Artemis Diamantouros

HbA1c testing in the community pharmacy: A new strategy to improve care for patients with diabetes.

Diabetes is one of the fastest growing diseases in Canada. It is estimated that 2 million Canadians have type 2 diabetes and that there are more than 60,000 new cases of this disease diagnosed each year. The cost of diabetes in Canada is projected to be up to

Community pharmacist-directed point-of-care group A Streptococcus testing: Evaluation of a Canadian program

9 billion annually.1 One-third of those affected with type 2 diabetes are unaware that they have the disease.1 Managing diabetes is a challenging endeavour for those diagnosed and involves routine monitoring and regular testing in order for patients to maintain reasonable glycemic control. The DICE study in 2005 found that 1 in 2 Canadians with type 2 diabetes do not have their blood sugar under control and that control is worse the longer patients have had diabetes.2 As a measure of glycemic control, the Canadian Diabetes Association (CDA) recommends glycated hemoglobin (HbA1c [%]) levels ≤7.0.3 However, according to one study, only 29% of patients with diabetes actually had an HbA1c test in the previous year, and among those tested, only 43% had an HbA1c less than 7%.4 Additionally, 18% of those tested had an HbA1c of 9.5% or more, meaning that their blood glucose levels were uncontrolled.4 Given the complexity of diabetes control, evidence suggests that diabetes can be best managed through an interdisciplinary team that includes a pharmacist.5 The relative accessibility of the community pharmacist allows patients the opportunity to discuss their health care concerns, typically without the need for a referral or appointment (though making an appointment so that the pharmacist is able to set aside an appropriate amount of time is becoming more common). This unique position allows pharmacists to readily monitor patients and assist them in attaining adequate glucose control. HbA1c testing is an important outcome measure in patients with diabetes. Unlike a point-in-time blood glucose measure, the HbA1c provides an estimate of glycemic control over a 3-month period. It allows the health care provider to monitor patients with diabetes and estimate how well their disease is controlled and whether they require additional interventions to maintain target levels. The United Kingdom Prospective Diabetes Study (UKPDS) has shown that lower HbA1c levels have been correlated with fewer complications.6 For instance, in epidemiologic analyses, HbA1c levels >7.0% are associated with a significantly increased risk of both microvascular and macrovascular complications, regardless of underlying treatment.3 John Papastergiou Pharmacy Limited operates at 3 locations as Shoppers Drug Mart in Toronto, Ontario. All 3 pharmacies are located in an urban setting with a diverse, multi-ethnic patient population. The Pharmacy team, including pharmacists, pharmacy technicians, interns and pharmacy students from all 3 locations, is working to improve the management of patients with diabetes through the use of HbA1c testing. Historically, the testing of HbA1c required a visit to the physician and was limited to a laboratory blood test. With the introduction of the Bayer A1C Now meters, patients can be tested by their community pharmacist without a laboratory requisition and HbA1c results can be made available within 5 minutes. The HbA1c meter has demonstrated an accuracy of 99% in 3 independent evaluation studies.7 The Pharmacy team decided that the level of accuracy, in combination with the ease and speed of testing, made this new innovation the perfect tool for testing and monitoring their patients with diabetes. The meters provide an efficient and reliable method for HbA1c monitoring. The HbA1c result provides the pharmacist with more information regarding the patients glycemic control and allows for additional consultation and recommendations in an attempt to improve outcomes.

Acetaminophen Post-Vaccination: To Give or Not to Give?

