Electronic Medication Refill Systems Improving Provider Productivity

This article details the study of a new electronic system implemented by Sharp Rees-Stealy Medical Group in 2014. In their new system, all incoming refill requests are received electronically and distributed to a more focused, centralized team. With a more centralized team, certain protocols were establish to better organized the incoming prescriptions from the personal care physicians that were sending them. The system was used to store and sort multiple types of information, including things such as dosing adjustment and the coordination between their pharmacy and other mail order pharmacies. In 2014, 302,592 tasks were taking in by the newly implemented system which resulted in 140,350 interventions being completed.

This article is important to the field of pharmacy because efficiency is one of the hallmarks of the practice of pharmacy in a community setting. Taking time out of activities such as taking in and organizing incoming prescriptions opens up for more time for the pharmacists to complete other, more important tasks. This includes the consultation of patients, checking outgoing prescriptions for accuracy, and other services such as providing immunizations. In the results and conclusion portion of the study, it reported that the new electronic system saved the team from 20-30 minutes each day. This might not seem very significant at first, but it opens the door for more time to complete patient-focused activities rather than logistical duties with an extra half-hour for the pharmacist and his or her team.

One question I would have for the team would be how to get more physicians on board to use the system. It would seem that getting them to comply and use the system with all their patients would be the most difficult part of making systems like this be functional and successful.
J Manag Care Spec Pharm, 2016 Mar;22(3):204-208.

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.

A Novel protective Protein Variant that Colocalizes with Kuru Exposure

Kuru is a type of spongiform encephalopathy, indicating that it is a prion disease. Kuru almost exclusively affected the population within the eastern highlands and province of Papua New Guinea.  Within the population the disease became epidemic for a period of time as the disease was transmitted between individuals in the community. After anthropologic inspection, the disease was only found to be transmitted to females and young children under the ages of six, excluding males after the age of six.  IT was identified that the disease was passed through ritualistic cannibalism of diseased relatives, thereby being the mechanism of transmission. The disease was eradicated in the 1950’s when government officials in the area ensured prohibition of cannibalism.  The disease however serves as a model for other forms of spongiform encephalopathy as other forms are still existant today, as Creutzfeldt-Jacob, and bovine spongiform encephalopathy in animals.

Genetic and clinical genealogic assessments of 3000 persons from the regions including those that participated in mortuary feasts were studied for variant alleles critical in resistance for developing Kuru.  It was found that most individuals are heterozygous for the understood resistance factor at codon 129 of the prion protein gene PRNP.  More interesting however is a new identified prion resistance factor being the 127V polymorphism.  This variant has only been found in individuals within the communities that have been exposed to Kuru indicating that this is a developed resistance to the disease. This variant has developed during the epidemic and represents a significant progression of recent selection in humans.

N Engl J Med 2009; 361:2056-2065November 19, 2009http://www.nejm.org/doi/full/10.1056/NEJMoa0809716

Autophagy in Human Health and Disease

There are a number of biological processes which can influence the progression and pathogenesis of diseases experienced by humans. Upon identifying the number of processes which can contribute to a disease state, being inflammation, apoptosis, and metabolism, it can be concluded that these pathways are critical in treating a particular disease state. Recently, these pathways have been the targets of various drug pathways. The most notable of which is the process of autophagy.  The process of autophagy occurs in response to regulatory cues stimulated by environmental factors.  Simply, autophagy is the ability of a cell to consume debris and particles outside of a cell. Primarily, this process serves as a protective mechanism to prevent cell death.  Many processes that involve disease states are identified. The development of cancer can be both inhibited and facilitated through autophagy.  In existing tumors, autophagy can be used by the tumor cells to prolong survival, where autophagy regulates or inhibits the initiation of cancer in healthy cells. In neurodegenerative diseases, it is found that the processes involving autophagy are altered. Autophagic enzymes are often over expressed in a compensatory type fashion to existing neurodegenerative diseases, or under expressed as the neurodegenerative disease inhibits their function or formation.  Pathways for autophagy also exist within infectious disease responses. Autophagy helps in the elimination of diseases such as herpes encephalitis, bacterial infections such as salmonella, and parasites while aiding in the cleaning of debris from immunologic responses.

As the role of autophagy in the development and pathogenesis of diseases, the applications in targeting these pathways are of value.  Currently, anticancer drug Sirolimus activates autophagy as an immunosuppressive drug and anticancer drug.  A progression in our understanding of autophagy will elicit further drug targets and ways in which the pathogenesis of diseases can be inhibited.

