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2.
J Diabetes Metab Disord ; 18(1): 155-162, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31275886

RESUMEN

Purpose: Many patients are unknowingly living with chronic hyperglycemia, possibly due to low screening rates. We aimed to correlate detection of unidentified chronic hyperglycemia to practitioner reported rationale for conducting diabetes screening. Methods: Physicians screened patients via a point-of-care A1C tests and recorded corresponding rationales. Elevated outcomes (A1C ≥ 5.7%) were correlated to recorded rationales, frequency of repeat screenings, documented diagnoses, and therapeutic actions taken as a result of elevated A1C. Results: Nearly one-half (45%) of selected patients were unknowingly living with chronic hyperglycemia, having an average A1C of 7.92% for outcomes ≥6.5%. Most commonly recorded rationales were overweight status (71%), high-risk ethnicity (58%), and age > 45 years (48%); previously recorded A1C result of ≥5.7% (χ2 16.02, p < 0.001) and hypertension diagnosis (χ2 10.37, p = 0.0013) showed statistically significant correlation with elevated A1C outcomes. A1C results ≥6.5% versus 5.7-6.5% more frequently prompted repeat screenings (77% vs 20%), ICD-10 code documentation (91% vs 28%), lifestyle modification recommendations (78% vs 35%), and drug therapy initiation (78% vs 9%). Conclusions: Reported rationales were largely impacted by visual inspections of age, race, and weight, and prediabetic A1C values garnered less attention compared to higher values. Utilization of POC A1C screening followed by conformational repeat testing is a practical approach to improve diagnostic rates and initiation of care for diabetes.

3.
J Am Pharm Assoc (2003) ; 59(5): 736-741, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31311759

RESUMEN

OBJECTIVES: To describe a pharmacist-led diabetes prevention service piloted within an employer-based wellness program. PRACTICE DESCRIPTION: A pharmacist-led ambulatory care clinic within a school of pharmacy that provides wellness services to university employees. PRACTICE INNOVATION: Implementation of a diabetes prevention service using opportunistic A1C screening within a biometric screening program. Patients with a prediabetes-level A1C from July 2016 to March 2019 were invited to participate in the National Diabetes Prevention Program (NDPP). EVALUATION: Comparison of baseline characteristics of participants with normal and elevated A1C. Evaluation of participation in the NDPP and changes in clinical values at the subsequent biometric screening appointment for individuals with a prediabetes-level AlC. RESULTS: A1C testing of 740 individuals identified 69 participants (9.3%) with a prediabetes-level A1C and 7 (1.0%) with a diabetes-level A1C. Compared with those with a normal A1C (< 5.7%), participants with an elevated A1C were more likely to be older, nonwhite, obese, and physically inactive, to have a sibling with diabetes, higher random blood sugar (RBS), lower high-density lipoprotein (HDL), and more likely to have hypertension. Twelve patients participated in the NDPP, although most attended only 1 session. Attenders had a significantly lower baseline weight and body mass index (BMI). There were no significant differences in the changes in A1C, BMI, weight, RBS, or HDL between attenders and nonattenders approximately 1 year later. CONCLUSION: This pilot demonstrated that opportunistic A1C testing could be incorporated into an ambulatory care clinic within a pharmacist-led employer-based wellness program. Uptake and retention of the NDPP were poor. Barriers to NDPP participation need to be investigated and addressed to improve service impact.

4.
Curr Pharm Teach Learn ; 11(8): 825-831, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31227198

RESUMEN

BACKGROUND AND PURPOSE: To describe advanced pharmacy practice experience (APPE) students' active learning engagement and changes in self-reported comfort with diabetes care activities by attending an overnight camp for children with type 1 diabetes mellitus (T1DM). EDUCATIONAL ACTIVITY AND SETTING: Fourth-year pharmacy students spend one or two weeks at an overnight camp for children ages six to 18 years with T1DM as part of their APPE and assist with diabetes care activities while participating in daily living activities. Students complete a survey one week before and one week after camp where they self-report their comfort level performing 16 different diabetes-related tasks. FINDINGS: Students (n = 21) participate in hands-on active learning while volunteering at a camp for children with diabetes. Before camp, 40-61% of students reported comfort with diabetes care activities related to pharmacotherapy, monitoring, and lifestyle management. After camp, the percent of students reporting comfort with these tasks increased to 78-96%. Specific items with greatest improvement were: when to monitor ketone levels (+79%), use of insulin pens and pumps (+64%), treatment of hypoglycemia (+50%), and carbohydrate counting (+50%). SUMMARY: By attending and participating at an overnight camp for children with T1DM, APPE students self-report gain in comfort in performing many diabetes care-related tasks.

