Improving hypertension control through a collaboration between an academic medical center and a chain community pharmacy

IntroductionApproximately one-third of adults in the United States have hypertension (HTN), leading to increased morbidity and mortality.ObjectivesThis quality improvement intervention was designed to improve HTN control among community-dwelling adults through collaboration between patient-centered medical homes (PCMH) within an academic medical center and chain community pharmacies.MethodsFour PCMH sites in Ann Arbor, Michigan that were in close proximity to two Meijer pharmacies participated in this study between September 2016 and March 2017, which compared HTN outcomes for patients seen at two community pharmacies where the pharmacists received training on HTN management for patients who received usual care at their PCMH. The primary outcome was percent of patients who met their blood pressure (BP) goal of either <140/90-mmHg or-<-150/90-mmHg compared with matched controls who received usual care at the PCMH. Secondary outcomes included number of medication recommendations made, percent of recommendations accepted by the primary care provider (PCP), and patient satisfaction.ResultsPatients who received care at the community pharmacy (n = 155) had a higher rate of BP control at 3-months than matched controls (61.8% vs 47.7%, P = 0.013). A total of 29 medication recommendations were made by community pharmacists and 26 were accepted by the PCP. Nearly 95% of patients rated the care they received as excellent or very good and over 95% stated that they would recommend the pharmacist at the Meijer pharmacy to their family and friends.ConclusionPatients who received HTN management services as part of a collaboration between an academic medical center and chain community pharmacy were significantly more likely to have controlled BP at 3-months compared with matched controls who received standard care. This model shows promise as being a strategy to expand access to care for patients while being mutually beneficial for community pharmacies and health systems.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151336/1/jac51158_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151336/2/jac51158.pd

The Effect of Order of Testing in Functional Performance in Persons with and Without Chronic Back Pain

Batteries of individually standardized physical and functional tests are commonly used to assess persons with chronic back pain disability. The order of testing may affect performance on later tests. One hundred and fifty patients with>3 months of back pain disability underwent a multidisciplinary Spine Team Assessment involving Physical Therapy, Occupational Therapy, Pain Psychology, and Vocational Rehabilitation Counselor assessments at a university spine clinic. Seventeen back healthy volunteers performed the physical component of the assessment. For the volunteers the order of testing was randomized to OT tests first or PT test first, with 0.5 h rest between the tests. For patients the order of testing was arbitrarily set by an alternating schedule, with 1 h psychological testing between the two components. For both the patients and volunteers, among the 14 test components, there was no significant difference ( p > 0.05) in performance with order of testing. This held true for the subgroup of patients who put out good cardiac effort. Volunteers performed better than patients on all individual tests ( p < 0.001). Results suggest that the order of physical testing during a Spine Team Assessment does not affect test performance either in chronic low back disabled patients or in volunteers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45008/1/10926_2004_Article_460353.pd

Establishing the value of genomics in medicine: the IGNITE Pragmatic Trials Network.

PURPOSE: A critical gap in the adoption of genomic medicine into medical practice is the need for the rigorous evaluation of the utility of genomic medicine interventions. METHODS: The Implementing Genomics in Practice Pragmatic Trials Network (IGNITE PTN) was formed in 2018 to measure the clinical utility and cost-effectiveness of genomic medicine interventions, to assess approaches for real-world application of genomic medicine in diverse clinical settings, and to produce generalizable knowledge on clinical trials using genomic interventions. Five clinical sites and a coordinating center evaluated trial proposals and developed working groups to enable their implementation. RESULTS: Two pragmatic clinical trials (PCTs) have been initiated, one evaluating genetic risk APOL1 variants in African Americans in the management of their hypertension, and the other to evaluate the use of pharmacogenetic testing for medications to manage acute and chronic pain as well as depression. CONCLUSION: IGNITE PTN is a network that carries out PCTs in genomic medicine; it is focused on diversity and inclusion of underrepresented minority trial participants; it uses electronic health records and clinical decision support to deliver the interventions. IGNITE PTN will develop the evidence to support (or oppose) the adoption of genomic medicine interventions by patients, providers, and payers

Tafamidis: A First-in-Class Transthyretin Stabilizer for Transthyretin Amyloid Cardiomyopathy.

Objective: To review the pharmacology, efficacy, and safety of the selective transthyretin inhibitor tafamidis for transthyretin amyloid cardiomyopathy (ATTR-CM). Data Sources: A PubMed (1966 to October 2019) and ClinicalTrials. gov search was conducted using the keywords tafamidis, Fx-1006A, Vyndaqel, and Vyndamax. Additional articles were identified from references. Study Selection and Data Extraction: We included English-language clinical studies evaluating the pharmacology, efficacy, or safety of tafamidis in humans for ATTR-CM. Data Synthesis: Tafamidis binds to the thyroxine-binding sites of the transthyretin tetramer and inhibits its dissociation into monomers, which is the rate-limiting step in the amyloidogenic process. Treatment with tafamidis was significantly associated with a significant reduction in mortality, lowered cardiovascular-related hospitalizations, less functional decline, and improved transthyretin stabilization compared with placebo. Additionally, tafamidis was found to have fewer adverse events, with no difference found compared with placebo. Relevance to Patient Care and Clinical Practice: Historically, symptomatic management for ATTR-CM was the only option, and the treatment of the underlying disease was limited to liver or heart transplantation. Tafamidis is the first medication approved for the treatment of ATTR-CM and the only medication that showed a reduction in all-cause mortality and cardiovascular-related hospitalizations in patients with amyloidosis. However, the role of tafamidis in patients with the New York Heart Association class III/IV heart failure or mutated transthyretin remains unclear. Conclusion: Tafamidis is an effective and safe oral medication for the treatment of the cardiomyopathy of transthyretin-mediated amyloidosis in adults to reduce cardiovascular mortality and cardiovascular-related hospitalization

Controlling Hypertension through Education and Coaching in Kidney Disease (CHECK-D): protocol of a cluster randomised controlled trial

Introduction Chronic kidney disease (CKD) affects 30 million Americans. Early management focused on blood pressure (BP) control decreases cardiovascular morbidity and mortality. Less than 40% of patients with CKD achieve recommended BP targets due to many barriers. These barriers include a lack of understanding of the implications of their diagnosis and how to optimise their health.This cluster randomised control trial hypothesises that the combination of early primary care CKD education, and motivational interviewing (MI)-based health coach support, will improve patient behaviours aligned with BP control by increasing patient knowledge, self-efficacy and motivation. The results will aid in sustainable interventions for future patient-centric education and coaching support to improve quality and outcomes in patients with CKD stages 3–5. Outcomes in patients with CKD stages 3–5 receiving the intervention will be compared with similar patients within a control group. Continuous quality improvement (CQI) and systems methodologies will be used to optimise resource neutrality and leverage existing technology to support implementation and future dissemination. The innovative approach of this research focuses on the importance of a multidisciplinary team, including off-site patient coaching, that can intervene early in the CKD care continuum by supporting patients with education and coaching.Methods and analysis We will test impact of BP control when clinician-delivered education is followed by 12 months of MI-based health coaching. We will compare outcomes in 350 patients with CKD stages 3–5 between intervention and control groups in primary care. CQI and systems methodologies will optimise education and coaching for future implementation and dissemination.Ethics and dissemination This study was approved by the University of Michigan Institutional Review Boards (IRBMED) HUM00136011, HUM00150672 and SITE00000092 and the results of the study will be published on ClinicalTrials.gov, in peer-reviewed journals, as well as conference abstracts, posters and presentations.Trial registration number NCT04087798