Diabetes care: Model for the future of primary care

Diabetes is a disease state that requires constant monitoring. Unfortunately, the supply of physicians available for this is not being met and does not appear to be in the near future. Due to this increased demand that cannot be met with available supply, more health care professionals such as pharmacists need to be added into these patients’ lives. Unlike some other diseases, diabetes is one that is educated on as the patient is coached or guided in ways to make changes in their daily life style. Losing weight and brining better therapeutic changes to this can improve the parameters that are looked over to determine progress. Doing this will allow decreased hospitalizations and emergency visits, which then brings the demand down, closer to the supply.

Diabetes is no the only disease state in which this can be useful. Employing pharmacists into this “team” will help multiple other chronic conditions as well. Brining pharmacists, nurse practitioners, and physician assistants into the mix can only improve one’s quality of life. At the end of the day, all of these professionals are part of a larger picture that consists of the patients well being. What suggestions would you make in order to improve the current lack of professionals being engaged for such tasks?

Posey L, Tanzi M. Diabetes care: Model for the future of primary care. J Am Pharm Assoc. 2010;20(5): 623-626.
http://www.japha.org/article/S1544-3191(15)30878-5/abstract

RxPATROL: A Web-based tool for combating pharmacy theft

Pharmacists are not only health care providers, but also gateway keepers to prevention of drug abuse. In some isntances, these cannot be helped when another party has malicious intent. Some of this intent results in pharmacy products becoming a supply for the black market. Within the products, controlled substances are most desired. In a study performed by a Risk Management & Health Policy group, theft data was gathered between 2005 and 2006. Points of data that were collected were incident type, date, and location; type of weapon involved; point of entry; and the pharmacies security features. Although this features security breaches, fraud was 46.4% of the total incidents that occurd, followed by forgery at 22.7%

Most of this occurred in the north eastern coast of the United States, near the Ohio-Kentucky border. All of this is a threat to the controlled substance supply of pharmacies in addition to the wrong hands it can enter through the black market. Communities perform these studies in order to better their future security.

What suggestions would you make in order to prevent medication from leaving the pharmacy with wrongful intents? Are there ideas that you have viewed from other pharmacies that were found to be effective?

Smith M, Graham J, Steffey A. RxPATROL: a web-based tool for combating pharmacy theft. J Am Pharm Assoc. 2009;49(5):599-603.

http://www.japha.org/article/S1544-3191(15)31048-7/fulltext

Caring for visually impaired patients

Each patient is unique in that, regardless of the similarities in medication regiments for two patients, they will forever be unique in their own regard for healthcare. Pediatric patients are treated differently than geriatric patients. Geriatric patients are known to need different care, such as different forms of dosage, smaller pills, easy open caps, etc. compared to younger patients. Patients who have certain disabilities that don’t allow them to perhaps be mobile, or those who lack acute vision abilities­, need their own special care. Limited vision allows for technologies to help assist pharmacists to give the best care for their patients. It can also affect adherence to medication. For example, those with limited vision may not be able to read prescription bottles as easy unless they have larger font. Technology is not the only route, as seen by this simple task of increasing font size.

When technology is involved, it can look towards the future. New assistive technologies can bring audio output, or even new writing technologies that improve visibility to those in low lighting or lacking vision.

What other types of patients would you assume need their own tailored-care? Do these patients fall under a large umbrella or each have their own true category for need of care?

 

Orrico, K. Caring for Visually Impaired Patients. J Am Pharm Assoc.  2013; 53(3):142-150.

http://www.japha.org/article/S1544-3191(15)30345-9/abstract

 

Pharmacists’ role in addressing opioid abuse, addiction, and diversion

Pharmacists have always been an authority to preventing controlled medications from getting into the wrong hands. One of the main responsibilities of pharmacists is to maintain this gatekeeper status in order to help patients who need controlled medications such opioids, and to deter those who seek to abuse them. The problem beings with issues that pharmacists face in order to manage opioids. Often conflicts can arise from Responsibilities that exist regarding opioids dispensing.  If the pharmacist is too strict with these prescriptions in order to avoid misuse and diversion, he or she may also place that same bias on to legitimate prescriptions needed by those in actual pain. The spillover from this bias results in a lack for those in need, while also removing dangerous substances from harmful hands.

