Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression

Depression is common in diabetes diagnosed patients and it also causes increased risk of hyperglycemia, morbidity, and mortality. A study was conducted to determine if the use of antidepressant medication is associated with glycemic control in depressed patients with type 2 diabetes.

This study was conducted using electronic medical record registry data of ambulatory primary care visits from 2008 to 2013. Relationship between ADM use (determined by prescription orders) and glycaemic control (determined from measures of glycated hemoglobin/ A1C) were studied. A good glycemic control was defined as AIC < 7.0%.  Good glycemic control was achieved by 50.9% of depressed subjects receiving ADM versus 34.6% of depressed subjects without ADM.

Although this relationship studied does not take into account adherence of medication, it still proves an interesting point; medication taken for a separate indication but relating to the primary disease state may help in patient drug therapy. It is important to not only look at the disease state and what medications are specific for that disease state, but also to view the broad picture. What else is the patient currently diagnosed with? Even if these disease states do not directly relate to the primary disease state, they could serve as clues into figuring out what is best for the patient.

Brieler J., Lustman P., Scherrer J., et al. Antidepressant medication use and glycaemic control in co-morbid type 2 diabetes and depression. Fam. Pract. 2016; 33: 30-6

Don’t assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy

Low health literacy populations are common occurrences. These populations have difficulties understanding basic health information and making appropriate health decisions. As future pharmacists, we have the responsibility to ensure that patients have a basic understanding of their medications as well as the risks and benefits of their regimen. A study was conducted to understand what the major challenges these low health literacy populations faced.

A one-on-one semi-structured interview study was conducted on the low health literate population. Each interview began with a verbal health literacy assessment, followed by open-ended questions focused on medication information. At the end of each interview, a written health literacy assessment was given which was later used to compare self-assessed health literacy scores. The population had an average age of 67 years old and 90% had been educated outside of North America. Low health literacy were found in 75% of these patients based on the S-TOFHLA. A flow chart was created to describe low health literate population’s pharmacy experience. Major challenges faced by this population was also recorded.

The major challenges faced by this population included, limited time with pharmacists, poor understanding of medication information, adherence, side effects, and food instructions/interactions. This study is important because it outlines the focus points for patient discussion. All of these points could be put to use when counseling low health literate patients or regular patients. What other challenges do you think exist within these low health literate populations?

Wall H., B SC., M SC., Don’t assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy. Res Social Adm Pharm. 2016

Text messaging reminders for influenza vaccine in primary care: a cluster randomized controlled trial

As technology grows, innovations within the pharmaceutical fields also grow. A new trend in community pharmacies to incorporating technologies like handheld devices into maintaining healthcare is steadily expanding. A study was conducted to develop methods for conducting cluster randomized trials of text messaging interventions utilizing routine electronic health records at low cost and to assess the effectiveness of text messaging influenza vaccine reminders in increasing vaccine uptake in patients with chronic conditions. This study included 156 general practices who used text messaging software who had not previously used text messaging influenza vaccination reminders. Eligible patients of these practices were within 18-64 years old. 77 practices out of 156 were assigned to the intervention group (random) and 79 practices were assigned to the standard care group. The results found that text messaging increased absolute vaccine uptake by 2.62% (95% CI −0.09% to 5.33%).

This study found that text-messaging, a very low cost method, resulted in moderate improvements in influenza vaccine uptake. Although the changes were not drastic, it shows that implementation of these new intervention types could have a positive impact within the community setting. Hopefully, a better intervention method using technologies like this will grow in the future.

Herrett E., Williamson E., Staa T., et al. Text messaging reminders for influenza vaccine in primary care: a cluster randomized controlled trial. BMJ. 2016; 6

‘Asking the Right Question’. A Comparison of Two Approaches to Gathering Data on ‘Herbals’ Use in Survey Based Studies

Herbal medicine usage has significantly increase during the last decade. As such, academic interest of herbal usage has also grown. Data for these studies often are collected by questionnaire survey, however methodological limitations are imposed when using this approach mainly limited to the defining the scope of ‘herbals’. A cross-sectional questionnaire survey that utilized two approaches to collect data on herbals was conducted. This survey included a single closed yes/no answer (“Have you used herbs, herbal medicines and herbal products in the last three months”) and a request to tick which of a list of 40 herbals that had been used within the same time period. A total of 889 responses were recorded, of which, 38 answered ‘yes’ to herbal use via the closed question. However, 350 respondents reported the use of one or more specific herbals.

This study demonstrated the possible misleading when using a single closed question about the use of ‘herbals’ and that it might provide a gross underestimation of actual use. It is interesting to note that using single closed questions may not always be the best way to retrieve information about a topic as broad as ‘herbals’. Even moreso, imagine asking a series of single closed questions for supplements and over-the-counter medication during a process like a CMR. Utilizing these broad yes/no statements might lead to underestimation of medications that a patient is taking and could cause serious drug-therapy problems. Although this article is very specific, it can relate to many aspects of patient medication counseling. But that poses the question, what is the best way to get a complete record of all of a patient’s medication?

