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Abstract
Dyslipidemia is one of a number of independent risk factors for cardiovascular disease. Numerous large-scale, randomized clinical trials demonstrate the benefit of aggressive lipid-modifying therapy in reducing the mortality and morbidity associated with cardiovascular disease. Despite these data and the wide dissemination of clinical practice guidelines outlining management strategies for patients with dyslipidemia, particularly those at the greatest cardiovascular risk, studies indicate that a significant proportion of patients are not screened, initiated on appropriate therapy, or treated to target lipid levels. Pharmacists, as part of the multidisciplinary team, can play a vital role in assisting in the management of patients with dyslipidemias. This article reviews published studies that have evaluated the pharmacist's role in lipid management, reviews the process for managing a patient with dyslipidemia, and provides suggestions on how pharmacists can become more involved in lipid management.
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Affiliation(s)
- Kari L. Olson
- School of Pharmacy, University of Colorado at Denver and Health Sciences Center; 16601 East Centretech Parkway, Aurora, CO 80011
| | - Lisa A. Potts
- Ambulatory Care, Department of Pharmacy, Harper University Hospital, Detroit, Michigan
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Hanna A, White L, Yanamandram V. Patients' willingness to pay for diabetes disease state management services in Australian community pharmacies. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2010. [DOI: 10.1108/17506121011095191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Caamaño F, Ruano A, Figueiras A, Gestal-Otero JJ. Data collection methods for analyzing the quality of the dispensing in pharmacies. PHARMACY WORLD & SCIENCE : PWS 2002; 24:217-23. [PMID: 12512153 DOI: 10.1023/a:1021808923928] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies. METHODS A bibliographic search was carried out in MEDLINE (1980-2000). Articles with Medical Subject Heading (Mesh) "pharmacies" written in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selected. RESULTS Various data collection methods were observed. To analyze the quality of the structure, questionnaires and pharmacist interviews were used. To analyze the quality of the process, self-completed records, external observers and simulated clients were used. For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected. CONCLUSIONS The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity. On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources. Therefore, an analysis of the quality of the process is the best option. Methods utilizing external observers and simulated clients may best conjugate both internal and external validity.
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Affiliation(s)
- Francisco Caamaño
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain
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MacKinnon GE, Mahrous H. Assessing consumers' interest in health care services offered in community pharmacies. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2002; 42:512-5. [PMID: 12035762 DOI: 10.1331/108658002763316969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- George E MacKinnon
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, Ariz. 85308, USA.
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Singhal PK, Gupchup GV, Raisch DW, Schommer JC, Holdsworth MT. Impact of pharmacists' directive guidance behaviors on patient satisfaction. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2002; 42:407-12. [PMID: 12030626 DOI: 10.1331/108658002763316824] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the impact of directive guidance (DG) behaviors by pharmacists on patient satisfaction with pharmaceutical care services. DG behaviors are social support behaviors and include such activities as supplying information about medications and providing encouragement and feedback regarding drug therapy. DESIGN Cross-sectional observational study using a self-administered survey. SETTING Two university-affiliated ambulatory care clinics, two chain pharmacies, and one independent pharmacy. PATIENTS One hundred sixty patients with a chronic disease (e.g., asthma, hypertension, diabetes). MAIN OUTCOME MEASURE Patient satisfaction with pharmaceutical care services. RESULTS A total of 160 completed questionnaires were collected from patients at 5 sites. Overall, patients patronizing ambulatory care clinics perceived higher rates of DG behaviors and were more satisfied with pharmaceutical care services, compared with patients in community pharmacies (P < .05). The hierarchical regression model was significant (F(13,112) = 4.9091, P < .001). DG behaviors explained 32.4% (P < .001) of the variance in patient satisfaction with pharmaceutical care services. CONCLUSION Higher rates of DG behaviors by pharmacists are associated with greater patient satisfaction with pharmaceutical care services.
