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PubMed2006

Pharmacies, pharmacists, and conscientious objection.

This paper examines the obligations of pharmacy licensees and pharmacists in the context of conscience-based objections to filling lawful prescriptions for certain types of medications--e.g., standard and emergency contraceptives. Claims of conscience are analyzed as means to preserve or maintain an individual's moral integrity. It is argued that pharmacy licensees have an obligation to dispense prescription medications that satisfy the health needs of the populations they serve, and this obligation can override claims of conscience. Although efforts should be made to respect the moral integrity of pharmacists and accommodate their claims of conscience, it is argued that the health needs of patients and the professional obligations of pharmacists limit the extent to which pharmacists may refuse to assist patients who have lawful prescriptions for medically indicated drugs.

Codes of Ethics↗

PubMed1976

Principles for dentist-pharmacist relationships: guidelines developed in Connecticut.

The "Guiding principles for dentist-pharmacist relationships in Connecticut" was prepared under the auspices of the Connecticut Joint Dental-Pharmaceutical Committee of the Connecticut State Dental Association and the Connecticut Pharmaceutical Association. The committee is made up of six dentists and six pharmacists who represent their respective state associations. The committee provides a forum in which practicing, academic licensing, and supervisory representatives of both professions meet voluntarily to discuss scientific objects of mutual interest, make pertinent recommendations on matters of professional and public concern and, on request, attempt to resolve occasional differences that arise between responsible pharmacists and dentists. The "Guide" was prepared because of the significant increase in prescription writing by practicing dentists in Connecticut. Further, with the increased involvement of third party programs, the committee thought that the relationship between dentists and pharmacists should be formalized to establish that prescription writing is a significant part of dental practice. The "Guide" was approved by the executive committee of the Connecticut Pharmaceutical Association in January 1975 and the house of delegates of the Connecticut State Dental Association in May 1975.

Connecticut↗

PubMed2007

Prevention of pediatric medication errors by hospital pharmacists and the potential benefit of computerized physician order entry.

OBJECTIVES: The purpose of this work was to characterize medication errors and adverse drug events intercepted by a system of pediatric clinical pharmacists and to determine whether the addition of a computerized physician order entry system would improve medication safety. METHODS: The study included 16,938 medication orders for 678 admissions to the pediatric units of a large academic community hospital. Pediatric clinical pharmacists reviewed medication orders and monitored subsequent medication use. Medication errors and adverse drug events were identified by daily review of documentation, voluntary reporting, and solicitation. Each potentially harmful medication error was judged whether or not it was intercepted and, if not, whether it would have been captured by a computerized physician order entry system. RESULTS: Overall, 865 medication errors occurred, corresponding with a rate of 5.2 per 100 medication orders. A near-miss rate of 0.96% and a preventable adverse drug event rate of 0.09% were observed. Overall, 78% of potentially harmful prescribing errors were intercepted; however, none of the potentially harmful errors occurring at administration was intercepted and accounted for 50% of preventable adverse drug events. A computerized physician order entry system could capture additional potentially harmful prescribing and transcription errors (54%-73%) but not administration errors (0% vs 6%). CONCLUSIONS: A system of pediatric clinical pharmacists effectively intercepted inpatient prescribing errors but did not capture potentially harmful medication administration errors. The addition of a computerized physician order entry system to pharmacists is unlikely to prevent administration errors, which pose the highest risk of patient injury.

Child↗

PubMed2000

An economic analysis of a randomized, controlled, multicenter study of clinical pharmacist interventions for high-risk veterans: the IMPROVE study. Impact of Managed Pharmaceutical Care Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

STUDY OBJECTIVE: To determine if clinical pharmacists could affect economic resource use and humanistic outcomes in an ambulatory, high-risk population. DESIGN: Prospective, randomized, controlled study. SETTING: Nine Veterans Affairs medical centers. PATIENTS: Patients who were at high risk for medication-related problems. INTERVENTION: Patients were randomized to usual medical care with input from a clinical pharmacist (intervention group) or just usual medical care (control group). MEASUREMENTS AND MAIN RESULTS: Of 1,054 patients enrolled, 523 were randomized to the intervention group and 531 to the control group. The number of clinic visits increased in the intervention group (p=0.003), but there was no difference in clinic costs. Mean increases in total health care costs were $1,020 for the intervention group and $1,313 for the control group (p=0.06). CONCLUSION: Including the cost of pharmacist interventions, overall health care expenditures were similar for patients randomized to see a clinical pharmacist versus usual medical care.