OBJECTIVE Streptococcus pyogenes is an aerobic, gram-positive bacterium responsible for a wide variety of infections including common pharyngitis. Novel rapid antigen detection tests allow for diagnosis of group A Streptococcus (GAS) at the point of care. The objective of the study is to evaluate the effects and feasibility of community pharmacist-directed GAS testing. SETTING A retrospective analysis of aggregate billing data was conducted using descriptive statistics to evaluate the acceptance and feasibility of a community pharmacist-directed Streptococcus testing program at Shoppers Drug Mart pharmacies in the Canadian provinces of British Columbia, Alberta, and Nova Scotia. PRACTICE DESCRIPTION Pharmacists trained in sample collection offered the screening to patients with symptoms suggestive of Streptococcus species infection from November 28, 2015, to May 31, 2016. Throat swabs were collected and analyzed using the BD Veritor system for rapid detection of GAS. PRACTICE INNOVATION Pharmacist-directed point-of-care group A Streptococcus testing and management. EVALUATION Proportion of GAS-positive cases that resulted in the same day initiation of antibiotic therapy by pharmacists were collected. Patient satisfaction with the service was also evaluated. RESULTS Seven thousand and fifty patients were tested across 204 participating locations. The average age was 27.3 years, with children (age 5-14 years) representing 30.7% of the population; 25.5% of patients tested positive for GAS infection. Of the patients with positive results, antibiotic therapy was initiated within the same day in 68.7% of cases. In Alberta, where pharmacists have advanced prescribing authority, same-day initiation of therapy was 73.8% compared with a rate of 40.5% (P < 0.05) in the other jurisdictions. CONCLUSION These results highlight both the public readiness to access point-of-care services in community pharmacies and the ability of pharmacists to expedite management of patients with GAS. Pharmacy-based Streptococcus testing can facilitate prompt and appropriate access to antibiotic therapy, as was demonstrated in regions with advanced prescribing authority. Communication of recommendations to the physician remains a barrier.

Does an Aspirin a Day Keep the Doctor Away

MANY PHYSICIANS WILL COMMONLY SUGGEST THAT PARENTS GIVE THEIR babies prophylactic round-the-clock acetaminophen after routine vaccinations to reduce the risk of fever and associated symptoms such as irritability. Although fever is a normal inflammatory response and potentially beneficial, it can be of concern to many parents who worry it may represent a more serious infection or may lead to febrile seizures.

Treating Hot Flashes — Based on Evidence or Hot Air?: Study Examines the Various Alternatives to Estrogen

How can this question be addressed? Aspirin’s role in secondary prevention in patients with established vascular disease has been well-demonstrated, and the benefits outweigh the risks. The area of therapy where the role of aspirin is not as clear is in primary prevention, where some suggestion has been made that the risks may outweigh the benefits. This question was previously addressed in a meta-analysis by Berger and colleagues, who looked at the primary prevention trials from a sex-specific perspective. It has now been further addressed in a meta-analysis conducted by the Antithrombotic Trialists’ (ATT) Collaboration, who used individual participant data rather than aggregate data as the Berger group did. The ATT group’s analysis involved the compilation of data from 95,000 participants from 6 primary prevention trials and contrasted them with those from 17,000 patients in the secondary prevention trials. The analysis was conducted as an intention-to-treat analysis (ITT), meaning that everyone who began the trials was included in the analysis.

Can We Ever Predict Nonadherence with Drug Therapy?: Rx Number is Strongest Predictor

C P J / R P C • J U LY / A U G U S T 2 0 0 6 • V O L 1 3 9 , N O 4 In the post-Women’s Health Initiative era, many women are reluctant to use estrogen, while others are unable to take estrogen and approach their pharmacist for alternative treatments for hot flashes. A number of therapies have been proposed in the literature, often leaving us to wonder whether we should be recommending these options to our patients. Some help in answering this question comes from a recent systematic review and meta-analysis of nonhormonal therapies for menopausal hot flashes reported in a recent issue of the Journal of the American Medical Association. Nelson et al. considered all randomized controlled trials published in the English language and, based on inclusion and exclusion criteria, reviewed 43 trials, of which 24 were included in the meta-analysis (6 for SSRIs or SNRIs, 4 for clonidine, 2 for gabapentin, 6 for red clover isoflavone extracts and 6 for soy isoflavone extracts).