Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma.

OBJECTIVES: To determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers' knowledge of asthma is described. DESIGN: This study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients' homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SETTING: A local Medicaid managed care organization. PARTICIPANTS: Pediatric African American patients (4-17 years old) with uncontrolled asthma. MAIN OUTCOME MEASURES: Outcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. RESULTS: Overall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. CONCLUSION: Rates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.

Provision of Medication Therapy Management by Pharmacists to Patients With Type-2 Diabetes Mellitus in a Federally Qualified Health Center.

BACKGROUND: Type-2 diabetes mellitus is a complex condition for which pharmacists are well suited to improve patient outcomes by delivering medication therapy management (MTM) services. When diabetes is well controlled, patients can avoid its long-term complications, such as cardiovascular and renal diseases. This article describes an MTM pilot program that was implemented at a federally qualified health center (FQHC). METHODS: This program was implemented at three clinics involving patients with uncontrolled diabetes, defined as hemoglobin A1c (HbA1c) greater than 8%. The primary endpoint assessed was HbA1c. Secondary endpoints included knowledge scores, medication adherence, and patient satisfaction. Outcomes were compared with a group of patients from the same clinics who did not receive MTM. RESULTS: Fifty-seven patients met the established criteria and were enrolled in the six-month program. Thirty-seven patients completed the program and had an average 15% reduction in HbA1c (P < 0.05). Their average knowledge scores and medication adherence scores also increased from baseline. CONCLUSION: MTM provided by pharmacists as part of a health care team at an FQHC led to significant reductions in HbA1c.

Dapagliflozin: A Sodium Glucose Cotransporter 2 Inhibitor for the Treatment of Diabetes Mellitus.

OBJECTIVE: To review clinical evidence for the efficacy, safety, and tolerability of dapagliflozin (Farxiga-AstraZeneca), a sodium glucose cotransporter 2 inhibitor, as monotherapy or in combination with other hypoglycemic agents for the treatment of type 2 diabetes. DATA SOURCES: Literature was identified through a systematic MEDLINE search of clinical trial results for dapagliflozin. DATA SYNTHESIS: Multiple controlled clinical trials have established the efficacy, safety, and tolerability of dapagliflozin as monotherapy or in combination with other therapies for type 2 diabetes. Dapagliflozin is approved by Food and Drug Administration as monotherapy or as an add-on to other glucose lowering agents including insulin for the treatment of type 2 diabetes. CONCLUSION: Dapagliflozin is effective for the treatment of type 2 diabetes.

Albiglutide: A once-weekly glucagon-like peptide-1 receptor agonist for type 2 diabetes mellitus.

PURPOSE: The pharmacology, pharmacokinetics, efficacy, safety, dosage and administration, and place in therapy of the glucagon-like peptide-1 (GLP-1) receptor agonist albiglutide are reviewed. SUMMARY: Albiglutide (Tanzeum, GlaxoSmithKline) is an injectable GLP-1 agonist approved in 2014 for use as an adjunct to diet modification and exercise to improve glycemic control in adults with type 2 diabetes. Albiglutide augments glucose-dependent insulin secretion and slows gastric emptying; it has an elimination half-life of approximately five days, allowing for once-weekly administration. Clinical trials demonstrated mean absolute reductions in glycosylated hemoglobin (HbA1c) values of 0.78-1.55% after 16 weeks of adjunctive therapy with albiglutide. Specific recommendations on albiglutide use have been issued by the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA). Studies show that the potential for hypoglycemic episodes with albiglutide use is low. In clinical trials, the most frequently reported adverse events were nausea and diarrhea. The use of albiglutide is contraindicated in patients with a history of pancreatitis and patients with a personal or family history of thyroid cancer. CONCLUSION: Albiglutide has been shown to be effective for the management of type 2 diabetes in adults and is recommended (by ADA) as second-line therapy when used in combination with metformin and (by AACE) as first-line monotherapy in patients with an HbA1c concentration of ≤7.5% at treatment initiation. In clinical trials, albiglutide was generally well tolerated by patients, with adverse effects comparable to those seen with other GLP-1 agonists.