Aged↗

PubMed2000

Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

We examined the impact of ambulatory care clinical pharmacist interventions on clinical and economic outcomes of 208 patients with dyslipidemia and 229 controls treated at nine Veterans Affairs medical centers. This was a randomized, controlled trial involving patients at high risk of drug-related problems. Only those with dyslipidemia are reported here. In addition to usual medical care, clinical pharmacists were responsible for providing pharmaceutical care for patients in the intervention group. The control group did not receive pharmaceutical care. Seventy-two percent of the intervention group and 70% of controls required secondary prevention according to the National Cholesterol Education Program guidelines. Significantly more patients in the intervention group had a fasting lipid profile compared with controls (p=0.021). The absolute change in total cholesterol (17.7 vs 7.4 mg/dl, p=0.028) and low-density lipoprotein (23.4 vs 12.8 mg/dl, p=0.042) was greater in the intervention than in the control group. There were no differences in patients achieving goal lipid values or in overall costs despite increased visits to pharmacists. Ambulatory care clinical pharmacists can significantly improve dyslipidemia in a practice setting designed to manage many medical and drug-related problems.

Aged↗

PubMed2000

Types of interventions made by clinical pharmacists in the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

The purpose of this study was to describe and evaluate the activities and interventions provided by ambulatory care clinical pharmacists during the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) study. A total of 523 patients were randomized into the intervention arm at nine Veterans Affairs medical centers if they were considered to be at high risk for drug-related problems. Patients randomized to the control group had no interventions and they are not reported. Using a standard form, pharmacists were asked to document the length of visit, method of contact, medical conditions addressed, and drug-related problems addressed and resolved during each contact. Seventy-eight ambulatory care clinical pharmacists documented 1855 contacts over 12 months, an average of 3.54 +/- 2.31/patient. The length of visits was 15 minutes or more for 73% of contacts. In-person contacts accounted for 1421 visits (76.6%), with the remainder being telephone contacts. During each contact the average number of drug-related problems addressed and resolved were 1.64 +/- 1.16 and 1.14 +/- 0.98, respectively. More drug-related problems were addressed and resolved when visits were 15 minutes or longer (p=0.001) and when the contact was in person (p=0.001). These data may provide information to clinical pharmacists developing pharmacy-managed clinics for patients at high risk for drug-related problems. The information may be a benchmark for types of interventions that can be made, as well as the time commitments required to make them.

Aged↗

PubMed2000

Development and validation of the satisfaction with pharmacist scale.

To assess patients' satisfaction with pharmacists, seven questions were developed with semistructured input from 5 pharmacy practice faculty members and 11 patients with cancer. The study identified 1617 English- and Spanish-speaking patients with cancer or human immunodeficiency virus infection or acquired immunodeficiency syndrome who participated in a multisite validation of the Functional Assessment of Cancer Therapy Scale. Of these, 1124 had seen a pharmacist in the past 7 days and therefore were eligible; 608 spoke English and 516 Spanish. The seven items on the Satisfaction with Pharmacist (SWiP) scale were rated on a five-point Likert scale (0 = not at all to 4 = very much). The reliability of the English and Spanish versions was evaluated by Cronbach's alpha coefficients. The unidimensionality and construct validity were analyzed with the Rasch rating scale model. The alpha coefficients for the English and Spanish versions were 0.90 and 0.92, respectively. Rasch analyses of item responses showed that none of the items in either language was a misfit, which supported their ability to measure a unidimensional construct. Item difficulty plots revealed that no item exhibited differential functioning, indicating that the items performed the same in both languages. The SWiP scale has reliable and valid psychometric properties in English and Spanish and can be used to document the value of the pharmacist-patient relationship. It is easy to administer and is ready for further use and evaluation to determine and document outcomes of pharmaceutical care.

