Increasing Naloxone Knowledge and Use Through Direct-to-Patient Education

Background: In the United States, opioid overdoses account for 130 deaths daily. Barriers to obtaining naloxone, the drug-of-choice for opioid overdose reversal, include limited education, access, and perceptions of provider judgement. Objectives: This study aimed to assess the efficacy of mailed education about naloxone, with or without a live teaching seminar, to patients at risk for opioid overdose. Methods: This observational study was conducted in a federally qualified health system. A phone presurvey was administered to patients on long-term opioid therapy or with a diagnosis of opioid use disorder to assess opioid overdose-related knowledge. Subjects were mailed a handout about naloxone and an invitation to receive naloxone at no cost at a seminar. Three-month phone postsurveys were conducted. The primary outcome was change in mean knowledge score from presurvey to postsurvey. Secondary outcomes included scores on individual survey items, naloxone prescriptions provided, and overdose reversals reported. Results: Ninety-four patients received mailed education. Sixty-two subjects took presurveys and 23 took 3-month follow-up surveys. Five subjects attended the live seminar. The mean cumulative knowledge score improved by 8.7% from the presurvey to the postsurvey. During the study period, one new naloxone prescription was written and one overdose reversal was reported. Conclusion: Direct-to-patient mailed education slightly improved knowledge regarding naloxone and opioid overdose response, and it may have led to one successful overdose reversal. Mailing education to a larger population of patients at risk for opioid overdose may be necessary to observe a substantial clinical impact.

Patient experience with clinical pharmacist services in Travis County Federally Qualified Health Centers

Background

Positive patient experiences with care have been linked to improved health outcomes. Patient experience surveys can provide feedback about the level of patient-centered care provided by clinical pharmacists and information about how to improve services.

Objectives

Study objectives are: 1) To describe patient experience with clinical pharmacist services in a federally qualified health center (FQHC). 2) To determine if demographic or health-related factors were associated with patient experience.

Methods

This cross-sectional survey included adult patients who were English or Spanish speaking, and completed a clinical pharmacist visit in March or April 2018. Patient experience was evaluated, on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with 10 items using four domains: pharmacist-patient interaction information provision, support for self-care, and involvement in decision making. In addition, one item was used to rate the overall experience. Demographic and health-related variables were also collected. Eligible patients completed the survey after their clinical pharmacist visit. Descriptive and inferential statistics, as well as Cronbach's alpha for scale reliability, were employed.

Results

Respondents (N=99) were 55.4 (SD=12.1) years and 53.1% were women. Overall, patients rated their experiences very high with the 10-item scale score of 4.8 (SD=0.4) out of 5 points and the overall experience rating of 4.9 (SD=0.4) out of 5 points. With the exception of race, there were no differences between patient experience and demographic and health-related variables. African Americans had significantly (p=0.0466) higher patient experience scores compared to Hispanics.

Conclusions

Patients receiving care in a FQHC highly rated their experience with clinical pharmacists. This indicates that clinical pharmacists provided a high level of patient-centered care to a diverse group.

Efficacy and safety of evogliptin versus sitagliptin as an add-on therapy in Indian patients with type 2 diabetes mellitus inadequately controlled with metformin: A 24-week randomized, double-blind, non-inferiority, EVOLUTION INDIA study

AIM

This study aimed to assess efficacy and safety of evogliptin versus sitagliptin, when added to background metformin therapy in Indian patients with uncontrolled type 2 diabetes.

METHOD

Overall, 184 patients with uncontrolled type 2 diabetes (7% ≤ HbA_1c < 10%) receiving ≥8 weeks of stable metformin monotherapy (≥1 g/day), were randomized to receive add-on treatment (evogliptin 5 mg or sitagliptin 100 mg) for 24 weeks. Primary endpoint was change in HbA_1c from baseline to 12 weeks (non-inferiority margin: <0.35).

RESULTS

Mean reductions in HbA1c at 12 weeks in evogliptin- and sitagliptin-treated patients were -0.37 (1.06) and -0.32 (1.14), respectively. The adjusted mean difference between treatment groups was -0.022 (95% CI: -0.374, 0.330; P = 0.901), that demonstrated non-inferiority. Reductions in FPG and PPG were similar between evogliptin and sitagliptin at 12 and 24 weeks. Changes in body weight were comparable between the treatment groups. Patients achieving target HbA_1c < 7.0% (evogliptin, 26.7% vs. sitagliptin, 20%) was almost equal in both groups. Treatment-emergent adverse events occured in 52 patients (evogliptin, 25% and sitagliptin, 31.5%) and were generally mild.

CONCLUSIONS

Evogliptin was non-inferior to sitagliptin in HbA_1c reduction. It effectively improved glycemic control and was well tolerated in type 2 diabetes patients inadequately controlled by metformin alone.

