From product dispensing to patient care: The role of the pharmacist in providing pharmaceutical care as part of an integrated disease management approach

During the past decade, the profession of pharmacy has changed dramatically. The Doctor of Pharmacy degree has replaced the Bachelor of Science degree as the first professional degree offered at most accredited U.S. pharmacy schools. Advanced clinical training is now a mainstay of pharmacy training, and this has enabled pharmacists to contribute to disease management efforts. In addition, technological improvements in prescription processing have afforded pharmacists more time to participate in disease management activities. This paper describes how the role of the pharmacist has changed and reviews the results of programs involving pharmacists as disease management providers in the areas of asthma, hypertension, diabetes, and hyperlipidemia. Pharmacists\u27 contributions in various practice settings are also discussed

HEALTH POLICY AND SYSTEMS Nurses' Practice Environments, Error Interception Practices, and Inpatient Medication Errors

Abstract Purpose: Medication errors remain a threat to patient safety. Therefore, the purpose of this study was to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses' error interception practices, and rates of nonintercepted medication errors in acute care hospitals. Design: This study, using a nonexperimental design, was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals. Registered nurses (RNs) on the 82 units were surveyed, producing a sample of 686 staff nurses

Impact of Disease and Health Management Strategies on Formulary Design and Management

Recent changes in the healthcare system have prompted the growth and management of disease and health management strategies in the US. Most of the initiatives include a heavy emphasis on the pharmacotherapy component as it has been noted that effective therapies can lead to improvement in care and in some cases lower overall healthcare costs. As markets continue to move to increased integration, there will be a greater focus on traditional pharmacy and therapeutic committees to evaluate the impact of therapies on the overall care of and cost to their covered members. Additionally, pharmaceutical products will be evaluated as to their place in the overall health and disease management strategies that the plan offers to its payers and providers. A growing trend among pharmaceutical benefit designs is to offer various levels of coverage via patient copayments to reduce the growth of drug expenditures. This places a greater emphasis on provider communication and patient awareness and understanding of the value of pharmaceutical products as a means to improving health.Formularies, Pharmacoeconomics

Treatment Costs and Factors Associated with Glycemic Control among Patients with Diabetes in the United Arab Emirates

Background: We aimed to estimate the proportion of patients with diabetes who achieved target glycemic control, to estimate diabetes-related costs attributable to poor control, and to identify factors associated with them in the United Arab Emirates. Methods: This retrospective cohort study used administrative claims data handled by Abu Dhabi Health Authority (January 2010 to June 2012) to determine glycemic control and diabetes-related treatment costs. A total of 4,058 patients were matched using propensity scores to eliminate selection bias between patients with glycosylated hemoglobin (HbA1c) ＜7% and HbA1c ≥7%. Diabetes-related costs attributable to poor control were estimated using a recycled prediction method. Factors associated with glycemic control were investigated using logistic regression and factors associated with these costs were identified using a generalized linear model. Results: During the 1-year follow-up period, 46.6% of the patients achieved HbA1c ＜7%. Older age, female sex, better insurance coverage, non-use of insulin in the index diagnosis month, and non-use of antidiabetic medications during the follow-up period were significantly associated with improved glycemic control. The mean diabetes-related annual costs were $2,282 and$2,667 for patients with and without glycemic control, respectively, and the cost attributable to poor glycemic control was $172 (95$164-180). The diabetes-related costs were lower with mean HbA1c levels ＜7% (cost ratio, 0.94; 95% CI, 0.88-0.99). The costs were significantly higher in patients aged ≥65 years than those aged ≤44 years (cost ratio, 1.45; 95% CI, 1.25-1.70). Conclusion: More than 50% of patients with diabetes had poorly controlled HbA1c. Poor glycemic control may increase diabetes-related costs

The association of socioeconomic and clinical characteristics with health-related quality of life in patients with psoriasis: a cross-sectional study