Adult↗

PubMed2001

Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic.

STUDY OBJECTIVE: To measure clinical, economic, and humanistic outcomes associated with a pharmacist-managed hypertension clinic compared with physician-managed clinics. DESIGN: Prospective, randomized, comparative study. SETTING: Managed care organization. PATIENTS: A total of 330 patients with mild-to-moderate essential hypertension. INTERVENTION: Hypertension care provided by either the pharmacist-managed hypertension clinic or physician-managed general medical clinics. MEASUREMENTS AND MAIN RESULTS: Baseline and 6-month evaluations consisted of systolic and diastolic blood pressure measurements, a short-form health survey, and collection of health care utilization information. After treatment, blood pressure measurements were significantly lower (p<0.001) in the pharmacist-managed hypertension clinic group than in the physician-managed clinic group. Patient satisfaction was significantly higher in the hypertension clinic group. Total costs for the hypertension clinic group were not different from those of the physician-managed clinic group ($242.46 vs $233.20, p=0.71), but cost:effectiveness ratios were lower in the hypertension clinic group ($27 vs $193/mm Hg for systolic blood pressure readings, and $48 vs $151/mm Hg for diastolic blood pressure readings). CONCLUSION: In a hypertension clinic, pharmacists can be a cost-effective alternative to physicians in management of patients, and they can improve clinical outcomes and patient satisfaction.

Aged↗

PubMed2002

A retrospective cohort analysis of the clinical effectiveness of a physician-pharmacist collaborative drug therapy management diabetes clinic.

The glycemic control of patients with diabetes in a physician-supervised, pharmacist-managed primary care clinic was compared with that of patients receiving standard care in the same health care system. We retrospectively analyzed the glycemic control of 87 men with type 1 or type 2 diabetes whose diabetes-related drug therapy was managed by clinical pharmacists compared with a control group of 85 similar patients whose care was not augmented by clinical pharmacists. Primary outcomes were differences in fasting blood glucose (FBG) and glycosylated hemoglobin (A1C) levels between groups. Secondary outcomes were relative risk (RR) for achieving an A1C of 7% or below, frequency of diabetes-related scheduled and unscheduled clinic visits, and frequency of hypoglycemic events. The study group had 864 clinic visits and the control group had 712 between October 1997 and June 2000. No statistical differences were noted in FBG or A1C between groups. The RR of achieving an A1C of 7% or below was significantly higher in the study cohort (RR 5.19, 95% confidence interval [CI] 2.62-10.26). The frequency of hypoglycemic events did not differ between groups. The mean +/- SD frequency of unscheduled diabetes-related clinic visits/patient/year was higher in the control group (1.33 +/- 3.74) than in the study group (0.11 +/- 0.46, p = 0.003). Pharmacist-managed diabetes care was effective in improving glycemic control and was not associated with an increased risk for hypoglycemic events or unscheduled diabetes-related clinic visits.

Adult↗

PubMed2003

Role of the pharmacist in establishing lipid intervention programs.

Despite the availability of the National Cholesterol Education Program Adult Treatment Panel (ATP) guidelines for the management of hyperlipidemia since 1988, most patients do not achieve their target low-density lipoprotein cholesterol (LDL) goals. With the publication of the most recent guidelines (ATP III), which contain more aggressive treatment recommendations, the cholesterol treatment gap is likely to widen further. Factors responsible for patients not receiving adequate treatment include a lack of focus on asymptomatic diseases, time and reimbursement constraints, inadequate training, a reluctance to prescribe aggressive treatment regimens, and poor communication among health care professionals. Results of several studies evaluating intervention programs indicate that pharmacists can play a key role in improving cholesterol management whether in lipid clinics, community pharmacies, or hospitals. In these intervention programs, pharmacists provided a wide range of functions that included reviewing the medical history, monitoring laboratory values, selecting lipid-lowering therapies, and educating patients regarding drug therapies and the importance of compliance. These interventions produced significant improvements in lipid parameters and in the number of patients who achieved LDL treatment goals. Most important, these interventions were associated with decreases in clinical events. Pharmacist intervention also was highly cost-effective and time efficient. These results suggest that pharmacists are in a unique position and possess the requisite skills to improve the treatment of patients with hyperlipidemia.

