Sensitivity of Patient Outcomes to Pharmacist Interventions. Part I: Systematic Review and Meta-Analysis in Diabetes Management

Machado, Márcio; Bajcar, Jana; Guzzo, Giovanni C; Einarson, Thomas R.

doi:10.1345/aph.1k151

Cited by 207 publications

(182 citation statements)

References 41 publications

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“…Guidelines recommend a team-based approach to diabetes management, 1 to address complex comorbidities and increase the achievement of diabetes-related treatment goals. 40,41 However, tailored strategies such as clinical decision support are needed to assist providers and patients with complex comorbidity management. 42 One of the limitations of this study is the use of data from a single healthcare system, potentially limiting the generalizability.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

et al. 2015

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BACKGROUND: Early hypertension control reduces the risk of cardiovascular complications among patients with diabetes mellitus. There is a need to improve hypertension management among patients with diabetes mellitus. OBJECTIVE: We aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. DESIGN: This was a 4-year retrospective analysis of electronic health records. PARTICIPANTS: Adults ≥18 years old (n=771) with diabetes mellitus, who met criteria for incident hypertension and received primary care at a large, Midwestern academic group practice from 2008 to 2011 were included MAIN MEASURES: Cut-points of 130/80 and 140/ 90 mmHg were used to identify incident cases of hypertension. Kaplan-Meier analysis estimated the probability of receiving: 1) an initial hypertension diagnosis and 2) antihypertensive medication at specific time points. Cox proportional-hazard frailty models (HR; 95 % CI) were fit to identify associations of time to hypertension diagnosis and treatment. KEY RESULTS: Among patients with diabetes mellitus who met clinical criteria for hypertension, 41 % received a diagnosis and 37 % received medication using the 130/ 80 mmHg cut-point. At the 140/90 mmHg cut-point, 52 % received a diagnosis and 49 % received medication. Atrial fibrillation (HR 2.18; 1.21-4.67) was associated with faster diagnosis rates; peripheral vascular disease (HR 0.18; 0.04-0.74) and fewer primary care visits (HR 0.93; 0.88-0.98) were associated with slower diagnosis rates. Atrial fibrillation (HR 3.07; 1.39-6.74) and ischemic heart disease/congestive heart failure (HR 2.16; 1.24-3.76) were associated with faster treatment rates; peripheral vascular disease (HR 0.16;) and fewer visits (HR 0.93;) predicted slower medication initiation. Diagnosis and treatment of incident hypertension were similar using cut-points of 130/80 and 140/90 mmHg. CONCLUSIONS: Among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 % remained undiagnosed and untreated for hypertension. Future interventions should target patients with multiple comorbidities to improve hypertension and diabetes clinical care.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

et al. 2015

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“…____________________________________ Pharmaceutical care programs have been found useful in reducing coronary heart disease risk factors such as increased blood pressure, high blood glucose, and high lipid levels (4)(5)(6). However, most of these studies have focused on a research context rather than practices implemented within health care systems.…”

Section: Introductionmentioning

confidence: 99%

Effect of a 36-month Pharmaceutical Care Program on the Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients

et al. 2011

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-Purpose. To examine the effect of an implemented pharmaceutical care program on coronary heart disease risk in elderly diabetic and hypertensive patients. Methods. A total of 200 elderly (≥60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements was evaluated at baseline and for 36 months. The intervention-group patients received pharmaceutical care from a clinical pharmacist, whereas the control-group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk of all patients. Results. A total of 194 patients completed the study. Significant reductions (P < 0.05) in the mean values (baseline vs. 36 months) of systolic blood pressure (156.7 mmHg vs. 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001), fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P < 0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL) cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m 2 vs. 26.1 kg/m 2 ; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P = 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group. Conclusion. The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.