This study shows that more people have died from overdoses in 2011 than those in vehicular accidents. There are multiple strategies that are made available to pharmacists in order to bring these numbers down. The tools at disposal involve better assessment for the prescriptions that are written for opioids, more follow up appointments and options for the patient in order to identify current or possible misuse, overuse, or diversion, and lastly management of patients receiving these opioids.

Involving these strategies can surely help the patient care increase. Pharmacist support is also needed to push for this movement. Fully eliminating misuse, abuse, and diversion is not avoidable but these tools and strategies can surely improve the current trends. More efficient outreach to electronic patient records is one way, along with pain management through palliative care.

 

Association, American Pharmacists. Pharmacists’ Role in Addressing Opioid Abuse, Addiction, and Diversion. J Am Pharm Assoc. 2013;54(1): 5-15

http://www.japha.org/article/S1544-3191(15)30146-1/fulltext

Students as catalysts to increase community pharmacy-led direct patient care services

Pharmacy students are already required to, and also voluntarily participate in community pharmacies during their schooling. Some are also apt to finding ways for improvement in the community pharmacy experience. Schools in the states of Arizona, Illinois, Ohio, Utah, and West Virginia, sought to push the community pharmacy practice forward. This began with a collaborative model known as the Partner for Promotion (PFP). The impact of this program was collected every year through surveys at each site.

Within a period of 3 years, 19 teams assembled in the five states of Arizona, Illinois, Ohio, Utah, and West Virginia to put together 15 teams to perform patient care services. The goal of this program helped 38 students create a service that is supportable within community pharmacies. They are so sustainable in fact, that of the 15 teams put together, 12 were still functioning and available to patients when this data was initially gathered. The results from the surveys showed that 100% of the pharmacies inducted into the PFP program showed results that deemed the program a score of 4, “very useful,” based on a scale rating from 1 to 4.

The model employed by these universities shows a clear pattern that joint programs such as these between schools and community pharmacies had a positive effect in the five states they were performed in. If undertaken in other states, especially those with programs that are lacking, there is no telling what ideas can come from improving community pharmacies in our society.

Rodis J, Ulbrich T, Jennings B, Elswick B, Mckinley R. Students as Catalysts to Increase Community Pharmacy-led Direct Patient Care Services. J Am Pharm Assoc. 2015 ;55(6):642-648.

http://www.japha.org/article/S1544-3191(16)30009-7/abstract

 

Effectiveness of clinical pharmacist intervention on health-related quality of lifein chronic obstructive pulmonary disorder patients – a randomized controlledstudy

 

Due to the scarcity of multiple health professionals including physician and pharmacists, compromises often have to be made. A preventable and treatable disease chronic obstructive pulmonary disease is often preventable with medication, but it is stated that in order to effectively rid the disease from the patient, they must be educated on it. A study was performed in India in which the role and impact of clinical pharmacists was observed in order to determine if the health-related quality of life in patients with chronic obstructive pulmonary disease increased due to the intervention of clinical pharmacists

In this study two groups, a control group (without clinical pharmacists) and an intervention group (containing clinical pharmacists) were set up. 328 patients with COPD were originally brought in, but only 202 of the final 260 participants were assessed the study. To assess and determine which group experienced a better quality of life after each group performed their tasks, St. George’s Respiratory Questionnaire (SGRQ). The SGRQ is an index in which quantifiable measurement of health in a person with chronic airflow limits can be assessed.

Within the intervention group, the clinical pharmacists placed an importance on medication compliance, cessation of smoking, exercise, correct use of inhalers, and adherence to follow-up appointments. After 6, 12, 18, and 24 months, both groups were given SGRQ’s in order to score the differences between them. After a baseline was determined and questionnaires were taken, the study demonstrated that the intervention group involving clinical pharmacists had higher SGRQ scores indicating a better health-related quality of life after treatment had began. This study demonstrates that the role of pharmacists can clearly impact the healthcare of patients than with the physician alone. A greater involvement in a patient’s life and the aforementioned steps taking by the pharmacists show the contribution clinical pharmacists make in the field of healthcare

