Biomedical subjects

Barry L Carter

Publications and source records attributed to Barry L Carter.

25 records · Page 2Linked to original sources

PubMed2002

Eplerenone--a novel selective aldosterone blocker.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety of eplerenone, a new selective aldosterone blocker. DATA SOURCES: Primary literature and review articles were obtained via MEDLINE search (1966-April 2002). Additional studies and abstracts were identified from the bibliographies of reviewed literature. STUDY SELECTION AND DATA EXTRACTION: Studies and review articles related to eplerenone, aldosterone, aldosterone antagonist, and spironolactone were reviewed. Data pertinent to this article were included. DATA SYNTHESIS: Eplerenone is a selective aldosterone blocker. Recent data have demonstrated the deleterious effects of aldosterone in several chronic disease states including hypertension and heart failure. Animal studies using eplerenone have shown a positive role for aldosterone antagonism in the treatment of hypertension, heart failure, myocardial infarction, renal disease, and atherosclerosis. In humans, eplerenone appears to be effective for the treatment of hypertension. An ongoing study will examine the effect of eplerenone for heart failure. To date, the incidence of adverse effects with eplerenone has been slightly lower than with spironolactone. CONCLUSIONS: Eplerenone appears to be a promising drug in a new class of agents called selective aldosterone blockers. The drug may be approved for treatment of hypertension in 2002. Additional studies are ongoing that may provide information on other clinical uses for this medication.

Animals↗

PubMedDate not supplied

Development and initial validation of an instrument to measure physician-pharmacist collaboration from the physician perspective.

OBJECTIVE: Using a conceptual model of collaborative working relationships between pharmacists and physicians, a measure for physician-pharmacist collaboration from the physician perspective was developed. The measure was analyzed for its factor structure, internal consistency, construct validity, and other psychometric properties. METHODS: An initial 27-item Physician-Pharmacist Collaboration Instrument (PPCI) was developed to assess seven themes about professional relationships using Likert scales. The PPCI was mailed to a random sample of 1000 primary care physicians. Principal component analysis was used to assess the structure and uncover underlying dimensions of the initial instrument. Items were evaluated for inclusion or exclusion into a refined instrument. Internal consistency was assessed by calculating Alpha coefficients for each identified factor. Convergent validity was assessed using Spearman correlations between the identified factors and a previous measure of collaborative care. After measure refinement, confirmatory factor analysis was used to evaluate the fit of both versions of the instrument. RESULTS: Three hundred forty usable surveys were returned for a response rate of 34%. Almost 70% of the respondents were male with a mean age of 45.8. A majority were family practice physicians (72.1%) in private practice (67.3%). Three unique factors were identified during principal component analysis and utilized in a confirmatory factor analysis. Both a full and a 14-item reduced model were constructed and tested. Cronbach's alpha for the three factors of the full model ranged from 0.91 to 0.97, while the reliability for the reduced model ranged from 0.86 to 0.96. Comparative fit indexes of 0.97 and 0.98 were obtained, indicating good fit for the models. CONCLUSIONS: The results indicate good reliability and validity of the refined (14-item) PPCI. This instrument can be useful as a research tool for assessment of the physicians' perspective about a physician-pharmacist relationship. Further research is warranted to examine if the extent of relationship development, as measured with the PPCI, can affect patient care outcomes.

Attitude of Health Personnel↗

PubMedDate not supplied

How pharmacists can assist physicians with controlling blood pressure.

The goals for hypertension in the publication Healthy People 2010 require a much more intensive approach in order to achieve desired blood pressure control rates. The pharmacist is uniquely positioned in the health care system to assist with improving blood pressure control by utilizing strategies to solve medication-related problems. Studies within integrated health systems have demonstrated that when pharmacists are included as members of health care teams, control rates for hypertension increase. In addition, drug interactions, nonadherence, and costs can be reduced. The authors suggest that incorporating a pharmacist or some services typically provided by traditional pharmacists into physician practices can improve blood pressure control. This review summarizes studies involving pharmacist participation in hypertension management and provides recommendations for obtaining pharmacist involvement.