N Engl J Med 2013; 368:651-662February 14, 2013http://www.nejm.org/doi/full/10.1056/NEJMra1205406

A New Antibiotic and the evolution of Resistance

Since their discovery, antibiotics have served as a vehicle for medical and human advancement.  There are medical procedures now performed that would be entirely ineffective or even outrageous without the effects of antibiotics.  The effects of antibiotics have largely infiltrated many parts of our lives, as we are practically ensured protection from infection. Despite the miracles performed by antibiotics in the past, antibiotic resistant infections are now killing more lives than the current epidemics of the globe. These epidemics include HIV in America and Ebola. By the year 2050 the cumulative healthcare costs of these resistant infections will total over 100 trillion dollars to the global economy. That will occur only if we continue down the current path of resistance we are experiencing.  There have been decreased incentives for pharmaceutical companies to produce new antibiotics as lead discovery costs are now around a million dollars, with a very low compound advancement. Investment efforts are allocated elsewhere.

Despite this decreased incentive for development, new technologies and approaches are aiding in the arms race against resistance. Researcher Ling et al. has been using novel culturing techniques through an isolation chip process to identify new antimicrobial compounds.  Through this process he has discovered a compound called teixobactin. This compound is produced by the bacterium Eleftheria terrae, which inhibits the growth of Staphylococcus aureus. The compound is shown to be highly effective against gram negative pathogens, particularly tuberculosis.  However despite advancements in clinical trials, it may take years before a commercial product.

It appears as though another promising antibiotic has been found. But what is more important is understanding the challenges we face in this arms race with evolution. Our current understanding of the cell tells us that this antibiotic targets an irreplaceable component of the cell, and this drug should be effective for years to come.  However, we have already learned this lesson through vancomycin, as we previously thought that cells would not be able to adapt to overcome its inhibitory effect through its critical target area. After the large use however, as one could predict, cells became resistant.  For now, we must utilize our advances as they come to combat infection and save lives.

N Engl J Med 2015; 372:1168-1170March 19, 2015


Metformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study

Atypical antipsychotics are very well known for causing weight gain in patients. However, patients are usually dependent on these medications for the sake of their daily function, so discontinuing treatment because of weight gain is not an option. One way to alleviate this side effect is to use a medication that would cause weight loss in conjunction with using the antipsychotic. One commonly used drug that is known to cause weight loss is metformin. This study looks into the effectiveness of metformin as a weight loss agent when used with an atypical antipsychotic, with a particular focus on South Asian patients for some reason.

The study showed that metformin is an effective weight loss agent when used with an atypical antipsychotic. Patients often lost the weight that they gained from taking the antipsychotic, but they did not lose an unsafe amount of weight. It canceled out the weight gained by taking the antipsychotic while still keeping the patient very safe in all respects.

This study shows that creative drug therapies can be used to optimize the patient experience.

de Silva VA, Dayabandara M, Wijesundara H, et al. Metformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study. J Psychopharmacol. 2015: 29(12): 1255-1261


A qualitative evaluation of MTM in Minnesota health systems

This article details a study that was completed involving the collaboration of six separate health care systems in Minnesota. The basis of this study was a qualitative survey which was completed at each site. These qualitative interviews were conducted with individuals who were thought to be essential and involved at the clinics when it came to the implementation and use of medication management services. These interviews were recorded and analyzed to search for certain common thread of thought that served as the data, so to speak, for the experiment. After analysis of the interviews, thirteen themes were determined to be distinct in successful medication management programs. The themes were as follows: “(1) external influences, (2) pharmacists as an untapped resource, (3) principles and professionalism, (4) organizational culture, (5) momentum champions, (6) collaborative relationships, (7) service promotion, (8) team-based care, (9) implementation strategies, (10) overcoming challenges, (11) supportive care model process, (12) measuring and reporting results, and (13) sustainability strategies.”

This study is slightly significant because it tries to bring to light certain aspects of how pharmacists can be more successful in medication therapy management. Over the recent years, the profession has been trying to move away from a product-focused practice to a more patient-centered one, and this may be a good first step to help new pharmacies and pharmacists who want to help try to move the profession to a more promising future.
AJHP. 2016 ; 73(5) : 307-314

Anticholinergic vs Long-Acting β-Agonist in Combination With Inhaled Corticosteroids in Black Adults With Asthma

Many experts question the safety of using long acting beta agonists (LABAs) in treating asthma. Particularly, many feel as though African-Americans who use LABAs are at an increased risk for exacerbating their asthma symptoms. One idea is that allelic variation in the Arg16Gly gene could be causing pharmacogenetic variability that is disproportionately affecting African-Americans.

