The impact of an appointment-based medication synchronization programme on chronic medication adherence in an adult community pharmacy population.

What Is Known And Objectives: Non-adherence to medication regimens is the primary cause of suboptimal clinical benefit in patients with chronic diseases. The primary objective of this study was to assess and compare adherence to chronic medications among adults participating in Time My Meds (TMM), an appointment-based medication synchronization programme, to patients receiving usual care.

Methods: This was a quasi-experimental study that evaluated data from 18 partner community pharmacies in three lower U.

Comparing Direct Oral Anticoagulants and Warfarin for Atrial Fibrillation, Venous Thromboembolism, and Mechanical Heart Valves.

Objectives: To summarize available data for use of direct oral anticoagulants in nonvalvular atrial fibrillation, venous thromboembolism, and mechanical heart valves including dose-response consistency to offer considerations for pharmacotherapeutic decision-making for oral anticoagulants.

Data Sources: A Medline search of English-language studies published between 2000 and March 2015 was conducted to identify pertinent papers using combinations of the following words: apixaban, atrial fibrillation, dabigatran, direct oral anticoagulant, edoxaban, factor IIa inhibitors, factor Xa inhibitors, mechanical heart valves, novel oral anticoagulant, rivaroxaban, venous thromboembolism, and warfarin.

Study Selection And Extraction: Original studies, guidelines, and approved prescribing information were evaluated and included if contributing new or complementary data toward the objective.

The impact of pioglitazone on bladder cancer and cardiovascular events.

Type 2 diabetes mellitus (T2DM) is a chronic condition with increasing prevalence and severe complications. Thiazolidinediones have been marketed since 1997 and are effective glucose-lowering drugs, but individual drugs within the class have been linked to serious adverse effects that resulted in the removal of troglitazone from the market, restrictions to rosiglitazone's use, and a warning added to pioglitazone's label. In 2007, a meta-analysis linked rosiglitazone to myocardial infarction (MI).

Patient participation in a clinic-based community pharmacy medication take-back program.

Objectives: To describe patient interest and involvement in participating in a clinic-based community pharmacy drug take-back program to dispose of unused, unwanted, or expired (UUE) medications and to identify patients' reasons for participating in the program.

Methods: A convenience sample of patients at the University of Oklahoma Family Medicine Pharmacy was recruited to complete a needs assessment survey regarding interest in drug take-back programs and current practices for handling UUE medications. Participants who purchased a postage-paid drug disposal envelope were asked to complete a program survey identifying sources of UUE medications, experience with drug take-back programs, and reasons for participation.

Incretin-based therapy compared with non-insulin alternatives in elderly patients with type 2 diabetes.

Type 2 diabetes mellitus is an increasingly common threat to the health of elderly Americans. There are a variety of treatment options, each with a unique set of advantages and disadvantages in this population. Discriminating factors between non-insulin drug classes include glucose-lowering effectiveness, weight effects, propensity for hypoglycemia or other adverse events, route of administration, and cost.

Exploring patient expectations for pharmacist-provided literacy-sensitive communication.

Background: Limited health literacy is common and associated with adverse health care outcomes. Although pharmacies and pharmacists are accessible to most patients, research has indicated that they do not routinely report efforts to target interventions for patients with suboptimal health literacy. Moreover, little is known about the use and expectation of literacy-based communication techniques in pharmacies from the patient perspective.

Warfarin versus dabigatran: comparing the old with the new.

Warfarin is an oral anticoagulant for treatment and prevention of venous and arterial thromboembolism. It requires regular monitoring and patient adherence to a variety of lifestyle factors that can influence its effect. Dabigatran is an oral direct thrombin-inhibitor recently approved for stroke prevention in atrial fibrillation.

Identification of barriers to appropriate dietary behavior in low-income patients with type 2 diabetes mellitus.

Objective: To identify barriers to appropriate dietary behavior in an urban, low-income population of patients with type 2 diabetes and to examine a new instrument in the identification of these barriers in this population.

Methods: A cross-sectional survey was developed, validated, and anonymously administered to low-income adults with type 2 diabetes in an academic family medicine physician group practice with a pharmacist-operated diabetes education and comanagement service. The survey consisted of three key subscales: determinants of food selection, importance of life challenges, and barriers to appropriate eating.

Motivating smokers in the hospital pulmonary function laboratory to quit smoking by use of the lung age concept.

Introduction: The purpose of this study was to investigate the use of lung age to motivate a quit attempt among smokers presenting to a hospital pulmonary function testing (PFT) laboratory.

