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Hadisuyatmana S, Boyd JH, Efendi F, Malik G, Bauer M, Reisenhofer S. Non-medical and non-invasive interventions for erectile dysfunction in men with type 2 diabetes mellitus: A scoping review. Heliyon 2023; 9:e15778. [PMID: 37187905 PMCID: PMC10176068 DOI: 10.1016/j.heliyon.2023.e15778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Background Erectile dysfunction (ED) often affects men with type 2 diabetes mellitus (T2DM) due to microvascular damage. However, medical interventions are not always appropriate. Aim This scoping review aimed to answer the following question: What evidence is available about the effects of non-medical and non-invasive healthcare interventions to improve ED in men with T2DM? Method Potential studies were collected from the Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase via Ovid, MEDLINE via Ovid, Web of Science, PubMed, ProQuest, and PsycINFO via Ovid. Findings From 2,611 identified titles, 17 studies, including 11 interventional and 6 observational studies, were included. Four main alternatives to medical interventions were identified from the included studies. Amongst these, four studies recommended patient education on lifestyle modification, twelve studies encouraged dietary changes and physical activities, two studies emphasized the use of vacuum erectile device, and three studies suggested the application of low-intensity extracorporeal shockwave therapy by healthcare professionals. Discussion Dietary modification and physical activities were promoted as effective interventions to help maintaining the erectile function in men with T2DM. Several methods of patient education were identified as the approach to facilitate lifestyle modification in men with T2DM-associated ED. The positive outcomes of this review support early ED screening to help preventing T2DM complications such as ED in men. Further, T2DM management is a shared responsibility between the men and healthcare professionals. Despite the success of Vacuum Erectile Device and Low-intensity Extracorporeal Shockwave Therapy in regaining erectile function, further research is needed in this area based on the recommendations of the American Urological Association. Moreover, the health and quality of life of men with T2DM must be improved.
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Affiliation(s)
- Setho Hadisuyatmana
- School of Psychology & Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
- Faculty of Nursing, Universitas Airlangga Indonesia, Kampus C Jln Mulyorejo, 60115, Surabaya, East Java, Indonesia
| | - James H. Boyd
- School of Psychology and Public Health, La Trobe University of Australia, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga Indonesia, Kampus C Jln Mulyorejo, 60115, Surabaya, East Java, Indonesia
- Honorary Fellow at La Trobe University of Australia, Kampus C Jln Mulyorejo, 60115, Surabaya, East Java, Indonesia
| | - Gulzar Malik
- School of Nursing & Midwifery, La Trobe University of Australia, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Michael Bauer
- School of Engineering, La Trobe University of Australia, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Sonia Reisenhofer
- Bairnsdale Regional Health Service, Victoria, Australia, 122 Day St, Bairnsdale, VIC, 3875, Australia
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Cheng AL, Snider EM, Prather H, Dougherty NL, Wilcher-Roberts M, Hunt DM. Provider-Perceived Value of Interprofessional Team Meetings as a Core Element of a Lifestyle Medicine Program: A Mixed-Methods Analysis of One Center’s Experience. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221135539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Interprofessional care improves outcomes for medically complex patients and may be a valuable addition to standard lifestyle medicine practice, but implementation barriers exist. The purpose of this study was to explore the key features, perceived impact, and implementation considerations related to holding interprofessional team meetings as part of an intensive lifestyle medicine program. In this mixed-methods study, focus groups were conducted with 15 lifestyle medicine clinicians from various healthcare disciplines who had participated in interprofessional team meetings. Quantitative descriptive statistics of the meeting minutes were also calculated. Clinician-perceived benefits from participating in interprofessional team meetings included increased acquisition of knowledge, access to other clinicians, collaborative decision-making, patient satisfaction, and achievement of patient-centered goals. Participants described the importance of preparing an agenda for the interprofessional team meetings in advance, but a major implementation challenge was the time required to prepare for and conduct the meetings. Commitment and financial support by organization and program leadership were reported as key facilitators to implementing the meetings. Clinicians perceive significant value from incorporation of interprofessional team meetings into an intensive lifestyle medicine program, but successful implementation of meetings requires investment from all levels within a healthcare system.
