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152
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Dixon DL, Salgado TM, Caldas LM, Van Tassell BW, Sisson EM. The 2017 American College of Cardiology/American Heart Association hypertension guideline and opportunities for community pharmacists. J Am Pharm Assoc (2003) 2018; 58:382-386. [DOI: 10.1016/j.japh.2018.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/20/2018] [Accepted: 04/15/2018] [Indexed: 01/22/2023]
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153
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Campbell DJ, Coller JM, Gong FF, McGrady M, Prior DL, Boffa U, Shiel L, Liew D, Wolfe R, Owen AJ, Krum H, Reid CM. Risk factor management in a contemporary Australian population at increased cardiovascular disease risk. Intern Med J 2018; 48:688-698. [DOI: 10.1111/imj.13678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/11/2017] [Accepted: 11/01/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Duncan J. Campbell
- Department of Molecular Cardiology; St Vincent's Institute of Medical Research; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiology; St Vincent's Hospital; Melbourne Victoria Australia
| | - Jennifer M. Coller
- Department of Cardiology; St Vincent's Hospital; Melbourne Victoria Australia
| | - Fei Fei Gong
- Department of Molecular Cardiology; St Vincent's Institute of Medical Research; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiology; St Vincent's Hospital; Melbourne Victoria Australia
| | - Michele McGrady
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - David L. Prior
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiology; St Vincent's Hospital; Melbourne Victoria Australia
| | - Umberto Boffa
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Louise Shiel
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Alice J. Owen
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Henry Krum
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- School of Public Health; Curtin University; Perth Western Australia Australia
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154
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Epure AM, Leyvraz M, Mivelaz Y, Di Bernardo S, da Costa BR, Chiolero A, Sekarski N. Risk factors and determinants of carotid intima-media thickness in children: protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e019644. [PMID: 29866720 PMCID: PMC5988176 DOI: 10.1136/bmjopen-2017-019644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis that is measured in adults and children to better understand the natural history of cardiovascular disease (CVD). In adults, CIMT is predictive of myocardial infarction and stroke. In children and adolescents, CIMT is used to assess vascular changes in the presence of CVD risk factors (obesity, hypertension, smoking, etc) or clinical conditions associated with a high risk for premature CVD. However, there is no comprehensive overview, in a life-course epidemiology perspective, of the risk factors and determinants of CIMT in children. It is also important to evaluate between-study differences in CIMT measurement methods and take them into consideration when drawing conclusions. Our objective is to systematically review the evidence on the relationship between CIMT and prenatal and postnatal exposures or interventions in children, as well as documenting and discussing the CIMT measurement methods. METHODS AND ANALYSIS Systematic searches of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (EMBASE)and Central Register of Controlled Trials (CENTRAL) databases will be conducted. The reference lists and other literatures sources will be browsed. Observational and experimental studies in children from birth up to 18 years will be included. Prenatal and postnatal exposures or interventions assessed in relationship with CIMT will be considered for inclusion. Examples might include gestational age, obesity, hypertension, tobacco exposure, specific at-risk conditions (chronic kidney disease, diabetes, etc) or statin treatment. The outcome will be CIMT assessed by ultrasonography. The setting, scanning and measurement methods for each included study will be described in detail. Results will be synthesised descriptively and, if appropriate, will be pooled across studies to perform meta-analyses. Separate meta-analyses for each exposure or intervention type will be conducted. ETHICS AND DISSEMINATION This systematic review will be published in a peer-reviewed journal. A report will be prepared for clinicians and other healthcare decision-makers. PROSPERO REGISTRATION NUMBER CRD42017075169.
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Affiliation(s)
- Adina Mihaela Epure
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yvan Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefano Di Bernardo
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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155
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Bonetti AF, Reis WC, Lombardi NF, Mendes AM, Netto HP, Rotta I, Fernandez-Llimos F, Pontarolo R. Pharmacist-led discharge medication counselling: A scoping review. J Eval Clin Pract 2018; 24:570-579. [PMID: 29691955 DOI: 10.1111/jep.12933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Discharge medication counselling has produced improved quality of care and health outcomes, especially by reducing medication errors and readmission rates, and improving medication adherence. However, no studies have assembled an evidence-based discharge counselling process for clinical pharmacists. Thus, the present study aims to map the components of the pharmacist-led discharge medication counselling process. METHODS We performed a scoping review by searching electronic databases (Pubmed, Scopus, and DOAJ) and conducting a manual search to identify studies published up to July 2017. Studies that addressed pharmacist-led discharge medication counselling, regardless of the population, clinical conditions, and outcomes evaluated, were included. RESULTS A total of 1563 studies were retrieved, with 75 matching the inclusion criteria. Thirty-two different components were identified, and the most prevalent were the indication of the medications and adverse drug reactions, which were reported in more than 50% of the studies. The components were reported similarly by studies from the USA and the rest of the world, and over the years. However, 2 differences were identified: the use of a dosage schedule, which was more frequent in studies published in 2011 or before and in studies outside the USA; and the teach-back technique, which was used more frequently in the USA. Poor quality reporting was also observed, especially regarding the duration of the counselling, the number of patients, and the medical condition. CONCLUSION Mapping the components of the pharmacist-led discharge counselling studies through a scoping review allowed us to reveal how this service is performed around the world. Wide variability in this process and poor reporting were identified. Future studies are needed to define the core outcome set of this clinical pharmacy service to allow the generation of robust evidence and reproducibility in clinical practice.
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Affiliation(s)
- Aline F Bonetti
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana, Curitiba, Brazil
| | - Wálleri C Reis
- Department of Pharmacy, Federal University of Paraiba, João Pessoa, Brazil
| | | | - Antonio M Mendes
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana, Curitiba, Brazil
| | - Harli Pasquini Netto
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana, Curitiba, Brazil
| | - Inajara Rotta
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana, Curitiba, Brazil
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Roberto Pontarolo
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Parana, Curitiba, Brazil
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156
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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157
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Al Harmarneh YN, Lamb S, Donald M, Hemmelgarn B, King Shier K, Jones CA, Mitchell C, Tsuyuki RT. Pharmacist prescribing and care improves cardiovascular risk, but what do patients think? A substudy of the R xEACH study. Can Pharm J (Ott) 2018; 151:223-227. [PMID: 30237836 DOI: 10.1177/1715163518779092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yazid N Al Harmarneh
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Sarah Lamb
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Maoliosa Donald
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Brenda Hemmelgarn
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Kathryn King Shier
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Charlotte A Jones
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Cliff Mitchell
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
| | - Ross T Tsuyuki
- Department of Medicine (Al Hamarneh, Lamb, Tsuyuki), University of Alberta, Edmonton.,Cumming School of Medicine (Donald), University of Calgary, Calgary, Alberta.,Departments of Family Medicine and Community Health Sciences (Hemmelgarn), University of Calgary, Calgary, Alberta.,Faculty of Nursing (King-Shier), University of Calgary, Calgary, Alberta.,UBC-Okanagan Health Sciences Centre (Jones), Kelowna, British Columbia
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Matzke GR, Moczygemba LR, Williams KJ, Czar MJ, Lee WT. Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization. Am J Health Syst Pharm 2018; 75:1039-1047. [PMID: 29789318 DOI: 10.2146/ajhp170789] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described. METHODS Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system. A total of 2,480 evaluable patients were included in both the collaborative care group and the usual care group. The primary clinical outcomes measured were the absolute change in values associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline within and between the collaborative care and usual care groups. RESULTS Significant improvements (p < 0.01) in glycosylated hemoglobin, blood pressure, low-density-lipoprotein cholesterol, and total cholesterol were observed in the collaborative care group compared with the usual care group. Hospitalizations declined significantly in the collaborative care group (23.4%), yielding an estimated cost savings of $2,619 per patient. The return on investment (net savings divided by program cost) was 504%. CONCLUSION Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based PCMH model was associated with significant improvements in patients' medication-related clinical health outcomes and a reduction in hospitalizations.