Correlation of antidepressant target dose optimization and achievement of glycemic control

Introduction

Depression is a recognized cause of disability globally with a propensity to be comorbid in patients with diabetes, leading to poorer health-related outcomes. Although a number of studies have investigated the correlation between improvement in depression and chronic disease, none have reported on achievement of target doses of antidepressant therapies and diabetes control. The objective of this study is to determine the influence of antidepressant dosing optimization on reducing hemoglobin A1c (HbA1c).

Methods

This was a retrospective cohort study of patients seen at CommUnityCare Health Centers who were initiated on an antidepressant and had uncontrolled diabetes (HbA1c > 7%). Eligible patients were followed for 12 months after initiation and separated into those who achieved target dose and those who did not. Patient health questionnaire scores were collected when available in an attempt to quantify change in depressive symptoms.

Results

A total of 178 patients met inclusion criteria with 76 achieving an optimal dose (target group) and 102 patients below optimal dose (control group) at the end of the study period. Patients in both groups were similar at baseline with an HbA1c of 9.29% compared to 9.24% in the target and control groups, respectively. At the end of the study period, more patients in the target group achieved an HbA1c < 7% (22.9%, n = 48 vs 4.3%, n = 23, respectively; P < .05).

Discussion

These results suggest that optimization of antidepressant dosing in patients with diabetes may lead to an increased likelihood of reaching goal HbA1c < 7% although correlation to improvement of depression remains unknown.

Adherence to the 2013 Blood Cholesterol Guidelines in Patients With Diabetes at a PCMH: Comparison of Physician Only and Combination Physician/Pharmacist Visits

PURPOSE

The purpose of this study is to assess adherence to the 2013 blood cholesterol guideline in a population with diabetes based on the atherosclerotic cardiovascular (ASCVD) risk.

METHODS

Patients with diabetes were assessed to see whether they received the appropriate intensity statin therapy via chart review. Patients seen by a physician or pharmacist at CommUnityCare, a PCMH, from December 2013 to October 2014 were included in this retrospective study. The ASCVD risks were calculated to determine if the patients received appropriate intensity statin.

RESULTS

A total of 583 patients met the inclusion criteria; there were 475 in the physician only group and 108 with additional pharmacist visits. Statin therapy was prescribed in 71% of patients in the physician group and 88% of patients in the pharmacist/physician group. The appropriate intensity statin was prescribed in 32% of patients in the physician group and 35% of patients in the pharmacist/physician group. The appropriate intensity statin in statin naïve patients was prescribed in 45% of the physician group and 50% of patients in the pharmacist/physician group.

CONCLUSION

The proportion of patients prescribed an appropriate intensity statin did not differ between patients managed by physicians alone compared to those managed by pharmacists and physicians. Overall adherence to the 2013 blood cholesterol guidelines was 33%, and this measure can be used as a baseline assessment of current adherence with the guidelines.

Project DIS-IMPACT: Drug information in English and Spanish to improve patient preparation before colonoscopy

OBJECTIVE

To create culturally appropriate colonoscopy education services and handouts for the Hispanic population undergoing a colonoscopy procedure to ensure correct bowel preparation.

SETTING

Project DIS-IMPACT was conducted at a federally qualified, nonprofit community health center along the United States-Mexico border.

PRACTICE DESCRIPTION

Patients identified in the study included those who were at least 50 years of age and had not received a colonoscopy between July 1, 2012, and February 28, 2013. Participants included uninsured Hispanics, able to speak English or Spanish, registered with the clinic, and referred by a provider working at the health center.

PRACTICE INNOVATION

The process of evaluating and developing colonoscopy screening education included creating a standing order, developing medication education handouts in both English and Spanish, and documenting areas of improvement at monthly pharmacy staff meetings.

MAIN OUTCOME MEASURES

Outcomes of the program included a descriptive statistics analysis of the served population and culturally appropriate counseling recommendations used in the medication (polyethylene glycol electrolyte solution) education handouts.

RESULTS

A total of 143 participants received colonoscopy, including 49 men and 94 women. As the classes were conducted, the patient information handouts were adapted accordingly based on culturally appropriate recommendations from participants and providers.

CONCLUSION

Pharmacists played a unique role in providing culturally appropriate precolonoscopy education material to assist in successful colonoscopy preparation.

GS-02 for dysthymic disorder: results of a preliminary, open study

In an open clinical trial, 15 patients diagnosed with DSM-IV dysthymic disorder were treated with GS-02, a herbal formulation containing extracts of four Indian herbs: Ashvatha, Kapikachu, Dhanvayasa, and Bhuriphali. Twelve patients completed the study. The medication was very well-tolerated. Among treatment completers, three (25%) patients showed no response, two (16.7%) showed partial response, and seven (58.3%) showed good response; these response rates are similar to what can be expected from an allopathic antidepressant trial. In an intent- to-treat analysis, significant improvement was observed on Hamilton depression ratings as well as on global measures. The results of this preliminary study encourage further clinical investigation of the GS-02 formulation.