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Affiliation(s)
- Abby L. Cheng
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Elsa M. Snider
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Heidi Prather
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Nikole L. Dougherty
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Myisha Wilcher-Roberts
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
| | - Devyani M. Hunt
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University in St Louis School of Medicine, St Louis, MO, USA (ALC, DMH); Brown School Evaluation Center, Brown School at Washington University in St Louis, St Louis, MO, USA (EMS, NLD, MWR); Kirksville College of Osteopathic Medicine, A. T. Still University, Kirksville, MO, USA (EMS); Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA (HP)
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Hildebrand CA, Gaviria DB, Samuel-Hodge CD, Ammerman AS, Keyserling TC. How Physicians Can Assess and Address Dietary Behaviors to Reduce Chronic Disease Risk. Med Clin North Am 2022; 106:785-807. [PMID: 36154700 DOI: 10.1016/j.mcna.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
With the growing burden of diet-related chronic disease impacting the public's health, nutrition counseling in a primary care setting is essential and can be accomplished through brief and creative approaches. This article reviews an example of a brief dietary assessment and counseling tool and counseling strategies focusing on dietary behavior changes that emphasize impact on health outcomes, ease of behavior change, and affordability. These, plus integrating office supports, are practical ways to start the conversation about improving diet quality with patients. Collaborative efforts in nutrition care, particularly through collaboration with registered dietitians, present a valuable opportunity to meet the nutrition care needs of patients. Additionally, this article reviews screening for eating disorders, food insecurity, and dietary supplement use.
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Affiliation(s)
- Caitlin A Hildebrand
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599-7426, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7461, Chapel Hill, NC, 27599-7461, USA
| | - David B Gaviria
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599-7426, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7461, Chapel Hill, NC, 27599-7461, USA
| | - Carmen D Samuel-Hodge
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599-7426, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7461, Chapel Hill, NC, 27599-7461, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599-7426, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7461, Chapel Hill, NC, 27599-7461, USA
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599-7426, USA; Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina, CB# 7110, Chapel Hill, NC, 27599-7110, USA.
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Gatwood JD, Chisholm-Burns M, Davis R, Thomas F, Potukuchi P, Hung A, Shawn McFarland M, Kovesdy CP. Impact of pharmacy services on initial clinical outcomes and medication adherence among veterans with uncontrolled diabetes. BMC Health Serv Res 2018; 18:855. [PMID: 30428877 PMCID: PMC6236984 DOI: 10.1186/s12913-018-3665-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/30/2018] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes remains a growing public health threat but evidence supports the role that pharmacists can play in improving diabetes medication use and outcomes. To improve the quality of care, the Veterans Health Administration has widely adopted care models that integrate clinical pharmacists, but more data are needed to interpret the impact of these services. Our objective was to assess clinical pharmacy services’ impact on outcomes and oral antidiabetic medication (OAD) use among veterans with uncontrolled diabetes in the first year of therapy. Methods This was a retrospective cohort analysis using the Veterans Affairs (VA) Corporate Data Warehouse to identify the first diagnosis of and initiation of OAD therapy for uncomplicated, uncontrolled diabetes (A1C > 7.0%) during 2002–2014. Receipt of clinical pharmacy services was identified using codes within VA electronic health records, and clinical values were obtained at or near the initial fill date and 365 days later. Use of OADs was assessed by proportion of days covered (PDC) for one year following the first filled prescription. Veterans having received clinical pharmacy services were matched 1:1 to those having not seen a clinical pharmacist in the first year of therapy, and generalized linear models assessed changes and differences in outcomes. Results The analysis included 5749 patients in each cohort. On average, patients saw a clinical pharmacist 2.5 times throughout the first year of OAD therapy. Adherence to OAD medications was higher in veterans having seen a pharmacist (84.3% vs. 82.4%, p < 0.0001) and more such patients achieved a PDC of at least 80% (72.2% vs. 68.2%, p < 0.0001). After one year of OAD therapy, mean change in hemoglobin A1C was greater among those receiving pharmacy services (− 1.5% vs. -1.4%, p < 0.0001). Conclusion Pharmacist participation in diabetes patients’ primary care positively affects the multifaceted needs of patients with this condition and comorbid chronic disease. Electronic supplementary material The online version of this article (10.1186/s12913-018-3665-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justin D Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Marie Chisholm-Burns