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Affiliation(s)
- Gary R Matzke
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University School of Pharmacy, Richmond, VA.
| | - Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, University of Texas at Austin College of Pharmacy, Austin, TX
| | | | - Michael J Czar
- Department of Pharmacy, Carilion New River Valley Medical Center, Christiansburg, VA
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159
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Victor RG, Lynch K, Li N, Blyler C, Muhammad E, Handler J, Brettler J, Rashid M, Hsu B, Foxx-Drew D, Moy N, Reid AE, Elashoff RM. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018; 378. [PMID: 29527973 PMCID: PMC6018053 DOI: 10.1056/nejmoa1717250] [Citation(s) in RCA: 355] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. METHODS We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months. RESULTS At baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group; the mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001). A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001). In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury). CONCLUSIONS Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618 .).
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Affiliation(s)
- Ronald G Victor
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Kathleen Lynch
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Ning Li
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Ciantel Blyler
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Eric Muhammad
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Joel Handler
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Jeffrey Brettler
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Mohamad Rashid
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Brent Hsu
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Davontae Foxx-Drew
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Norma Moy
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Anthony E Reid
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
| | - Robert M Elashoff
- From the Smidt Heart Institute at Cedars-Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) - all in Los Angeles
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160
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Avena-Woods C, Mangione RA, Wu WK. Exploring the Community Pharmacist's Knowledge of Celiac Disease. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6353. [PMID: 29606714 PMCID: PMC5869756 DOI: 10.5688/ajpe6353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/23/2017] [Indexed: 06/08/2023]
Abstract
Objective. To evaluate pharmacists' knowledge of celiac disease, and identify potential areas where additional continuing education may be needed. Methods. A survey was sent to community pharmacists practicing in a national chain pharmacy in one region of New Jersey and New York. Results. There were 418 pharmacists who responded to the survey with a response rate of 38%. Only 27% of all respondents who reported their understanding of celiac disease to be basic or advanced correctly defined celiac disease as both an autoimmune and a chronic lifelong disease. The majority (60%) of respondents correctly stated there are no federal regulations requiring manufacturers to designate medications as gluten-free. Twenty percent of respondents said they often recommended a change in diet to people suspected to have celiac disease before a confirmed diagnosis. Conclusion. Community pharmacists possess some knowledge of the disease and would benefit from and desire additional education about this disorder.
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161
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Anderegg MD, Gums TH, Uribe L, MacLaughlin EJ, Hoehns J, Bazaldua OV, Ives TJ, Hahn DL, Coffey CS, Carter BL. Pharmacist Intervention for Blood Pressure Control in Patients with Diabetes and/or Chronic Kidney Disease. Pharmacotherapy 2018; 38:309-318. [PMID: 29331037 PMCID: PMC5867244 DOI: 10.1002/phar.2083] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objectives of this study were to determine if hypertensive patients with comorbid diabetes mellitus (DM) and/or chronic kidney disease (CKD) receiving a pharmacist intervention had a greater reduction in mean blood pressure (BP) and improved BP control at 9 months compared with those receiving usual care; and compare Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guideline and 2014 guideline (JNC 8) BP control rates in patients with DM and/or CKD. METHODS This cluster randomized trial included 32 medical offices in 15 states. Clinical pharmacists made treatment recommendations to physicians at intervention sites. This post hoc analysis evaluated mean BP and BP control rates in the intervention and control groups. MAIN RESULTS The study included 335 patients (227 intervention, 108 control) when mean BP and control rates were evaluated by JNC 7 inclusion and control criteria. When JNC 8 inclusion and control criteria were applied, 241 patients (165 intervention, 76 control) remained and were included in the analysis. The pharmacist-intervention group had significantly greater mean systolic blood pressure reduction compared with usual care at 9 months (8.64 mm Hg; 95% confidence interval [CI] -12.8 to -4.49, p<0.001). The pharmacist-intervention group had significantly higher BP control at 9 months than usual care by either the JNC 7 or JNC 8 inclusion and control groups (adjusted odds ratio [OR] 1.97, 95% CI 1.01-3.86, p=0.0470 and OR 2.16, 95% CI 1.21-3.85, p=0.0102, respectively). PRINCIPAL CONCLUSIONS This study demonstrated that a physician-pharmacist collaborative intervention was effective in reducing mean systolic BP and improving BP control in patients with uncontrolled hypertension with DM and/or CKD, regardless of which BP guidelines were used.
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Affiliation(s)
- Maxwell D. Anderegg
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA
| | - Tyler H. Gums
- Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas, Austin, Texas
| | - Liz Uribe
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Eric J. MacLaughlin
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - James Hoehns
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA
- Northeast Iowa Medical Education Foundation, Waterloo, Iowa
| | - Oralia V. Bazaldua
- Department of Family and Community Medicine, The University of Texas Health Sciences Center at San Antonio, Texas
| | - Timothy J. Ives
- UNC Eshelman School of Pharmacy and the Department of Medicine, The University of North Carolina at Chapel Hill, North Carolina
| | - David L. Hahn
- Wisconsin Research and Education Network, University of Wisconsin, Madison, Wisconsin
| | - Christopher S. Coffey
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Barry L. Carter
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
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Komwong D, Greenfield G, Zaman H, Majeed A, Hayhoe B. Clinical pharmacists in primary care: a safe solution to the workforce crisis? J R Soc Med 2018; 111:120-124. [PMID: 29480743 DOI: 10.1177/0141076818756618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daoroong Komwong
- 1 Department of Pharmacy, 293644 Sirindhorn College of Public Health , Praboromarajchanok Institute of Health Workforce Development, Chon Buri 20000, Thailand
| | - Geva Greenfield
- 2 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Hadar Zaman
- 3 School of Pharmacy and Medical Sciences, Faculty of Life Sciences, 1905 University of Bradford , West Yorkshire BD7 1DP, UK
| | - Azeem Majeed
- 2 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Benedict Hayhoe
- 2 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
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163
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life. JMIR Res Protoc 2018; 7:e57. [PMID: 29463490 PMCID: PMC5840476 DOI: 10.2196/resprot.8659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients' adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes. OBJECTIVE This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately. METHODS The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient's medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use. RESULTS The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019. CONCLUSIONS The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy).
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norweigan University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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164
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation. JMIR Res Protoc 2018; 7:e21. [PMID: 29382630 PMCID: PMC5811650 DOI: 10.2196/resprot.8660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. OBJECTIVE This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. METHODS The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients' beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients' overall experience of care after coronary heart disease. RESULTS The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known. CONCLUSIONS This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions.
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Affiliation(s)
- Malin Johansson Östbring
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden.,eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tommy Eriksson
- Department of Biomedical Science, Malmö University, Malmö, Sweden.,Department of Clinical and Molecular Medicine, Norwegian University of Sciences and Technology, Trondheim, Norway
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- Pharmaceutical Department, Kalmar County Council, Kalmar, Sweden
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Abstract
PURPOSE OF REVIEW This review aims to emphasize how therapeutic inertia, the failure of clinicians to intensify treatment when blood pressure rises or remains above therapeutic goals, contributes to suboptimal blood pressure control in hypertensive populations. RECENT FINDINGS Studies reveal that the therapeutic inertia is quite common and contributes to suboptimal blood pressure control. Quality improvement programs and standardized approaches to support antihypertensive treatment intensification are ways to combat therapeutic inertia. Furthermore, programs that utilize non-physician medical professionals such as pharmacists and nurses demonstrate promise in mitigating the effects of this important problem. Therapeutic inertia impedes antihypertensive management and requires a broad effort to reduce its effects. There is an ongoing need for renewed focus and research in this area to improve hypertension control.