5.
Artículo en Inglés | MEDLINE | ID: mdl-31889653

RESUMEN

OBJECTIVE: To compare risk factor-based screening tools for identifying prediabetes. METHODS: Participants in an employer-based wellness program were tested for glycosylated hemoglobin (A1C) at a regularly scheduled appointment, and prediabetes risk factor information was collected. The likelihood of having prediabetes and the need for laboratory testing were determined based on 3 risk factor-based screening tools: the Prediabetes Screening Test (PST), Prediabetes Risk Test (PRT), and 2016 American Diabetes Association guidelines (ADA2016). The results from the screening tools were compared with those of the A1C test. The predictive ability of the PST, PRT, and ADA2016 were compared using logistic regression. Results were validated with data from a secondary population. RESULTS: Of the 3 risk factor-based tools examined, the PRT demonstrated the best combination of sensitivity and specificity for identifying prediabetes. From July 2016 to March 2017, 740 beneficiaries of an employer-sponsored wellness program had their A1C tested and provided risk factor information. The population prevalence of prediabetes was 9.3%. Analysis of a second independent population with a prediabetes prevalence of more than 50% of confirmed PRT's superiority despite differences in the calculated sensitivity and specificity for each population. CONCLUSION: Because PRT predicts prediabetes better than PST or ADA2016, it should be used preferentially.

6.
Am J Pharm Educ ; 82(9): 6725, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30559501

RESUMEN

Objective. To develop and establish validity for a grading rubric to evaluate diabetes subjective, objective, assessment, plan (SOAP) note writing on primary care (PC) advanced pharmacy practice experiences (APPEs), and to assess reliability and student perceptions of the rubric. Methods. Ten PC APPE faculty members collaborated to develop a rubric to provide formative and summative feedback on three written SOAP notes per APPE student over a 10-month period. Correlation analyses were conducted between rubric scores and three criterion variables to assess criterion-related validity: APPE grades, Pharmaceutical Care Ability Profile Scores, and Global Impression Scores. Inter-rater and intra-rater reliability testing were completed using Cohen's kappa and Intraclass Correlation Coefficients (ICC). Student perceptions were assessed through an anonymous student survey. Results. Fifty-one students and 167 SOAP notes were evaluated using the final rubric. The mean score significantly increased from the first to second SOAP note and from the first to third SOAP note. Statistically significant positive correlations were found between final rubric scores and criterion variables. The ICC for inter-rater reliability was fair (.59) for final rubric scores and excellent for intra-rater reliability (.98 to1.00). Students responded that the rubric improved their ability (84.9%) and confidence (92.4%) to write SOAP notes. Conclusion. The rubric may be used to make valid decisions about students' SOAP note writing ability and may increase their confidence in this area. The use of the rubric allows for greater reliability among multiple graders, supporting grading consistency.


Asunto(s)
Documentación/normas , Evaluación Educacional/métodos , Educación en Farmacia/métodos , Docentes , Retroalimentación Formativa , Objetivos , Humanos , Reproducibilidad de los Resultados , Estudiantes de Farmacia , Escritura
7.
Ann Fam Med ; 15(2): 162-164, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28289117

RESUMEN

This prospective longitudinal study compares diabetes screenings between standard practices vs systematically offered point-of-care (POC) hemoglobin A1c (HbA1c) tests in patients aged 45 years or older. Systematically screened participants (n = 164) identified 63% (n = 104) with unknown hyperglycemia and 53% (n = 88) in prediabetes. The standard practice (n = 324) screened 22% (n = 73), most commonly by blood glucose (96%); 8% (n = 6) and 33% (n = 24) were found to have diabetes and prediabetes, respectively. The association between screening outcome and screening method was statistically significant (P = 0.005) in favor of HbA1C HbA1c may be the most effective method to identify patients unknowingly living in hyperglycemia. Point-of-care tests further facilitate screening evaluation in a timely and feasible fashion.


