Project EVADE: Evaluating the effects of a pharmacist-run transitions of care clinic on hospital readmissions.

OBJECTIVES: The primary objective of this report is to describe the implementation of a pilot pharmacist-run transitions of care clinic. The secondary objective is to present data collected on the impact of this clinic in regard to 30-day, all-cause hospital readmission rates and provider acceptance rates of pharmacist recommendations. SETTING: This transitions of care clinic was implemented in a Department of Veterans Affairs ambulatory care center located in Columbus, Ohio. PRACTICE DESCRIPTION: Pharmacists saw high-acuity patients who met inclusion criteria in the transitions of care clinic to complete medication reconciliation, disease state education, and medication counseling. After the visit, the pharmacist made recommendations to the patient's primary care provider. PRACTICE INNOVATION: This transitions of care clinic is unique in that it is solely pharmacist-run and is located within a primary care setting. EVALUATION: The impact of the pharmacist-run clinic was evaluated against a matched control group via a retrospective chart review. A chi-square test was run to assess the difference in 30-day, all-cause hospital readmission rates between patients seen in the transitions of care clinic and those who were not. RESULTS: There was a statistically insignificant difference in 30-day, all-cause hospital readmission rates between the transitions of care and control groups (13% vs. 26.1%; P = 0.265). For secondary outcomes assessed in the transitions of care group, 32.9% of medication-related recommendations, 47.4% of laboratory blood work recommendations, and 48.6% of care coordination referrals made by pharmacists were accepted by providers. CONCLUSION: Pharmacist involvement in the transitions of care process in the primary care setting through the implementation of a pharmacist-run clinic may decrease the likelihood of hospital readmission.

Pharmacologic treatment of type 2 diabetes: oral medications.

OBJECTIVE: To review the oral and injectable pharmacologic treatment options for type 2 diabetes. DATA SOURCES: A literature search was conducted using PubMed electronic database for studies published in English between 1993 and September 2014. Search terms included diabetes mellitus, type 2 diabetes, and the individual name for each antidiabetic medication reviewed. In addition, manual searches were performed for cross-references from publications. Package inserts, United States Food and Drug Administration (FDA) Web site, Institute for Safe Medication Practices Web site, American Diabetes Association Web site and scientific session poster presentations, and individual drug company Web pages were also reviewed. STUDY SELECTION AND DATA EXTRACTION: This review focused on information elucidated over the past 10 years to assist prescribers in choosing optimal therapy based on individual patient characteristics. Studies leading to the approval of or raising safety concerns for the antidiabetic medications reviewed in this article were included. DATA SYNTHESIS: In the past 10 years, there have been 4 novel oral antidiabetic medication classes and 9 new injectable agents and insulin products approved by the FDA for the treatment of type 2 diabetes as well as new information regarding the safety and use of several older antidiabetic medication classes. The distinctions were reviewed for each individual agent, and a comparison was completed if there was more than one agent in a particular therapeutic class. Using current information available, select investigational agents in phase III trials or those with a pending new drug application were highlighted. CONCLUSION: There are now 9 distinct oral pharmacologic classes and a variety of insulin and noninsulin injectable medications available for the treatment of type 2 diabetes. Metformin remains the first-line treatment option for most patients. When considering options for alternative or additional treatment, prescribers must weigh the benefits and risks using individual patient characteristics.

Pharmacologic treatment of type 2 diabetes: injectable medications.

OBJECTIVE: To review the oral and injectable pharmacologic treatment options for type 2 diabetes. DATA SOURCES: A literature search was conducted using PubMed electronic database for studies published in English between 1993 and September 2014. Search terms included diabetes mellitus, type 2 diabetes, and the individual name for each antidiabetic medication reviewed. In addition, manual searches were performed for cross-references from publications. Package inserts, United States Food and Drug Administration (FDA) Web site, Institute for Safe Medication Practices Web site, American Diabetes Association Web site and scientific session poster presentations, and individual drug company Web pages were also reviewed. STUDY SELECTION AND DATA EXTRACTION: This review focused on information elucidated over the past 10 years to assist prescribers in choosing optimal therapy based on individual patient characteristics. Studies leading to the approval of or raising safety concerns for the antidiabetic medications reviewed in this article were included. DATA SYNTHESIS: In the past 10 years, there have been 4 novel oral antidiabetic medication classes and 10 new injectable agents and insulin products approved by the FDA for the treatment of type 2 diabetes as well as new information regarding the safety and use of several older antidiabetic medication classes. The distinctions were reviewed for each individual agent, and a comparison was completed if there was more than one agent in a particular therapeutic class. Using current information available, select investigational agents in phase III trials or with a pending new drug application were highlighted. CONCLUSION: There are now 9 distinct oral pharmacologic classes and a variety of insulin and noninsulin injectable medications available for the treatment of type 2 diabetes. Metformin remains the first-line treatment option for most patients. When considering options for alternative or additional treatment, prescribers must weigh the benefits and risks using individual patient characteristics.

The impact of extended release exenatide as adjuvant therapy on hemoglobin A1C, weight, and total daily dose of insulin in patients with type 2 diabetes mellitus using U-500 insulin.

AIMS: To evaluate the efficacy and safety of adjuvant exenatide extended release (ER) therapy in patients treated with regular U-500 insulin. METHODS: In this retrospective chart review at an ambulatory care center in the Midwest, 18 patients with type 2 diabetes being treated with regular U-500 insulin and adjuvant exenatide ER were identified. These patients were evaluated for outcomes following the addition of exenatide ER. The primary outcome was change in HbA1C from baseline to 3, 6, and 12months. Secondary outcomes included change in weight, total daily dose (TDD) of insulin, and hypoglycemia. Repeated measures ANOVA was performed to assess the differences in mean scores over four time periods. RESULTS: A total of 18 of 50 patients met inclusion criteria with sufficient data to be included in analysis. HbA1C showed non-significant findings from baseline to 12months (8.08% vs. 8.23%; p=0.75). A non-significant, modest weight loss occurred (146.4kgvs. 144.2kg; -2.2kg; p=0.31). A significant decrease in TDD of insulin was observed (378 units vs. 326 units; p<0.001). There was a trend towards hypoglycemia from baseline to month 3 post addition of exenatide ER (0.33 events vs. 1.33 events; p=0.055). CONCLUSIONS: In patients treated with regular U-500 insulin, adjuvant exenatide ER therapy showed no significant improvement in HbA1C, but did show modest weight loss as well as decreased insulin requirements to achieve a HbA1C that was comparable to baseline.