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166
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Mills KT, Obst KM, Shen W, Molina S, Zhang HJ, He H, Cooper LA, He J. Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis. Ann Intern Med 2018; 168:110-120. [PMID: 29277852 PMCID: PMC5788021 DOI: 10.7326/m17-1805] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The prevalence of hypertension is high and is increasing worldwide, whereas the proportion of controlled hypertension is low. PURPOSE To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. DATA SOURCES Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches. STUDY SELECTION Randomized controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension. DATA EXTRACTION Two investigators independently extracted data and assessed study quality. DATA SYNTHESIS A total of 121 comparisons from 100 articles with 55 920 hypertensive patients were included. Multilevel, multicomponent strategies were most effective for systolic BP reduction, including team-based care with medication titration by a nonphysician (-7.1 mm Hg [95% CI, -8.9 to -5.2 mm Hg]), team-based care with medication titration by a physician (-6.2 mm Hg [CI, -8.1 to -4.2 mm Hg]), and multilevel strategies without team-based care (-5.0 mm Hg [CI, -8.0 to -2.0 mm Hg]). Patient-level strategies resulted in systolic BP changes of -3.9 mm Hg (CI, -5.4 to -2.3 mm Hg) for health coaching and -2.7 mm Hg (CI, -3.6 to -1.7 mm Hg) for home BP monitoring. Similar trends were seen for diastolic BP reduction. LIMITATION Sparse data from low- and middle-income countries; few trials of some implementation strategies, such as provider training; and possible publication bias. CONCLUSION Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Katherine T Mills
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine M Obst
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Wei Shen
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Sandra Molina
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Hui-Jie Zhang
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Hua He
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa A Cooper
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Jiang He
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
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167
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Omboni S, Caserini M. Effectiveness of pharmacist's intervention in the management of cardiovascular diseases. Open Heart 2018; 5:e000687. [PMID: 29344376 PMCID: PMC5761304 DOI: 10.1136/openhrt-2017-000687] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The pharmacist may play a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes. Systematic reviews of randomised controlled and observational studies have documented an improved control of hypertension, dyslipidaemia or diabetes, smoking cessation and reduced hospitalisation in patients with heart failure, following a pharmacist’s intervention. Limited proof for effectiveness is available for humanistic (patient satisfaction, adherence and knowledge) and economic outcomes. A multidisciplinary approach, including medical input plus a pharmacist, specialist nurse or both, and a greater involvement of community rather than hospital pharmacists, seems to represent the most efficient and modern healthcare delivery model. However, further well-designed research is demanded in order to quantitatively and qualitatively evaluate the impact of pharmacist’s interventions on cardiovascular disease and to identify specific areas of impact of collaborative practice. Such research should particularly focus on the demonstration of a sensitivity to community pharmacist’s intervention. Since pharmacy services are easily accessible and widely distributed in the community setting, a maximum benefit should be expected from interventions provided in this context.
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Affiliation(s)
- Stefano Omboni
- Department of Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
| | - Marina Caserini
- Department of Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
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168
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Dixon DL, Sisson EM, Parod ED, Van Tassell BW, Nadpara PA, Carl D, W. Dow A. Pharmacist-physician collaborative care model and time to goal blood pressure in the uninsured population. J Clin Hypertens (Greenwich) 2018; 20:88-95. [PMID: 29237095 PMCID: PMC8031164 DOI: 10.1111/jch.13150] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
Pharmacist-physician collaborative practice models (PPCPMs) improve blood pressure (BP) control, but their effect on time to goal BP is unknown. This retrospective cohort study evaluated the impact of a PPCPM on time to goal BP compared with usual care using data from existing medical records in uninsured patients with hypertension. The primary outcome was time from the initial visit to the first follow-up visit with a BP <140/90 mm Hg. The study included 377 patients (259 = PPCPM; 118 = usual care). Median time to BP goal was 36 days vs 259 days in the PPCPM and usual care cohorts, respectively (P < .001). At 12 months, BP control was 81% and 44% in the PPCPM and usual care cohorts, respectively (P < .001) and therapeutic inertia was lower in the PPCPM cohort (27.6%) compared with usual care (43.7%) (P < .0001). Collaborative models involving pharmacists should be considered to improve BP control in high-risk populations.
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Affiliation(s)
- Dave L. Dixon
- Center for Pharmacy Practice InnovationVirginia Commonwealth University School of PharmacyRichmondVAUSA
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Evan M. Sisson
- Center for Pharmacy Practice InnovationVirginia Commonwealth University School of PharmacyRichmondVAUSA
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Eric D. Parod
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Benjamin W. Van Tassell
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Pramit A. Nadpara
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Daniel Carl
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Alan W. Dow
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVAUSA
- Center for Interprofessional Education and Collaborative CareVirginia Commonwealth UniversityRichmondVAUSA
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169
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Lamb SA, Al Hamarneh YN, Houle SKD, Leung AA, Tsuyuki RT. Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention and treatment of hypertension in adults for pharmacists: An update. Can Pharm J (Ott) 2018; 151:33-42. [PMID: 29317935 PMCID: PMC5755821 DOI: 10.1177/1715163517743525] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sarah A. Lamb
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Yazid N. Al Hamarneh
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Sherilyn K. D. Houle
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
| | - Alexander A. Leung
- the Faculty of Pharmacy and Pharmaceutical Sciences (Lamb), Department of Medicine (Al Hamarneh, Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
- the School of Pharmacy (Houle), University of Waterloo, Ontario
- the Department of Medicine (Leung), University of Calgary, Alberta
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170
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Okada H, Onda M, Shoji M, Sakane N, Nakagawa Y, Sozu T, Kitajima Y, Tsuyuki RT, Nakayama T. Effects of lifestyle advice provided by pharmacists on blood pressure: The COMmunity Pharmacists ASSist for Blood Pressure (COMPASS-BP) randomized trial. Biosci Trends 2017; 11:632-639. [PMID: 29249774 DOI: 10.5582/bst.2017.01256] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The COMmunity Pharamcists ASSist for Blood Pressure (COMPASS-BP) study aimed to assess the effectiveness of lifestyle support programs administered in community pharmacies on hypertension control. This open-label, two-armed parallel group, cluster-randomized controlled trial included 73 pharmacies (clusters) in Japan randomized to a control or intervention group. Eligible hypertensive patients (n = 125), aged 20-75 years, received the intervention (n = 64) or the control treatment (n = 61), as dictated by their pharmacy randomization. Patients in the intervention group received brochures and healthy lifestyle advice from pharmacists using motivational interviewing methods during pharmacy visits over a 12-week period, with their usual pharmacy care. Conversely, the control group just received usual care. The main outcome measure was a change in morning systolic blood pressure (SBP) from baseline to week 12. The intervention group exhibited a decrease in morning SBP that was 6.0 mmHg greater than that of the control group (95% confidence interval [CI]: -11.0 to -0.9, p = 0.021). In a mixed-effect model for repeated measures analysis, the intergroup difference in morning SBP decrease was -4.5 mmHg (95% CI: -8.5 to -0.6, p = 0.024). Our findings indicate that implementation of a lifestyle advice program in pharmacies is feasible and may lead to reduced blood pressure.