Clinical Trials as Topic↗

PubMed2003

Physician-pharmacist comanagement of hypertension: a randomized, comparative trial.

OBJECTIVE: To compare the effectiveness of an evidence-based, systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension. METHODS: Patients in a staff model medical group with uncontrolled hypertension were randomized to either a usual care (UC) or a physician-pharmacist comanagement (PPCM) group. All physicians in the study received both group and individual education and participated in the development of an evidence-based hypertension treatment algorithm. Physicians were then given the names of their patients whose medical records documented elevated blood pressures (defined as systolic > or = 140 mm Hg and/or diastolic > or = 90 mm Hg for patients aged < 65 yrs, and systolic > or = 160 mm Hg and/or diastolic > or = 90 mm Hg for those aged > or = 65 yrs). Patients randomized to the UC group were managed by primary care physicians alone. Those randomized to the PPCM group were comanaged by their primary care physician and a clinical pharmacist, who provided patient education, made treatment recommendations, and provided follow-up. Blood pressure measurements, antihypertensive drugs, and visit costs/patient were obtained from medical records. RESULTS: One hundred ninety-seven patients with uncontrolled hypertension participated in the study. Both PPCM and UC groups experienced significant reductions in blood pressure (systolic -22 and -11 mm Hg, respectively, p < 0.01; diastolic -7 and -8 mm Hg, respectively, p < 0.01). The reduction in systolic blood pressure was greater in the PPCM group after adjusting for differences in baseline blood pressure between the groups (p < 0.01). More patients achieved blood pressure control in the PPCM than in the UC group (60% vs 43%, p = 0.02). Average provider visit costs/patient were higher in the UC than the PPCM group ($195 vs $160, p = 0.02). CONCLUSIONS: An evidence-based, systematic approach using physician-pharmacist comanagement for patients with uncontrolled hypertension resulted in improved blood pressure control and reduced average visit costs/patient.

Aged↗

PubMed2003

Bioterrorism: pivotal clinical issues. Consensus review of the Society of Infectious Diseases Pharmacists.

OBJECTIVES: To discuss specific facts regarding use as a bioweapon, epidemiology, microbiology, clinical manifestations, diagnosis, antimicrobial therapy, immunization, and isolation precautions for five most likely agents of bioterrorism; to review and provide recommendations for health care clinicians on the management of these bioterrorism agents; and to share information on the pharmacist's role in preparedness and response. PARTICIPANTS: The manuscript was drafted by the three authors, reviewed by a group of selected members of the Society of Infectious Diseases Pharmacists, and approved by its Board of Directors. EVIDENCE: The primary focus was to review and summarize recent and key articles on bioterrorism. Preference was given to peer-reviewed journal information and government-sponsored journals, such as the MMWR, Morbidity and Mortality Weekly Report. CONSENSUS PROCESS: Written comments were requested from each reviewer. Comments were incorporated into the final draft. CONCLUSION: Pharmacists play an integral role in disaster preparedness and response and should be involved in planning committees. As drug information specialists, pharmacists can assist other health care providers and emergency personnel, as well as provide counseling to calm, comfort, and empower the public.

Adult↗

PubMed2006

Workplace-based cardiovascular risk management by community pharmacists: impact on blood pressure, lipid levels, and weight.