Methods: Participants were randomized to receive a lung age-based motivational strategy (intervention group) versus standard care (control group). At 1 month, all participants were interviewed by telephone to determine whether they made a quit attempt.

Extended therapy for primary and secondary prevention of venous thromboembolism.

Clinical practice guidelines currently suggest extended anticoagulation therapy for primary and secondary prevention of venous thromboembolism (VTE). The optimal duration of anticoagulation has been an active area of clinical investigation for patients undergoing orthopedic surgeries and those diagnosed with a first episode of unprovoked VTE. Practice guidelines, VTE incidence, clinical predictors/mediators, and clinical trial evidence is reviewed to help pharmacists and other health care providers make an informed, patient-specific decision on the optimal duration of anticoagulation therapy.

Medication reconciliation in a community pharmacy setting.

Objectives: To describe the types and frequencies of medication discrepancies identified through medication reconciliation in a community pharmacy setting, to identify potential correlations between a patient's electronic medical record (EMR) and pharmacy medication list, and to determine the relationship between patients who use prescribers and/or pharmacies outside of the Family Medicine Center (FMC) and the occurrence of medication discrepancies.

Methods: Cross-sectional comparison of patients' EMR medication lists and pharmacy medication fill history for a sample of patients presenting to the Family Medicine Pharmacy (FMP), which is located in the FMC on the University of Oklahoma Health Sciences Center campus in Oklahoma City. Discrepancies identified were classified according to one of six categories that included therapeutic duplication, medication exclusion, medications that should be designated inactive in the EMR medication list, and differences in medication strength, dosage form, or dosing regimen.

Warfarin versus aspirin: using CHADS2 to guide therapy for stroke prevention in nonvalvular atrial fibrillation.

Atrial fibrillation (AF) results in nearly a quarter of the strokes suffered in patients 80 to 89 years of age. Aspirin and warfarin are primary choices for preventing these ischemic strokes. CHADS2 (Congestive heart failure, Hypertention, Age, Diabetes, Stroke) is a validated assessment tool for cardioembolic stroke in AF.

Developing a decision support system for tobacco use counselling using primary care physicians.

Background: Clinical decision support systems (CDSS) have the potential to improve adherence to guidelines, but only if they are designed to work in the complex environment of ambulatory clinics as otherwise physicians may not use them.

Objective: To gain input from primary care physicians in designing a CDSS for smoking cessation to ensure that the design is appropriate to a clinical environment before attempts to test this CDSS in a clinical trial. This approach is of general interest to those designing similar systems.

Interest in treatments to stop smoking.

We surveyed 884 Vermont (VT) tobacco smokers by random digit dialing to determine past and future use of treatment. Among those who had recently attempted to quit, 61% had ever used a treatment, 21% had ever used a psychosocial treatment, and 57% had used a medication. Among those who planned to quit in the next month, 68% stated they would use a treatment, 35% would use a psychosocial treatment, and 62% would use a medication.

Radon awareness and mitigation in Vermont: a public health survey.

Radon exposure is associated with an increased incidence of lung cancer, and elevated levels may be found in as many as 1 out of 15 homes. The U.S.

A wireless, handheld decision support system to promote smoking cessation in primary care.

Tobacco use remains a relatively unaddressed cause of disease and death in the daily care of patients by physicians. To overcome the barriers that physicians face in addressing tobacco use and its treatment in the primary care setting, we have developed a clinical decision support system that is readily accessible through the use of familiar wireless handheld devices and supportive of treatment through the implementation of the Tobacco Use and Dependence Treatment Guideline recommendations. We adopted the Information Management Services model to ensure that the application would effectively implement the guideline.

Aldosterone antagonists in the treatment of heart failure.

Purpose: The clinical benefits, adverse effects, pharmacokinetics, and recommendations for the appropriate use of the aldosterone antagonists spironolactone and eplerenone in patients with heart failure are reviewed.

Summary: Heart failure is a clinical syndrome characterized by the functional inability of the ventricle to meet the metabolic demands of the body. Renal hypoperfusion occurs as a result of reduced cardiac output, resulting in the activation of the renin-angiotensin-aldosterone system, which compensates for the hypoperfusion.

Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians.

Background: The importance of office spirometry has been strongly advocated in the pulmonary community, but whether its importance is recognized and accepted by primary care physicians is less well established.

Methods: To assess primary care physicians' knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease, we conducted a brief mail survey on the local practice of office spirometry, barriers to performing office spirometry, and general knowledge about spirometry. We also provided 60-min educational workshops to assess whether such an approach would increase spirometry testing or perceptions about spirometry.