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Affiliation(s)
- Hiroshi Okada
- Department of Health Informatics, Kyoto University School of Public Health.,Division of Preventive Medicine, Clinical Research, National Hospital Organization, Kyoto Medical Center.,EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Mitsuko Onda
- Clinical Laboratory of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences
| | - Masaki Shoji
- Clinical Laboratory of Practical Pharmacy, Osaka University of Pharmaceutical Sciences, Osaka, Japan; 6 Polon Company
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research, National Hospital Organization, Kyoto Medical Center
| | | | - Takashi Sozu
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science
| | - Yui Kitajima
- Department of Management Science, Faculty of Engineering, Tokyo University of Science
| | - Ross T Tsuyuki
- EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
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171
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Affiliation(s)
- Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA.,Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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172
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Bucheit JD, Helsing H, Nadpara P, Virani SS, Dixon DL. Clinical pharmacist understanding of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. J Clin Lipidol 2017; 12:367-374.e3. [PMID: 29277495 DOI: 10.1016/j.jacl.2017.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical pharmacists are frequently involved in the management of dyslipidemia, yet clinical pharmacists' knowledge, awareness, and the level of agreement with the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guideline are unknown. OBJECTIVE The objective of the study was to examine clinical pharmacists' knowledge, awareness, and the level of agreement with the 2013 ACC/AHA cholesterol guideline. METHODS We administered a validated questionnaire via an online survey that was electronically mailed to clinical pharmacists. We compared responses between those in practice for ≤ 10 and those in practice for > 10 years, and according to practice specialty. RESULTS The response rate was 11% (314 of 2845). Most respondents were from the Midwestern and Southeastern US, in practice for ≤ 10 years, and practiced in family practice/primary care. Nearly all (92%) respondents had read the guideline and 72% were able to identify the 4 statin benefit groups. Notable knowledge gaps included recalling the 4 outcomes of the 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimator (41.4%), understanding differences between the Framingham Risk Score and the ASCVD risk estimator (33.7%), and monitoring lipids after initiating a statin (41.1%). More knowledge gaps were identified in those practicing for > 10 years and who specialized in internal medicine. The use of the ASCVD risk estimator was high; yet nearly half (44.2%) were concerned whether the ASCVD risk estimator would overestimate 10-year ASCVD risk. CONCLUSION Although most clinical pharmacists had read the 2013 ACC/AHA cholesterol guideline, several knowledge gaps were identified, especially among those with more experience and those practicing in internal medicine. Targeted education efforts are needed to address these gaps.
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Affiliation(s)
- John D Bucheit
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Haleigh Helsing
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Pramit Nadpara
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dave L Dixon
- Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA; Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA.
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173
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Modesti PA, Donigaglia G, Fabiani P, Mumoli N, Colella A, Boddi M. The involvement of pharmacies in the screening of undiagnosed atrial fibrillation. Intern Emerg Med 2017; 12:1081-1086. [PMID: 28929326 DOI: 10.1007/s11739-017-1752-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/11/2017] [Indexed: 01/21/2023]
Abstract
Early identification of atrial fibrillation (AF) is now a priority in cardiovascular prevention because AF is common although often asymptomatic, and is associated with poor outcomes that are highly preventable with appropriate medical treatment. In Italy, AF prevalence among subjects aged ≥65 years ranges from 5 to 6% in observational studies based on the diagnosis recorded by general practitioners to 10-11% in studies where ECG screening is routinely offered. It is thus evident that a large number of subjects are not detected by conventional approach, and new strategies are required to increase early detection of AF. In particular, the changing position of pharmacies in the health system should be considered. Because of its small geographical size, insular nature and captive population, the Isle of Elba represents an ideal setting to test new strategies for stroke reduction. The Elba-FA project was thus designed to determine the feasibility and impact of the combined involvement of pharmacies and general practices to screen undiagnosed AF, with the ultimate aim of reducing the burden of stroke and arterial thromboembolism. The findings obtained with this approach might have broad implications for cardiovascular prevention at the general population level in Italy.
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Affiliation(s)
- Pietro Amedeo Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Universita' degli Studi di Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Gianni Donigaglia
- Direttore di Zona Distretto Elba, ATNO, Portoferraio, Livorno, Italy
| | - Plinio Fabiani
- Unità Operativa di Medicina dell'Ospedale di Portoferraio, Livorno, Italy
| | - Nicola Mumoli
- Unità Operativa di Medicina dell'Ospedale di Portoferraio, Livorno, Italy
| | - Andrea Colella
- Dipartimento di Medicina Sperimentale e Clinica, Universita' degli Studi di Firenze, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Boddi
- Dipartimento di Medicina Sperimentale e Clinica, Universita' degli Studi di Firenze, Largo Brambilla 3, 50134, Florence, Italy
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174
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Tsuyuki RT, Berg A, Khan NA. The ultimate opportunity for advancing pharmacy practice. Can Pharm J (Ott) 2017; 150:225-226. [PMID: 29163715 DOI: 10.1177/1715163517712938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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175
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e13-e115. [PMID: 29133356 DOI: 10.1161/hyp.0000000000000065] [Citation(s) in RCA: 1577] [Impact Index Per Article: 225.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:1269-1324. [PMID: 29133354 DOI: 10.1161/hyp.0000000000000066] [Citation(s) in RCA: 2152] [Impact Index Per Article: 307.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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177
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Drug adherence in hypertension. Pharmacol Res 2017; 125:142-149. [DOI: 10.1016/j.phrs.2017.08.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 01/13/2023]
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178
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Pellegrin KL, Lee E, Uyeno R, Ayson C, Goo R. Potentially preventable medication-related hospitalizations: A clinical pharmacist approach to assessment, categorization, and quality improvement. J Am Pharm Assoc (2003) 2017; 57:711-716. [DOI: 10.1016/j.japh.2017.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/30/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
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179
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Hammad EA, Qudah RA, Akour AA. The impact of clinical pharmacists in improving Jordanian patients' health outcomes. Saudi Med J 2017; 38:1077-1089. [PMID: 29114694 PMCID: PMC5767609 DOI: 10.15537/smj.2017.11.21453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess the impacts of clinical pharmacists on Jordanian patients' health outcomes. Methods: A systematic review was conducted until July 2016 within EBSCO, Pubmed, Cochrane database, and ISI Web of Knowledge. Published studies evaluating the benefit of clinical pharmacy services on therapeutic, safety, humanistic, and economic outcomes in hospital or community settings in Jordan were targeted. Two reviewers independently extracted and assessed risk of bias using a pre-published validated tool. The literature search identified 130 publications of which 21 full texts met predetermined inclusion criteria. Results: Studies were of moderate quality. Pharmacist interventions resulted in an average reduction (95% CI) in systolic blood pressure of 5.45 mm Hg (2.95-7.92) and diastolic blood pressure of 3.03 mm Hg (1.09-4.96). The mean reduction in glycosylated hemoglobin was 0.75% (-0.49-1.99) and fasting blood sugar was 36.73 mg/dl (-19.7-93.1). The average reduction in low-density lipoprotein cholesterol was 2.36 (1.8-16.62) mg/dl and triglycerides was 20.16 (6.14-46.47). There was a minimal increase in the level of high-density lipoprotein cholesterol of 1.24 (1.64-4.11) mg/dl. Effects on safety along with humanistic and economic outcomes and long term effects remained unclear. Conclusion: Published evidence from Jordan highlights service opportunities for clinical pharmacists. Favorable but not always statistically significant impacts were found on therapeutic outcomes. More studies are needed to understand safety, humanistic, economic, and long-term outcomes. Therefore, the add-on benefits of this service to the health system are not well understood. Future studies of higher rigor and multi-perspective outcomes are mandated.
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Affiliation(s)
- Eman A Hammad
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan. E-mail.
