The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia

Bunting, Barry A.; Smith, Ben; Sutherland, Susan E.

doi:10.1331/japha.2008.07140

Cited by 302 publications

(261 citation statements)

References 6 publications

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“…The Asheville Project realized important clinical and financial outcomes. 21,22 At the first sixmonth follow-up, 24.3 percent more diabetes patients had optimal hemoglobin A1c values (below 7.0 percent) than at the baseline assessment. Additional increases of 27.2 percent and 18.2 percent more patients with optimal HbA1c values were noted at the second and third six-month follow-ups, respectively.…”

Section: Medication Management Programsmentioning

confidence: 99%

Why Pharmacists Belong In The Medical Home

et al. 2010

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Pharmacists can affect the delivery of primary care by addressing the challenges of medication therapy management. Most office visits involve medications for chronic conditions and require assessment of medication effectiveness, the cost of therapies, and patients' adherence with medication regimens. Pharmacists are often underused in conducting these activities. They perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs, and recommend cost-effective therapies. Pharmacists should play key roles as team members in medical homes, and their potential to serve effectively in this role should be evaluated as part of medical home demonstration projects.

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Section: Medication Management Programsmentioning

confidence: 99%

Why Pharmacists Belong In The Medical Home

et al. 2010

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“…For example, in the Asheville Project studies of medication therapy management provided in community pharmacies, pre-intervention versus post-intervention comparisons were used. [40][41][42] A 2008 report of an Asheville Project program for patients with hypertension and/or dyslipidemia noted that study patients "agreed to complete education classes related to cardiovascular risk reduction and to be matched with a participating care manager/coach with whom they would meet on a regular, long-term basis … as frequently as once a month." 42 Thus, the analysis was, in effect, limited to patients sufficiently motivated to make a substantial time commitment to chronic disease care.…”

Section: Selection Effectmentioning

confidence: 99%

“…[40][41][42] A 2008 report of an Asheville Project program for patients with hypertension and/or dyslipidemia noted that study patients "agreed to complete education classes related to cardiovascular risk reduction and to be matched with a participating care manager/coach with whom they would meet on a regular, long-term basis … as frequently as once a month." 42 Thus, the analysis was, in effect, limited to patients sufficiently motivated to make a substantial time commitment to chronic disease care. In the MHS, patients randomized to DSM could choose whether to participate; those participating were, on average, "healthier" and "less costly" at baseline than patients who were randomized to DSM but opted out.…”

Section: Selection Effectmentioning

confidence: 99%

Why Hypotheses Informed by Observation Are Often Wrong: Results of Randomized Controlled Trials Challenge Chronic Disease Management Strategies Based on Epidemiological Evidence

Fairman¹

2011

JMCP

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Initiated in 2001 by the National Heart Lung and Blood Institute (NHLBI), ACCORD was an important landmark clinical trial for patients with type 2 diabetes and risk factors for cardiovascular disease; it represented the first large, experimental investigation of several key treatment guidelines that were based on sound epidemiological evidence but had never been subjected to the more rigorous test of an RCT.3 ACCORD study subjects had type 2 diabetes, with a hemoglobin A1c level of at least 7.5%, and met cardiovascular risk criteria including (a) aged 40 years or older with cardiovascular disease or (b) aged 55 years or older with atherosclerosis, albuminuria, left ventricular hypertrophy, or at least 2 cardiovascular disease risk factors (obesity, smoking, dyslipidemia, or hypertension). 2Of the 10,251 ACCORD study subjects, 4,733 met clinical criteria for inclusion in the blood pressure control component of the trial (systolic blood pressure [SBP] between 130 and 180 millimeters mercury [mmHg], taking 3 or fewer antihypertensive medications, and "the equivalent of a 24-hour protein excretion rate of less than 1.0 [grams]"). Patients were randomized to "intensive" therapy targeted to SBP less than 120 mmHg (n = 2,362) or "standard" therapy targeted to SBP less than 140 mmHg (n = 2,371). Patients were treated using "strategies that are currently available in clinical practice" and "drug classes … shown to result in a reduction in cardiovascular events among participants with diabetes."2 At 1-year follow-up, mean SBPs were 119.3 (95% confidence interval [CI] = 118.9-119.7) mmHg and 133.5 (95% CI = 133.1-133.8) mmHg in the intensive-and standard-therapy groups, respectively, a difference that was "significant and sustained" throughout the study. However, in a mean 4.7 years of follow-up, the SBP differences did not translate into significant improvements in the primary endpoint outcome, a composite of nonfatal myocardial infarction (MI), nonfatal stroke, or cardiovascular death; annual rates were 1.87% in intensive therapy and 2.09% in standard therapy (hazard ratio [HR] = 0.88, 95% CI = 0.73-1.06, P = 0.20). Additionally, serious adverse events attributable to antihypertensive treatment, including hypotension, bradycardia or arrhythmia, and hyperkalemia, were more common in the intensive-than standard-therapy arm (3.3% vs. 1.3%, respectively, P < 0.001).

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“…Pharmacists do so by improving health while minimizing overall long term health care costs; they do this by promoting the optimal use of prescription drugs while working to prevent adverse drug effects. The success of medication therapy management programs have in fact, been documented, from the initial Asheville studies performed in North Carolina, [4][5][6] to a more recent analysis by Barnett et al, published in the January/February 2009 issue of JMCP. 7 Additionally, Mirixa, an NCPA subsidiary dedicated to helping pharmacists provide medication therapy management to patients, has made great strides in developing contracts with over 46,000 pharmacies.…”

Section: ■■ the Challenge Of Medicare Part D For Community Pharmaciesmentioning

confidence: 99%

The Challenge of Medicare Part D for Community Pharmacies

Stone¹

2009

JMCP

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The Asheville Project: Clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia

Cited by 302 publications

References 6 publications

Why Pharmacists Belong In The Medical Home

Why Pharmacists Belong In The Medical Home

Why Hypotheses Informed by Observation Are Often Wrong: Results of Randomized Controlled Trials Challenge Chronic Disease Management Strategies Based on Epidemiological Evidence

The Challenge of Medicare Part D for Community Pharmacies

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