Pharmacist-implemented pharmaceutical manufacturers' assistance programs: effects on health outcomes for seniors.

In the environment of rapidly mounting medication costs, pharmaceutical manufacturers' assistance programs (PMAPs) have become increasingly important in supplying medications to financially vulnerable patients. At Shenandoah Valley Compassionate Pharmacy, Winchester, Virginia, a nonprofit facility serving low-income seniors, a pharmacist and a patient advocate implement PMAPs by helping to enroll patients, dispensing medications, and providing patient counseling. To examine the effects of the program, we compared patients' clinical indicators before and after a 42-month intervention. Statistical analysis evaluated changes in clinical variables, such as systolic and diastolic blood pressure, glycosylated hemoglobin A1c, lipid panel (total cholesterol, low-density lipoprotein [LDL], highdensity lipoprotein [HDL], and triglycerides [TG]) for 84 seniors diagnosed with one or more chronic conditions. Results show statistically significant improvement in total cholesterol, LDL, and mean arterial pressure (calculated). TGs and A1c did not change significantly. In addition to dispensing free medications, the pharmacist provides counseling to enhance the efficacy of geriatric pharmacotherapy.

Combining olfaction and cognition measures to screen for mild cognitive impairment.

PURPOSE: This exploratory study examined the relationship between performance on the University of Pennsylvania Smell Identification Test (UPSIT) and the Addenbrooke's Cognitive Examination (ACE) to identify a possible association between olfaction and mild cognitive impairment(MCI). DESIGN AND METHODS: 54 community-dwelling older (ages 49-91) volunteers were given the UPSIT and ACE. RESULTS: The ACE identified 7 subjects (13%) who had probable MCI. UPSIT total scores were significantly related to ACE total scores (r = 0.37, p = 0.005). Four specific odorants (mint, lime, chocolate, and cheddar cheese) from the UPSIT identified 4 of the 7 (57.1%) probable MCI subjects. The prevalence rate of MCI in subjects over 65 was 19.4%. IMPLICATIONS: Selective odorants in UPSIT used with ACE show promise as a non-invasive method of detecting MCI in community dwelling elders. Detection of MCI could facilitate earlier interventions and treatment of dementia.

Impact of the Medicare modernization act on low-income persons.

BACKGROUND: Low-income Medicare beneficiaries without prescription benefits have high out-of-pocket medication expenses that can discourage adherence to treatment regimens. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 created a temporary drug discount card program and a prescription benefit with low-income provisions to assist with medication expenditures for eligible seniors. OBJECTIVE: To determine the impact of the new drug discount card and prescription benefit on medication expenditures by low-income Medicare recipients who require pharmaceutical company assistance for obtaining medications. DESIGN: Retrospective, nonrandomized evaluation. SETTING: Family practice physicians' office in northern Virginia. PATIENTS: 137 Medicare recipients without prescription coverage who received assistance from pharmaceutical companies for medications. MEASUREMENTS: Patients were stratified into 3 categories according to income, household size, and the federal poverty line (FPL), as defined by the new Medicare act. Participants' long-term oral and inhaled medications, dosages, and instructions for use were obtained. The MMA criteria for low-income provisions were applied for the drug discount program and for the prescription benefit. Medication costs under the new Medicare benefits were compared with those incurred without assistance and with the use of pharmaceutical company programs for the cohort and FPL categories. RESULTS: In all income categories, medication costs were lower after enrollment in all programs than those of patients without assistance. Compared with pharmaceutical company assistance, Medicare drug discount cards resulted in less savings for all income groups. For the prescription benefit, persons with incomes less than 135% of FPL had the greatest benefit because of low-income subsidies. Persons ineligible for low-income subsidies receiving the standard benefit had a smaller reduction in out-of-pocket costs and variable monthly expenditures; they realized a superior savings with pharmaceutical company assistance programs. LIMITATIONS: The generalizability of these findings is limited because the authors used a discount pharmacy to determine drug costs for persons receiving no assistance, could not determine asset criteria for the MMA drug benefit low-income subsidy, and used a selected Medicare population. CONCLUSIONS: In a low-income Medicare population without prescription coverage, pharmaceutical company programs offered considerable savings and were superior to the Medicare drug discount cards. For the Medicare prescription plan, the greatest savings was among those eligible for low-income subsidies. Month-to-month medication costs may vary substantially for persons ineligible for such subsidies, and pharmaceutical company assistance may be a better alternative.

Detection of paralytic shellfish poison by rapid cell bioassay: antagonism of voltage-gated sodium channel active toxins in vitro.

Although cytotoxicity assays provide several advantages over mouse bioassays, sodium channel-blocking marine toxins, such as those associated with paralytic shellfish poison (PSP), require prolonged incubation periods of 24-48 h. This is in marked contrast to in vitro detection of sodium channel-enhancing marine toxins such as ciguatoxins or brevetoxins which can be accomplished in as few as 4-6 h. We developed a modified PSP cell bioassay that is as rapid as in vitro methods for sodium channel-enhancing toxins. The cell bioassay is based on a saxitoxin-dependent antagonism of the rapid in vitro effects of brevetoxin or ciguatoxin. Comparative analysis of naturally incurred PSP residues by both antagonism cell bioassay and the mouse bioassay demonstrated significant correlation. The simplicity, sensitivity, and enhanced kinetics of the new antagonism cell bioassay format provide the basis for development of a practical alternative to conventional mouse testing for PSP.