S. Hudson

Sex-Specific differences in metabolic control, cardiovascular risk, and interventions in patients with type 2 diabetes mellitus

BACKGROUND Sex-specific differences appear particularly relevant in the management of type 2 diabetes mellitus (T2DM), with women experiencing greater increases in cardiovascular morbidity and mortality than do men. OBJECTIVE The aim of this article was to investigate the influence of biological sex on clinical care and microvascular and macrovascular complications in patients with T2DM in a Central European university diabetes clinic. METHODS In a cross-sectional study, sex-specific disparities in metabolic control, cardiovascular risk factors, and diabetic complications, as well as concomitant medication use and adherence to treatment recommendations, were evaluated in 350 consecutive patients who were comparable for age, diabetes duration, and body mass index. Study inclusion criteria included age ≤75 years, T2DM, a documented history of presence or absence of coronary heart disease (CHD), and informed consent. Patients were followed in the diabetes outpatient clinic between November 2007 and March 2008. RESULTS Two hundred and one patients with T2DM met inclusion criteria (93 [46.3%] women, 108 [53.7%] men). Women with T2DM had higher mean (SE) systolic blood pressure (155.4 [22.5] vs 141.0 [19.8] mm Hg for men; P < 0.001) and total cholesterol (TC) (5.28 [1.34] vs 4.86 [1.29] mmol/L for men; P < 0.05), but a lower TC:HDL-C ratio (4.1 [1.19] vs 4.5 [1.2] for men; P < 0.05). Slightly more men (32.4%) than women (26.9%) reached the therapeutic goal of <7.0% for glycosylated hemoglobin. Women with shorter diabetes duration (<10 years) received oral antihyperglycemic therapy less frequently (P < 0.05). Women with longer disease duration had hypertension more frequently than did their male counterparts (100% vs 86.0%, respectively; P < 0.01). Despite a similar rate of CHD, men were twice as likely as women to have had coronary interventions (percutaneous transluminal coronary angioplasty/coronary artery bypass graft, 25.0% vs 12.9%, respectively; P < 0.05). Women with CHD also had a higher rate of cerebral ischemia than did men (27.6% vs 5.4%, respectively; P < 0.05) and received aspirin less frequently for secondary prevention (P < 0.001). Men had greater overall adherence to diabetes and cardiovascular risk guidelines than did women (66.4% vs 58.9%, respectively; P < 0.01). CONCLUSIONS In this study of diabetes clinic outpatients, women with T2DM had a worse cardiovascular risk profile and achieved therapeutic goals less frequently than did men. Treatment strategies should be improved in both sexes, but women with diabetes may be in need of more aggressive treatment, especially when cardiovascular disease is present.

Reliability of the medication appropriateness index in Dutch residential home

Objective To validate the reliability of the Medication Appropriateness Index in the appraisal of quality of prescribing by assessing the inter- and intra-group variation in Dutch residential home patients. Setting and method Eight raters evaluated 81 medication records of 15 patients from a group of older patients living in a residential nursing home the Netherlands. These patients had been recruited for a medication review investigation throughout a period of 12 months over the period April 2003 until April 2004. Patient information was acquired by connecting the medical record with the complete prescription record and pharmaceutical record. Each patient was assessed twice by two independent reviewers on the basis of a patient profile in combination with the extracted medical record and using a structured procedure. Main outcome A summed MAI score, percent agreement, kappa, positive and negative agreement as well as intra-class correlation coefficient were calculated for each criterion. Measure Medication appropriateness was assessed with the Medication Appropriateness Index (MAI) by an independent panel of Dutch hospital and community pharmacists. Results The overall percentage agreement was 83%. For each of the 10 different medication appropriateness questions it ranged from 79 to 100% for appropriate and from 47 to 60% for inappropriate ratings. The overall chance adjusted inter-rater agreement reached a moderate kappa score of 0.47. The overall intra-group agreement was very good with an overall percentage of 98 and a kappa score of at least 0.84 (all schemes). Conclusion In a Dutch institutionalised setting with representative raters, the unmodified MAI can be used as an instrument to quantify changes in appropriateness of prescribing.