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180
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Buis LR, Roberson DN, Kadri R, Rockey NG, Plegue MA, Choe HM, Richardson CR. Utilizing Consumer Health Informatics to Support Management of Hypertension by Clinical Pharmacists in Primary Care: Study Protocol. JMIR Res Protoc 2017; 6:e193. [PMID: 29017994 PMCID: PMC5654738 DOI: 10.2196/resprot.8059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertension (HTN) is a major public health concern in the United States given its wide prevalence, high cost, and poor rates of control. Multiple strategies to counter this growing epidemic have been studied, and home blood pressure (BP) monitoring, mobile health (mHealth) interventions, and referrals to clinical pharmacists for BP management have all shown potential to be effective intervention strategies. OBJECTIVE The purpose of this study is to establish feasibility and acceptability of BPTrack, a clinical pharmacist-led mHealth intervention that aims to improve BP control by supporting home BP monitoring and medication adherence among patients with uncontrolled HTN. BPTrack is an intervention that makes home-monitored BP data available to clinical pharmacists for use in HTN management. Secondarily, this study seeks to understand barriers to adoption of this intervention, as well as points of improvement among key stakeholders, so that larger scale dissemination of the intervention may be achieved and more rigorous research can be conducted. METHODS This study is recruiting up to 25 individuals who have poorly controlled HTN from a Family Medicine clinic affiliated with a large Midwestern academic medical center. Patient participants complete a baseline visit, including installation and instructions on how to use BPTrack. Patient participants are then asked to follow the BP monitoring protocol for a period of 12 weeks, and subsequently complete a follow-up visit at the conclusion of the study period. RESULTS The recruitment period for the pilot study began in November 2016, and data collection is expected to conclude in late-2017. CONCLUSIONS This pilot study seeks to document the feasibility and acceptability of a clinical pharmacist-led mHealth approach to managing HTN within a primary care setting. Through our 12-week pilot study, we expect to lend support for this approach, and lay the foundation for translating this approach into wider-scale implementation. This mHealth intervention seeks to leverage the multidisciplinary care team already in place within primary care, and to improve health outcomes for patients with uncontrolled HTN. TRIAL REGISTRATION Clinicaltrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 (Archived by WebCite® at http://www.webcitation.org/6u3wTGbe6).
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Dana N Roberson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicole G Rockey
- University of Michigan Medical Group, Pharmacy Innovations and Partnerships, Ann Arbor, MI, United States
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Hae Mi Choe
- University of Michigan Medical Group, Pharmacy Innovations and Partnerships, Ann Arbor, MI, United States
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181
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Setiadi AP, Wibowo Y, Irawati S, Setiawan E, Presley B, Gudka S, Wardhani AS. Indonesian pharmacists' and pharmacy students' attitudes towards collaboration with physicians. Pharm Pract (Granada) 2017; 15:1052. [PMID: 29317920 PMCID: PMC5741997 DOI: 10.18549/pharmpract.2017.04.1052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recent implementation of national health coverage and the increasing health burden in Indonesia require health professionals, including pharmacists, to work more collaboratively to improve access and quality of health care. Nevertheless, relatively little is known about Indonesian pharmacists' attitude towards collaboration. OBJECTIVE To assess and compare the attitude of Indonesian pharmacy students and pharmacists towards collaboration with physicians. METHODS A survey of 95 pharmacy students (Universitas Surabaya) and 114 pharmacists (public health facilities in East Java) in Indonesia was conducted using the validated questionnaire, Scale of Attitudes Toward Physician-Pharmacist Collaboration (SATP2C), which was translated in Bahasa Indonesia. The questionnaire contained 16 items which were based on a 4-point Likert scale. Descriptive statistics were used to summarise the responses, (i.e., individual scores, factor scores and total scores). RESULTS Response rates of 97.9% and 65.8% were reported for students and pharmacists, respectively. The mean total score of SATP2C among Indonesian students and pharmacists were 56.53 versus 56.77, respectively; indicating positive attitudes toward collaboration. Further analysis of each item of SATP2C confirmed the positive attitudes in which mean and median scores of ≥3 were reported for most items in both groups. Significant differences between students and pharmacists were found regarding the following items: (i) 'there are many overlapping areas of responsibility between pharmacists and physicians' (3.28 versus 2.89, respectively; p<0.001), (ii) 'pharmacist should clarify a physician's order' (3.54 versus 3.71, respectively; p=0.046); and (iii) 'physicians should consult with pharmacists about adverse reactions or refractory to drug treatment' (3.60 versus 3.44, respectively; p=0.022). CONCLUSIONS Indonesian pharmacists reported positive attitudes toward collaboration with physicians. Further research is needed to understand other factors contributing in translating those positive attitudes into actual practice, and thus, providing a good foundation for policy makers, researchers and practitioners to support pharmacist-physician collaboration in Indonesia.
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Affiliation(s)
- Adji P Setiadi
- Centre for Medicines and Information Centre (CMIPC), Faculty of Pharmacy, Universitas Surabaya. Surabaya (Indonesia).
| | - Yosi Wibowo
- PhD. Centre for Medicines and Information Centre (CMIPC), Faculty of Pharmacy, Universitas Surabaya. Surabaya (Indonesia).
| | - Sylvi Irawati
- Centre for Medicines and Information Centre (CMIPC), Faculty of Pharmacy, Universitas Surabaya. Surabaya (Indonesia).
| | - Eko Setiawan
- Centre for Medicines and Information Centre (CMIPC), Faculty of Pharmacy, Universitas Surabaya. Surabaya (Indonesia).
| | - Bobby Presley
- Centre for Medicines and Information Centre (CMIPC), Faculty of Pharmacy, Universitas Surabaya. Surabaya (Indonesia).
| | - Sajni Gudka
- School of Medicine and Pharmacology, Pharmacy and Anaesthesiology Unit, University of Western Australia. Perth (Australia).
| | - Ari S Wardhani
- East Java Provincial Health Office, Ministry of Health of Indonesia. Surabaya (Indonesia).
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182
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Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care. J Hypertens 2017; 35:178-187. [PMID: 27684354 DOI: 10.1097/hjh.0000000000001126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To estimate long-term costs and outcomes attributable to a physician-pharmacist collaborative intervention compared with physician management alone for treating essential hypertension. METHODS A Markov model cohort simulation with a 6-month cycle length to predict acute coronary syndrome, stroke, and heart failure throughout lifetime was performed. A cohort of 399 patients was obtained from two prospective, cluster randomized controlled clinical trials implementing physician-pharmacist collaborative interventions in community-based medical offices in the Midwest, USA. Framingham risk equations and other algorithms were used to predict the vascular diseases. SBP reduction due to the interventions deteriorated until 5 years. Direct medical costs using a payer perspective were adjusted to 2015 dollar value, and the main outcome was quality-adjusted life years (QALYs); both were discounted at 3%. The intervention costs were estimated from the trials, whereas the remaining parameters were from published studies. A series of sensitivity analyses including changing patient risks of vascular diseases, probabilistic sensitivity analysis, and a cost-effectiveness acceptability curve were performed. RESULTS The lifetime incremental costs were $26 807.83 per QALY (QALYs gained = 0.14). The intervention provided the greatest benefit for the high-risk patients, moderate benefit for the trial patients, and the lowest benefit for the low-risk patients. If a payer is willing to pay $50 000 per QALY gained, in 48.6% of the time the intervention would be cost-effective. CONCLUSION Team-based care such as a physician-pharmacist collaboration appears to be a cost-effective strategy for treating hypertension. The intervention is most cost-effective for high-risk patients.
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183
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He J, Irazola V, Mills KT, Poggio R, Beratarrechea A, Dolan J, Chen CS, Gibbons L, Krousel-Wood M, Bazzano LA, Nejamis A, Gulayin P, Santero M, Augustovski F, Chen J, Rubinstein A. Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial. JAMA 2017; 318:1016-1025. [PMID: 28975305 PMCID: PMC5761321 DOI: 10.1001/jama.2017.11358] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. OBJECTIVE To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. INTERVENTIONS Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. MAIN OUTCOMES AND MEASURES The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. RESULTS Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. CONCLUSIONS AND RELEVANCE Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01834131.