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Affiliation(s)
- Puneet K Singhal
- Pharmaceutical Health Services Research Program, School of Pharmacy, University of Maryland-Baltimore, USA
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Larson RA. Patients' willingness to pay for pharmaceutical care. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2000; 40:618-24. [PMID: 11029842 DOI: 10.1016/s1086-5802(16)31101-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the level at which patients receive pharmaceutical care services and their willingness to pay for comprehensive pharmaceutical care services. DESIGN A mail survey was sent to 2,500 adults in the United States. SETTING Surveys were mailed to subjects' homes. PATIENTS OR OTHER PARTICIPANTS Subjects were randomly selected from a marketing database that included representation from each of the 50 states of the United States. INTERVENTION(S) The survey provided a description of comprehensive pharmaceutical care, and survey items asked about the level of care subjects were receiving and their willingness to pay for these services. MAIN OUTCOME MEASURES Level of various pharmacy services subjects reported receiving, and the dollar amount subjects were willing to pay for comprehensive pharmaceutical care. RESULTS The majority of the subjects were not receiving pharmaceutical care services. The average amount all respondents were willing to pay for these services was $13 for a one-time consultation and $28 for this plus 1 year of monitoring. Looking only at those respondents willing to pay (56%), the means rise to $23 and $50, respectively. CONCLUSION A majority of patients are willing to pay for pharmaceutical care services, even if they are not now receiving this level of care. Direct payment from patients who recognize the therapeutic benefits of pharmaceutical care may be a more viable option than is generally believed, at least until the profession can prove pharmaceutical care's utility and cost-effectiveness to third party payers.
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Affiliation(s)
- R A Larson
- College of Pharmacy, Ferris State University, Big Rapids, MI 49307-2740, USA.
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Nola KM, Gourley DR, Portner TS, Gourley GK, Solomon DK, Elam M, Regel B. Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. JOURNAL OF THE AMERICAN PHARMACEUTICAL ASSOCIATION (WASHINGTON, D.C. : 1996) 2000; 40:166-73. [PMID: 10730020 DOI: 10.1016/s1086-5802(16)31060-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify patients at risk for coronary artery disease (CAD) through a search of a community pharmacy's prescription database, to screen and identify patients with elevated cholesterol and at risk for CAD, to enroll patients in a pharmacist-directed lipid management program, and to evaluate selected clinical and humanistic outcomes. DESIGN Randomized, pretest-posttest control groups. SETTING Independent community pharmacy in a suburban metropolitan area. PATIENTS 51 patients who were not at National Cholesterol Education Program low-density lipoprotein cholesterol (LDL-C) or defined triglyceride goals and who met inclusion criteria. INTERVENTION Pharmacist-directed lipid management program. MAIN OUTCOME MEASURES Clinical outcome measures included total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglyceride levels; achievement of LDL-C goal; and risk factor prediction scores. Humanistic outcome measures included patient satisfaction with pharmaceutical care and patient knowledge of hyperlipidemia. RESULTS LDL-C was decreased in the pharmacist intervention group (n = 25), compared with an increase in the control group at study end. HDL-C levels increased and triglyceride levels decreased in both groups. Of treatment group patients, 32% achieved their cholesterol goals, compared with 15% of control group patients. Risk factor prediction scores improved in the treatment group and worsened in the control group. The treatment group's hyperlipidemia knowledge scores improved significantly from pretest to posttest. Both treatment and control group patient satisfaction scores for the pharmacist investigator were favorable at study end. CONCLUSION Both treatment and control patients benefited from participating in this study. Patients enrolled in the lipid management program made greater improvements in their knowledge of hyperlipidemia, risk factor scores, and cholesterol levels.
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Affiliation(s)
- K M Nola
- Immunex Corporation, Nashville, TN 37221, USA.
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Singhal PK, Raisch DW, Gupchup GV. The impact of pharmaceutical services in community and ambulatory care settings: evidence and recommendations for future research. Ann Pharmacother 1999; 33:1336-55. [PMID: 10630834 DOI: 10.1345/aph.18440] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review and evaluate research on pharmaceutical services in community and ambulatory care pharmacy settings, specifically study designs and patient outcome measures, and to provide recommendations to improve future research on pharmaceutical services in community and ambulatory care pharmacy settings. DATA SOURCE English-language articles were identified by searching MEDLINE (1966-December 1998) and International Pharmaceutical Abstracts (1970-December 1998), using a combination of search terms: pharmacist services, pharmacist interventions, community pharmacy, ambulatory care, primary care, and patient outcomes. Relevant studies were selected based on article abstracts. DATA EXTRACTION From each relevant study, we extracted the study objectives, sample size, study period, study design, major tasks performed by pharmacists, and economic, clinical, and humanistic outcomes (ECHO). Results were tabulated separately for research on community pharmacy and ambulatory care pharmacy settings. RESULTS We identified 95 relevant studies. Of these, 21 studies were conducted in community pharmacy settings and 74 in ambulatory care settings. Ten community pharmacy studies used prospective, single group, pretest/posttest, or posttest only designs; seven used prospective two or more group comparison designs; and four used randomized, controlled designs. Nine studies on community pharmacies measured clinical outcomes, two measured humanistic outcomes, and five measured economic outcomes. Four studies measured both clinical and humanistic outcomes and one measured humanistic and economic outcomes. No study measured all three ECHO variables. Twenty-three studies in ambulatory care settings used prospective or retrospective, single group, pretest/posttest or posttest only designs; 21 used prospective or retrospective two-or-more group comparison designs; and 30 used randomized, controlled designs. Thirty-six measured clinical outcomes, five measured humanistic outcomes, and 15 measured economic outcomes. Fifteen studies measured clinical and economic outcomes and three measured clinical and humanistic outcomes. CONCLUSIONS Only 21 of 95 selected studies were conducted in community pharmacy settings and measured the impact of pharmaceutical services on patient outcomes. Few studies employed adequate research designs to control threats to internal and external validity. In order to obtain a comprehensive and accurate picture of the impact of pharmaceutical services on patient outcomes, an attempt must be made to measure all three ECHO variables while employing adequate research design.