 

Suhaj A, Manu K, Unnikrishnan K, Vijayanarayana K, Mallikarjuna C. Effectiveness of clinical pharmacist intervention on health-related quality of life in chronic obstructive pulmonary disorder patients – a randomized controlled study. J Clin Pharm Ther Journal of Clinical Pharmacy and Therapeutics. 2016;41: 78-83

http://onlinelibrary.wiley.com/doi/10.1111/jcpt.12353/epdf

Kawasaki disease: a comprehensive review of treatment options

 

Kawasaki disease occurs in healthy young infants and children and is responsible for inflammation of their blood vessels, which can result in childhood heart disease. This disease is the leading cause of heart disease in our world’s society. There is no known reason for the cause of this, but treatment in the first ten days of onset shows a reduction for the risk of heart disease and coronary artery concerns. This study used PubMed as the main resource for determining which strategies are most useful in the prevention of this that have been documented over the course of 1988-2015.

The study determined that roughly 80-90% of patients’ symptoms are resolved through IVIG (intravenous immunoglobulin therapy) as it demonstrated a reduction in coronary disease risks. Aspirin treatment did not appear to have a significant impact in improving coronary artery outcomes. Although aspirin alone does not work, paired with IVIG and corticosteroids showed improvement in patients located in Japan. If one fails to show progress with a dose of IVIG, second doses are injected. Those who show no response to any of these methods are given other treatments which are unproven, but have shown slight correlation. These treatments include infliximab, cyclosporine or methotrexate. In rare cases even double-dosed patients do not show improvement. Currently the largest challenge is to identify patients early on in order to prevent this at onset. Research is still being done to find better alternatives for treatment.

Patel R, Shulman S. Kawasaki disease: a comprehensive review of treatment options. J Clin Pharm Ther Journal of Clinical Pharmacy and Therapeutics. 2015;40:620-625

Web. http://onlinelibrary.wiley.com/doi/10.1111/jcpt.12334/epdf

 

Cost-Benefit Analysis of At-home Visits by Community Pharmacists

When studying in class for Standard Patient situations, we often take for granted that the “patients” have come to visit students at their “office.” Rarely do we question or ask during the MTM session, whether this patient desires for us to visit them at home for health concerns, or simply convenience sake. Due to this, we, along with the majority of society have become used to the idea of patients finding healthcare rather than the opposite scenario. Home visits from a doctor or nurse, are and have been, common practices in medicine for centuries, so perhaps the expert on a patient’s medications should partake in this service as well? A study done by a research group sought specifically to accomplish that as their study consisted of a community pharmacy performing home visits over the course of a year.

Due to the evolving field of healthcare, two things are sought after, a better quality of care but with reduced costs for the patient. This study resulted in demonstrating that the quality of healthcare can indeed improve as the patient will require less hospital visits and more time with a healthcare professional. The results determined that one hundred and seventy-two house visits were able to be performed successfully. Although this was beneficial to the patient, as all prescription and OTC medications were able to be identified correctly, information about correct storage was able to be distributed, and expired medications were disposed of properly. Home visits also provide the benefit of a familiar learning setting for the patient. All of this came at a decent cost for the pharmacists in terms of two separate currencies: time and money. Although the study mentioned that there was no prior study similar to this in which a comparison can be made in regards to house visit costs versus non-visitation appointments, they concluded the assimilation of home visits comes at decent costs, this only shows more room for the pharmacy profession to occupy and master.

As pharmacists are not considered “health care providers” currently, home visits would align with the profession of medicine as stated in this study, to provide better care and experiences for the patient, along with another avenue for revenue. With the findings of this study, one can see the benefits of it are certainly clear, but so are the literal costs. Although one objective has been overcome (i.e. better quality of healthcare) the issue of costs must be solved. Perhaps a role in government can make changes to affect this, or another option from the pharmaceutical world. Once the cost option is solved, a community pharmacy can truly become involved with a community.

 

Passafiume S, et al. Pharmacist home visits: A 1-year experience from a community pharmacy. J Am Pharm Assoc. 2016;56(1):67-72

http://www.japha.org/article/S1544-3191(15)00003-5/fulltext