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Jacquelyn Dolan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Analia Nejamis
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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184
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Cowley M, Naunton M, Thomas J, Waddington F, Peterson GM. Does the “script” need a rewrite? Is medication advice in television medical dramas appropriate? J Clin Pharm Ther 2017; 42:765-773. [DOI: 10.1111/jcpt.12581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M. Cowley
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - M. Naunton
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - J. Thomas
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - F. Waddington
- Faculty of Health; University of Canberra; Canberra ACT Australia
| | - G. M. Peterson
- School of Medicine, Faculty of Health; University of Tasmania; Hobart TAS Australia
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185
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Frail CK, Cooper S, Gallagher T, Sarkis J, Topor L, Bruzek RJ. A technology-supported collaboration between a health plan and a community pharmacy to improve blood pressure control. J Am Pharm Assoc (2003) 2017; 57:630-634. [PMID: 28712738 DOI: 10.1016/j.japh.2017.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/28/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the impact of a health plan and community pharmacy partnership to improve blood pressure control. SETTING A midwestern health plan and a regional community pharmacy chain. PRACTICE INNOVATION Health plan members with a hypertension diagnosis and attributed to the pharmacy chain based on prescription claims were invited to participate. Interested patients enrolled in the program at their pharmacies and were assigned a "smart card" for use with a blood pressure kiosk in the pharmacy. When the card was used at the kiosk, individual patient readings were linked directly to their electronic pharmacy record and an online patient portal. Pharmacists intervened with patients and prescribers as necessary to address adherence issues and adjust therapy as needed. EVALUATION Before and after blood pressure readings were assessed to determine the impact of patient self-monitoring and pharmacist intervention for patients with 1) uncontrolled blood pressure at first reading and 2) multiple readings throughout the pilot period. RESULTS Fifty-six of 276 eligible patients (20%) were enrolled in the program. Fourteen patients qualified for before and after assessments, having uncontrolled blood pressure on initial reading and multiple readings throughout the pilot. These patients demonstrated a mean reduction in systolic blood pressure of 12 mm Hg and diastolic blood pressure of 8 mm Hg. Nine of 16 eligible pharmacy locations enrolled patients at their sites. Challenges faced in the initiative included gaining adequate pharmacist and patient engagement. CONCLUSION The pilot demonstrated promising early results in a model that has potential to improve blood pressure monitoring and management in a community pharmacy setting.
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186
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Barragan NC, DeFosset AR, Torres J, Kuo T. Pharmacist-Driven Strategies for Hypertension Management in Los Angeles: A Community and Stakeholder Needs Assessment, 2014-2015. Prev Chronic Dis 2017; 14:E54. [PMID: 28682744 PMCID: PMC5510301 DOI: 10.5888/pcd14.160423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2014, the Los Angeles County Department of Public Health received federal funding to improve the prevention and control of hypertension in the population through team-based health care delivery models, such as pharmacist-led medication therapy management. To inform this work, the department conducted a 3-part needs assessment consisting of 1) a targeted context scan of regional policies and efforts, 2) a key stakeholder survey, and 3) a public opinion internet-panel survey of Los Angeles residents. Results suggest that political will and professional readiness exists for expansion of pharmacist-led medication management strategies in Los Angeles. However, several infrastructure and economic barriers, such as a lack of sufficient payment or reimbursement mechanisms for these services, impede progress. The department is using assessment results to address barriers and shape efforts in scaling up pharmacist-led programming in Los Angeles.
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Affiliation(s)
- Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010.
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Amelia R DeFosset
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
| | - Jennifer Torres
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, California
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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187
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Pharmacist-led medication review in community settings: An overview of systematic reviews. Res Social Adm Pharm 2017; 13:661-685. [DOI: 10.1016/j.sapharm.2016.08.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/07/2016] [Accepted: 08/19/2016] [Indexed: 02/08/2023]
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188
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Xu L, Fang WY, Zhu F, Zhang HG, Liu K. A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China's community hypertension care: study protocol for a randomized controlled trial. Trials 2017; 18:236. [PMID: 28545514 PMCID: PMC5445306 DOI: 10.1186/s13063-017-1970-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/04/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular disease, and its control rate has remained low worldwide. Studies have found that telemonitoring blood pressure (BP) helped control hypertension in randomized controlled trials. However, little is known about its effect in a structured primary care model in which primary care physicians (PCPs) are partnering with cardiology specialists in electronic healthcare data sharing and medical interventions. This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine tools to facilitate community hypertension control in China. METHODS/DESIGN Patients with hypertension receiving care at four community healthcare centers that are academically affiliated to Shanghai Chest Hospital, Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the previous 3 months and access to mobile Internet. Study subjects are randomly assigned to three interventional groups: (1) usual care; (2) home-based BP telemonitor with embedded Global System for Mobile Communications (GSM) module and unlimited data plan, an app to access personal healthcare record and receive personalized lifestyle coaching contents, and proficiency training of their use; or (3) this plus coordinated PCP-cardiologist care in which PCPs and cardiologists share data via a secure CareLinker website to determine interventional approaches. The primary outcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes are changes of diastolic blood pressure, HbA1C, blood lipids, and medication adherence measured by the eight-item Morisky Medication Adherence Scale. DISCUSSION This study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that incorporates the latest telemedicine technologies will improve hypertension care. Success of the model would help streamline the present community healthcare processes and impact a greater number of patients with uncontrolled hypertension. TRIAL REGISTRATION ClinicalTrials.gov, NCT02919033 . Registered on 23 September 2016.
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Affiliation(s)
- Lei Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Wei-Yi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China.
| | - Fu Zhu
- Department of Cardiology, Shanghai XuHui Hospital, Zhongshan Hospital, FuDan University, Shanghai, China
| | | | - Kai Liu
- CareLinker Co., Ltd., Shanghai, China
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189
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Price-Haywood EG, Amering S, Luo Q, Lefante JJ. Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management. Popul Health Manag 2017; 20:123-131. [PMID: 27124294 PMCID: PMC5397232 DOI: 10.1089/pop.2015.0177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Collaborative care models incorporating pharmacists have been shown to improve quality of care for patients with hypertension and/or diabetes. Little is known about how to integrate such services outside of clinical trials. The authors implemented a 22-month observational study to evaluate pharmacy collaborative care for hypertension and diabetes in a safety net medical home that incorporated population risk stratification, clinical decision support, and medication dose adjustment protocols. Patients in the pharmacy group saw their primary care provider (PCP) more often and had higher baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) and A1c levels compared to patients who only received care from their PCPs. There were no significant differences in the proportion of patients achieving treatment goals (SBP <140, DBP <90; A1c < 8) or the magnitude of change in BP or A1c among patients who underwent collaborative care versus those who did not. Age, race, and number of PCP encounters were associated with BP and A1c trends. The median time to achieve disease control was longer in the pharmacy group. Although 70% of all patients with poorly controlled hypertension achieved treatment goals within 7 months, less than 50% of patients with poorly controlled diabetes achieved A1c < 8 within 15 months, suggesting that diabetes was harder to manage overall. Contextual factors that facilitated or hindered practice redesign included organizational culture, health information technology and related workflows, and pharmacy caseload optimization. Future studies should further examine implementation strategies that work best in specific settings to optimize the benefits of team-based care with clinical pharmacists.
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Affiliation(s)
- Eboni G. Price-Haywood
- Ochsner Clinic Foundation, Center for Applied Health Services Research, New Orleans, Louisiana
- Ochsner Clinical School, University of Queensland, Brisbane, Australia
| | - Sarah Amering
- Xavier University of Louisiana, College of Pharmacy, New Orleans, Louisiana
| | - Qingyang Luo
- Ochsner Clinic Foundation, Center for Applied Health Services Research, New Orleans, Louisiana
| | - John J. Lefante
- Tulane University School of Public Health and Tropical Medicine, Department of Biostatistics and Bioinformatics, New Orleans, Louisiana
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190
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Marra C, Johnston K, Santschi V, Tsuyuki RT. Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can Pharm J (Ott) 2017; 150:184-197. [PMID: 28507654 PMCID: PMC5415065 DOI: 10.1177/1715163517701109] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: More than half of all heart disease and stroke are attributable to
hypertension, which is associated with approximately 10% of direct medical
costs globally. Clinical trial evidence has demonstrated that the benefits
of pharmacist intervention, including education, consultation and/or
prescribing, can help to reduce blood pressure; a recent Canadian trial
found an 18.3 mmHg reduction in systolic blood pressure associated with
pharmacist care and prescribing. The objective of this study was to evaluate
the economic impact of such an intervention in a Canadian setting. Methods: A Markov cost-effectiveness model was developed to extrapolate potential
differences in long-term cardiovascular and renal disease outcomes, using
Framingham risk equations and other published risk equations. A range of
values for systolic blood pressure reduction was considered (7.6-18.3 mmHg)
to reflect the range of potential interventions and available evidence. The
model incorporated health outcomes, costs and quality of life to estimate an
overall incremental cost-effectiveness ratio. Costs considered included
direct medical costs as well as the costs associated with implementing the
pharmacist intervention strategy. Results: For a systolic blood pressure reduction of 18.3 mmHg, the estimated impact is
0.21 fewer cardiovascular events per person and, discounted at 5% per year,
0.3 additional life-years, 0.4 additional quality-adjusted life-years and
$6,364 cost savings over a lifetime. Thus, the intervention is economically
dominant, being both more effective and cost-saving relative to usual
care. Discussion: Across a range of one-way and probabilistic sensitivity analyses of key
parameters and assumptions, pharmacist intervention remained both effective
and cost-saving. Conclusion: Comprehensive pharmacist care of hypertension, including patient education
and prescribing, has the potential to offer both health benefits and cost
savings to Canadians and, as such, has important public health
implications.
