Bethanne Brown

Clinical outcomes of switching from insulin glargine to NPH insulin in indigent patients at a charitable pharmacy: The Charitable Insulin NPH: Care for the Indigent study

OBJECTIVES To assess the clinical outcomes of indigent patients with type 2 diabetes served by a charitable pharmacy after therapy change from insulin glargine to NPH insulin. DESIGN This was a 24-week prospective pilot study. SETTING Community charitable pharmacy. PARTICIPANTS Underserved, financially disadvantaged adults with type 2 diabetes. INTERVENTION Conversion from insulin glargine to NPH insulin. MAIN OUTCOME MEASURES HbA1c, 30-day average blood glucose, number of suspected and confirmed hypoglycemic episodes, total insulin dose, and Morisky Medication Adherence Scale (MMAS) scores. RESULTS Patients in both control and intervention groups improved in disease-state clinical markers, safety profile, and total insulin dose. MMAS scores were unchanged. CONCLUSION There were no statistically significant differences in glycemic control or hypoglycemic episodes between the control (NPH insulin) or intervention group (insulin glargine to NPH insulin).

Synergistic combinations of muscle relaxants may reduce costs.

Synergistic combinations of nondepolarizing muscle relaxants have been identified (l-61, and these combinations generally require 40%-50% less total drug for a similar clinical effect compared to either drug used separately. Because nondepolarizing muscle relaxants constitute a significant portion of the drug cost for anesthesia departments, it may be possible to use these synergistic combinations in some clinical situations to achieve substantial cost savings because less total drug is used. Table 1 shows a theoretical projection of drug cost based on the average wholesale cost (7) of an “intubating” dose, calculated at twice the 95% effective dose (8). Combinations of mivacurium with atracurium, rocuronium, or vecuronium are also synergistic, (2,91 and may therefore provide similar cost savings, although corresponding 95% effective dose values have not been published. These calculations are based on the preparation of drug combinations without waste. Actual drug costs may differ significantly from these calculations if some drugs are obtained through purchasing cooperatives at lower prices. Further study should evaluate the long-term drug stability and the pharmacokinetics of single and multiple doses of these combinations, as well as whether actual costs accumulated over a reasonable time using synergistic combinations are comparable to these theoretical projections.

The implementation and evaluation of health professions students as health coaches within a diabetes self-management education program

BACKGROUND AND PURPOSE The purpose of this article is to describe how health professions students were trained and incorporated as health coaches into a group diabetes self-management education (DSME) program in an underserved, urban federally qualified health center. EDUCATIONAL ACTIVITY AND SETTING Nursing, pharmacy, and physical therapy students from three local colleges were provided health coach training and then integrated into the DSME program with faculty assistance. The students connected with the assigned participants both in person and via weekly telephone calls over a three-month time period, applying concepts learned and providing patient-centered support. FINDINGS Students noted self-reported improvement in their own perceived knowledge, skills, and attitudes related to health coaching from both qualitative (weekly and end of experience reflections) and quantitative (pre- and post-survey) measures. Participants were also engaged in assessing the program directly via survey responses and indirectly via attainment of personal health-related behavior change goals based on American Association of Diabetes Educators Seven Self-Care Behaviors. SUMMARY With appropriate training and support from faculty, health professions students were successfully incorporated into an existing DSME program in the role of health coach, gaining knowledge, skills, and attitudes needed to help patients make behavior change.