{"title":"Concierge Pharmacy: A Potential Arena for Senior Care Pharmacists.","authors":"Alexandra Cambra, Jeannette Y Wick","doi":"10.4140/TCP.n.2018.352","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.352","url":null,"abstract":"<p><p>Concierge pharmacy is an emerging area of practice that appears to be well suited for pharmacists who prefer flexibility in geriatric practice, a system in which patients pay a fee for personalized care and access to their pharmacists. Older adults are a natural population for concierge pharmacists because of their individual increasing medical needs. At this time, concierge pharmacists tend to provide care to individuals who can afford to pay out-of-pocket or who are auxiliary personnel in medical offices, which provides payment. Other reimbursement models exist, and each concierge pharmacist's practice will be unique. The largest barrier to unfettered pharmacy practice is the inability to practice autonomously. Pharmacists can look to nurse practitioners' moderately successful march toward nationwide independent practice as a model for their own bid to practice independently.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36304767","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}
Pilar Z Murphy, Maryam Iranikhah, Crystal M Deas, Maisha K Freeman
{"title":"Fracture Risk Following Discontinuation of Teriparatide: A Review of the Literature.","authors":"Pilar Z Murphy, Maryam Iranikhah, Crystal M Deas, Maisha K Freeman","doi":"10.4140/TCP.n.2018.365","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.365","url":null,"abstract":"<p><strong>Objective: </strong>To review and summarize studies on the changes in bone mineral density (BMD) and fracture risk following discontinuation of teriparatide therapy.</p><p><strong>Data sources: </strong>A search of PubMed (1966-May 2016) and International Pharmaceutical Abstracts (1970-May 2016) was conducted using the Medical Subject Headings terms teriparatide, osteoporosis, and withholding treatment. Free text searches included drug holiday, discontinuation, and drug discontinuation.</p><p><strong>Study selection and data extraction: </strong>These searches yielded 79 articles. There were 7 articles reviewed that addressed the effects of teriparatide discontinuation on markers of overall bone health and fracture risk.</p><p><strong>Data synthesis: </strong>Teriparatide is a recombinant human parathyroid hormone that is indicated for a lifetime maximum of 24 months in the United States for the treatment of osteoporosis in men and women at high fracture risk. There is inconsistent evidence regarding retained skeletal integrity resulting from increased bone resorption. Study analyses have shown that female patients seem to have more reduction in BMD upon teriparatide discontinuation. Several studies evaluating teriparatide discontinuation were follow-up studies with small patient populations, limiting the generalizability and statistical rigor associated with assessing these outcomes. In addition, the majority of patients were receiving bisphosphonate therapy, and the true effect of discontinuing teriparatide remains unknown.</p><p><strong>Conclusion: </strong>Independent patient risk factors should be taken into consideration when weighing the risk-vs.-benefit of initiating and discontinuing teriparatide therapy. Additional randomized control trials should be conducted to determine long-term effects of discontinuing teriparatide in the presence and absence of other bone-strengthening agents.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36304768","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}
{"title":"Management of Breakthrough Pain in Hospitalized Older Adults.","authors":"Tran H Tran, Anne Reda","doi":"10.4140/TCP.n.2018.376","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.376","url":null,"abstract":"<p><strong>Objective: </strong>The appropriateness of analgesic administrations based on pain score and medication order in older adults during hospitalization was evaluated.</p><p><strong>Setting: </strong>As-needed analgesic administrations for geriatric patients on hospitalist general medicine services at a large-university-affiliated medical center from January 1 to March 31, 2015, were included.</p><p><strong>Practice description: </strong>The hospital is a level one trauma center with more than 500 beds serving an area of more than 500,000 people, 12% of whom are 65 years of age or older. At our institution, breakthrough pain is treated with as-needed analgesic medications based on pain scores specified by the ordering provider. Medication should be given according to which order contains the patient-reported severity of pain.</p><p><strong>Practice innovation: </strong>This is an institutional review board-approved retrospective chart review of 430 analgesic medication administrations in hospitalized older adults.</p><p><strong>Main outcome measurements: </strong>Incidence of appropriate medication administration based on pain score report and active medication orders.