These vital signs and percentages of clinic visits were varied until maximum significant differences were observed in total hospital utilization for each parameter. These values were then analyzed for differences based on age, race-ethnicity, and sex. When comparing patients whose vital signs were in control for at least 80% of clinic visits versus those whose were in control for less than 80% of clinic visits, significantly lower hospital utilization was associated with clinic SBP less than 140 mm Hg (median hospital utilization 3 vs 5 visits, p=0.0252), pulse pressure less than 65 mm Hg (3 vs 5 visits, p=0.0113), and heart rate of 55-70 beats/minute (2 vs 4 visits, p=0.0311). Among the 140 patients, 78 (56%) were Caucasian, 48 (34%) were Hispanic, and 14 (10%) were African-American. The African-American patients were significantly younger (p=0.0218) and had significantly poorer SBP control (< 140 mm Hg for >/= 80% of clinic visits: 14.3% vs 43.8%, p=0.0446) and higher hospital utilization (> 4 visits: 78.6% vs 43.8%, p=0.0218) than the Hispanic patients, despite similar percentages of missed clinic appointments (25% for each group). CONCLUSION: Controlling SBP at less than 140 mm Hg, pulse pressure at less than 65 mm Hg, and heart rate at 55-70 beats/minute for at least 80% of clinic visits were factors associated with decreased hospital utilization. African-American patients with heart failure and PEF were younger, had more poorly controlled SBP, and had higher hospital utilization despite similar percentage of missed clinic visits as their Hispanic counterparts.
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Presión Sanguínea/efectos de los fármacos , Insuficiencia Cardíaca/tratamiento farmacológico , Adulto , Negro o Afroamericano , Instituciones de Atención Ambulatoria , Femenino , Hispánicos o Latinos , Humanos , Masculino , Cooperación del Paciente , Grupos Raciales , Estudios Retrospectivos , Resultado del Tratamiento , Signos VitalesRESUMEN
BACKGROUND: This study assessed diabetes out-patient care at a single institution in Medicare patients with significant health care expenditures and correlated the control of these patients with hospital admission rates and charges. METHODS: A retrospective review was performed at a university health sciences center's clinics and affiliated hospital. Medicare patients with Type 2 diabetes, >65 years, and hospitalized >1 in the past year with annual incurred Medicare charges of >$6,000 were included in the study. Data collected over a year period included: hospitalization and emergency department use and charges, and key out-patient diabetes-related quality of care outcomes. These outcomes were compared with national benchmark National Health and Nutrition Examination Survey (NHANES) data. RESULTS: Ninety-three patients were identified (median age of 72). More patients were at goal hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure than benchmark National Health and Nutrition Examination Survey data. There was a significant correlation between HbA1c and diabetes-related and all cause hospitalizations and ER visits per patient (P < 0.025) and diabetes-related charges (P = 0.0291). There were no differences between an endocrinologist and general practitioners in the quality of care except for documented microalbuminuria and aspirin use. CONCLUSIONS: Diabetes care at this institution was better than national benchmark data. HbA1c correlated with diabetes-related hospitalizations, all-cause combined hospitalizations and emergency department visits and charges. There were no major differences in the care of patients between the endocrinologist and general practitioners.
