Adding Pharmacists to Primary Care Teams Increases Guideline-Concordant Antiplatelet Use in Patients with Type 2 Diabetes [article]

Here’s an interesting little tid-bit in the January issue of The Annals of Pharmacotherapy. According to the article “adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy“. Good stuff to be sure. Unfortunately the study only looked at the proportion of patients using antiplatelet therapy at 1-year after engaging the pharmacist. It would be interesting to see data around decreased morbidity, hospital readmission rates, etc to go along with the improved guideline-concordance.

Abstract

BACKGROUND: Antiplatelet therapy is recommended as part of a strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. However, compliance with these guideline-recommended therapies appears to be less than ideal.

OBJECTIVE: To assess the effect of adding pharmacists to primary care teams on initiation of guideline-concordant antiplatelet therapy in type 2 diabetic patients.

METHODS: Prespecified secondary analysis of randomized trial data. In the main study, the pharmacist intervention included a complete medication history, limited physical examination, provision of guideline-concordant recommendations to the physician to optimize drug therapy, and 1-year follow-up. Controls received usual care without pharmacist interactions. Patients with an indication for antiplatelet therapy, but not using an antiplatelet drug at randomization were included in this substudy. The primary outcome was the proportion of patients using an antiplatelet drug at 1 year.

RESULTS: At randomization, 257 of 260 study patients had guideline-concordant indications for antiplatelet therapy, but less than half (121; 47%) were using an antiplatelet drug. Overall, 136 patients met inclusion criteria for the substudy (71 intervention and 65 controls): 60% were women, with mean (SD) age 58.0 (11.9) years, diabetes duration 5.3 (6.0) years, and hemoglobin A1c 7.6% (1.5). Sixteen (12%) had established cardiovascular disease at enrollment. At 1 year, 43 (61%) intervention patients and 15 (23%) controls were using an antiplatelet drug (38% absolute difference; number needed to treat, 3; relative increase, 2.6; 95% CI 1.5-4.7; p < 0.001). Of these 58 patients, 52 (90%) were using aspirin 81 mg daily.

CONCLUSIONS: Adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy.

Effect of a Pharmacist Intervention on Clinically Important Medication Errors After Hospital Discharge [article]

Ann Intern Med. 3 July 2012;157(1):1-10

A study looking at pharmacist-assited med rec, counseling and telephone follow-up after dischage for adults hospitalized with acute coronary syndromes or acute decompensated heart failure. According to the article pharmacist intervention didn’t do much in the way of reducing “clinically important medication errors“, but may have led to fewer potential ADEs.
Continue reading Effect of a Pharmacist Intervention on Clinically Important Medication Errors After Hospital Discharge [article]

The joy of being a cartoon pharmacist

Pharmacists don’t exactly come to mind when you think of notable characters on TV. That’s why I felt compelled to post the short transcript below. It comes from Mort Goldman, owner of Goldman’s Pharmacy on the Family Guy cartoon series as he stands in front of a school class discussing his job as a pharmacist. It’s pretty funny. I tried to find a video clip, but couldn’t. In this case the written word doesn’t do it justice.

Mort: On the whole, I enjoy my job as a pharmacist. In fact, many of my customers are your mommies and daddies. Jimmy Hopkins, your mother had awful postpartum depression after you were born. And Danielle, your father had bad, very bad hemorrhoids that stung him unmerciful. Oh, they were awful. They were like stinky little balloons. And I gave him some special ointment and he hurt so bad that he had to apply it in the car with his sock. Thank you.

Boy: Cool! I want to be a pharmacist!

Boy 2: Oh, yeah!

________________________

Family Guy Episode: Mr. Saturday Knight - Aired on Tuesday, Jun 08, 2010

“What’d I miss?” – Week of October 24, 2010

As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
Continue reading “What’d I miss?” – Week of October 24, 2010

Confusion and varying opinions regarding the role of pharmacy in informatics remains the norm

Because I am a member of the American Society of Health-System Pharmacists (AHSP) I have access to the ASHP Pharmacy Informatics and Technology section listserv. Listservs are a great source of information, and as the name implies, this one is particularly good for getting information on all things related to pharmacy automation, technology and informatics.

A recent post on the informatics listserv caught my attention. The thread was started by a pharmacist asking what skills are necessary for a career in pharmacy informatics. Several pharmacists have chimed in with some great advice, while others have given what I consider to be less than helpful advice. Needless to say the responses have been all over the board as there is no universally accepted definition of what an informatics pharmacists does. Some pharmacists have recommended gaining skill in specific areas, i.e. reporting, HL7 ,etc, while others have taken a broad approach by offering advice on gaining experience in operations, project management, leadership and workflow concept and design.
Continue reading Confusion and varying opinions regarding the role of pharmacy in informatics remains the norm

“What’d I miss?” – Week of March 21, 2010

As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
Continue reading “What’d I miss?” – Week of March 21, 2010

NQF calls for pharmacists to take greater role in patient safety

HealthLeadersMedia.com: “Literature shows that when pharmacists are involved in care, the result is improved patient care, fewer adverse events, and reduced costs,” said Andrawis, speaking about Safe Practice 18. “But, in order for that full benefit to be realized, it’s really important that those pharmacists be given appropriate authority, and consequently that they continue to take accountability for patient outcomes.” – The article goes on to say that pharmacists should be involved in all facets of patient safety including leadership, technology and clinical rolls. Pharmacists are uniquely qualified to address patient safety issues. This is especially true when it comes to the pharmacists roll in the medication distribution model and implementation of new technology such as smart pumps, automated dispensing and barcoding. As the public becomes more aware of issues related to patient safety, the pharmacists roll in saving lives (and money) associated with medication errors will become even bigger.

Beyond technology – nurse/pharmacist collaboration for patient safety

Advanceweb.com via SafetyNurse on Twitter: “Pharmacists and nurses are essential professionals entrusted with medication safety. However, the medication delivery and other resources provided by pharmacy are not always well received by nursing, and vice versa. Nurses complain medications are not delivered on time. Gurses and Carayon (2007) noted that delays in getting medications from pharmacy as one of the most common nursing performance obstacles. Pharmacists complain they never received the order. Many blame today’s technology while others clamor for more advanced modes of medication delivery. Recently, studies have suggested computerized prescriber order entry can lead to new types of errors, especially during the early phase of technology deployment and dissemination. Technological advancements are not enough to ensure patients’ medication safety; collaboration between nurses and pharmacists is critical.” - I can tell you from years of experience that nursing and pharmacy frequently have issues and continuously play the “blame game.” I can also tell you that a good working relationship between pharmacy and nursing is key to successful patient care. I spent five years in a critical care satellite working closely with nursing. The more time I spent in the unit, the better my working relationship with nursing became. Trust developed and patient care was improved. While it is clear that technology is a tool that can improve patient safety, a solid nursing/pharmacy relationship is necessary to make it successful.

Pharmacists aren’t completely worthless after all.

An article in the most recent issue of Archives of Internal Medicine reports the results of adding a pharmacist to a health care team to offer up expertise on appropriate use of medication in heart failure and hypertension.

The results showed a 35% reduction in adverse drug events, a 48% reduction in preventable adverse drug events and a 37% reduction in medication errors. They did not analyze the economic impact. However, medication errors occur in at least 1.5 million people annually and add somewhere in the neighborhood of $3.5 billion a year to the cost of healthcare.

Now, about that raise….