Results of a Pharmacist Intervention on Weight Parameters and A1c Compared to Standard Patient Care.

Obesity is linked to many accompanying comorbidities and has a substantial effect on the cost of health care. Pharmacist are able to provide management and intervention for the treatment of these disease states. This study examined outcomes 12 months prior to pharmacist intervention and 6 months postintervention. The primary outcome was to determine if pharmacist service intervention resulted in improved markers of weight and diabetes. This study revealed significant improvement in the HgbA1c and body mass index (BMI) from baseline (A1c 7.9%, BMI 35.3 kg/m2) to postintervention (A1c 7%, BMI 34.1 kg/m2). These results were statistically significant (P < .001, Bonferroni correction applied for multiple comparisons), indicating the clinical importance of adding pharmacists to the health care team in obesity and diabetes management.

Incorporation of yoga in pharmacy education.

BACKGROUND: The well-being of pharmacists is critical to support personal and professional health. Identifying and integrating a variety of practices that promote wellness is prudent for schools/colleges of pharmacy so students may form habits before entering the profession as practitioners. Yoga, a practice that combines muscular activity with mindfulness, can be incorporated with minimal resources via numerous mechanisms within and outside of the curriculum. METHODS: The objective was to provide a summary of various strategies incorporating yoga in pharmacy professional curricula as well as detail various approaches to integrating yoga into pharmacy curricula. Literature was evaluated across professional pharmacy programs pertaining to yoga knowledge, beliefs, approaches, and benefits. RESULTS: Ten articles about yoga awareness, knowledge, beliefs, and benefits in professional pharmacy curricula were identified. Improvement in mental health and decreased stress were recognized as benefits. Within schools/colleges of pharmacy, yoga programming has been included in required as well as elective courses, co-curriculum programming, extracurricular activities, and post-graduate training. IMPLICATIONS: Schools of pharmacy can consider incorporation of yoga practice into curricula as a tool to promote well-being and resiliency.

Well-being Content Inclusion in Pharmacy Education Across the United States and Canada.

Objective. To describe the landscape of well-being content inclusion across schools and colleges of pharmacy in the United States and Canada through identification of content implementation, incorporation, and assessment.Methods. A cross-sectional survey was distributed to all accredited schools and colleges of pharmacy in the United States (n=143) and Canada (n=10). Survey questions included curricular and cocurricular timing, frequency, assessment strategies, and support for well-being initiatives, using a framework of eight dimensions (pillars) of wellness to categorize content.Results. Descriptive data analyses were applied to 99 completed surveys (65%), 89 (62%) in the United States and 10 (100%) in Canada. Well-being content was most prevalent within the cocurricular realm and incorporated into didactic and elective more than experiential curricula. The most content came from intellectual, emotional, and physical pillars, and the least content came from financial, spiritual, and environmental pillars. Less than 50% of schools and colleges of pharmacy include well-being within their strategic plans or core values. Funding is primarily at the level of the university (59%) or the school or college of pharmacy (59%). Almost half of respondents reported inclusion of some assessment, with a need for more training, expertise, and standardization.Conclusion. Survey results revealed a wide range of implementation and assessment of well-being programs across the United States and Canada. These results provide a reference point for the state of well-being programs that can serve as a call to action and research across the Academy.

Preceptor perceptions of fourth year student pharmacists' abilities regarding patient counseling on therapeutic lifestyle changes.