Effective Delivery of Pharmaceutical Palliative Care: Challenges in the Community Pharmacy Setting

BACKGROUND Medication, particularly analgesia, is an important component of palliative care. However, timely access to medication, particularly opioids, can become problematic for patients receiving palliative care in the community setting. In Scotland in 2009, NHS Greater Glasgow & Clyde Health Board (NHS GG&C), in partnership with Macmillan Cancer Support, established a programme to improve the local provision of pharmaceutical palliative care services with the appointment of Macmillan Pharmacist Facilitators. Researchers at the University of Strathclyde were commissioned to support the development and evaluation of this new service. We report the findings of this initial investigation into the provision of current palliative care services and outline an evidence-based action plan to support service improvement. METHODS AND RESULTS Qualitative data were gathered using focus group interviews. Three key themes were identified: medication supply, communication, and education and training. CONCLUSIONS The study findings have been used to develop an evidence-based action plan for the Macmillan Pharmacist Facilitators. This program of work is due for completion by December 2012.

A community pharmacist service to support patients with heart failure: a study of pharmacists' and patients' perceptions

ESCP 7th spring conference on clinical pharmacy, tackling inequalities in the delivery of pharmaceutical care, 16–19 May 2007, Edinburgh, UK PC-40 An evaluation of pharmacist prescribing for patients with hypertension Mohammed Ommar Ahmed, Sandra O’Neill, Fiona Reid, Moira Kinnear Lothian Pharmacy Practice Unit, Department of Pharmacy, NHS Lothian, Edinburgh, United Kingdom Background and objective A pharmacist-led cardiovascular risk clinic is established in two general practices. The pharmacist has implemented supplementary prescribing into routine practice. This study evaluated the opinions and expectations of doctors and patients one year after pharmacist prescribing was established. Clinical outcomes associated with the clinic are reported elsewhere [1, 2]. Design A questionnaire was designed following semi-structured one to one audio taped interviews with three randomly selected patients. The questionnaire was piloted and posted to 201 patients. One to one structured interviews were audio taped with four doctors. Setting Two general medical practices. Main outcome measures Frequency and nature of questionnaire/ interview responses. Results The questionnaire response rate was 74% (148/201) with an equal proportion of responders from both practices with no gender differences. Hypertension management by the pharmacist was preferred by 91 (61%) patients, 6 (4%) preferred management by their doctor. The service was rated excellent or good by 133 (90%) patients, 132 patients (89%) fully understood the information provided about their medication. One hundred and fifteen patients (88%) were satisfied with the service they received from community pharmacy for minor ailments; however, only 32 patients (22%) agreed that they would be happy to have their hypertension managed in the community pharmacy. When suggested that a similar model to the practice clinic, might be available in community pharmacy, the proportion increased to 42%. Doctors recognised the benefits of the clinic to both patients and themselves. Independent pharmacist prescribing was considered to be a natural development of this service and would enable prescribing for other conditions. Although the benefits in terms of continuity of care were acknowledged, doctors have concerns regarding competence and communication necessary to deliver a similar service from the community pharmacy. Conclusions Patients and doctors are satisfied with the pharmacist’s supplementary prescribing clinic. They acknowledge that pharmacists have the skills and competence to provide these services which result in better patient care. Although the patients and GPs in this study were satisfied with the current service, they indicated less enthusiasm for new services with which they may lack confidence, an issue which must be addressed to support future development of supplementary prescribing.

Patients' perspectives on medicines and pharmacy: views of patients with Type 2 diabetes

□ The study was conducted to inform the design of pharmaceutical care support to patients with Type 2 diabetes – a recognised health care priority and a target for new pharmacy initiatives

The quality of medication use in obesity management and in primary prevention of cardiovascular disease (CVD).

The pharmaceutical industry has a global market size in excess of

Evaluation of a pharmacy-led, community based, health information network to promote cancer prevention

600 billion. The industry has in recent times been the centre of much focus as its productivity levels have declined whilst the research and development cost have continued to rise. As the figures for drug development continue to escalate, sustainability of the current development model is being questioned and pharmaceutical companies are re-evaluating their development strategy with focus on implementing a global development programme to enable them to submit simultaneously in a number of regulatory authorities. Regulatory authorities’ role is to safeguard public health and ensure that the drug approval process is carried out in a timely manner. However, pharmaceutical companies can also influence this through the dossier submission strategies used. The aim of this study was to review approvals of new active substances (NASs) by US FDA, EU EMEA, Australian TGA, Canadian TPD, Japanese PMDA and Swissmedic between 1997 and 2008, in order to determine whether the harmonisation of technical guidelines (ICH) has enabled simultaneous submissions and approvals in these markets.Background and objective In 2003, State of North Carolina enacted legislation requiring licensed nursing homes to report medication errors. Since 2004, roughly 400 nursing homes have reported nearly 70,000 medication errors to a web-based error reporting system. Medication errors are a major concern, leading to estimated 800,000 preventable medication related injuries every year in the US. For every dollar spent on drugs in nursing homes,