</p><p><strong>Results: </strong>As-needed analgesic medications were given appropriately 44% of the time based on patient-reported pain score and active medication order. An active medication order was missing to treat the pain score reported by the patient 29% of the time. Out of 430 analgesic administrations, improvement in pain occurred 26% of the time. Pain was reassessed one hour after administration for almost 33% of the orders. Of those, 73% showed an improvement in pain score.</p><p><strong>Conclusion: </strong>Our results demonstrate a large discrepancy for hospitalized older adults in what medication is administered compared with what is ordered for as-needed pain treatment. Missing orders contributed to almost one third of inappropriate medication administrations.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36304769","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}
Audrey A Blenke, Rob J van Marum, Annemieke M Vermeulen Windsant-van den Tweel, Walter A Hermens, Hieronymus J Derijks
{"title":"Deprescribing in Newly Admitted Psychogeriatric Nursing Facility Patients.","authors":"Audrey A Blenke, Rob J van Marum, Annemieke M Vermeulen Windsant-van den Tweel, Walter A Hermens, Hieronymus J Derijks","doi":"10.4140/TCP.n.2018.331","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.331","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether advised changes as a result of structured medication reviews in psychogeriatric patients were implemented and if the implemented changes were maintained.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Three nursing facilities in The Netherlands.</p><p><strong>Patients, participants: </strong>Newly admitted psychogeriatric residents.</p><p><strong>Intervention: </strong>After admission, a structured medication review was performed by a pharmacist and physician resulting in a treatment plan that was approved by the patient's legal representative and implemented.</p><p><strong>Main outcome measure(s): </strong>The percentage of advised changes approved (= approval rate) and the percentage of implemented medication changes still present 90 days after approval (= 90-day implementation rate).</p><p><strong>Results: </strong>A total of 45 patients were included who used a total number of 333 drugs (mean ± standard deviation 7.4 ± 3.3 drugs). Changes were advised to 159 medications used by 42 patients. Of these changes, 150 were approved (approval rate 94.3%). Finally, 105 were implemented, and 89 were still implemented after 90 days (90-day implementation rate 84.8%). Overall, 59.7% of the advised changes concerned deprescribing (stopping or dose reduction). The proportion of advised changes implemented was similar for symptommodifying and risk-modifying drugs, namely, almost 85%. Overall, 55.3% of the recommended changes to deprescribe concerned 10 drug groups.</p><p><strong>Conclusion: </strong>Medication could be successfully deprescribed from psychogeriatric patients after structured medication reviews performed by pharmacists and nursing facility physicians. More than 50% of the advised changes to deprescribe involved 10 drug groups, which raises the question whether the structured medication review can be performed more efficiently by focusing on the most common problems.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36202771","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}
{"title":"The Many Faces of Polypharmacy.","authors":"H Edward Davidson","doi":"10.4140/TCP.n.2018.286","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.286","url":null,"abstract":"","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36203372","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}
Barbara Resnick, Elizabeth Galik, Marie Boltz, Sarah Holmes, Steven Fix, Erin Vigne, Shijun Zhu, Regina Lewis
{"title":"Polypharmacy in Assisted Living and Impact on Clinical Outcomes.","authors":"Barbara Resnick, Elizabeth Galik, Marie Boltz, Sarah Holmes, Steven Fix, Erin Vigne, Shijun Zhu, Regina Lewis","doi":"10.4140/TCP.n.2018.321","DOIUrl":"10.4140/TCP.n.2018.321","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to describe medication use and polypharmacy in assisted living settings. We hypothesized that: 1) age, gender, race, setting, multi-morbidity, and cognitive status would influence polypharmacy; and 2) polypharmacy would be associated with falls, emergency room visits, and hospitalizations.</p><p><strong>Design: </strong>This was a descriptive study using data from a larger study testing the Dissemination and Implementation of Function Focused Care for Assisted Living (FFC-AL-EIT).</p><p><strong>Setting: </strong>Participants were recruited from 26 assisted living settings.</p><p><strong>Participants: </strong>A total of 242 individuals for cohort 1 consented and completed baseline data collection.</p><p><strong>Interventions: </strong>Data were obtained from participant medical records, observations, and input from staff.