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Atención Ambulatoria/economía , Diabetes Mellitus Tipo 2 , Servicio de Urgencia en Hospital/economía , Precios de Hospital , Medicare , Calidad de la Atención de Salud , Anciano , Atención Ambulatoria/estadística & datos numéricos , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales Universitarios/economía , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Estudios Retrospectivos , Estados UnidosRESUMEN
BACKGROUND: This study evaluates the quality of care of a pharmacist-managed diabetes clinic focused on an indigent population and compares that quality of care to usual care in the same health care setting. METHODS: Two groups of subjects were evaluated by retrospective review of medical records. The experimental group (n = 47) consisted of patients whose care was facilitated by a clinical pharmacist (medication initiation and modification, laboratory and physical assessment) in addition to routine physician care. A control group (n = 45) consisted of patients not referred to the pharmacy service whose care was provided solely by a physician. Changes in glycemic, blood pressure, and lipid control were assessed as were use of specific medications. RESULTS: After an average of 1.8 years of follow-up, a larger reduction in hemoglobin A1C was observed in the experimental group (2.0%) compared to the control group (1.2%), but the difference was not statistically different. Both groups experienced significant improvements in blood pressure control with a higher absolute increase from baseline in the experimental group compared to the control group (34% vs. 22% respectively, P < 0.001). Low-density lipoprotein-cholesterol levels in the control group fell by 2 mg/dL, while a 29 mg/dL reduction was observed in the experimental group (P < 0.001). While aspirin, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker therapies were not different between the two groups, statin therapy was significantly improved in the experimental group (from 23% to 68%) compared to the control group (from 33% to 44%) (P = 0.038). CONCLUSIONS: Many key diabetes quality of care outcomes in an indigent population were significantly improved in patients whose diabetes management was facilitated by a clinical pharmacist.
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Instituciones de Atención Ambulatoria , Diabetes Mellitus/terapia , Servicios Farmacéuticos/organización & administración , Pobreza , Presión Sanguínea , Índice de Masa Corporal , LDL-Colesterol/sangre , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/metabolismo , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Farmacéuticos , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Texas , Resultado del TratamientoRESUMEN
Patients with type 2 diabetes mellitus often begin treatment by taking oral agents, usually metformin or a sulfonylurea, and then progress to the combination of these two agents. Most patients often require three or more agents or a change to an insulin regimen. However, no guidelines are available to aid the clinician in the decision-making process for selecting the third agent. Many options are available for additional therapy, including thiazolidinediones, intermediate- and long-acting insulins, exenatide, and dipeptidyl peptidase-4 inhibitors. Although the American Diabetes Association recommends metformin as first-line therapy, it does not give exact specifications for second- and third-line agents but only summarizes clinical data and options about each therapeutic drug class. Guidelines from the American College of Endocrinology and American Association of Clinical Endocrinologists recommend several options depending on the patient's hemoglobin A(1c) level. Therefore, a standard of care cannot be provided; rather, clinicians must evaluate each patient to ascertain that patient's optimum therapy. In doing so, clinicians need to be familiar with the efficacy, safety, and cost of each agent.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Costos de los Medicamentos , Exenatida , Hemoglobina Glucada/efectos de los fármacos , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemiantes/economía , Insulina/análogos & derivados , Insulina/uso terapéutico , Péptidos/uso terapéutico , Guías de Práctica Clínica como Asunto , Tiazolidinedionas/uso terapéutico , Ponzoñas/uso terapéuticoRESUMEN
A diabetes education program for healthcare professionals evolved out of a series of discussions among healthcare providers. This group realized the importance and the necessity of developing a current knowledge base for themselves, their clients, and their clients' families. The target audiences for this program were physicians, nurses, pharmacists, and dietitians who could be eligible to work toward becoming a certified diabetes educator. This article discusses the process used to develop and conduct these workshops. The lessons learned during this project are provided for consideration by others seeking to address common concerns and challenges in other areas of clinical practice.
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Diabetes Mellitus/terapia , Educación Continua/organización & administración , Personal de Salud/educación , Desarrollo de Programa/métodos , Publicidad , Certificación , Curriculum , Diabetes Mellitus/epidemiología , Evaluación Educacional , Grupos Focales , Personal de Salud/psicología , Humanos , Mercadotecnía , Evaluación de Necesidades , Investigación en Educación de Enfermería , Grupo de Atención al Paciente/organización & administración , Técnicas de Planificación , Evaluación de Programas y Proyectos de Salud , Telecomunicaciones , Texas/epidemiologíaRESUMEN
Healthcare professionals need valuable up-to-date information on diabetes management and skills to treat and educate patients with diabetes mellitus. The Diabetes Education for Healthcare Professionals program was developed to provide healthcare professionals with current diabetes management skills. It was also designed to increase the number of certified diabetes educators in the area in which it was delivered. The program enrolled 147 participants and was delivered on four different occasions. Fifty-five of those participants stated a strong interest in pursuing certified diabetes educator certification, which may significantly increase the number of certified diabetes educators in both rural and urban areas of West Texas.