Evaluation of the implementation of a local treatment guideline in secondary prevention post-myocardial infarction

1.33 is spent on treatment of drug related morbidity and mortality. This amounts to

Pharmaceutical care needs in patients on long-term corticosteroids: analysis of risks of diabetes, osteoporosis and cardiovascular events

7.6 billion for the USA. The aims were firstly to determine proportion of repeat errors occurring per nursing home, to assess contributory factors relating to repeat errors, and association of repeat errors with subsequent patient harm.HRQoL instruments such as the DLQI are useful in assessing how different skin conditions affect patients’ lives, efficacy of patients’ treatment over time and as an additional measure of benefit-risk ratio for certain drugs. If however any decisions are to be made on the basis of a change in HRQoL score over time, then there needs to be a definition of what change in score is meaningful to the patient. The smallest change in score over time that would be meaningful to the patient is called the Minimal Important Difference, or MID. The aim was to determine the MID for the DLQI.Background and objective Accurate dosing of unfractionated heparin (UFH) is difficult to achieve due to inter-patient variability in anticoagulant response, high rate of medication errors with UFH and problems in monitoring heparin via activated partial thromboplastin time (aPTT) levels. Although weight-based nomograms have marked an improvement, they have by no means eliminated limitations associated with UFH therapy. Study aims were to assess whether current dosing nomogram at UNC Hospitals was being used accurately by healthcare staff, and whether doses within the nomogram were achieving therapeutic anticoagulation.

A medication adherence risk assessment tool (RAT) compared with medication adherence report scale (MARS)

ESCP 7th spring conference on clinical pharmacy, tackling inequalities in the delivery of pharmaceutical care, 16–19 May 2007, Edinburgh, UK PC-40 An evaluation of pharmacist prescribing for patients with hypertension Mohammed Ommar Ahmed, Sandra O’Neill, Fiona Reid, Moira Kinnear Lothian Pharmacy Practice Unit, Department of Pharmacy, NHS Lothian, Edinburgh, United Kingdom Background and objective A pharmacist-led cardiovascular risk clinic is established in two general practices. The pharmacist has implemented supplementary prescribing into routine practice. This study evaluated the opinions and expectations of doctors and patients one year after pharmacist prescribing was established. Clinical outcomes associated with the clinic are reported elsewhere [1, 2]. Design A questionnaire was designed following semi-structured one to one audio taped interviews with three randomly selected patients. The questionnaire was piloted and posted to 201 patients. One to one structured interviews were audio taped with four doctors. Setting Two general medical practices. Main outcome measures Frequency and nature of questionnaire/ interview responses. Results The questionnaire response rate was 74% (148/201) with an equal proportion of responders from both practices with no gender differences. Hypertension management by the pharmacist was preferred by 91 (61%) patients, 6 (4%) preferred management by their doctor. The service was rated excellent or good by 133 (90%) patients, 132 patients (89%) fully understood the information provided about their medication. One hundred and fifteen patients (88%) were satisfied with the service they received from community pharmacy for minor ailments; however, only 32 patients (22%) agreed that they would be happy to have their hypertension managed in the community pharmacy. When suggested that a similar model to the practice clinic, might be available in community pharmacy, the proportion increased to 42%. Doctors recognised the benefits of the clinic to both patients and themselves. Independent pharmacist prescribing was considered to be a natural development of this service and would enable prescribing for other conditions. Although the benefits in terms of continuity of care were acknowledged, doctors have concerns regarding competence and communication necessary to deliver a similar service from the community pharmacy. Conclusions Patients and doctors are satisfied with the pharmacist’s supplementary prescribing clinic. They acknowledge that pharmacists have the skills and competence to provide these services which result in better patient care. Although the patients and GPs in this study were satisfied with the current service, they indicated less enthusiasm for new services with which they may lack confidence, an issue which must be addressed to support future development of supplementary prescribing.