Humans↗

PubMedDate not supplied

Effect of a telephone medication renewal service on blood pressure control.

OBJECTIVE: To evaluate the effect of a pharmacist-staffed telephone medication renewal service on blood pressure (BP) control. DESIGN: Retrospective review of telephone call logs and patient charts. SETTING: University-based family medicine clinic. PATIENTS AND OTHER PARTICIPANTS: All patients seen at the clinic with an International Classification of Diseases 9 code for hypertension during 2000. INTERVENTIONS: Age, sex, diagnosis of heart failure and/or diabetes, and frequency of clinic visits were recorded. Telephoned prescription renewal requests for 2000 were logged; patient name, age, medication requested, strength, and directions were recorded. Each log entry was reviewed to identify patients requesting a renewal for an antihypertensive agent. Patients with hypertension who used the renewal service were compared with those who did not. MAIN OUTCOME MEASURES: BP control rates were calculated for each group as the number of patients who met BP goals from the 1997 guidelines of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Analysis of variance and regression analysis were performed to examine the effect use of the renewal service had on BP control in both groups of patients. Covariables such as age, sex, and clinic visits were included in the model. RESULTS: Of the 938 patients seen for hypertension, 332 used the renewal service at least once. We found no statistical difference between the two groups with respect to BP control (P = .86; confidence interval [CI], 0.7-1.3). BP control did not improve more for patients who used the renewal service more frequently (P = .48; CI, 0.9-1.2). CONCLUSION: Use of the telephone medication renewal service had no effect on BP control. While increasing patients' access to medications is necessary, the results of this study suggest that this in itself is not sufficient to ensure good BP control.

Antihypertensive Agents↗

PubMedDate not supplied

Evaluation of the Iowa Medicaid pharmaceutical case management program.

OBJECTIVE: To test the effect of pharmaceutical case management (PCM) on medication safety and health care utilization. DESIGN: Prospective cohort design with 9-month follow-up period (enrollment from October 1, 2000, through July 1, 2001, with follow-up through July 1, 2002). SETTING: Iowa Medicaid program. PARTICIPANTS: 2,211 noninstitutionalized, continuously eligible Iowa Medicaid patients taking four or more chronic medications including at least one agent commonly used in at least 1 of 12 specific diseases who were cared for by pharmacists in 117 pharmacies. INTERVENTIONS: Reimbursement for PCM services (initial patient assessment, written recommendations to physician, follow-up assessments and communication of progress and new problems to physician). MAIN OUTCOME MEASURES: Use of high-risk medications, Medication Appropriateness Index (MAI) score, health care utilization. RESULTS: Pharmacists in 114 pharmacies had eligible patients during at least one quarter during the study period; 28 pharmacies were classified as high intensity based on the number of PCM patients they managed. A total of 524 of the eligible patients received 1,599 PCM services; 90% of claims were filed by pharmacists, and the remainder by physicians. Nearly one half (46.1%) of medications and 92.1% of patients had at least one medication problem before PCM. By closeout, the percentage of medications with problems decreased in 8 of 10 MAI domains for those who received PCM. Compared with baseline, mean MAI score improved significantly from 9.4 to 8.3 among PCM recipients (P < .001). Percentage of PCM recipients using high-risk medications decreased significantly compared with PCM eligibles who did not receive the service. In the 28 pharmacies that adopted the new service most intensely, patients had a significant decrease in high-risk medication use, compared with patients of low-intensity pharmacies (P < .001). No difference was observed between PCM recipients and PCM eligibles who did not receive PCM in health care utilization or charges, even after including reimbursements for PCM. CONCLUSION: Medication safety problems were prevalent in this high-risk population. The PCM program improved medication safety during a 9-month follow-up period.

Adult↗

PubMedDate not supplied

Utility of a questionnaire to measure physician-pharmacist collaborative relationships.

