Senior Care Pharmacist最新文献

Adverse Drug Events and Medication Safety.

Senior Care Pharmacist Pub Date : 2025-02-01 DOI: 10.4140/TCP.n.2025.54

Demetra Antimisiaris, Patricia W Slattum

引用次数: 0

Predictors of Use of Individual Insulin and GLP-1 RA Products Versus Fixed Ratio Insulin/GLP-1 RA Combinations in Medicare Beneficiaries.

Senior Care Pharmacist Pub Date : 2025-02-01 DOI: 10.4140/TCP.n.2025.97

Anthony F Jeter, Brittany L Melton, Bradley J Newell

{"title":"Predictors of Use of Individual Insulin and GLP-1 RA Products Versus Fixed Ratio Insulin/GLP-1 RA Combinations in Medicare Beneficiaries.","authors":"Anthony F Jeter, Brittany L Melton, Bradley J Newell","doi":"10.4140/TCP.n.2025.97","DOIUrl":"10.4140/TCP.n.2025.97","url":null,"abstract":"Background: In 2022, federal law capped insulin product costs at $35 per month for Medicare prescription drug plan recipients. However, this law did not address the high costs of other antihyperglycemic medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), with an average copay of $120 per month. Under the law, fixed-ratio insulin/GLP-1RA combination products are classified as \"insulin products,\" making these effective medications more accessible to patients who might otherwise be unable to afford them. Patients may not be aware of the potential financial benefits of combination products, highlighting the need to identify those using them to better educate both patients and providers. Objectives: The primary objective was to identify predictors of use for the insulin/GLP-1RA combinations. The secondary objective was to determine if there was a difference in medication cost to patients between individual and combination product users and determine cost savings potential of switching. Design: This was a retrospective, observational cohort analysis. Setting: Prescription fill data were examined for antihyperglycemic medications filled between January 1, 2022, and December 31, 2022. Prescriptions were filled within one regional division of a large community-based pharmacy chain, encompassing 71 pharmacies within Kansas, Nebraska, and Missouri. Methods: This retrospective observational cohort analysis examined prescription fill data for antihyperglycemic medications for the calendar year 2022 across one regional division of a large community-based pharmacy chain. Included patients 65 years of age or older with a Medicare prescription drug plan, using any basal insulin and any GLP-1RA, including combinations, as well as metformin, with ≥ 80% proportion of days covered. Demographics, usage predictors, and cost differences were compared between patients using individual products and those using insulin/GLP-1RA combination products. Results: A total of 138 patients were analyzed. The use of insulin/GLP-1RA combination products was associated with increased likelihood of using sodium-glucose cotransporter-2 inhibitors (P = 0.022). Median annual out-of-pocket spending was significantly different between groups (P < 0.001), with most combination users paying more than $1,000 less per year than individual product users. Conclusion: Insulin/GLP-1RA combination products represent a cost-effective alternative to individual antidiabetic pharmacotherapy agents.","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 2","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing the Rate of inappropriately Crushed Medications in Skilled Nursing Facilities.