Asunto(s)
Actitud del Personal de Salud , Curriculum , Diabetes Mellitus/terapia , Educación Continua/organización & administración , Personal de Salud , Necesidades y Demandas de Servicios de Salud , Certificación , Competencia Clínica , Diabetes Mellitus/economía , Diabetes Mellitus/epidemiología , Manejo de la Enfermedad , Empleo/organización & administración , Costos de la Atención en Salud , Personal de Salud/educación , Personal de Salud/psicología , Humanos , Investigación en Educación de Enfermería , Investigación Metodológica en Enfermería , Grupo de Atención al Paciente/organización & administración , Prevalencia , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Autocuidado , Encuestas y Cuestionarios , Texas/epidemiologíaRESUMEN
Objetivo: Comprender el papel del exenatide en el tratamiento de la diabetes tipo 2, analizando su coste-efectividad comparado con insulina intermedia (NPH) y de larga duración (glargina). Exetanide es una medicación recientemente aprobada para el tratamiento del a diabetes tipo 2, para ser usada además de los antidiabétios orales frecuentemente usados. Métodos: Para evaluar apropiadamente el coste-efectividad de las insulinas comparadas con exenatide, tanto en control glucémico como de peso, se identificaron dos estudios en una búsqueda en Medline (1996 a octubre 2005) que eran similares en duración, control de la glucemia basal, tamaño de la población y resultados principales. Resultados: Tanto la NPH como la glergina parecen ser más coste-efectivos que el exenatide en relación al control glucémico (ratio CE incremental -1968 y -65520 respectivamente). El exenatide parece ser más coste-efectivo para la reducción del peso corporal que la NPH (Ratio CE 235) o la gargina (ratio CE 128). Conclusiones: Comparada con la insulina intermedia y de larga duración, exenatide no parece ser más coste-efectivo para el tratamiento de la diabetes tipo 2 (AU)
Objective: To better understand exenatide’s role in the treatment of type 2 diabetes, this analysis assessed its cost-effectiveness in comparison to an intermediate (NPH) and long-acting insulin (glargine). Exenatide is a recently approved medication for the treatment of type 2 diabetes for use in addition to frequently used oral diabetes medications. Methods: Two studies were identified by a Medline search (1996-Oct 2005) that were similar in study duration, baseline glycemic control, population size, and primary outcomes to appropriately assess the cost-effectiveness of either insulin in comparison to exenatide on both glycemic and weight control. Results: Both NPH and glargine appear to be more cost effective than exenatide with respect to glycemic control (incremental CE ratios -1,968 and -65,520 respectively). Exenatide appears to be more cost effective for reductions in body weight than either NPH (CE ratio 235) or glargine (CE ratio 128). Conclusions Compared to intermediate and long-acting insulin therapies, exenatide does not appear to be as cost effective for the treatment of type 2 diabetes (AU)
Asunto(s)
Humanos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/farmacocinética , Índice Glucémico , Insulina/administración & dosificación , Análisis Costo-EficienciaRESUMEN
OBJECTIVE: To assess a model to screen minority, elderly, and at-risk individuals for diabetes, hypertension, and dyslipidemia in pharmacy and non-health care settings. DESIGN: Multicenter, prospective, observational trial. SETTING: 26 pharmacies and 4 non-health care settings. PARTICIPANTS: 888 individuals with one or more of the following risk factors: first-degree relative with diabetes, age 55 years or older, obesity, previous diagnosis of hypertension, or a previous diagnosis of dyslipidemia. INTERVENTION: Measurement of plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood pressure; risk assessment using a risk factor tool; referral of participants with abnormalities to physicians. MAIN OUTCOME MEASURES: Adherence with follow-up, physician recommendations, and new diagnoses of diabetes, hypertension, and dyslipidemia. RESULTS: Pharmacists screened 888 participants in pharmacies and non-health care settings; 794 scored at least 10 on the risk factor tool and received further screenings. Of these, 81% were referred for follow-up for at least one abnormality: 15% glucose, 68% blood pressure, 66% total cholesterol, and 26% HDL-C. For those referred, the mean (+/- SD) fasting plasma glucose concentration was 179 +/- 87 mg/dL, and the random glucose concentration was 234 +/- 90 mg/dL. Of participants completing follow-up, 16% received one or more new diagnoses as follows: diabetes, 8; hypertension, 9; and dyslipidemia, 29. Therapy changed for 42% of participants. Participants who were elderly, of African American and Hispanic race/ethnicity, or those with elevated cholesterol values were at significantly greater risk for elevated glucose levels. Screenings in community pharmacy settings had improved follow-up rates with physicians compared with screenings conducted in non-health care settings. CONCLUSION: Pharmacists identified individuals with elevated glucose, cholesterol, and blood pressure values through community-based screenings. Pharmacists also identified individuals who could benefit from further control of previously diagnosed hypertension and hyperlipidemia.
Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Diabetes Mellitus Tipo 2/diagnóstico , Dislipidemias/diagnóstico , Hipertensión/diagnóstico , Tamizaje Masivo/organización & administración , Negro o Afroamericano , Anciano , Glucemia , Femenino , Hispánicos o Latinos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estados UnidosRESUMEN
Background: The pharmacist’s role in dispensing emergency contraception (EC) has become controversial due to the intersection of personal and professional ethics. Therefore, to examine the issue of EC availability, we surveyed a sample of West Texas pharmacists. West Texas is a religiously and politically conservative region where no methods of EC have been made available. Objective: to survey a sample of pharmacists in West Texas about their experience, beliefs, and knowledge of EC both before and after a presentation of the current literature about EC. Methods: We asked a convenience sample of 75 pharmacists about their experience, beliefs, and knowledge of EC both before and after a presentation of the current literature about EC. Results: Sixty-four (85%) pharmacists agreed to complete the study questionnaire. None carries EC in his/her pharmacy, and scientific understanding of EC was generally poor. Fourteen percent stated EC conflicts with their religious views, 17% considered it a method of abortion, 11% would not be willing to fill an EC prescription written by a doctor. 58% would be willing to offer EC over the counter. The presentation encouraged more to offer it over the counter, but in general did not significantly change their beliefs. Conclusion: Our sample of West Texas pharmacists demonstrated very little experience with, a general lack of knowledge about, and some personal and religious objections to EC (AU)
Antecedentes: El papel del farmacéutico dispensando contraceptivos de emergencias (CE) es controvertido debido a la intersección de la ética personal y profesional. Así que para examinar el problema de la disponibilidad de CE investigamos una muestra de farmacéuticos de West Texas. West Texas es una región religiosa y políticamente conservadora donde no están disponibles métodos de CE. Objetivo: Investigar una muestra de farmacéuticos de West Texas sobre sus experiencias, creencias y conocimiento de CE antes y después de una presentación sobre la literatura actual sobre CE. Métodos: Preguntamos a una muestra de conveniencia de 75 farmacéuticos sobre sus experiencias, creencias y conocimiento sobre CE antes y después de una presentación de la literatura actual sobre CE. Resultados: Sesenta y cuatro (85%) farmacéuticos aceptaron completar el cuestionario del estudio. Ninguno posee CE en su farmacia, y el conocimiento científico de la CE era realmente pobre. El catorce por ciento afirmó que la CE colisiona con sus creencias religiosas, el 17% lo consideró un método de aborto, el 11% no era capaz de dispensar una receta de CE escrita por un médico. El 58% sería capaz de ofrecer CE de libre venta. La presentación animó a ofrecerla como libre venta, pero en general no cambió sus creencias significativamente. Conclusión: Nuestra muestra de farmacéuticos de West Texas demostró muy poca experiencia, una falta general de conocimientos y algunas objeciones personales y religiosas sobre la CE (AU)