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Affiliation(s)
- Carlo Marra
- School of Pharmacy (Marra), University of Otago, New Zealand; Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, BC; the School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Switzerland; and Faculty of Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Karissa Johnston
- School of Pharmacy (Marra), University of Otago, New Zealand; Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, BC; the School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Switzerland; and Faculty of Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Valerie Santschi
- School of Pharmacy (Marra), University of Otago, New Zealand; Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, BC; the School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Switzerland; and Faculty of Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Ross T Tsuyuki
- School of Pharmacy (Marra), University of Otago, New Zealand; Broadstreet Health Economics & Outcomes Research (Johnston), Vancouver, BC; the School of Nursing Sciences (Santschi), University of Applied Sciences Western Switzerland, Switzerland; and Faculty of Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
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Santschi V, Wuerzner G, Chiolero A, Burnand B, Schaller P, Cloutier L, Paradis G, Burnier M. Team-based care for improving hypertension management among outpatients (TBC-HTA): study protocol for a pragmatic randomized controlled trial. BMC Cardiovasc Disord 2017; 17:39. [PMID: 28109266 PMCID: PMC5251291 DOI: 10.1186/s12872-017-0472-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 12/22/2022] Open
Abstract
Background Blood pressure (BP) is poorly controlled among a large proportion of hypertensive outpatients. Innovative models of care are therefore needed to improve BP control. The Team-Based Care for improving Hypertension management (TBC-HTA) study aims to evaluate the effect of a team-based care (TBC) interprofessional intervention, involving nurses, community pharmacists and physicians, on BP control of hypertensive outpatients compared to usual care in routine clinical practice. Methods/design The TBC-HTA study is a pragmatic randomized controlled study with a 6-month follow-up which tests a TBC interprofessionnal intervention conducted among uncontrolled treated hypertensive outpatients in two ambulatory clinics and among seven nearby community pharmacies in Lausanne and Geneva, Switzerland. A total of 110 patients are being recruited and randomized to TBC (TBC: N = 55) or usual care group (UC: N = 55). Patients allocated to the TBC group receive the TBC intervention conducted by an interprofessional team, involving an ambulatory clinic nurse, a community pharmacist and a physician. A nurse and a community pharmacist meet patients every 6 weeks to measure BP, to assess lifestyle, to estimate medication adherence, and to provide education to the patient about disease, treatment and lifestyle. After each visit, the nurse and pharmacist write a summary report with recommendations related to medication adherence, lifestyle, and changes in therapy. The physician then adjusts antihypertensive therapy accordingly. Patients in the UC group receive usual routine care without sessions with a nurse and a pharmacist. The primary outcome is the difference in daytime ambulatory BP between TBC and UC patients at 6-month of follow-up. Secondary outcomes include patients’ and healthcare professionals’ satisfaction with the TBC intervention and BP control at 12 months (6 months after the end of the intervention). Discussion This ongoing study aims to evaluate the effect of a newly developed team-based care intervention engaging different healthcare professionals on BP control in a primary care setting in Switzerland. The results will inform policymakers on implementable strategies for routine clinical practice. Trial registration ClinicalTrials.gov registration: NCT02511093. Retrospectively registered on 28 July 2015.
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Affiliation(s)
- Valérie Santschi
- La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland, Av. Vinet 30, 1004, Lausanne, Switzerland. .,Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Lyne Cloutier
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
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Abstract
Adherence to antihypertensive medication remains a key modifiable factor in the management of hypertension. The multidimensional nature of adherence and blood pressure (BP) control call for multicomponent, patient-centered interventions to improve adherence. Promising strategies to improve antihypertensive medication adherence and BP control include regimen simplification, reduction of out-of-pocket costs, use of allied health professionals for intervention delivery, and self-monitoring of BP. Research to understand the effects of technology-mediated interventions, mechanisms underlying adherence behavior, and sex-race differences in determinants of low adherence and intervention effectiveness may enhance patient-specific approaches to improve adherence and disease control.
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Affiliation(s)
- Erin Peacock
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA; Center for Health Research, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Azevedo MDGBD, Pedrosa RS, Aoqui CM, Martins RR, Nagashima Junior T. Effectiveness of home pharmaceutical interventions in metabolic syndrome: a randomized controlled trial. BRAZ J PHARM SCI 2017. [DOI: 10.1590/s2175-97902017000216089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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195
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Menéndez Villalva C, Luis Muiño López-Alvarez X, Menéndez Rodríguez M, José Modroño Freire M, Quintairos Veloso O, Conde Guede L, Vilchez Dosantos S, Blanco Ramos M. Blood Pressure Monitoring in Cardiovascular Disease. AIMS MEDICAL SCIENCE 2017. [DOI: 10.3934/medsci.2017.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Olsen MH, Angell SY, Asma S, Boutouyrie P, Burger D, Chirinos JA, Damasceno A, Delles C, Gimenez-Roqueplo AP, Hering D, López-Jaramillo P, Martinez F, Perkovic V, Rietzschel ER, Schillaci G, Schutte AE, Scuteri A, Sharman JE, Wachtell K, Wang JG. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet 2016; 388:2665-2712. [PMID: 27671667 DOI: 10.1016/s0140-6736(16)31134-5] [Citation(s) in RCA: 586] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Michael H Olsen
- Department of Internal Medicine, Holbæk Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Sonia Y Angell
- Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Samira Asma
- Global NCD Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre Boutouyrie
- Department of Pharmacology and INSERM U 970, Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada
| | - Julio A Chirinos
- Department of Medicine at University Hospital of Pennsylvania and Veteran's Administration, PA, USA
| | | | - Christian Delles
- Christian Delles: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Anne-Paule Gimenez-Roqueplo
- INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015, Paris, France; Paris Descartes University, F-75006, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Genetics, F-75015, Paris, France
| | - Dagmara Hering
- The University of Western Australia-Royal Perth Hospital, Perth, WA, Australia
| | - Patricio López-Jaramillo
- Direccion de Investigaciones, FOSCAL and Instituto de Investigaciones MASIRA, Facultad de Medicina, Universidad de Santander, Bucaramanga, Colombia
| | - Fernando Martinez
- Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain
| | - Vlado Perkovic
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Ernst R Rietzschel
- Department of Cardiology, Ghent University and Biobanking & Cardiovascular Epidemiology, Ghent University Hospital, Ghent, Belgium
| | - Giuseppe Schillaci
- Department of Internal Medicine, University of Perugia, Terni University Hospital, Terni, Italy
| | - Aletta E Schutte
- Medical Research Council Unit on Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Angelo Scuteri
- Hypertension Center, Hypertension and Nephrology Unit, Department of Medicien, Policlinico Tor Vergata, Rome, Italy
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kristian Wachtell
- Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases Oslo University Hospital, Oslo, Norway
| | - Ji Guang Wang
- The Shanghai Institute of Hypertension, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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197
