How pharmacists address the healthcare needs of patients today

by Thomas Sullivan

In addition to outlining patient’s medications, and teaching them what times of day to take the drugs that will help control their specific disease, pharmacists are now taking on a new role to address the growing healthcare needs and demands of Americans, according to a recent article in the New York Times.

For example, at Barney’s Pharmacy in Augusta, Ga., the pharmacy offers classes at the store for patients once a month on how to manage diseases with drugs, diet and exercise. This new service, according to the Times, reflects the expanding role of the nation’s pharmacists in ways that may benefit their customers and also represent a new source of revenue for the profession.” In fact, “some health plans are even paying pharmacists to monitor patients taking regular medications for chronic illnesses like diabetes or heart disease.” And these pharmacists don’t just dispense drugs to patients, they also partner with patients to improve their health as well.”

Another role that pharmacists are playing at independent drugstores and some national chains like Walgreens and the Medicine Shoppe and even supermarkets like Kroger, is “by working with doctors and nurses to care for people with long-term illnesses.”

Pharmacists are also “being enlisted by some health insurers and large employers to help address the fact that “as many as half of the nation’s patients do not take their medications as prescribed, which ends up costing nearly $300 billion a year in emergency room visits, hospital stays and other medical expenditures.”

In their unique role, pharmacists also maintain the “front line of detecting prescription overlap or dangerous interaction between drugs and for recommending cheaper options to expensive medicines.

As a result of the numerous responsibilities pharmacists already carry out, pilot programs, such as the one started by Dr. Andrew Halpert, senior medical director for Blue Shield of California, are attempting to show that pharmacists “could do as well and better than a physician” for less money. Specifically, the program seeks to address the shortage of primary care doctors by using the education, expertise, free time and plain-spoken approach pharmacists use to talk to patients at length about what medicines they are taking and to keep close tabs on their well-being as a way.

“Some health insurers and large employers who pay for programs called medication therapy management, which typically involve face-to-face sessions between pharmacists and patients in retail stores or clinics”, have already taken this kind of approach. Programs such as these pay pharmacists to track patients, monitor cholesterol or blood glucose levels, or prod customers to change their diets or exercise.

Since 2006, some “Medicare plans started covering medication therapy management programs, paying $1 to $2 a minute to pharmacists to review patients’ medicines with them, and in 2010, about one in four people covered by Medicare Part D prescription drug plans will be eligible.”

Pharmacists are also advising patients about medication through grants and such as the Wisconsin Pharmacy Quality Collaborative, which standardizes medication therapy management and ensures quality care. Similarly, Humana, which has offered pharmacists medication advising for a few years, is studying a third of 62,000 pharmacies in its network to see “whether a pharmacist seeing a patient in person has more impact than a phone call.”

According to the Times, the result of these new services “has spawned a new industry of medication therapy management companies to run clinical pharmacy programs for health insurers, contracting with pharmacists and tracking the financial and health outcomes of their services.” And results so far have been positive. For example one recent study financed by GlaxoSmithKline, tracked 573 people with diabetes (30 employers in 10 cities) who took part in at least two sessions with pharmacists who helped them track their blood sugar, blood pressure and cholesterol levels and offered diet and exercise advice. The results of the study showed that after a year, blood pressure, blood sugar and cholesterol levels typically improved — and saved an average $593 a person on diabetes drugs and supplies.

While some groups may be concerned about the proper role pharmacists should play, as Michelle A. Chui, an assistant professor at the University of Wisconsin School of Pharmacy pointed out, “pharmacists do not want to compete with doctors, they merely want to provide more information “so the physician has a more in-depth picture.”

Consequently, pharmacists who provide more education and information to share with health care providers and patients should be encouraged because it gives patients a better chance to understand and follow medication directions in a consistent manner. As a result, using education companies, which teaches other pharmacies how to introduce in-store services, should also be encouraged because as the owner of Barney’s Pharmacy noted, when pharmacists “get involved with chronic care patients, their outcomes improve.”

Accordingly, with 31 million more patients entering the health care system through government programs, and with populations getting older and living longer, the number of prescriptions will grow exponentially. Not only will we need companies and funding to create and discover the drugs to provide to this influx of people, we will also need pharmacists to help fill prescriptions.

