Adrienne Z. Ables

Physician–Pharmacist Collaborative Management of Asthma in Primary Care

To determine if asthma control improves in patients who receive physician–pharmacist collaborative management (PPCM) during visits to primary care medical offices.

Opportunities missed: improving the rate of contraceptive counseling or provision when prescribing reproductive-aged women potentially teratogenic medications in a family medicine resident clinic

BACKGROUND Studies show poor documentation of contraceptive counseling when prescribing women teratogenic medications, suggesting a missed opportunity for contraceptive education. STUDY DESIGN A retrospective chart review of selected Food and Drug Administration class D and X medications evaluated the office visit initiating this medication for documentation of either contraceptive counseling or provision. Following an educational intervention, another retrospective review was conducted to determine if the rate of counseling improved. RESULTS The initial rate of documented counseling was 46% and improved to 80% following the educational intervention (p=.0002), an improvement in both overall rate and that seen in the previous year. CONCLUSIONS This study is the first to document contraceptive counseling rates when providing teratogenic medications in a training setting. It illustrates a need for increased attentiveness in primary care training practices to the risks of teratogenic medications and the need for comprehensive contraceptive counseling. Simple interventions may improve this rate and decrease missed opportunities.

Complementary and Alternative Therapies for Weight Loss

Although many complementary therapies are promoted for the treatment of obesity, few are truly therapeutic. Evidence suggests that food containing diacylglycerol oil, acupuncture, and hypnosis are the only evidence-based complementary therapies for the treatment of obesity, and, at best, these should be used as adjuvants to the more conventional therapies of calorie restriction and exercise.

Measuring Diabetes Care in the National Interdisciplinary Primary Care Practice-Based Research Network (NIPC-PBRN)

Study Objective. To assess diabetes care in a network of primary care practices that include pharmacist support by using a scoring system designed for the National Committee for Quality Assurance (NCQA) Diabetes Recognition Program (DRP) measures.

Blood Glucose Control in Noncritically Ill Patients Is Associated With a Decreased Length of Stay, Readmission Rate, and Hospital Mortality.

Purpose:Multiple studies have shown that hyperglycemia correlates with mortality and morbidity in critically ill patients. This has not been demonstrated in noncritically hospitalized patients. The primary objective of this study was to determine whether glycemic control shortens the length of stay (LOS). Secondary objectives included assessing readmissions, in-hospital mortality, and rates of hypoglycemia. Methods:A retrospective review of hospitalized patients admitted between 2008 and 2012 with fingerstick blood sugar (FSBS) was performed. Patients were divided into two groups: “controlled” FSBS (≥80% of FSBS were <180 mg/dL) and “uncontrolled” FSBS (<80% of FSBS were <180 mg/dL). The average LOS (ALOS) in days, in-hospital mortality, readmission rates, and rates of hypoglycemia was compared. Results:A total of 32,851 patient records were reviewed. ALOS for patients with controlled and uncontrolled FSBS was 5.86 and 6.17 days, respectively (p < .0001). Readmission within 30 days and hospital mortality were significantly lower in patients with controlled FSBS (p = .0000, .00001), whereas rates of hypoglycemia were significantly higher in the uncontrolled group (p = .00000). Conclusions:Glycemic control was associated with decreased LOS, hospital mortality, and 30-day readmission rate in noncritically ill patients regardless of the presence or absence of diabetes.

Improving Diabetic Retinopathy in an Indigent Population

Diabetic retinopathy is the leading cause of preventable blindness in working-age American adults. This study hypothesized that patients with diabetes types I and II at St.Lukes Free Medical Clinic in Spartanburg, South Carolina were not being systematically referred for annual diabetic retinopathy screening. We evaluated the number of patients referred for screening, those patients who actually went for the screening, and the rate at which retinopathy was found in those who went. Of the 111 charts reviewed, only 49.5% of the patients were referred to an eye care professional between January 1, 2013 and December 31, 2014. Of those referred, 21.1% were found to have vision-threatening pathology. The median number of days to have an eye exam was 28.5. A standardized method to screen for diabetic retinopathy in the clinic would alleviate the referral burden and ultimately allow for detection of ocular pathology earlier in the course of disease.