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Davis
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fridtjof Thomas
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Praveen Potukuchi
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Memphis VA Medical Center, Memphis, TN, USA
| | - Adriana Hung
- Vanderbilt University School of Medicine, 1161 21st Avenue South, S-3223 Medical Center North Nashville, Nashville, TN, 37232, USA.,Nashville VA Medical Center, Nashville, TN, USA
| | | | - Csaba P Kovesdy
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Memphis VA Medical Center, Memphis, TN, USA
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Sikand G, Cole RE, Handu D, deWaal D, Christaldi J, Johnson EQ, Arpino LM, Ekvall SM. Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: A systematic review and meta-analysis. J Clin Lipidol 2018; 12:1113-1122. [DOI: 10.1016/j.jacl.2018.06.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/30/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms. OBJECTIVE To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes. METHODS A systematic literature review of past research, using the MEDLINE, ScienceDirect and Web of Science databases. RESULTS Four types of team composition were identified: specialized teams, highly multidisciplinary teams, doctor-nurse-pharmacist triad and physician-nurse centred teams. Four types of collaboration within teams were identified: co-located collaboration, non-hierarchical collaboration, collaboration through shared consultations and collaboration via referral and counter-referral. Two combinations were commonly repeated: non-hierarchical collaboration in highly multidisciplinary teams and co-located collaboration in specialist teams. Fifty-two per cent of articles reported positive results when comparing collaboration against the non-collaborative alternative, whereas 16% showed no difference and 32% did not present a comparison. CONCLUSION Overall, collaboration was found to be positive or neutral in every study that compared collaboration with a non-collaborative alternative. A collaboration typology based on objective measures was devised, in contrast to typologies that involve interviews, perception-based questionnaires and other subjective instruments.
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Affiliation(s)
- Cecilia Saint-Pierre
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Herskovic
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
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Fazel MT, Bagalagel A, Lee JK, Martin JR, Slack MK. Impact of Diabetes Care by Pharmacists as Part of Health Care Team in Ambulatory Settings: A Systematic Review and Meta-analysis. Ann Pharmacother 2017; 51:890-907. [PMID: 28573873 DOI: 10.1177/1060028017711454] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To conduct a comprehensive systematic review and meta-analyses examining the impact of pharmacist interventions as part of health care teams on diabetes therapeutic outcomes in ambulatory care settings. DATA SOURCES PubMed/MEDLINE, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Web of Science, Scopus, WHO's Global Health Library, ClinicalTrials.gov , and Google Scholar were searched (1995 to February 2017). Search terms included pharmacist, team, and diabetes. STUDY SELECTION Full-text articles published in English with comparative designs, including randomized controlled trials, nonrandomized controlled trials, and pretest-posttest studies evaluating hemoglobin A1C (A1C), were assessed. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened for study inclusion and extracted data. Quality of the studies was assessed using tools developed based on the framework of the Cochrane Collaboration's recommendations. DATA SYNTHESIS A total of 1908 studies were identified from the literature and reference searches; 42 studies were included in the systematic review (n = 10 860) and 35 in the meta-analyses (n = 7417). Mean age ranged from 42 to 73 years, and 8% to 100% were male. The overall standardized mean difference (SMD) for A1C for pharmacist care versus comparison was 0.57 ( P < 0.01), a moderate effect representing a mean difference of 1.1% (95% CI = 0.88-1.27). The effects for systolic blood pressure and low-density lipoprotein cholesterol were between small and moderate (SMD = 0.31 and 0.32; P < 0.01). The heterogeneity was high for all outcomes (>83%), indicating functional differences among the studies. No publication bias was detected. CONCLUSION Pharmacists' interventions as part of the patient's health care team improved diabetes therapeutic outcomes, substantiating the important role of pharmacists in team-based diabetes management.