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Affiliation(s)
- P K Singhal
- College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, USA.
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Blumenschein K, Johannesson M. Use of contingent valuation to place a monetary value on pharmacy services: an overview and review of the literature. Clin Ther 1999; 21:1402-17; discussion 1401. [PMID: 10485511 DOI: 10.1016/s0149-2918(99)80041-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An important goal for the pharmacy profession is to quantify the economic value of pharmacy services. The contingent valuation (CV), or willingness-to-pay method, offers one approach to valuing the benefits of pharmacy services. The potential advantage CV offers is that it reflects, in a single monetary amount, the entire range of attributes (both benefits and "nonbenefits") offered by the good or service being valued. This paper provides a brief overview of the CV method and reviews 10 published studies that used a willingness-to-pay question to place a monetary value on pharmacy services. Suggestions for other researchers wishing to use this method are provided.
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Affiliation(s)
- K Blumenschein
- College of Pharmacy and Martin School of Public Policy and Administration, University of Kentucky, Lexington 40536-0082, USA
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Abstract
The contingent valuation method (CVM) is a survey-based, hypothetical and direct method to determine monetary valuations of effects of health technologies. This comprehensive review of CVM in the health care literature points at methodological as well as conceptual issues of CVM and on willingness to pay as a measure of benefits compared with other measures used in medical technology assessment. Studies published before 1998 were found by searching computerised databases and former review literature. Studies were included, when performing CVM using original data and meeting qualitative criteria. Theoretical validity of CVM was sufficiently shown and there were several indications of convergent validity. No results on criterion validity and only a few on reliability were found. There was widespread use of different elicitation formats, which make comparisons of studies problematic. Direct questions were seen problematic. First bids used in bidding games influenced the monetary valuation significantly (starting point bias). There were indications that the range of bids of payment cards also affected the valuation (range bias). However, no strategic bias was found. The influence of different states of valuation (ex-ante, ex-post) and of payment methods, as well as the possible aggregation of the results of decomposed scenarios rather than more complex holistic scenarios, were rarely investigated. Further methodological analysis and testing seems to be necessary before CVM may be used in health care decision making. Important research topics are the connection of assessment of different elicitation methods and criterion validity as well as tests on reliability according to methodological issues. Concerning conceptual issues, the analysis of the influence of different states of evaluation and of the status of the respondents as diseased or non-diseased, as well as the aggregation of results of decomposed scenarios, proved to be topics of further research.
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Affiliation(s)
- T Klose
- Department of Health Economics, University of Ulm, Germany
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Jungnickel PW, Wisehart DA. Evaluation of Community Pharmacists' Experiences withCholesterol Screening Programs. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1086-5802(16)30272-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shibley MC, Pugh CB. Implementation of pharmaceutical care services for patients with hyperlipidemias by independent community pharmacy practitioners. Ann Pharmacother 1997; 31:713-9. [PMID: 9184710 DOI: 10.1177/106002809703100608] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To implement and evaluate pharmaceutical care services for patients with hyperlipidemias in the community pharmacy setting, to evaluate the results of a pharmaceutical care training process for pharmacists by using an assessment quiz, and to measure patient outcomes resulting from provision of pharmaceutical care to patients with hyperlipidemia. DESIGN A prospective study was conducted over a 1-year period. Patients served as their own controls. SETTING Two independent community pharmacies in Richmond, Virginia. PARTICIPANTS Twenty-five adult patients with confirmed dyslipidemias completed the study. INTERVENTIONS Study pharmacists assessed each patient and assisted in setting therapeutic goals; patients also completed a visit with a registered dietitian. Drug therapy recommendations were made to physicians by the pharmacist when appropriate. Follow-up was scheduled with the pharmacist to ensure positive outcomes and reduce adverse effects. MAIN OUTCOME MEASURES Fasting lipoprotein profiles were measured initially and at 6 and 12 months. The SF-36 survey, the MacKeigan-Larson satisfaction survey, and a patient opinion survey were administered initially and at the conclusion of the study. RESULTS Total cholesterol and low-density lipoprotein cholesterol values were significantly decreased at 12 months compared with either the baseline or 6-month values (p < 0.02). Significant improvement was found in several domains of the surveys; quality of life, patient satisfaction with pharmacy services, and patient opinions on the role of the pharmacist improved after the intervention. CONCLUSIONS Pharmaceutical care may positively affect lipid values, quality of life, and patient satisfaction.