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Weeks G, George J, Maclure K, Stewart D. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev 2016; 11:CD011227. [PMID: 27873322 PMCID: PMC6464275 DOI: 10.1002/14651858.cd011227.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. OBJECTIVES To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). SEARCH METHODS We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared outcomes to a random-effects model where clinical or statistical heterogeneity existed. MAIN RESULTS We included 46 studies (37,337 participants); non-medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non-medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non-medical prescribing being undertaken by other health professionals. The education requirement for non-medical prescribing varied with country and location.A meta-analysis of surrogate markers of chronic disease (systolic blood pressure, glycated haemoglobin, and low-density lipoprotein) showed positive intervention group effects. There was a moderate-certainty of evidence for studies of blood pressure at 12 months (mean difference (MD) -5.31 mmHg, 95% confidence interval (CI) -6.46 to -4.16; 12 studies, 4229 participants) and low-density lipoprotein (MD -0.21, 95% CI -0.29 to -0.14; 7 studies, 1469 participants); we downgraded the certainty of evidence from high due to considerations of serious inconsistency (considerable heterogeneity), multifaceted interventions, and variable prescribing autonomy. A high-certainty of evidence existed for comparative studies of glycated haemoglobin management at 12 months (MD -0.62, 95% CI -0.85 to -0.38; 6 studies, 775 participants). While there appeared little difference in medication adherence across studies, a meta-analysis of continuous outcome data from four studies showed an effect favouring patient adherence in the non-medical prescribing group (MD 0.15, 95% CI 0.00 to 0.30; 4 studies, 700 participants). We downgraded the certainty of evidence for adherence to moderate due to the serious risk of performance bias. While little difference was seen in patient-related adverse events between treatment groups, we downgraded the certainty of evidence to low due to indirectness, as the range of adverse events may not be related to the intervention and selective reporting failed to adequately report adverse events in many studies.Patients were generally satisfied with non-medical prescriber care (14 studies, 7514 participants). We downgraded the certainty of evidence from high to moderate due to indirectness, in that satisfaction with the prescribing component of care was only addressed in one study, and there was variability of satisfaction measures with little use of validated tools. A meta-analysis of health-related quality of life scores (SF-12 and SF-36) found a difference favouring usual care for the physical component score (MD 1.17, 95% CI 0.16 to 2.17), but not the mental component score (MD 0.58, 95% CI -0.40 to 1.55). However, the quality of life measurement may more appropriately reflect composite care rather than the prescribing component of care, and for this reason we downgraded the certainty of evidence to moderate due to indirectness of the measure of effect. A wide variety of resource use measures were reported across studies with little difference between groups for hospitalisations, emergency department visits, and outpatient visits. In the majority of studies reporting medication use, non-medical prescribers prescribed more drugs, intensified drug doses, and used a greater variety of drugs compared to usual care medical prescribers.The risk of bias across studies was generally low for selection bias (random sequence generation), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), and reporting bias (selective reporting). There was an unclear risk of selection bias (allocation concealment) and for other biases. A high risk of performance bias (blinding of participants and personnel) existed. AUTHORS' CONCLUSIONS The findings suggest that non-medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non-medical prescribers can deliver comparable outcomes for systolic blood pressure, glycated haemoglobin, low-density lipoprotein, medication adherence, patient satisfaction, and health-related quality of life. It was difficult to determine the impact of non-medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient-reported, resource use, and economic outcomes of non-medical prescribing, in both high-income and low-income countries.
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Affiliation(s)
- Greg Weeks
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
- Barwon HealthPharmacy DepartmentGeelongVictoriaAustralia
| | - Johnson George
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
| | - Katie Maclure
- Robert Gordon UniversitySchool of PharmacyRiverside EastGarthdee RoadAberdeenUKAB10 7GJ
| | - Derek Stewart
- Robert Gordon UniversitySchool of PharmacyRiverside EastGarthdee RoadAberdeenUKAB10 7GJ
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Al Hamarneh YN, Houle SKD, Padwal R, Tsuyuki RT. Hypertension Canada's 2016 Canadian Hypertension Education Program guidelines for pharmacists: An update. Can Pharm J (Ott) 2016; 149:337-344. [PMID: 27829857 DOI: 10.1177/1715163516671747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yazid N Al Hamarneh
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Sherilyn K D Houle
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Raj Padwal
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Ross T Tsuyuki
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
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199
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Anderegg MD, Gums TH, Uribe L, Coffey CS, James PA, Carter BL. Physician-Pharmacist Collaborative Management: Narrowing the Socioeconomic Blood Pressure Gap. Hypertension 2016; 68:1314-1320. [PMID: 27600181 DOI: 10.1161/hypertensionaha.116.08043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/11/2016] [Indexed: 01/23/2023]
Abstract
Physician-pharmacist collaboration improves blood pressure, but there is little information on whether this model can reduce the gap in healthcare disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate whether the pharmacist intervention could reduce healthcare disparities by improving blood pressure in high-risk racial and socioeconomic subjects compared with the control group. The analyses in minority subjects were prespecified secondary analyses, but all other comparisons were secondary, post hoc analyses. The 9-month visit was completed by 539 patients: 345 received the intervention, and 194 were in the control group. Following the intervention, mean systolic blood pressure was found to be 7.3 mm Hg (95% confidence interval 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared with the control group (P=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% confidence interval 3.2, 13.1) lower than the control group with lower education (P=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid, or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. Although disparities in blood pressure were reduced by the intervention, there were still nonsignificant gaps in mean systolic blood pressure when compared with intervention subjects not at risk. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00935077.
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Affiliation(s)
- Maxwell D Anderegg
- From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.)
| | - Tyler H Gums
- From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.)
| | - Liz Uribe
- From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.)
| | - Christopher S Coffey
- From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.)
| | - Paul A James
- From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.)
| | - Barry L Carter
- From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.).
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Swieczkowski D, Mogielnicki M, Merks P, Gruchala M, Jaguszewski M. Pharmaceutical services as a tool to improve outcomes in patients with cardiovascular diseases. Int J Cardiol 2016; 222:238-241. [PMID: 27497101 DOI: 10.1016/j.ijcard.2016.07.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/28/2016] [Indexed: 01/23/2023]
Abstract
Despite the presence of effective and safe pharmacotherapy, and availability of multidimensional non-pharmacological treatment, the overall rate of major adverse cardiovascular outcomes remains still unsatisfactory. The clinical pharmacy activities and pharmaceutical care available in the community pharmacy settings have a significant impact on outcomes in cardiovascular patients, e.g. adherence, the level of blood pressure, total cholesterol or patients' health literacy. Pharmaceutical care in patients diagnosed with cardiovascular diseases remains beneficial both to the patients and the entire health care system. However, the prediction of results of pharmacists' interventions is particularly difficult and random. Many factors contribute to outcomes of community pharmacy services, e.g. time spent with the patients or quality of communication between patients and healthcare professionals. The most important issue in delivering effective pharmaceutical care is to develop an evidence-based model. Globally, the development of interprofessional collaboration between physicians and pharmacists, and preparing more sophisticated pharmacoeconomics analyses in the scope of pharmaceutical care are the next step in the improvement of advanced pharmaceutical services. Further research, particularly based on real data on this highly interesting topic is needed and recommended.
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Affiliation(s)
- Damian Swieczkowski
- First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland; Department of Pharmaceutical Technology, Faculty of Pharmacy, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, dr. A. Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Mariusz Mogielnicki
- Oceanic - Research and Development Laboratory, Łokietka 58, 81-736 Sopot, Poland
| | - Piotr Merks
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Ludwig Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, dr. A. Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Marcin Gruchala
- First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Debinki 7, 80-211 Gdansk, Poland.
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