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Affiliation(s)
| | - Alaa Bagalagel
- 1 The University of Arizona, Tucson, AZ, USA.,2 King Abdulaziz University, Jeddah, Saudi Arabia
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Affiliation(s)
- Lisa W. Goldstone
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson
| | - Shannon N. Saldaña
- Psychiatry, Intermountain Primary Children’s Hospital, Salt Lake City, UT, and Adjunct Assistant Professor of Psychiatry, School of Medicine, University of Utah, Salt Lake City
| | - Amy Werremeyer
- Department of Pharmacy Practice, College of Pharmacy, Nursing and Allied Sciences, North Dakota State University, Fargo
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Norman S, Davis E, Goldstone LW, Villa L, Warholak TL. A Rasch analysis of a questionnaire designed to evaluate psychiatric patient attitudes and knowledge after attending a pharmacist-led patient medication education group. Res Social Adm Pharm 2014; 10:867-876. [PMID: 24746029 DOI: 10.1016/j.sapharm.2014.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There are many barriers that prevent persons with mental health disorders from achieving remission, including medication nonadherence. Research on the impact of pharmacist-led patient medication education groups on patient attitudes, knowledge and adherence is limited. OBJECTIVE To evaluate the reliability and validity of the Medication Attitudes and Knowledge Questionnaire (MAKQ). METHODS A retrospective pre-post questionnaire was distributed to patients. Variables collected included: patient self-reported medication knowledge and attitudes, patient demographics, number of previous psychiatric hospitalizations, whether the patient attended the whole meeting or only a portion, and outpatient pharmacist relationships. Knowledge and attitude items were measured on a 4-point scale with a range of options from "Agree" to "Disagree." Rasch analysis was conducted to ensure all items measured the same construct and to assess scale and item reliability and validity. Additionally, the Rasch technique evaluated the change in each person's self-perceived attitudes, knowledge, and confidence in self-managing medications from pre- to post-intervention if the data fit the model. A z-test was used to evaluate gaps in content validity. RESULTS Sixty patients responded to the MAKQ over the 16-week data collection period. Analysis showed that the 4-point rating scale was not useful and that negatively worded items should be eliminated. Gaps identified in instrument item content were not statistically significant (p > 0.05), indicating comprehensive content validity. CONCLUSIONS Medication attitudes and knowledge items on the retrospective pre-post questionnaire were valid and reliable.
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Affiliation(s)
- Sarah Norman
- The University of Montana - Providence Saint Patrick Hospital, Missoula, MT, USA; The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Erica Davis
- The University of Arizona College of Pharmacy, Tucson, AZ, USA; Kingsbrook Jewish Medical Center, Brooklyn, NY, USA
| | - Lisa W Goldstone
- Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ, USA; The University of Arizona Medical Center - South Campus, Tucson, AZ, USA
| | - Lorenzo Villa
- Pharmaceutical Economics Policy and Outcomes, Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ, USA; University of Concepcion, Faculty of Pharmacy, Chile
| | - Terri L Warholak
- Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ, USA.
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Ip EJ, Shah BM, Yu J, Chan J, Nguyen LT, Bhatt DC. Enhancing diabetes care by adding a pharmacist to the primary care team. Am J Health Syst Pharm 2013; 70:877-86. [PMID: 23640349 DOI: 10.2146/ajhp120238] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of pharmacist interventions on short-term clinical markers and long-term cardiovascular risk in patients with type 2 diabetes is investigated. METHODS Selected health outcomes were retrospectively analyzed in 147 adults with type 2 diabetes whose care was managed by a team of providers including a pharmacist (the enhanced care group) and a matched sample of patients (n = 147) managed by a primary care physician only (the control group). All patients received services through the same health maintenance organization (HMO). The primary study endpoints were (1) the changes from baseline to 12-month follow-up in glycosylated hemoglobin (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) values, (2) rates of attainment of HbA(1c), LDL-C and BP goals, and (3) changes from baseline in predicted 10-year risks of coronary heart disease (CHD) and stroke. RESULTS During the 12-month study period, the mean HbA(1c) value was decreased from 9.5% to 6.9% in the enhanced care group and from 9.3% to 8.4% in the control group (p < 0.001); patients in the enhanced care group were significantly more likely to attain goals for HbA(1c) (odds ratio [OR], 3.9), LDL-C (OR, 2.0), and BP reduction (OR, 2.0) and three times more likely to attain all three goals (OR, 3.2). The estimated 10-year risk of CHD was decreased from 16.4% to 9.3% with enhanced care versus a reduction from 17.4% to 14.8% with usual care (p < 0.001). CONCLUSION The addition of a pharmacist to an HMO primary care team improved short-term surrogate markers as well as long-term cardiovascular risk in adult patients with type 2 diabetes.