OBJECTIVE: To examine the sensitivity and criterion validity of the 14-item Physician/Pharmacist Collaboration Index (PPCI). DESIGN: Substudy of an unblinded, randomized trial of pharmacist interventions with patients with uncontrolled hypertension. SETTING: 6 intervention and 6 control pharmacies in eastern Iowa. PARTICIPANTS: 25 community pharmacists. INTERVENTIONS: Pharmacists completed the PPCI at baseline and at a 3-month follow-up for each patient's physician. MAIN OUTCOME MEASURES: Respondents' perceptions about their relationships with each patient's physicians as measured through scores in three domains, Trustworthiness (TW; score range, 6-42), Role Specification (RS, 5-35), Relationship Initiation (RI, 3-21), and compared using nonparametric tests. RESULTS: Pharmacists' mean scores of their relations with 38 different physicians (54 completed PPCIs) in the intervention group were 33.8 for TW, 23.2 for RS, and 16.4 for RI at baseline. At 3 months, the scores had improved significantly to 35.5, 25.0, and 17.4, respectively. Pharmacists' scores for 43 different physicians (49 completed PPCIs) in the control group did not change significantly between baseline and 3 months (TW, 30.7 at each time point; RS, 20.3 and 19.7, respectively; RI, 14.3 at each time point). CONCLUSION: Improved scores in the intervention group suggest that collaborative relations improved between the physician and pharmacist during the 3-month study, while no such improvement was found in the control group. Since the intervention was designed to promote collaboration between pharmacists and physicians, these results support the PPCI as a tool to measure pharmacist-physician collaboration and could be used by pharmacists to benchmark collaborative relationships. Additional research is needed to corroborate the results of this study.

Adult↗

PubMedDate not supplied

Extent of services provided by pharmacists in the Iowa Medicaid Pharmaceutical Case Management program.

OBJECTIVE: To summarize the start-up experience with patients identified as eligible during the first four quarters of the Iowa Pharmaceutical Case Management (PCM) program and to characterize the extent of the services proved by pharmacists in the program. DESIGN: Prospective pharmaceutical care intervention project. SETTING: One hundred seventeen community pharmacies in Iowa. PATIENTS: Medicaid patients at high risk for drug-related problems based on using 4 or more nontopical medications and having 1 of 12 specific disease states. INTERVENTION: To become eligible to provide PCM services, licensed pharmacists had to undergo training and submit five care plans to the Iowa Department of Human Services. Community pharmacists were provided names of newly eligible patents each calendar quarter for 1 year. For each patient, pharmacists were asked to indicate by fax whether they had met with the patient, performed a written work-up of the patient, sent recommendations to the patient's physician, and whether the physician replied. When pharmacists were unable to provide the service, they were asked to state the reason. Both the pharmacist and the physician receive $75 for the initial assessment, with additional payments after each follow-up visit performed. MAIN OUTCOME MEASURES: An intensity score and the percentage of eligible patients for whom all steps were completed were calculated for each pharmacy. RESULTS: Fax survey results were retumed for 2,834 (96.7%) of the 2,931 patients eligible for PCM services. Pharmacists met with 943 (33.3%), worked up 763 (26.9%), sent recommendations to physicians for 500 (17.6%), and received replies from physicians for 327 (11.5%) patients. Pharmacists were unable to provide PCM services for 1,891 (66.7%) patients. The primary reasons given for this inability to provide services were patient access issues for 438 (23.2%) patients, pharmacy staffing or start-up issues for 419 (22.2%) patients, or no reason specified for 575 (30.4%) patients. A PCM intensity score was developed to represent the scope of services provided and the number of patients served. A higher intensity score indicated pharmacies that provided PCM to more patients and/or that offered higher levels of care (e.g., provided a written set of recommendations to the physician rather than simply assessing the patient without preparing or sending recommendations). Future evaluations will determine the validity of the score on the basis of patient outcomes. CONCLUSION: Some pharmacies implemented PCM services very effectively. However, 40% to 60% of the pharmacies provided little or no PCM services within 3 months of notification of patient eligibility. Future investigations will evaluate the quality of prescribing and quality of life for patients who received PCM services.

Child↗