Biomedical subjects

Michael E Ernst

Publications and source records attributed to Michael E Ernst.

20 records · Page 2Linked to original sources

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 4 years of clinical pharmacist anticoagulation case management in a rural, private physician office.

OBJECTIVES: To evaluate patient outcomes after 4 years of anticoagulation case management by a pharmacist and to document patient and provider satisfaction with the service. SETTING: Rural, private physician office in Mt. Vernon, Iowa. PRACTICE DESCRIPTION: Clinical pharmacist anticoagulation clinic. PRACTICE INNOVATION: Under a protocol reviewed annually, a clinical pharmacist faculty member from the University of Iowa College of Pharmacy provides on-site, point-of-care anticoagulation dose adjustment and monitoring 1 day per week. MAIN OUTCOME MEASURES: Data on anticoagulation outcomes from 1998 to 2002 were obtained through retrospective review of medical charts of patients served by the clinic. A survey of patient satisfaction with the clinic was mailed to all currently active patients enrolled in the anticoagulation clinic, and a second satisfaction survey was distributed to providers and ancillary staff of the physician office. RESULTS: Eighty patients met the criteria for evaluation of therapeutic outcomes. The mean +/- standard deviation percentage of international normalized ratios in the therapeutic range ("percent therapeutic") for the anticoagulation clinic population was 57.5 +/- 17.4. The percent therapeutic for patients who had been on warfarin before enrolling in the pharmacist case management anticoagulation clinic (defined as the usual medical care group) was 37.6%, compared with 57.8% for those patients receiving care in the pharmacist case management anticoagulation clinic (P < .001). In nearly all instances, responses to the surveys indicated that patient and provider satisfaction with the anticoagulation service was extremely high. CONCLUSION: A clinical pharmacist can provide anticoagulation case management services safely and effectively in a private physician office, and the service is highly valued by both patients and providers. We believe case management is an optimal method for systematically monitoring outpatient anticoagulation therapies and is preferable to usual medical care.

Adult↗