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Affiliation(s)
- Eric J Ip
- Department of Pharmacy Practice, College of Pharmacy, Touro University California, Vallejo, CA 94592, USA.
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Norman S, Davis E, Goldstone LW. Impact of pharmacist-led or co-led medication education groups on patient outcomes: A literature review. Ment Health Clin 2012. [DOI: 10.9740/mhc.n117932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Psychiatric pharmacists lead groups for patients with mental health disorders in a variety of locations. It is unknown whether these groups are effective in increasing patient knowledge and adherence or reducing negative healthcare outcomes. It is also unclear whether certain modalities of pharmacist-led medication education groups are more effective than others.
Methods: A literature search using MEDLINE and PsycINFO was performed using the search terms “medication,” “patient education,” “pharmacy” or “pharmacist,” and “psychiatric” or “behavioral” or “mental.” Full text articles of randomized controlled trials or those with a pre-post study design that reported outcomes of a pharmacist-led or coled medication group were included.
Results: Six studies were included in the review, many of which were limited by small sample sizes and confounding factors. These studies suggest that pharmacist-led group medication education can improve cardiac risk factors in patients with diabetes, increase inhaler medication compliance in patients with asthma or chronic obstructive pulmonary disease, and improve the ability of pediatric patients and their parents to manage asthma. Elderly patients' ability to manage their medications improved in one study, but was only shown to be significant for patients using four or more medications in another study. Appropriate medication use by psychiatric outpatients was significantly improved with a pharmacist intervention while decreasing total drug and salary costs.
Discussion: Group interventions provided by pharmacists can be successful in improving patient care outcomes for a variety of disease states in diverse patient populations such as pediatrics and geriatrics. Further research is needed to evaluate the full impact of pharmacist-led medication education groups on outcomes such as patient attitudes, knowledge, patient ability to self-manage medications, adherence, and utilization of health care resources.
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Affiliation(s)
- Sarah Norman
- University of Arizona College of Pharmacy, Tucson, AZ
| | - Erica Davis
- University of Arizona College of Pharmacy, Tucson, AZ
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Eaton CB, Parker DR, Borkan J, McMurray J, Roberts MB, Lu B, Goldman R, Ahern DK. Translating cholesterol guidelines into primary care practice: a multimodal cluster randomized trial. Ann Fam Med 2011; 9:528-37. [PMID: 22084264 PMCID: PMC3252191 DOI: 10.1370/afm.1297] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We wanted to determine whether an intervention based on patient activation and a physician decision support tool was more effective than usual care for improving adherence to National Cholesterol Education Program guidelines. METHODS A 1-year cluster randomized controlled trial was performed using 30 primary care practices (4,105 patients) in southeastern New England. The main outcome was the percentage of patients screened for hyperlipidemia and treated to their low-density lipoprotein (LDL) and non-high-density lipoprotein (HDL) cholesterol goals. RESULTS After 1 year of intervention, both randomized practice groups improved screening (89% screened), and 74% of patients in both groups were at their LDL and non-HDL cholesterol goals (P <.001). Using intent-to-treat analysis, we found no statistically significant differences between practice groups in screening or percentage of patients who achieved LDL and non-HDL cholesterol goals. Post hoc analysis showed practices who made high use of the patient activation kiosk were more likely to have patients screened (odds ratio [OR] = 2.54; 95% confidence interval [CI], 1.97-3.27) compared with those who made infrequent or no use. Additionally, physicians who made high use of decision support tools were more likely to have their patients at their LDL cholesterol goals (OR = 1.27; 95% CI, 1.07-1.50) and non-HDL goals (OR = 1.23; 95% CI, 1.04-1.46) than low-use or no-use physicians. CONCLUSION This study showed null results with the intent-to-treat analysis regarding the benefits of a patient activation and a decision support tool in improving cholesterol management in primary care practices. Post hoc analysis showed a potential benefit in practices that used the e-health tools more frequently in screening and management of dyslipidemia. Further research on how to incorporate and increase adoption of user-friendly, patient-centered e-health tools to improve screening and management of chronic diseases and their risk factors is warranted.