Abstract Background This study aimed to determine the socioeconomic and clinical characteristics affecting health-related quality of life (HRQoL) in patients with psoriasis. Methods A cross-sectional study was conducted between March and June 2015 using data obtained via an Internet-based survey completed by a psoriasis patient group in Korea. The survey included items regarding demographic, socioeconomic, and clinical characteristics and HRQoL. Patients’ HRQoL impairment was classified as severe if their Dermatology Life Quality Index Scores were ≥ 11. Factors influencing HRQoL impairment were identified using multivariate logistic regression analysis. Results Of the 299 respondents, 161 (53.8%) exhibited severe HRQoL impairment. The Dermatology Life Quality Index scores were significantly associated with gender, annual income, neck psoriasis, psoriasis-related resignation from work, and use of oral and herbal medications. The severity of HRQoL impairment in women was twice that observed in men (odds ratio [OR] = 2.00, 95% confidence interval (CI): 1.05–3.80). Patients with psoriasis on the neck exhibited significantly greater HRQoL impairment than those with psoriasis on other areas of their bodies (OR = 2.30, 95% CI: 1.20–4.43). With respect to the socioeconomic status, patients who earned > 40 million KRW (approximately 34,000 USD; high-income group) showed less HRQoL impairment compared with those who had lower incomes (OR = 0.47, 95% CI: 0.28–0.80). Patients with severe HRQoL impairment used oral (OR = 2.04, 95% CI: 1.20–3.44) and herbal (OR = 1.86, 95% CI: 1.04–3.34) medications more often relative to patients with less severe HRQoL impairment. Conclusions HRQoL in patients with psoriasis was significantly associated with their demographic and socioeconomic characteristics and employment status. The presence of psoriasis on exposed areas of the body was significantly associated with patients’ HRQoL and employment status. Further research is required to evaluate the impact of psoriasis on patients’ productivity

Economic Impact of an Asthma Education Programme on Medical Care Utilisation

Objective: To determine the economic impact of an asthma education programme. Design and setting: The study was population-based and used claims data to determine changes in the resources used by identified patients with asthma 9 months before (January 1997 to September 1997) and 9 months after (January 1998 to September 1998) the implementation of the asthma education programme. Direct medical costs and frequency of use of services for asthma treatment before and after implementation of the asthma intervention programme were compared to evaluate the impact of the programme on medical treatment costs. Perspective: Third-party payer. Patients: Patients who were diagnosed with asthma at least 12 months prior to the implementation of the intervention were included; all patients were members of a union health and welfare fund, located in the northeastern part of the US. Of the 5527 patients, 2235 were included in the intervention group and 3292 patients served as the control group. Intervention: The asthma education focused on asthma prevention and treatment, recognition and elimination of asthma triggers, and compliance with asthma medications. The programme also included therapy management intervention with physicians, drug product selection and compliance intervention when needed. Main outcome measures and results: The total asthma treatment cost decreased from $US499 to$US415 per patient (a 17% reduction; p = 0.0142) in the intervention group and decreased from $US227 to$US217 in the control group (a 4% decrease; p = 0.6172) [1997 values]. The decrease in the intervention group was significantly greater than that in the control group after controlling for the differences in treatment costs before the intervention (p = 0.0001). The average cost per patient associated with hospitalisation, emergency room visits, physician visits and asthma medications decreased by 13%, 29%, 36% and 18%, respectively, after the intervention in the study group. There was a 9% reduction in the frequency of hospitalisations, a 27% reduction in emergency room usage, a 27% reduction in physician office visits and a 6% reduction in the number of prescriptions per patient for asthma medications after the intervention in the study group. Conclusions: Significant reductions in overall asthma treatment costs were observed after the implementation of the asthma education programme. Therefore, intense patient education and management should be advocated to reduce treatment costs in patients with asthma.Asthma, Cost analysis, Patient education, Pharmacoeconomics, Resource use

Health Literacy Level and Comprehension of Prescription and Nonprescription Drug Information