Allowing our pharmacists to continue their role in educating patients will help ensure that patients follow their medical therapy and management, which will save lives and money

Abbott Laboratories agrees to withdraw its obesity drug Meridia

Meridia Capsules
Meridia Capsules

Abbott Laboratories has agreed to voluntarily withdraw its obesity drug Meridia (sibutramine) from the U.S. market because of clinical trial data indicating an increased risk of heart attack and stroke, the U.S. Food and Drug Administration announced today.

“Meridia’s continued availability is not justified when you compare the very modest weight loss that people achieve on this drug to their risk of heart attack or stroke,” said John Jenkins, M.D., director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research (CDER). “Physicians are advised to stop prescribing Meridia to their patients and patients should stop taking this medication. Patients should talk to their health care provider about alternative weight loss and weight loss maintenance programs.”

Meridia was approved by the FDA in November 1997 for weight loss and maintenance of weight loss in obese people, as well as in certain overweight people with other risks for heart disease. The approval was based on clinical data showing that more people receiving sibutramine lost at least 5 percent of their body weight than people on placebo who relied on diet and exercise alone.

The FDA requested the market withdrawal after reviewing data from the Sibutramine Cardiovascular Outcomes Trial (SCOUT).  SCOUT was initiated as part of a postmarket requirement to look at cardiovascular safety of sibutramine after the European approval of this drug. The trial demonstrated a 16 percent increase in the risk of serious heart events, including non-fatal heart attack, non-fatal stroke, the need to be resuscitated once the heart stopped, and death, in a group of patients given sibutramine and another given placebo. There was a small difference in weight loss between the placebo group and the group that received sibutramine.

ADHD Diet: Do food additives cause hyperactivity?

ADHD Diet
ADHD Diet?

Question

I have a son with attention-deficit/hyperactivity disorder (ADHD). What does the research say about the relationship between food additives and ADHD?

Answer from  Mayo Clinic child psychiatrist John E. Huxsahl, M.D.

There’s no evidence that food additives cause attention-deficit/hyperactivity disorder (ADHD), but an increasing number of studies show that certain food colorings and preservatives may cause or worsen hyperactive behavior in some children. Because several studies looked at a combination of food additives and their possible effects on hyperactivity and ADHD, it isn’t clear which additives may affect behavior.

Food additives that may increase hyperactive behavior include:

  • Sodium benzoate
  • FD&C Yellow No. 6 (sunset yellow)
  • D&C Yellow No. 10 (quinoline yellow)
  • FD&C Yellow No. 5 (tartrazine)
  • FD&C Red No.40 (allura red)

FD&C Yellow No. 5, used in beverages, candy, ice cream, custards and other foods, may be more likely to cause reactions than other additives. The Food and Drug Administration requires that FD&C Yellow No. 5 be clearly labeled on food packaging along with other ingredients. But many colorings and food additives don’t require similar labeling, so it can be difficult to tell whether a food contains artificial coloring or other additives. One rule of thumb is that brightly colored processed foods are most likely to contain one or more coloring additives.

More research is needed regarding whether limiting certain foods helps prevent hyperactivity and ADHD symptoms. If you notice that a certain food causes a change in your child’s behavior, you may want to try eliminating it from your child’s diet to see if it makes a difference. However, consult with your child’s doctor before putting your child on a limited diet. A diet that eliminates too many foods can be unhealthy because it may lack necessary vitamins and nutrients.

The approach for your child’s overall health and nutrition is a diet that limits sugary and processed foods and is rich in fruits, vegetables, grains and healthy fats such as omega-3 fatty acids found in fish, flaxseed and other foods.

References

  1. McCann D, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: A randomised, double-blinded, placebo-controlled trial. The Lancet. 2007;370:1560.
  2. Bateman B, et al. The effects of a double blind, placebo controlled artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood. 2004;89:506.
  3. Schab DW, et al. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. Journal of Developmental and Behavioral Pediatrics. 2004;6:423.
  4. Food ingredients and colors. U.S. Food and Drug Administration. http://www.fda.gov/Food/FoodIngredientsPackaging/ucm094211.htm. Accessed Sept. 24, 2009.
  5. Weber W, et al. Complementary and alternative medical therapies for attention-deficit hyperactivity disorder and autism. Pediatric Clinics of North America. 2007;54:983.