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Affiliation(s)
- Charles B Eaton
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Taveira TH, Dooley AG, Cohen LB, Khatana SAM, Wu WC. Pharmacist-Led Group Medical Appointments for the Management of Type 2 Diabetes with Comorbid Depression in Older Adults. Ann Pharmacother 2011; 45:1346-55. [DOI: 10.1345/aph.1q212] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:: Depression is associated with poor glycemic control, increased number of microvascular and macrovascular complications, functional impairment, mortality, and 4.5 times higher total health care costs in patients with diabetes. Shared medical appointments (SMAs) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support, counseling, problem solving, and improved access to care. Objective: To test the efficacy as assessed by attainment of a hemoglobin A1c (A1C) <7% of pharmacistted group SMA visits, Veterans Affairs Multidisciplinary Education in Diabetes and Intervention for Cardiac Risk Reduction in Depression (VA-MEDIC-D), in patients with type 2 diabetes mellitus. Methods: This was a randomized controlled trial of VA-MEDIC-D added to standard care versus standard care alone in depressed patients with diabetes with A1C >6.5%. VA-MEDIC-D consisted of 4 once-weekly, 2-hour sessions followed by 5 monthly 90-minute group sessions. Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes, lipids, smoking, and blood pressure. No pharmacologic interventions for depression were provided. The change in the proportion of participants who achieved an A1C <7% at 6 months was compared. Results: Compared to standard care (n = 44), a lower proportion of patients in VA-MEDIC-D (n = 44) had systolic blood pressure (SBP) <130 mm Hg at baseline, but were similar in other cardiovascular risk factors and psychiatric comorbidity. The change in the proportion of participants achieving an A1C <7% was greater in the VA-MEDIC-D arm than in the standard care arm (29.6% vs 11.9%), with odds ratio 3.6 (95% CI 1.1 to 12.3). VA-MEDIC-D participants also achieved significant reductions in SBP, low-density lipoprotein cholesterol, and non–high-density lipoprotein (HDL) cholesterol from baseline, whereas significant reductions were attained only in non–HDL cholesterol with standard care. There was no significant change in depressive symptoms for either arm. Conclusions: Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms.
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Affiliation(s)
- Tracey H Taveira
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence Veterans Administration (VA) Medical Center, Providence, RI; Associate Professor of Pharmacy, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Andrea G Dooley
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center; Clinical Assistant Professor of Pharmacy, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island
| | - Lisa B Cohen
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center; Assistant Professor of Pharmacy, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island
| | - Sameed Ahmed M Khatana
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center
| | - Wen-Chih Wu
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center; Associate Professor of Medicine, Department of Medicine, Warren Alpert Medical School of Brown University; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island
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Greer DM, Hill DC. Implementing an evidence-based metabolic syndrome prevention and treatment program utilizing group visits. ACTA ACUST UNITED AC 2011; 23:76-83. [DOI: 10.1111/j.1745-7599.2010.00585.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wang J, Hong SH, Meng S, Brown LM. Pharmacists' acceptable levels of compensation for MTM services: a conjoint analysis. Res Social Adm Pharm 2010; 7:383-95. [PMID: 21272533 DOI: 10.1016/j.sapharm.2010.