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Affiliation(s)
- M C Shibley
- Richmond Apothecaries, Inc., Richmond, VA, USA
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Hatoum HT, Akhras K. 1993 Bibliography: a 32-year literature review on the value and acceptance of ambulatory care provided by pharmacists. Ann Pharmacother 1993; 27:1106-19. [PMID: 8219447 DOI: 10.1177/106002809302700917] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To review the published literature on the value and acceptance of pharmaceutical services provided by pharmacists in ambulatory care settings. DATA SOURCES AND METHODS Articles published between 1960 and 1992. A MEDLINE search of the English-language literature was conducted using the terms pharmacists, services, and ambulatory settings. Studies were selected for inclusion if they addressed services provided by pharmacists in ambulatory settings and dealt with the cost of patient care, quality of care, or attitudinal surveys. Original research reports were summarized according to objectives, sample size, duration of study, methods, and findings. Summaries were categorized according to reported positive impact, negative impact, or investigational reports with no outcome. RESULTS One hundred seventy articles were identified; 104 of them reported research data and were summarized. The 1970s was the most prolific decade for publication of articles reporting positive, negative, or no impact, which numbered 47, 20, and 37, respectively. Positive correlation was found among studies conducted according to predetermined protocol and reporting positive impact. Moreover, academic interest in pharmacy varied for the different decades. CONCLUSIONS Collectively, this article provides references of the published reports on pharmacy professional services in ambulatory care settings, and a summary of the articles reporting research data. Additional and more focused research on pharmaceutical services in the community is needed. Emphasis is required on practicing pharmacists' attitudes toward nondispensing, patient-oriented pharmaceutical services; the impact of educational changes on the practice of pharmacy and consumers' attitudes and willingness to pay for services; and the link between patient outcome and pharmaceutical services.
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Affiliation(s)
- H T Hatoum
- Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago
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Abstract
There is a growing emphasis on developing ambulatory care services in an attempt to minimize healthcare costs through preventive medicine and outpatient therapeutic management. This creates an environment that can greatly benefit from a pharmacist-managed ambulatory TDM service. The implementation of a pharmacist-managed TDM service can improve patient care, contain the cost of healthcare, and enhance the education of pharmacy/medical students and physicians. The opportunity exists for further development of clinical pharmacy services to positively influence patient care in the ambulatory care setting. This development, however, may be hindered by inadequate reimbursement for services and lack of documentation to support the beneficial impact of clinical pharmacy services on patient outcome. Methods of documenting clinical pharmacists' interventions and outcome must be developed in order to obtain reimbursement for these services.
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Ibrahim OM, Catania PN, Mergener MA, Supernaw RB. Outcome of cholesterol screening in a community pharmacy. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:817-21. [PMID: 2260335 DOI: 10.1177/106002809002400903] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of our study was to determine if a community pharmacist could affect total blood cholesterol (TBC) of ambulatory patients by a program of education, consultation, and cholesterol screening. Of 241 initially screened individuals, 57 patients with TBC greater than 5.17 mmol/L (greater than 200 mg/dL) met the inclusion criteria of this six-month study. Of these, 51 completed the study. Outcome was determined by changes in TBC measured during the initial screening and after two follow-up visits. Pharmacist intervention included obtaining TBC concentrations and reporting the results to patients, teaching patients about the role of cholesterol in illness and health, explaining risk factors associated with cardiovascular disease, and providing follow-up communication with patients. Data were analyzed using ANOVA, Mann-Whitney, and chi-square. The mean TBC was 5.84 mmol/L (225.7 mg/dL) for the study group and 4.23 mmol/L (163.8 mg/dL) for participants with TBC less than 5.17 mmol/L (less than 200 mg/dL (p less than 0.0001). There was a significant difference (p = 0.0124) in mean age for the study group (36.4 years) versus other participants (30.0 years) but no difference in distribution by gender (p = 0.18). ANOVA showed significant differences in TBC during the three visits (p less than 0.0001). There was a significant decrease in mean TBC concentrations between visits 1 and 2 and between visits 1 and 3 (p less than 0.0001), but no difference between visits 2 and 3 (p = 0.48). Compared with mean baseline values, 81.4 and 72.6 percent of the patients had a decline in TBC at visits 2 and 3, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- O M Ibrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Egypt
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