STUDY OBJECTIVE: To assess the effectiveness of a community pharmacist-delivered cardiovascular case-management program by comparing body mass index (weight), systolic and diastolic blood pressure, and full lipid profile at the beginning of the program with these outcome measures at the end of the program. DESIGN: Retrospective data analysis using billing data submitted between July 1, 2001, and October 31, 2004, with a pre-post design in which subjects served as their own controls. SETTING: Manufacturing workplace in rural Iowa. PARTICIPANTS: Fifty-six workers with risk factors for cardiovascular disease (mean age 40.67 yrs), 37 had diabetes mellitus and 19 did not. INTERVENTION: During visits to the workers, pharmacists provided education about cardiovascular disease, identification of drug therapy problems, and importance of routine blood pressure, pulse, and weight measurements; they communicated with participants' physicians as needed. MEASUREMENTS AND MAIN RESULTS: The number of pharmacist visits/participant ranged from 1-13 (mean +/- SD 6.97 +/- 3.05). Outcome measures were weight, systolic and diastolic blood pressures, full lipid profiles (in patients with diabetes), and percentage of patients achieving treatment goal by the end of the 3 years. Statistically significant differences between the first and last visits were achieved for both systolic (124.12 +/- 11.07 and 120.36 +/- 14.39 mm Hg, respectively, p=0.016) and diastolic (80.4 +/- 9.01 and 77.43 +/- 9.14 mm Hg, respectively, p=0.019) blood pressure. The 19 patients without diabetes showed a statistically significant improvement in diastolic blood pressure (p=0.039), but the 37 patients with diabetes did not show a significant difference. A nonsignificant increase was seen in the percentage of patients with diabetes achieving low-density lipoprotein cholesterol (LDL) level goal between the first and last visits (p=0.06). CONCLUSION: A cardiovascular case-management program delivered in the workplace to middle-aged working adults by community pharmacists improved blood pressure and reduced LDL levels. The program was not effective, however, in weight reduction.

Adult↗

PubMed2006

Effect of patient withdrawal on a study evaluating pharmacist management of hypertension.

STUDY OBJECTIVES: To examine potential threats to internal and external study validity caused by differential patient withdrawal from a randomized controlled trial evaluating pharmacist management of hypertension, to compare the characteristics of patients who withdrew with those of patients who completed the study, and to identify characteristics that predispose patients to withdraw from hypertension management. DESIGN: Prospective, randomized, comparative study. SETTING: Network of primary care clinics. PATIENTS: Four hundred sixty-three patients with a diagnosis of hypertension and a last documented systolic blood pressure of 160 mm Hg or greater and/or diastolic blood pressure of 100 mm Hg or greater. INTERVENTION: Patients were randomly allocated to the pharmacist intervention or usual-care (control) group. Those in the pharmacist intervention group were collaboratively managed by a primary care clinical pharmacy specialist and their primary care provider. Patients in the control group received usual care from only their primary care provider. MEASUREMENTS AND MAIN RESULTS: Of the 463 patients, 191 (41%) withdrew from the study after randomization and 272 (59%) completed the study. Patients who withdrew from the pharmacist intervention group were similar to patients who withdrew from the usual-care group with respect to age, sex, insurance status, and chronic conditions. Patients who smoked or had commercial insurance were more likely to withdraw from the study than the other participants. However, multivariate analysis of all variables, when adjusted for the effect of the intervention, revealed that insurance status was the only variable associated with a heightened probability of withdrawal (p=0.002). CONCLUSION: Although this study had a high withdrawal rate, between-group patient characteristics remained balanced. Therefore, internal validity was preserved, and outcomes from the study groups could be reliably compared. A lack of significant differences between patients who withdrew versus those who completed, with the exception of insurance status, suggests that external validity was not jeopardized.

Aged↗

PubMedDate not supplied

Lipid levels and use of lipid-lowering drugs for patients in pharmacist-managed lipid clinics versus usual care in 2 VA Medical Centers.