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/09/2010] [Accepted: 09/09/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Medicare Modernization Act of 2003 requires prescription drug plans to provide medication therapy management (MTM) services to Medicare beneficiaries who are at high risk for inappropriate use of medications. However, inadequate compensation has been a barrier for MTM expansion among pharmacists. OBJECTIVES The objective of this study was to determine pharmacists' acceptable levels of compensation for MTM services. METHODS A preference-based fractional factorial design of conjoint analysis was used by surveying 1524 active pharmacists in Tennessee. Pharmacists were asked to select between packages (scenarios) of MTM services that represented combinations of MTM attributes (characteristics). The MTM attributes included type of patient (new or returning), patient's number of chronic conditions (1, 3, or 6), patient's number of medications (4, 8, or 16), patient's annual drug costs ($2000, $3000, or $4000), service duration (15 minutes, 30 minutes, or 45 minutes), and price of MTM services ($30, $60, or $120). A survival analysis model was used to predict pharmacists' willingness to select 1 versus another MTM service package. Pharmacists' acceptable level of compensation was estimated as the marginal rate of substitution between the parameter estimates of an attribute and the price attribute of MTM. RESULTS The parameter estimates were -0.0303 (P<.0001) for service duration and 0.0210 (P<.0001) for price of MTM services, respectively, so pharmacists were willing to accept $1.44/min (0.0303/0.0210), or $86.4/h, for MTM services. Pharmacists' characteristics were associated significantly with their acceptable levels of compensation: years of practice was associated with a higher need for compensation, pharmacy ownership (vs nonowner) associated with a lower need, and having provided MTM previously (vs having not provided MTM) was associated with a higher need. CONCLUSIONS Pharmacists' acceptable level of compensation is in the higher part of current ranges from $30 to $100/h. To increase participation in MTM services, pharmacist compensation needs to be increased. Future studies might continue to corroborate the generalizability of findings from this study.
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Affiliation(s)
- Junling Wang
- Health Outcomes and Policy Research, Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, 847 Monroe Avenue, Memphis, TN 38163, USA.
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Wang J, Thomas J, Byrd D, Nola K, Liu J. Status of diabetes care among community pharmacy patients with diabetes: Analysis of the Medical Expenditure Panel Survey. J Am Pharm Assoc (2003) 2010; 50:478-84. [DOI: 10.1331/japha.2010.08173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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McGrath SH, Snyder ME, Dueñas GG, Pringle JL, Smith RB, McGivney MS. Physician perceptions of pharmacist-provided medication therapy management: Qualitative analysis. J Am Pharm Assoc (2003) 2010; 50:67-71. [PMID: 20097641 DOI: 10.1331/japha.2010.08186] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Suh DC, Kim CM, Choi IS, Plauschinat CA, Barone JA. Trends in blood pressure control and treatment among type 2 diabetes with comorbid hypertension in the United States: 1988-2004. J Hypertens. 2009;27:1908-1916. [PMID: 19491704 DOI: 10.1097/hjh.0b013e32832d4aee] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to examine the trends in the prevalence of type 2 diabetic patients with comorbid hypertension and blood pressure (BP) control rates in the United States and determine factors associated with these outcomes. METHODS We used data from National Health and Nutrition Examination Surveys (NHANES) III (1988-1994) and NHANES 1999-2004, a cross-sectional sample of the noninstitutionalized US populations. Type 2 diabetic patients were identified as patients at least 30 years of age with physician-diagnosed diabetes who were taking insulin or oral antidiabetic drugs to manage the condition. A diagnosis of hypertension was based on physician diagnosis, treatment with antihypertensive medications, or BP at least 140/90 mmHg. BP control was defined as diabetic patients who maintained BP <130/80 mmHg. Logistic regression was used to estimate risks of high BP, and odds of high BP treatment and control rates, after adjusting for demographic and clinical risk factors. RESULTS The age-adjusted prevalence of diabetic patients and those with hypertension increased significantly from 5.8 to 7.1% and 3.9 to 4.7%, respectively, from NHANES III to NHANES 1999-2004. Among diabetic patients with hypertension, patients who were treated with medication or lifestyle or behavioral modification therapy have increased significantly from 76.5 to 87.8% during the observation period. The proportion of patients who controlled BP increased from 15.9 to 29.6%, but 70% of patients still did not meet the target BP goal. CONCLUSION Aggressive public health efforts are needed to improve BP control in type 2 diabetic patients with hypertension.
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