</p><p><strong>Main outcome measure(s): </strong>Age, gender, race, ethnicity, comorbidities, cognitive status, medications, falls, emergency room visits, hospitalizations, function based on the Barthel Index and physical activity using the MotionWatch 8.</p><p><strong>Results: </strong>Participants had a mean age of 86.86 (standard deviation [SD] = 7.0), the majority were women (n = 179, 74%) and white (n = 233, 96%), with five (SD = 2) diagnoses. The mean number of drugs was seven (SD = 3.56), and 51% were exposed to polypharmacy. The mean Barthel Index score was 63.06 (SD = 20.20), and they engaged in 111,353 (SD = 87,262) counts of activity daily. Fifty-eight residents fell at least once (24%), 22 were sent to the hospital (9%), and 32 (13%) to the emergency room. Neither hypothesis was supported.</p><p><strong>Conclusion: </strong>Continued research is needed to explore the factors that influence polypharmacy. Identification of these factors will help guide deprescribing so that medication management does not harm older adults physically or cause unnecessary financial burden.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311411/pdf/nihms-1003214.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36202770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"New Models of Care: How Pharmacists Can Provide Better Care at Lower Costs.","authors":"Marie Smith, Jeannette Y Wick","doi":"10.4140/TCP.n.2018.294","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.294","url":null,"abstract":"<p><p>Pharmacists, highly trained and accessible health care professionals, continue to be underused in American communities. Helping pharmacists to make the best use of their extensive clinical education and skills is a primary focus for the discipline's leaders. The University of Connecticut School of Pharmacy's PRISM initiative ( PeRformance I mprovement for Safe Medication Management) creates opportunities to partner with other health professionals or programs to advance the pharmacist's role in the community. All stakeholders must understand the evolving health care climate as society moves toward \"health care without walls\" (i. e., health care that is innovative, convenient, and likely to be entirely different than previous models). This article discusses progress made in Connecticut to advance pharmacy practice and describes programs that, if replicated in other areas of the country, could significantly improve care for vulnerable populations, especially the elderly. Programs that have been especially useful have emphasized the difference between needing medical versus pharmacy services, and approached provision of care in entirely new ways.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36203373","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}
{"title":"Evaluating the Evidence Behind Treating Osteoporosis in the Oldest Adults.","authors":"Daniel Wolverton, David P Elliott","doi":"10.4140/TCP.n.2018.308","DOIUrl":"https://doi.org/10.4140/TCP.n.2018.308","url":null,"abstract":"<p><strong>Objective: </strong>To review clinical trial data supporting the use of drugs to treat osteoporosis in the oldest adults, 74 years of age and older.</p><p><strong>Data sources: </strong>The PubMed database (September 1969-June 2017) was searched utilizing the following Medical Subject Headings terms: osteoporosis, postmenopausal, aged, 80 and over, and fractures, bone, in combination with diphosphonates, denosumab, parathyroid hormone, raloxifene, and calcitonin.</p><p><strong>Study selection/data extraction: </strong>An initial search revealed 119 results, of which 18 clinical trials were included. Studies were selected that featured a randomized controlled design, fractures reported as a key outcome, and included subjects within the desired age range.</p><p><strong>Data synthesis: </strong>Osteoporosis is common among older adults, and with an increasingly aging population, it will be imperative to know how to best manage this condition. Sparse clinical evidence exists for the impact of osteoporosis treatments in the given age range, and no clinical trials have exclusively looked at this age group as the primary target.</p><p><strong>Conclusion: </strong>Studies that included participants in this age group were found for alendronate, risedronate, zoledronic acid, denosumab, teriparatide, and abaloparatide. Efficacy appears to be maintained with advancing age for alendronate, zoledronic acid, denosumab, and teriparatide as demonstrated by post hoc analyses of pivotal trials. Alendronate has only demonstrated benefit in patients with previous vertebral fractures because of the study design of the trial. Abaloparatide showed improvement with treatment in the overall population, but age-specific analyses have not been published at this time.</p>","PeriodicalId":45985,"journal":{"name":"CONSULTANT PHARMACIST","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4140/TCP.n.2018.308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36202768","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}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