Senior Care Pharmacist Pub Date : 2025-02-01 DOI: 10.4140/TCP.n.2025.72

Alicia Brunemann, Alexandra Schifano, Stephanie Fenwick, Casondra Seibert

{"title":"Assessing the Rate of inappropriately Crushed Medications in Skilled Nursing Facilities.","authors":"Alicia Brunemann, Alexandra Schifano, Stephanie Fenwick, Casondra Seibert","doi":"10.4140/TCP.n.2025.72","DOIUrl":"10.4140/TCP.n.2025.72","url":null,"abstract":"Purpose: Evaluate the impact of senior care pharmacists' medication management when a Do Not Crush (DNC) list is used to identify patients inappropriately receiving crushed medications. Methods: Participating senior care pharmacists retrospectively assessed skilled nursing residents with active medications on the DNC list for study inclusion. Study outcomes included assessing prevalence of residents with the inability to receive medications whole orally yet receiving DNC medication(s). Additional outcomes included prevalence rate of patients receiving DNC medications who also have enteral feeding tubing, nothing by mouth orders (NPO), or inability/unwillingness to swallow medications whole. Results: A total of 1,070 skilled nursing patients were reviewed with 778 meeting inclusion criteria. Of those 778 patients, approximately 27% were receiving inappropriately crushed medications. Of those patients, 90% warranted pharmacist intervention associated with a total of 473 medications. Females represented 67% of the patient population, and 90% of patients were 65 years of age or older. The average number of DNC medications was three per patient. The reasons for crushing medications varied. Four patients were classified as NPO, 13 had enteral feeding tubes, 130 patients could not physically swallow medications due to dysphagia, and 122 refused to receive medications whole. Conclusion: Senior care pharmacists can play an integral role in ensuring patients receive medications in accordance with manufacturer guidelines, safe medication practices, and use of alternative formulations as appropriate. The rate of inappropriately crushed medications administered in skilled nursing facilities is high at 27% in the present study. This rate could be further confounded because of the possibility of medications being crushed despite the fact that there is not an indication to do so in the patient chart.","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 2","pages":"72-96"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Recalibration of Power: Republicans Take Control of the Senate and Key Health Care Committees.

Senior Care Pharmacist Pub Date : 2025-02-01 DOI: 10.4140/TCP.n.2025.105

Leigh Davitian

引用次数: 0

Insulin Pen Administration Efficacy and Safety in an Older Patient.

Senior Care Pharmacist Pub Date : 2025-02-01 DOI: 10.4140/TCP.n.2025.64

Dylan K Montgomery, Tiffany R Shin, Bradley J Newell

{"title":"Insulin Pen Administration Efficacy and Safety in an Older Patient.","authors":"Dylan K Montgomery, Tiffany R Shin, Bradley J Newell","doi":"10.4140/TCP.n.2025.64","DOIUrl":"10.4140/TCP.n.2025.64","url":null,"abstract":"Objective To describe a successful pharmacist-led intervention to effectively and safely provide education and pharmacotherapy management for an older patient with uncontrolled type 2 diabetes mellitus (T2DM) who failed to remove the needle shield on insulin pens for injection. Setting: Family medicine residency clinic. Practice Description: The clinic, part of a major urban health system, consists of 27 medical residents, 15 attending physicians, and 1 ambulatory care pharmacist managing chronic diseases collaboratively. It primarily serves low-income patients in a Midwest city. Practice Innovation: A 93-year-old White female with T2DM, receiving insulin therapy, was referred to the ambulatory care pharmacist by her physician for diabetes management. The patient had been hospitalized recently for hyperosmolar hyperglycemic state with a hemoglobin A1c of 15.9%. The pharmacist identified a failure to remove the needle shield on the insulin pen resulting in ineffective insulin administration, which caused persistent hyperglycemia and subsequent hospitalizations. This also posed a safety concern for severe hypoglycemia if proper administration resumed without adjusting the inflated dosing. The pharmacist used demonstration devices and the teach-back method to provide education and implement pharmacotherapy adjustments, resulting in effective and safe insulin administration. Main Outcome Measurements: Change in diabetes medication regimen, home blood glucose readings including continuous glucose monitor data, hemoglobin A1c results, frequency of hypoglycemic episodes, and number of hospitalizations for T2DM. Results: Over seven months, dose adjustments to basal insulin, combined with proper administration technique and the addition of empagliflozin, resulted in a hemoglobin A1c below 7%, with no severe hypoglycemia or diabetes-related hospitalizations. Conclusion: Medication errors, including insulin administration errors, highlight the need for thorough education in insulin therapy management. Education and monitoring empower older patients to self-manage diabetes safely and effectively, aligning with guidelines. Further research is required to identify optimal strategies for educating older patients on self-managing T2DM with insulin therapy.","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 2","pages":"64-71"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of Dry Mouth.

