Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-Morbidities

HIV patients are likely to have certain medical co-morbidities at a higher prevalence than members of their age group and are more vulnerable to adverse events related to these problems. For this reason, monitoring of patients with this condition is highly utilized through primary care clinics that specialize in the treatment of the infection in association with chronic disease states. The disease states common among HIV patients over the age of 60 include hypertension (45% of people), diabetes (21% of people), and vascular disease (23% of people). Interdisciplinary practice models used in treatment of patients with this condition have been effective in managing these chronic disease states. Because pharmacists play a crucial role in how HIV patients adhere to medications and treatment guidelines, this study focused on determining if there is a benefit to adding pharmacists to this inter professional team.

This study found that pharmacists were able to help in the management of  lipid levels and the cessation of smoking. Along with this, pharmacists were found to significantly decrease the amount of money these patients spend management of their individual chronic co-morbidities (with average savings of $3,000). For this reason, pharmacists involvement in the primary care of patients with HIV should expand past the provision of medications to include counseling and other services.

I think this study is important due to the fact that it represents how the role of a pharmacist within the health system is constantly changing. We are not only trusted sources of information for medications and proper treatment techniques, but we are also crucial in providing adequate counseling to patients. This is something that I believe has been a major focus throughout our studies in pharmacy school over the course of the year, and as a result, a feel I will be well prepared to fill this role in my future profession. This article makes me want to learn specific ways that I can help patients from this population manage their condition.

Cope R, Berkowitz L, Arcebido R, et al. Evaluating the effects of an interdisciplinary practice model with pharmacist collaboration on HIV patient co-morbidities. AIDS Patient Care and STDs. 2015, 29(8): 445-453

Improving Patients Primary Medication Adherence

Pharmacists across the globe face a key issue in their ability to provide patients with the tools that enable them to adhere to medication regimens. Increasing adherence to prescribed treatment options will help to improve the overall health outcomes of the patients that pharmacist’s are serving.  For this reason, research into the causes for non-adherence and its resulting issues is and will continue to be an area of high importance. The interest that I have in improving medication adherence led me to the article entitled improving Patients Primary Medication Adherence.

This article is focused around a study completed in a French hospital during the months of November 2010 to June 2011. The study, which included patients over the age of 18 that were admitted into the ITD (Infectious and Topical Disease) and the general medicine unit, was developed to determine if incorporating clinical pharmacy activities into the discharge process would decrease the amount of post-discharge adverse effects.  To assess the results of this study, medication adherence was determined by contacting the patients’ community pharmacists 7 days after discharge.  The study did not find a correlation between the rate of re-admittance and/or visits to emergency rooms, but patients who received extra counseling during discharge were more likely to be adherent to newly prescribed medications.  For this reason, the study supported the idea that adherence can be increased by providing discharge counseling sessions to patients.

I feel like this is an important study for us to consider as pharmacists because managing patient adherence to medication regimens is the most important role we play in improving health outcomes.  By improving adherence, we have the ability to lower the risk for serious adverse drug events which can lead to hospitalization.  For this reason, I believe that pharmacists should implement all activities that are proven to increase adherence to maximize the results of treatment options.  This article has left me wondering how similar programs to increase medication adherence can be implemented in community pharmacy settings.

Leguelinel-Blache G, Dubois F, Bouvet S, et al. Improving patient’s primary medication adherence: the value of pharmaceutical counseling. Med. 2015;94(41)


Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

As we progress further through flu season, it is important to consider different options to prevent contracting it or how to treat it if preventive measures fail. This study looked at the effectiveness of physicians and pharmacists working together as a team to diagnose patients with flu-like symptoms and prescribe treatments to them via established collaborative practice agreements. The study found that only 11% of the 121 patients screened tested positive for the flu, but the pharmacists were able to provide timely treatment to patients with the flu and also those who only required symptomatic treatments.

The study looked at community pharmacies throughout Michigan, Minnesota, and Nebraska that offered rapid influenza diagnostic tests, brief physical assessments, then used results to determine a diagnosis for each patient and recommended treatment or prescribed medications by the collaborative practice agreement. The study concluded that pharmacists using the data collected from the evidence-based collaborative practice agreements provided a very streamlined treatment experience to patients, and could possibly overtake urgent care and emergency room visits for these types of health care problems.

This practice set-up is one way that patients who have a hard time accessing health care providers can easily receive treatment for the flu. 34.6% of the patients included in the study who came to the pharmacy to get screened for influenza didn’t have a primary care physician and would have gone to urgent care or the emergency room to seek treatment, which is much less efficient and much more expensive. This also shows how health care providers working together can streamline a patient’s health care experience significantly, and also how pharmacists can use their accessibility to provide much more health care to patients than they normally do now. If this practice became the norm for pharmaceutical care, how do you think the role and the views of pharmacists would change?

Citation: Klepser ME, Klepser DG, Dering-Anderson AM et al. Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc. 56: 14-21.


Preventing infant mortality: Pharmacists’ call to action

The United States has a higher infant mortality rate than many other developed countries.  6.1 of every 1000 babies born in the U.S. dies within their first 12 months of life, not including miscarriages or stillbirths.  The leading causes of death in this country are preterm births (when the baby is born before the 37th week of the pregnancy), sudden infant death syndrome (SIDS), or low birth weight.  These deaths aren’t caused by a single factor, but a multitude of them.  Pharmacists can impact society more than they know by informing the population of the factors that contribute to infant mortality and hopefully reduce their frequency.

For example, tobacco use during pregnancy increases the likelihood of all of the leading causes of infant death in the U.S. in addition to birth defects.  Both smoking and smokeless tobacco have affects on the baby  even after it is born and can lead to complications.  Pharmacists can intervene by providing information and advice on smoking cessation as well as recommend products to help mothers quit.  Alcohol, illicit drugs, and marijuana all can have deleterious affects as well, and pharmacists can spread knowledge about these too.

Vaccines are also highly recommended to pregnant women to prevent infants from susceptibility to those diseases and infections.  The inactive forms are preferred and can range from flu to tetanus.  Pharmacists can educate their pregnant patients as well as administer these immunizations to prevent death from preventable causes.

Pharmacists can also inform the public on the advantages of breastfeeding, for instance babies who are breast fed have a lower risk of death due to SIDS.  Critical vitamins during pregnancy are another counseling point for pharmacists.

Overall, including pharmacists in the education of mothers during and after pregnancy can and should have a profound effect.  Together with their inter-professional health team, they can reduce infant mortality rates by informing the public on preventable actions that cause infant death.

DiPietro Mager N. Preventing infant mortality: Pharmacists’ call to action. JAPhA. 2016;56(1):82-87