OBJECTIVE: The objective of this study was to assess the effectiveness of pharmacist- managed dyslipidemia clinics at 2 Veterans Affairs medical centers since the release of the 2001 National Cholesterol Education Panel Adult Treatment Panel III (NCEP ATP III) guideline compared with the usual care (UC) provided by other health care professionals in the same setting. METHODS: Analysis was performed through retrospective chart review of patients with a diagnosis of dyslipidemia who received care in either the Amarillo or Lubbock, Texas, pharmacist-managed lipid clinics (LCs) or UC from a primary care physician. Data from medical charts were abstracted for dates of service from July 2001 to December 2003 for 115 patients selected randomly from LC rolls matched with 115 patients with a diagnosis of dyslipidemia selected randomly from UC. All patients had to have had at least 3 visits with the LC or 3 visits in UC with a billing code of dyslipidemia; they were followed for at least 6 months after an initial visit in July 2001 or thereafter and were enrolled in the VA health care system for at least 1 year. Baseline lipid values were available for LC but not UC patients. Cholesterol target goals were determined according to NCEP ATP III guideline. RESULTS: After an average of 21.6 months of follow-up, the proportion of patients in the LC group that attained goal level increased from 45.2% at baseline to 82.6% for total cholesterol (TC) and from 36.5% at baseline to 64.3% for lowdensity lipoprotein cholesterol (LDL-C [P <0.001 for both comparisons]). There was an average 24.5 mg/dL absolute reduction (relative reduction, 19.4%) in LDL-C along with significant improvements in the other lipid levels (P <0.001 for TC and LDL-C, P = 0.007 for triglycerides [TGs]) with the exception of highdensity lipoprotein cholesterol (HDL-C), which declined from 40.0 mg/dL to 36.3 mg/dL (P <0.001). A total of 50 patients (43.5%) were on lipid-lowering pharmacotherapy at baseline versus 108 patients (93.9%) at follow-up. Compared with UC, LC patients were more likely to have achieved goal LDL-C (64.3% vs. 15.7% for UC, P <0.001) and TC (82.6% vs. 40.9%, P <0.001), but there was no difference in the proportion of patients at TG goal for LC (65.2%) compared with UC (52.2%, P = 0.061) or at HDL-C goal (23.5% for LC vs. 33.0% for UC, P = 0.143). A higher proportion of LC patients (93.9%) used lipid-lowering agents compared with UC patients (24.3%, P <0.001). Subanalysis of patients on a lipid-lowering agent found that a significantly higher proportion (85.2%) in the LC group were at goal total cholesterol compared with 60.7% for UC (P = 0.012) and at goal LDL-C (66.7% for LC vs. 39.3% for UC, P = 0.016). However, a lower proportion were at goal HDL-C for LC (21.3%) versus 42.9% for UC (P = 0.043). Overall, only 11 LC patients (9.6%) attained goal levels for all 4 serum lipid values by the end of follow-up versus 2 UC patients (1.7%, P = 0.019). CONCLUSIONS: Nearly two thirds of patients diagnosed with dyslipidemia and enrolled in a pharmacist-managed LC had LDL-C levels at or below NCEP ATP III target goal compared with 16% of dyslipidemia patients who received UC from their primary care provider. The pharmacist-managed LC patients were also twice as likely (83 vs. 41%) to have attained the TC target goal, but there was no difference between the 2 groups in the proportion of patients who attained either TG or HDL-C target goals. Only 9.6% of LC patients were at goal for all 4 individual lipid measures at the end of follow-up.

Ambulatory Care Facilities↗

PubMed2006

Development and clinical outcomes of pharmacist-managed diabetes care clinics.

PURPOSE: The development and outcomes of two pharmacist-managed diabetes care clinics (DCCs) are described. METHODS: Retrospective data analysis was performed to determine the outcomes for patients with type 2 diabetes mellitus who were treated in two pharmacist-managed DCCs. Primary outcome measures included changes in glycosylated hemoglobin (HbA(1c)), fasting plasma glucose, body mass index, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein cholesterol, triglycerides, and blood pressure and documented annual retinal and micro-albumin screening. Secondary outcome measures included the use of aspirin and kidney-sparing agents and annual screening for thyroid-stimulating hormone. RESULTS: Data from 113 patients in the DCCs were analyzed. After one year, the mean reduction in HbA(1c) levels was 1.3%, with a mean HbA(1c) of 7.8%. HbA(1c) goals were based on the institution's HbA(1c) normal range of 4.1-6.5%. Compared with baseline, over one third of patients met the HbA(1c) and blood pressure goals of <7.5% and <130/80 mm Hg, respectively. Mean LDL cholesterol concentration decreased from 110 to 94 mg/dL. The mean concentration of triglycerides decreased from 243 to 178 mg/dL. Mean systolic blood pressure decreased from 136 to 132 mm Hg. Whereas the national average for uncontrolled diabetes (HbA(1c) > 9.5%) was 36.9%, only 3.5% of patients at the pharmacist-managed DCCs had uncontrolled diabetes. Attainment rates of LDL cholesterol goals and annual retinal and microalbumin screenings were significantly higher in clinic patients compared with national averages. Three-year postclinic inception data revealed similar favorable outcomes, most notably an average HbA(1c) of 7.6% and 55% of patients meeting their target HbA(1c) goal of <7.5%. CONCLUSION: Compared with national averages, DCCs managed by clinical pharmacists achieved higher screening rates and attained treatment goals more often.