Pharmageddon: America’s New Drug Crisis

New Drug Pandemic strikes U.S.

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For the first time ever, the leading cause of accidental death has shifted from car accidents to involuntary overdose in fifteen states and the District of Columbia.

This drug abuse crisis sweeping the nation is so severe it has been coined as “Pharmageddon.”

Dr. Barbra Krantz, medical director of the Hanley Center, a drug treatment center in West Palm Beach, FL, explained that this issue arose in the 1990’s, and can be attributed to a number of factors, including a change in standard therapy practices for treating chronic pain, consumer-driven marketing campaigns for name-brand medications, and over-prescribing physicians.

These three factors contribute to what Krantz labels “the perfect storm.” In addition, the most common people suffering from prescription drug addiction are not street junkies but rather “people that are working, that are educated, that have had professions that are now looking for that better living through better chemistry,” said Krantz.

For more information click here.

Big Breakthrough in Adult Stem Cell research

By Dave Andrusko

Scientists reported more progress yesterday with a method of creating stem cells without using embryos

Yes, that is it in a nutshell, and what follows in TN&V today is simply an elaboration of an important breakthrough in what are known as induced pluripotent stem cells (iPS cells).

Everybody knows about the ultra-controversial Embryonic Stem Cell Research (ESCR). How could they not when we are told insistently that if you just are willing to pump federal money into hollowing out human embryos, you can use those stem cells to (eventually) cure most everything? This is all bunk, but… The proven alternatives to ESCR–by that I mean a source that is helping people here and now–are so-called adult stem cells. These non-controversial cells come from adult stem cells–bone marrow, umbilical cord blood and other tissues.

They “are treating thousands of patients around the globe, with an estimated 50,000 adult stem cell transplants occurring annually worldwide,” says David Prentice. “For some diseases, adult stem cell transplants have become the “standard of care,” meaning the treatments are so effective that they are a doctor’s best choice for sick patients.” For the most part, adult stem cells get a respectful response from the media, but hardly enthusiastic.

But the flashier alternative that is getting far more attention are induced pluripotent stem cells (iPS cells). That will only increase with today’s report published online by researchers at Children’s Hospital and the Harvard Stem Cell Institute.

In essence, in fashioning iPS cells scientists have “rewound” the clock on an adult cell (typically a skin cell), turning the cell back into something very, very close to an embryonic stem cell.

Without getting too technical, the hang-up–the reason it couldn’t be tested in humans–was that the technique carried a risk endemic to the embryonic stem cells they so closely resembled: the iPS cells could turn cancerous. (It had to do with the way four genes were injected and in the process “tampering with the DNA,” as Ritter put it.)

So scientists have tried a number of ways to more gently reprogram the cells, including a cold virus, plastimids (circles of DNA), and chemicals. The technique explained in the paper published today by the journal Cell Stem Cell “treats skin cells with modified forms of RNA, a chemical cousin of DNA that normally transmits instructions from genes to the protein-making machinery of the cell,” Ritter explains.

It gets better. Beyond being safer, this alternative strategy “coax[es] those cells to morph into specific tissues that would be a perfect match for transplantation into patients,” according to Rob Stein of the Washington Post. The trifecta was complete when it was found that the technique is much more efficient.

According to Stein, “[T] he researchers found that a daily cocktail of their creations were surprisingly fast and efficient at reprogramming the cells. The approach converted the cells in about half the time of previous methods – only about 17 days – with surprising economy – up to 100 times more efficient than the standard approach.”

All this is taking place against the backdrop of the ongoing controversy over federal funding of ESCR. As we noted several times in Today’s News & Views, last month Royce C. Lamberth, Chief Judge of the U.S. District Court for the District of Columbia, said that it appeared that the Obama Administration’s decision to fund embryonic stem cell research was inconsistent with a federal law known as the Dickey-Wicker Amendment.

The ruling was preliminary, but the judge ordered the funding to cease while the case progresses. Subsequently a different court ruled that funding could resume while legal arguments proceed.