Senior Care Pharmacist Pub Date : 2025-02-01 DOI: 10.4140/TCP.n.2025.55

Renee L Hayslett, Leisa L Marshall

{"title":"Management of Dry Mouth.","authors":"Renee L Hayslett, Leisa L Marshall","doi":"10.4140/TCP.n.2025.55","DOIUrl":"10.4140/TCP.n.2025.55","url":null,"abstract":"Background: Dry mouth, or xerostomia, is a common complaint among older people. Dry mouth can result in a variety of dental complications, oral discomfort, difficulty swallowing and eating, and decreased taste sensation, all of which can adversely affect quality of life. Objective: To provide an overview of the definition, diagnosis, causes, potential complications, and treatment strategies for dry mouth. Data Sources: PubMed, Proquest, Cochrane Library, drug prescribing information, drug information databases, and manufacturers' websites were used. Search terms were \"xerostomia,\" \"dry mouth,\" \"hyposalivation,\" \"causes,\" \"treatment,\" and \"pharmacology.\" The resources identified included clinical practice guidelines, review articles, and original research articles. Data Synthesis: The literature described the causes and treatment strategies for managing xerostomia, including concerns for older adults, and pharmacists' involvement for providing care. Discussion: The most common cause of dry mouth in the general population and in older adults is medication use. Individual medications may cause dry mouth, primarily through anticholinergic side effects. Polypharmacy is also a cause. Other causes are dehydration, alcohol and caffeine intake, and systemic diseases such as Sjögren's disease. If not addressed, individuals experiencing chronic dry mouth are at increased risk for various oral conditions such as dental caries, periodontal disease, and infections. Interventions such as good oral hygiene methods, using saliva substitutes containing xylitol and prescription cholinergic agonists, if appropriate, can reduce symptoms and complications. Conclusion: Pharmacists can play an important role in managing dry mouth by conducting medication reviews, providing patient education for oral health practices, and recommending treatment strategies.","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 2","pages":"55-63"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Combination Inhaled Corticosteroid and Short-acting Beta2 Agonist (ICS-SABA) Use for Older Adults With Asthma. 吸入皮质类固醇和短效β 2激动剂（ICS-SABA）联合用于老年哮喘患者。

Senior Care Pharmacist Pub Date : 2025-01-01 DOI: 10.4140/TCP.n.2025.3

Jaycie Truong, Kimberly A B Cauthon

{"title":"Combination Inhaled Corticosteroid and Short-acting Beta2 Agonist (ICS-SABA) Use for Older Adults With Asthma.","authors":"Jaycie Truong, Kimberly A B Cauthon","doi":"10.4140/TCP.n.2025.3","DOIUrl":"https://doi.org/10.4140/TCP.n.2025.3","url":null,"abstract":"The first combination inhaled corticosteroid and short-acting beta₂ agonist (ICS-SABA) was approved by the Food and Drug Administration (FDA) in 2023 for as-needed treatment or prevention of bronchoconstriction and to reduce the risk of asthma exacerbations in patients 18 years of age and older. The recently approved product contains an ICS-albuterol combination. The 2024 Global Initiative for Asthma (GINA) guidelines recommend as-needed ICS-formoterol as the preferred asthma reliever therapy; however, a GINA alternative recommendation is the use of ICS whenever an as-needed (SABA) is used. There is no difference in as-needed asthma treatment recommended by the GINA guidelines in older adults, and there has been minimal study in older adults. Because of limited guidance on the use of the ICS-SABA reliever inhaler in older adults, the purpose of this review is to evaluate the DENALI and MANDALA studies and the potential role of ICS-SABA in older adults. The mean ages in both studies were 50 years. The MANDALA primary outcome result was a statistically significant lower risk of severe exacerbations in the ICS-SABA reliever group compared with the as-needed albuterol (ALB) group at 24 weeks. In the MANDALA older adults subgroup analysis, there was not a statistically significant difference in the ICS-SABA reliever group compared with the as-needed ALB-alone group but the results favored ICS-SABA. The DENALI primary outcome results were a greater change from baseline in forced expiratory volume in the first second (FEV1) area under the curve averaged over 12 weeks with albuterol/budesonide (ALB-BUD) 180/160 ug compared with budesonide alone and placebo and a greater change from baseline in trough FEV1 with ALB-BUD 180/160 ug and 180/80 ug than ALB-alone and placebo. Because of minimal adverse effects in both trials and the benefits in preventing asthma exacerbations reported in the MANDALA trial, it is important to assess and recommend that older adults with asthma receive inhaled corticosteroid with their reliever asthma inhaler.","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 1","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antibiotic Length of Therapy: Is Shorter Better in Older Adults? 抗生素治疗时间：对老年人越短越好？