OBJECTIVE: Advanced pharmacy practice experiences (APPEs) provide an opportunity for students to showcase health and wellness knowledge and skills attained during didactic education. The primary objective of this study was to assess preceptor perceptions of how well pharmacy year four (PY4) students are prepared to provide guideline-based and patient-specific therapeutic lifestyle change (TLC) counseling at onset of an APPE rotation. A secondary objective included assessment of differences in counseling abilities if the preceptor considered the student normal weight versus overweight or obese, or if they were a known smoker. METHODS: A questionnaire containing Likert questions about perceptions regarding TLC counseling was distributed electronically in October 2014 to 708 PY4 preceptors from two pharmacy schools. Only preceptors who routinely provided TLC counseling were included in data analysis that were done using descriptive statistics. The project was approved by both universities' institutional review boards. RESULTS: The survey was completed by 165 PY4 preceptors (response rate = 23.3%), and 67 met inclusion criteria. Regarding nutrition counseling, a greater percentage of preceptors agreed that students more adequately provided counseling per guidelines (79.1%) versus individual patient needs (62.6%). Preceptors perceived students of normal weight were more likely to provide adequate lifestyle-modification counseling to overweight/obese patients (81%) compared to students that were overweight/obese themselves (69%). Students of normal weight were perceived to be more likely to adequately counsel normal weight patients on lifestyle modifications (81%) compared to students that were overweight/obese (64%). Students who smoked were perceived to adequately counsel about not smoking, though, to a lesser degree than students who were non-smokers. IMPLICATIONS: While students are perceived as adequately equipped to provide guideline-based recommendations, there is room for improvement in providing patient-specific counseling. Additionally, it is perceived that student health status related to weight impacts TLC counseling.

Prevalence, Pathophysiology, and Management of Androgen Deficiency in Men with Metabolic Syndrome, Type 2 Diabetes Mellitus, or Both.

The prevalence of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) has increased in the United States over the past 40 years. These conditions, long linked with many cardiovascular complications, have recently been linked with androgen or testosterone deficiency in men. Several pathophysiologic hypotheses exist regarding this association, with the most widely reported a relationship to obesity and insulin resistance. Several randomized trials have confirmed that when testosterone replacement therapy is given to patients with T2DM, MetS, or both, metabolic parameters such as waist circumference, hemoglobin A1c , and systolic blood pressure are significantly reduced by up to 11 cm, 1.9%, and 23 mm Hg, respectively. This has not, however, resulted in improved cardiovascular outcomes, as evidenced in studies that found increased rates of cardiovascular events following testosterone replacement therapy. In this review, we summarize the relevant literature regarding the pathophysiology and management of androgen deficiency in men with T2DM, MetS, or both.

Impact of a pill box clinic to improve systolic blood pressure in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications.

BACKGROUND: Two-thirds of Americans who are prescribed antihypertensive medications are not at a blood pressure (BP) goal of <140/90 mmHg, and low adherence is identified as a primary cause of inadequate control. Improved adherence to antihypertensive medications has been shown to enhance BP control and reduce the risk of cardiovascular complications. This study investigated the effectiveness of a pill box clinic to improve BP in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications. OBJECTIVES: To (a) investigate the reduction of systolic BP by 10 mmHg from pre-intervention to post-intervention (primary outcome) and (b) investigate the percentage of patients meeting goal blood pressure--as defined by The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)--and percentage of patient adherence to antihypertensive medications (secondary outcomes). METHODS: Patients with uncontrolled hypertension currently taking at least 3 antihypertensive medications were enrolled in this prospective pre/post study. Under the supervision of a pharmacist, each patient was provided two 7-day pill boxes to organize all antihypertensive medications. In addition, baseline BP and previous history of nonadherence were documented. Following the initial encounter, patients attended 2 follow-up appointments, at 2 and 4 weeks, for refill of pill boxes, BP measurement, and adherence assessment. A chi-square test was used for categorical outcomes and logistic regression for nominal outcomes as well as descriptive statistics, as appropriate. RESULTS: Sixty patients were enrolled, with 50 completing appointments 1 and 2, and 45 completing all 3 appointments. Of those, 24% and 31% achieved at least a 10 mmHg reduction in systolic BP from baseline to appointments 2 and 3, respectively (P = 0.438). Systolic BP readings for appointments 1, 2, and 3 were not statistically significant (mean [SD]: 134.1 [11.8], 131.9 [9.4], and 130.6 [11.4], respectively). Goal BP per JNC7 was achieved by 44% and 51% of patients at appointments 2 and 3, respectively, compared with baseline (P = 0.201). All patients had ≥ 80% adherence to antihypertensive medications, assessed via pill counts at the second and third appointments. CONCLUSION: Although results were not statistically significant, the pill box clinic resulted in clinically significant reductions in systolic BP by 10 mmHg, as well as an increased number of patients meeting prescribed BP goals.