The aim of this study was to investigate the level of misunderstanding of medication information in Korean adults after stratifying by level of health literacy and to identify the factors influencing the misunderstanding of medication information and reading amounts of information on OTC drug labels. A cross-sectional survey was performed with 375 adult participants using the survey instrument. Multiple linear regression analyses were performed to identify factors which influence misunderstanding of medication information. Participants misunderstood 20% of words on OTC drug labels, 9% of prescription drug instructions, and 9% of pictograms. Participants on average read 59% of the overall contents of the OTC drug labels. As prescription drugs’ dosing regimens became more complicated, the level of misunderstanding instructions increased. The level of misunderstanding words on OTC drug labels significantly decreased as participants had adequate health literacy (β = −18.11, p < 0.001) and higher education levels (β = −6.83, p < 0.001), after adjusting for the study variables. The level of misunderstanding instructions for prescription drugs increased as participants became older (β = 8.81, p < 0.001) and had lower education levels (β = −5.05, p < 0.001), after adjusting for the study variables. The level of misunderstanding pictograms was similar to that of misunderstanding instructions for prescription drug labels. The amount of reading information on OTC drug labels significantly increased as respondents had adequate health literacy (β = 9.27, p < 0.001), were older (β = 12.49, p < 0.001), or had chronic diseases (β = 7.49, p = 0.007). Individuals’ health literacy level, reading behaviors, and complexity of medication instructions are associated with misunderstanding of medication information. Appropriate word choices in drug labels and an improved format of medication instructions could increase understanding of medication information and prevent adverse drug reactions

Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies

Abstract Background Medications influencing the risk of fall-related injuries (FRIs) in older adults have been inconsistent in previous guidelines. This study employed case–control design to assess the association between FRIs and medications, and an additional case-crossover design was conducted to examine the consistency of the associations and the transient effects of the medications on FRIs. Methods This study was conducted using a national claims database (2002–2015) in Korea. Older adults (≥ 65 years) who had their first FRI between 2007 and 2015 were matched with non-cases in 1:2 ratio. Drug exposure was examined for 60 days prior to the date of the first FRI (index date) in the case–control design. The hazard period (1–60 days) and two control periods (121–180 and 181–240 days prior to the index date) were investigated in the case-crossover design. The risk of FRIs with 32 medications was examined using conditional logistic regression after adjusting for other medications that were significant in the univariate analysis. In the case-crossover study, the same conditional model was applied. Results In the case–control design, the five medications associated with the highest risk of FRIs were muscle relaxants (adjusted odd ratio(AOR) = 1.35, 95% confidence interval (CI) = 1.31–1.39), anti-Parkinson agents (AOR = 1.30, 95%CI = 1.19–1.40), opioids (AOR = 1.23, 95%CI = 1.19–1.27), antiepileptics (AOR = 1.19, 95%CI = 1.12–1.26), and antipsychotics (AOR = 1.16, 95%CI = 1.06–1.27). In the case-crossover design, the five medications associated with the highest risk of FRIs were angiotensin II antagonists (AOR = 1.87, 95%CI = 1.77–1.97), antipsychotics (AOR = 1.63, 95%CI = 1.42–1.83), anti-Parkinson agents (AOR = 1.58, 95%CI = 1.32–1.85), muscle relaxants (AOR = 1.42, 95%CI = 1.35–1.48), and opioids (AOR = 1.35, 95%CI = 1.30–1.39). Conclusions Anti-Parkinson agents, opioids, antiepileptics, antipsychotics, antidepressants, hypnotics and sedatives, anxiolytics, muscle relaxants, and NSAIDs/antirheumatic agents increased the risk of FRIs in both designs among older adults. Medications with a significant risk only in the case-crossover analysis, such as antithrombotic agents, calcium channel blockers, angiotensin II antagonists, lipid modifying agents, and benign prostatic hypertrophy agents, may have transient effects on FRIs at the time of initiation. Corticosteroids, which were only associated with risk of FRIs in the case–control analysis, had more of cumulative than transient effects on FRIs