Patients' needs and interests in a self-pay medication therapy management service.

OBJECTIVES: To determine patients' willingness to receive and self-pay for medication therapy management (MTM) services and to examine factors that may influence willingness to pay. METHODS: A self-administered, anonymous survey was given to a convenience sample of patients at grocery store chain pharmacies in the Chicago metropolitan area. RESULTS: 683 patients completed the survey. The average price patients were willing to pay for MTM services was $17.57. The majority of patients felt that pharmacists should provide MTM services. No correlation was found between complexity of the medication regimen and willingness to pay. Presence of certain chronic conditions and insurance status appeared to have a correlation with willingness to pay. CONCLUSION: Patients were interested in MTM services and recognize pharmacists as potential providers. Prices patients were willing to pay are similar to many prescription copay amounts.

Effects of antidepressants in patients with irritable bowel syndrome and comorbid depression.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects up to 15% of community dwelling individuals. Psychiatric comorbidities, particularly symptoms of major depressive disorder (MDD), occur in up to 90% of patients with IBS. OBJECTIVE: This article reviews the available literature on the use of antidepressants for both IBS and psychiatric depressive symptoms in patients with IBS. METHODS: MEDLINE and International Pharmaceutical Abstracts (both, 1980-May 2010) were searched for English-language publications that involved antidepressant treatment of MDD in patients with IBS. The search terms were depression, irritable, bowel, treatment, and functional. The reference lists of key articles were searched for additional pertinent articles. Randomized controlled trials published in the past 10 years were given priority. RESULTS: Of 46 articles identified by the literature search, 11 were included in the review: 4 studies of selective serotonin reuptake inhibitors (SSRIs), 4 of tricyclic antidepressants (TCAs), 1 comparing an SSRI and a TCA, 1 of the serotonin-norepinephrine reuptake inhibitor duloxetine, and a case report involving the tetracyclic antidepressant mirtazapine. Most of the identified studies excluded patients with a diagnosis of depression and/or anxiety. No controlled studies were identified in which the primary outcome was objective assessment of MDD symptoms in patients with IBS. Two of the SSRI studies, one of citalopram and the other of paroxetine, reported approximately 50% improvement in IBS symptoms (both studies, P = 0.01); the study of paroxetine reported a 30% improvement in scores on the Beck Depression Inventory (P = 0.01). The 2 studies of fluoxetine found no statistically significant benefit on IBS symptoms. TCAs were reported to have benefits on IBS symptoms, predominantly diarrhea. Only one of the TCA studies examined and found a significant improvement in depressive symptoms with desipramine 150 mg/d (P = 0.025). Both the open-label study of duloxetine and the case report involving mirtazapine found improvements in IBS and psychiatric symptoms. CONCLUSIONS: The evidence for the benefit of antidepressant treatment in patients with IBS and comorbid depression was limited and contradictory. Some anti-depressants may help symptoms of IBS, although whether the same drugs and doses are associated with improvements in concomitant depressive symptoms remains to be elucidated.