McLay J., Pallivalappila A., Shetty A., et al. ‘Asking the Right Question’. A Comparison of Two Approaches to Gathering Data on ‘Herbals’ Use in Survey Based Studies. PLoS One. 2016; 11: 1-9

Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians

A national cross-sectional online survey was conducted to explore patient behavior and interest in using the Internet to contact physicians. The sample consisted of 4,510 CVS customers with an inclusion criteria of at least one chronic condition. Out of the 4,510 subjects sampled, 2,252 responded. This survey measured demographic and health information, patient use of email and Facebook to contact physicians, and patient interest in and use of Web-based tools for health. Out of the 2,252 respondents, 37% reported contacting their physician(s) via email within the last six months, whereas 18% contacted via Facebook. The study also found a negative association between older age and contact with physician via email (OR 0.57 [95 % CI 0.41–0.78]) or Facebook (OR 0.28 [0.17–0.45]). Some patients were found to be interested in using Web-based tools to fill prescriptions, track health, and access health information (37-57%), but very few were currently doing so (4-8%)

Although this study only measured patient contact with physicians, the findings still may apply to pharmacists. The article noted one important detail from its findings; the gap between patient interest for online communication and the opportunities that physicians currently provide. With more development and adoption of creating a secure Web messaging system, a solution could be found that addresses patient demand for quicker and more convenient contact. The research also notes a very important statistic; patient interest in using web-based tools to fill prescriptions and track health/health information and the amount of patients already doing so. This shows that there are currently no well developed and implemented way for patients to perform all of these tasks. Although community pharmacies are rolling out individual programs for these needs, there is no one global tool that is available to patients that often visit multiple community pharmacies.

Lee J., Choudhry N., Wu A., et al. Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users. J Gen Intern Med. 2016; 31: 45-51

Enactment of mandatory pharmacy technician certification in Kansas

This article discussed the process and accomplishment of an enactment of mandatory pharmacy technician certification in Kansas. In 2004, Kansas began the step in requiring registration of all pharmacy technicians. These technicians were required to register, however they did not require any certification. Later, on September 2012, the Kansas Board of Pharmacy created a task force to research practices of technician certification in other states and to make recommendations to the board of pharmacy on how to create mandatory technician certification. This task force then formed the steps needed to achieve the legislation to support mandatory technician certification. These recommendations were then finalized at the August 2013 Kansas Pharmacy Summit and proposed legislation was then passed during the 2014 session. This legislation outlined topics such as training requirements, age and education requirements, pharmacist to technician ratio, and more.

Pharmacists are not able to provide everything that a patient in a community setting will want. That is why having pharmacy technicians is important within the community field. As of now the state of Pennsylvania has a certification that is available for people interested in becoming a pharmacy technician, however this is not required. Along with this, there are no strict guidelines for being a pharmacy technician. These guidelines and requirements might make a positive impact on work conducted within a community setting. Having a more regular and monitored assistant position within a community pharmacy might also improve patient care and reduce the risk of mistakes.

Lucas A.. Massey L., Gill T., et al. Enactment of mandatory pharmacy technician certification in Kansas. Am J Health Syst Pharm. 2016; 73: 133-36

Unused Medication Disposal Patterns : Medicare Patient Survey

A recent study was conducted to examine what medications were most often left unused, how much is left unused, and how these medications were disposed, focusing mainly among Medicare beneficiaries. The study included a telephone survey conducted by a survey research center. This survey included 721 Medicare Advantage members who had Part D coverage as of December 31, 2013 and had completed the telephone survey in May 2014. There were 2994 reported medications. Out of these 2994 medications, 247 (8%) were reported being left unused by patients. Out of this 247 unused medication, 15% were for pain, 14% for hypertension, 11% for antibiotics, and 9% for psychiatric disorders. Some reasoning given by these patients included “dosage changed by doctor”, as well as over-prescribing and adverse effects. Surprisingly, only 11% of the unused medication were disposed of via drug take-back programs, whereas a majority (55%) were kept in a cabinet. The other methods included thrown in the trash (14%) and flushed down the toilet (9%). This study concluded that the lack of patient adherence alone can not be enough to explain the large percentage in unused medications. Community-level interventions must be in place to improve adherence as well as reduce improper disposal of unused medications.

I believe that this study is important because it puts data to the very important problem of improper disposal. I often have geriatric patients bringing their prescription vials to our presentations and visits. Some, if not most, of these vials turn out to be months or years old and are still filled with medication. It is also interesting to see what type of medications are often reported unused, such as antibiotic medication.

 

Maeng DD., Snyder RC., Medico CJ., et al Unused medications and disposal patterns at home: Findings from a Medicare patient survey and claims data J Am Pharm Assoc 2016;56:41–46

Interventions by Health Care Professionals in Reducing Tobacco Smoke Exposure in Children : A Review and Meta-analysis

A recent review was conducted to determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing tobacco smoke exposure in children. A meta-analysis conducted on 57 trials was performed. The primary outcome was reduction in child tobacco smoke exposure with a secondary outcome of parental smoking cessation. 16 studies met the selection criteria. The only trials that demonstrated a significant overall intervention effect were trials that affected maternal postpartum smoking relapse prevention.

Although this meta-analysis did not provide much in the way of finding interventions that could be effective in reducing child tobacco smoke exposure, it did find one intervention that could affect child TSA. This could be a first step towards finding other interventions that are effective. Much like the other intervention types, this intervention gets to the heart of the problem; parents smoking around their offspring. Even though tobacco use in adults over 18 have decreased since 2004, the percentage of adult smokers are still high. I believe interventions like this will prove useful in the future.

Daly JB., Mackenzie LJ., Freund M., et al Interventions by Health Care Professionals Who Provide Routine Child Health Care to Reduce Tobacco Smoke Exposure in Children. J Am Pharm Assoc Ped 2016; 170