This study tested this hypothesis by comparing the asthmatic symptoms of African-American patients using LABAs with an inhaled corticosteroid (ICS) to  African-American patients using tiotropium and an ICS. Each patient also underwent genotyping to gauge the effect of the Arg16Gly gene. The results of the study showed that use of LABAs with an ICS did not exacerbate asthmatic symptoms any more than the use of tiotropium with an ICS. The study also showed that the Arg16Gly gene did not correlate to an increase in asthmatic symptoms, thus debunking the idea of pharmacogentic variability. Overall, the study showed that there is no difference in the worsening of asthma symptoms between LABAs and tiotropium.

This study shows the importance of researching preconceived notions about discrepancies in how certain patient populations handle medications. Without this research, some patients could receive sub-optimal therapy because of an untested yet widely accepted idea.

Wechlser ME, Yawn BP, Fuhlbrigge AL, et al. Anticholinergic vs Long Acting ß-Agonist In Combination with Inhaled Corticosteroids in Black Adults with Asthma. JAMA. 2015: 314(16): 1720-1730.  

Evidence supporting the use of Minocycline to treat MDRO infections

A serious problem that exists today in the world of medicine is bacterial resistance to antibiotics. Particularly resistant and bothersome strains of bacteria are referred to as MDRO’s, or multidrug-resistant organisms. The purpose of this paper was the explain the fact that there is evidence suggesting the usefulness of treating these types of infections with Minocycline in the IV form. The study details how 200 mg of Minocycline was administered to achieve serum concentrations in the body similar to other tetracyclines. The study showed how minocycline treatment was effective in maintaining antimicrobial activity in numerous types of resistant bacterial strains such as Staph infections and gram-negative pathogens.

This article is very important and relevant in the field of pharmacy. The growing threat of resistant bacterial strains can be detrimental to the overall health of the human population if the process of over prescribing antibiotics is not stopped. New studies like this showing that certain drugs are effective at fighting resistant bacterial strains is important because this could lead to more doctors and pharmacists working together to monitor their prescribing habits more closely. If they would switch the therapies they use for each patient so that the entire population is then resistant to a certain drug, then there will be a better chance of not creating resistant bacteria populations.
AJHP. 2016 ; 73(5) : 279-285

Health System Loyalty Programs: An Innovation in Customer Care and Service

This article discusses the potential opportunities and benefits for patient care loyalty programs within healthcare organizations. Loyalty programs for commercial businesses have proved successful at promoting customer retention, encouraging positive customer attitudes, and increasing referrals to others. This consumer-driven approach of customer care could be translated to patient care in health care systems, but this is not a common occurrence. Accountable Care Organizations (ACOs), in which patients are free to move among health care centers and physicians, see a high turnover of patients. Several studies have shown a range of 38 – 60% patient turnover rate each year in certain ACOs. This article proposed the introduction of a loyalty programs within an ACO will help with patient retention and overall satisfaction. Potential aspects of patient loyalty program include benefits to loyal members such as parking vouchers, cab and bus vouchers, and cafeteria discounts. Benefits could be customized for patient’s personal care needs, such as customized messages for certain disease states or healthy eating coupons.

This loyalty program model would offer three key benefits. First, greater likelihood for patient allegiance would allow for more comprehensive care, and cost and outcome management. This would benefit both patients and health care organizations. Second, it offers potential improvement in patient-satisfaction scores for reimbursement purposes. Third, tailoring of patient-centered care plans would promote a holistic population health model over a traditional hospital-centric model of care. In order to avoid abuse of the healthcare system as a result of loyalty programs, member rewards should be based on length and strength of loyalty rather than frequency of use. Overall, by involving patients in their own health management, and improving the business aspect of health systems, health care loyalty programs carry many potential benefits.

I feel that promoting patient retention is a key benefit of this type of loyalty program. Patients are much more likely to experience a continuity of care when they stay within a certain healthcare network and all parts are affiliated with one another. Do you think a health system loyalty program could be successful? What potential drawbacks does something like this present?

McMahon, L., Tipirneni, R., Chopra, V. Health System Loyalty Programs: An Innovation in Customer Care and Service. JAMA. 2016;315:863-864. doi:10.1001/jama.2015.19463.