Senior Care Pharmacist Pub Date : 2025-01-01 DOI: 10.4140/TCP.n.2025.18

Alice N Hemenway, Caitlyn Patton, Elias B Chahine

{"title":"Antibiotic Length of Therapy: Is Shorter Better in Older Adults?","authors":"Alice N Hemenway, Caitlyn Patton, Elias B Chahine","doi":"10.4140/TCP.n.2025.18","DOIUrl":"10.4140/TCP.n.2025.18","url":null,"abstract":"Background Antibiotic lengths of therapy (LOT) vary widely, based on infection type, antibiotic regimen, and patient characteristics. Longer LOT are associated with increased risk of antibiotic resistance, adverse effects, and health care costs. There are increasing data supporting shorter LOT for many infections based on randomized, controlled trials (RCTs). Objective To evaluate RCTs supporting shorter antibiotic LOT for common infections, with an emphasis on applying the data to older adults. Data Sources A list of RCTs that evaluated shorter LOT for common infections was first gathered from the website of Brad Spellberg, MD, at <ext-link ext-link-type=\"uri\" xlink:href=\"https://www.bradspellberg.com/shorter-is-better\">https://www.bradspellberg.com/shorter-is-better</ext-link>. The list was then verified through a PubMed search using the terms for each infection and LOT. Data Synthesis Of the 28 identified RCTs, 27 supported shorter antibiotic LOT. These trials were categorized by disease states: complicated urinary tract infections including pyelonephritis (n = 9), community-acquired pneumonia (n = 6), hospital-acquired pneumonia/ ventilator-associated pneumonia (n = 3), skin and soft tissue infections (n = 4), complicated intra-abdominal infections (n = 2), and gram-negative bacteremia (n = 3). The single incongruent trial was conducted on male patients with complicated urinary tract infections, and the results could be explained by a lower than usual dose of antibiotic utilized in the study. Discussion Many RCTs have demonstrated the safety and efficacy of shorter antibiotic LOT for the disease states included in this review. Several of these trials enrolled older adults. Conclusion There are sufficient data to support using shorter antibiotic LOT in older patients. Implementing this strategy can help pharmacists and other health care professionals optimize antibiotic use in older adults.","PeriodicalId":41635,"journal":{"name":"Senior Care Pharmacist","volume":"40 1","pages":"18-31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Complicated Overactive Bladder Management. 复杂膀胱过度活动症的治疗。

Senior Care Pharmacist Pub Date : 2025-01-01 DOI: 10.4140/TCP.n.2025.10

Kaylee Mehlman, Victoria Nalls, Douglas Wessel

引用次数: 0

The Slow Crawl to Making a President's Cabinet: Vetting, Nominating, and Confirming. 组建总统内阁的缓慢爬行：审查、提名和确认。

Senior Care Pharmacist Pub Date : 2025-01-01 DOI: 10.4140/TCP.n.2025.50

Leigh Davitian

引用次数: 0