Ambulatory Care↗

PubMed2006

Outcomes of pharmacist-managed diabetes care services in a community health center.

PURPOSE: The outcomes of pharmacist-managed diabetes care services in a community health center were studied. METHODS: Eligible patients were over age 18 years and had a diagnosis of type 2 diabetes mellitus. Patients were randomly assigned by the clinical pharmacist and nurse to the intervention group (n = 76) or control group (n = 73). Patients in the intervention group were enrolled in a pharmacist-managed diabetes care program. Patients in the control group received the standard diabetes care. The primary endpoint was reduction in glycosylated hemoglobin (HbA(1c)); secondary outcome measures included weight loss, an improved body mass index, decreased blood pressure, and an improved lipid panel. Quality-of-life measures (health level, satisfaction, impact, worry about disease, and worry about social and vocational issues) were also assessed. RESULTS: Demographic differences between groups were not remarkable. Mean HbA(1c) levels fell significantly (p < 0.05) from baseline to nine months in both groups. A difference of 1.0 was reported between the groups' HbA(1c) levels (95% confidence interval, 0.08-1.78; p < 0.05). Satisfaction level improved from 63.7 to 77.4 in the intervention group, which was significant when compared with the control group, whose satisfaction score improved from 57.0 to 63.4 (p < 0.05). CONCLUSION: Patients with type 2 diabetes mellitus who received pharmacist-managed diabetes care demonstrated improved HbA(1c), systolic blood pressure, and low-density-lipoprotein cholesterol levels and quality-of-life measures and met treatment goals more often than patients receiving standard care.

Adolescent↗

PubMed2006

Evaluation of patient and provider satisfaction with a pharmacist-managed lipid clinic in a Veterans Affairs medical center.

PURPOSE: Patient and provider satisfaction with a pharmacist-managed lipid clinic in a Veterans Affairs medical center were assessed. METHODS: All patients at Louis Stokes Cleveland Veterans Affairs Medical Center who were referred to a pharmacist-managed lipid clinic for drug therapy management were mailed a questionnaire addressing overall satisfaction with care provided by the lipid clinic. Chart reviews were performed for patients completing the questionnaire to ascertain lipid-lowering medications used, changes in serum cholesterol levels, and achievement of low-density-lipoprotein (LDL) cholesterol goal. Health care providers referring patients to the lipid clinic were sent an anonymous electronic questionnaire to assess provider satisfaction with the clinic. Responses to the questionnaire were rated on a Likert scale (strongly agree, somewhat agree, neutral, somewhat disagree, strongly disagree). A paired t test was used to assess the percent change in lipid values, and chi-square analysis was used to evaluate the achievement of each patient's LDL cholesterol goal. RESULTS: Surveys were sent to 224 patients and 104 providers. A total of 105 patients (47%) and 49 providers (47%) completed the questionnaire. Most patients and providers expressed satisfaction with the clinic, with 91.4% of patients and 87.8% of providers indicating that they were strongly or somewhat satisfied with the care provided by the pharmacist-managed clinic. Attainment rates of goal LDL cholesterol levels increased from 8.6% at baseline to 53.3% at discharge or the most recent measurement (p < 0.001). CONCLUSION: Most patients and providers were satisfied with the services provided by the pharmacist-managed lipid clinic. The clinic helped improve patients' LDL cholesterol, total cholesterol, and triglyceride levels.

Ambulatory Care Facilities↗