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“…The pharmaceutical care includes a wide range of clinical services, ranging from the benchmarks to pharmacotherapeutic monitoring itself. Recently, in order to clarify definitions and guide professional activity, the which regulate the attributions of clinical pharmacists and of pharmaceutical prescription.The importance of pharmaceutical services has been recognized by various studies (Blenkinsopp, Bond, Raynor, 2012; Castelino, Bajorek, Chen, 2010;Krska et al, 2001), which indicate improvements in the profile of medication usage (Castelino, Bajorek, Chen, 2010;Cobb, 2014;Cramer, 2004;Gellad, Grenard, Mcglynn, 2009;Hatah et al, 2014;Machado et al, 2007b), clinical outcomes (Charrois et al, 2009;Machado et al, 2007a;Santschi et al, 2012;Sookaneknun et al, 2004;Wubben, Vivian, 2008), humanistic outcomes (Garrett, Bluml, 2005;Singhal et al, 1999) and economical outcomes (Altowaijri, Phillips, Fitzsimmons, 2013;Cranor, Christensen, 2003;Desborough et al, 2012;Gallagher et al, 2015;Garrett, Bluml, 2005;Riley, 2013), in numerous chronic conditions, besides the level of evident patient satisfaction. As such, many countries, including the United States, Canada and the United Kingdom, have added clinical pharmaceutical services to their healthcare systems.…”

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confidence: 99%

Quality indicators of pharmacists' services in community pharmacies in Paraná State, Brazil

Júnior

Halila

Reis

et al. 2017

Braz. J. Pharm. Sci.

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Pharmacists and their pharmacies have been evolving in their roles as health promoters in Brazil. Some examples are the recent legislation reaffirming the role of Brazilian pharmacies as health institutions, rather than having only a commercial profile, giving greater clarity to pharmacists about their roles as health care providers. This evolution came with the recognition that is already seen in other developed countries, confirming the need for the pharmacist as a health promoter, and not simply a dispenser of drugs in society. This study has obtained the profile and activities of community pharmacists, as well as the quality indicators of private community pharmacies throughout the State of Paraná through the application of an online survey sent to pharmacists in the state. Out of all pharmacists surveyed, 533 were part of the final analysis, being the pharmacists to complete the survey in full. Participants were mostly female (69.4%) and were, on average, 35.2 ± 9.2 years old. Of these, 60% worked in pharmacy chains and just 37% of all pharmacist respondents were issuing the Declaration of Pharmaceutical Services. The current study showed that many pharmaceutical services are not adopted by pharmacies as these services bring no significant financial reward. Regarding the structure, the Paraná State showed that pharmacies present a good overall structure. The kind of pharmacy (chain or independent) influenced the pharmaceutical services provided and the available structure, where the independent pharmacies provide a wider range of services and have better structure. This study was able to identify the profile and behaviors of pharmacists and also the quality indicators of pharmacies in Paraná State.Uniterms: Pharmaceutical care. Pharmacists/professional practice. Community pharmacy/structure indicators/Paraná State, Brazil. INTRODUCTIONThe pharmaceutical profession has undergone important changes in the last few decades in Brazil, especially in relation to community pharmacies, with changing roles and a focus on providing clinical services to patients.The pharmacy, as commercial establishment, has evolved significantly (França Filho et al., 2008;Silva, Vieira, 2004), with regulatory advancements such as the publication of law 13.021/14, which inverts the profit oriented logic, by defining the pharmacy as a health care entity geared toward providing a pharmaceutical service, and technical and clinical assistance, to promote the best health care for the patients Souza, 2012).The term service refers to a set of activities organized in a work process. In a broad definition, pharmaceutical services represent any particular service provided by pharmacists and they may be clinical or not. The pharmaceutical care includes a wide range of clinical services, ranging from the benchmarks to pharmacotherapeutic monitoring itself. Recently, in order to clarify definitions and guide professional activity, the which regulate the attributions of clinical pharmacists and of pharmaceutical prescription.The importance of phar...

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Sensitivity of Patient Outcomes to Pharmacist Interventions. Part I: Systematic Review and Meta-Analysis in Diabetes Management

Abstract: A1C is sensitive to pharmacists' interventions. Several potentially sensitive outcomes were identified, but too few studies were available for quantitative summaries. More research is needed.

Cited by 207 publications

References 41 publications

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

Effect of a 36-month Pharmaceutical Care Program on the Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients

Quality indicators of pharmacists' services in community pharmacies in Paraná State, Brazil

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