Asunto(s)
Hemoglobina A Glucada/análisis , Hiperglucemia/diagnóstico , Tamizaje Masivo/métodos , Estado Prediabético/diagnóstico , Anciano , Alabama , Glucemia/análisis , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas en el Punto de Atención/estadística & datos numéricos , Estudios Prospectivos
9.
Diabetes Spectr ; 28(3): 201-8, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26300614

RESUMEN

A1C point-of-care (POC) instruments benefit patients with diabetes by facilitating clinician decision making that results in significant glycemic improvements. Three National Glycohemoglobin Standardization Program (NGSP)-certified POC products are available in the United States: the handheld A1CNow (formerly manufactured by Bayer Diabetes Care but now made by Chek Diagnostics) and two bench-top models called the Axis-Shield Afinion Analyzer and the Siemens DCA Vantage. This article compares the three available NGSP-certified POC products in terms of accuracy, precision, ease of use, cost, and additional features. Its goal is to aid health care facilities in conveniently identifying the A1C POC product that best meets their needs. It additionally reviews evidence that supports the continued use of A1C POC instruments in the clinical arena.

10.
Curr Med Res Opin ; 31(9): 1733-41, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26285788

RESUMEN

Type 2 diabetes mellitus (T2DM) carries a high prevalence in the United States and worldwide. Therefore, the number of medication classes being developed and studied has grown. The individualized management of diabetes is accomplished by evaluating a medication's efficacy, safety, and cost, along with the patient's preference and tolerance to the medication. Sodium glucose co-transporter 2 inhibitors are a new therapeutic class indicated for the treatment of diabetes and have a unique mechanism of action, independent of beta-cell function. The first agent approved by the Food and Drug Administration (FDA) was canagliflozin in March 2013. Two agents - dapagliflozin and empagliflozin - were FDA-approved in January and July 2014, respectively. A clear understanding of the new class is needed to identify its appropriate use in clinical practice. Members of the American College of Clinical Pharmacy Endocrine and Metabolism Practice and Research Network reviewed available literature regarding this therapeutic class. The article addresses the advantages, disadvantages, emerging role, and patient education for sodium glucose co-transporter 2 inhibitors. Key limitations for this article include limited access to clinical trial data not published by the pharmaceutical company and limited data on products produced outside the United States.


Asunto(s)
Compuestos de Bencidrilo/farmacología , Canagliflozina/farmacología , Diabetes Mellitus Tipo 2 , Glucósidos/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemiantes/farmacología , Farmacovigilancia , Estados Unidos
11.
Am J Pharm Educ ; 79(10): 149, 2015 Dec 25.
Artículo en Inglés | MEDLINE | ID: mdl-26889061

RESUMEN

Team-based learning (TBL) helps instructors develop an active teaching approach for the classroom through group work. The TBL infrastructure engages students in the learning process through the Readiness Assessment Process, problem-solving through team discussions, and peer feedback to ensure accountability. This manuscript describes the benefits and barriers of TBL, and the tools necessary for developing, implementing, and critically evaluating the technique within coursework in a user-friendly method. Specifically, the manuscript describes the processes underpinning effective TBL development, preparation, implementation, assessment, and evaluation, as well as practical techniques and advice from authors' classroom experiences. The paper also highlights published articles in the area of TBL in education, with a focus on pharmacy education.


Asunto(s)
Educación en Farmacia/métodos , Grupo Paritario , Aprendizaje Basado en Problemas , Estudiantes de Farmacia , Enseñanza/métodos , Curriculum , Escolaridad , Docentes , Retroalimentación Psicológica , Humanos , Relaciones Interpersonales , Solución de Problemas
12.
Am J Pharm Educ ; 78(7): 140, 2014 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-25258445

RESUMEN

OBJECTIVE: To adapt a classroom assessment technique (CAT) from an anthropology course to a diabetes module in a clinical pharmacy skills laboratory and to determine student knowledge retention from baseline. DESIGN: Diabetes item stems, focused on module objectives, replaced anthropology terms. Answer choices, coded to Bloom's Taxonomy, were expanded to include higher-order thinking. Students completed the online 5-item probe 4 times: prelaboratory lecture, postlaboratory, and at 6 months and 12 months after laboratory. Statistical analyses utilized a single factor, repeated measures design using rank transformations of means with a Mann-Whitney-Wilcoxon test. ASSESSMENT: The CAT revealed a significant increase in knowledge from prelaboratory compared to all postlaboratory measurements (p<0.0001). Significant knowledge retention was maintained with basic terms, but declined with complex terms between 6 and 12 months. CONCLUSION: The anthropology assessment tool was effectively adapted using Bloom's Taxonomy as a guide and, when used repeatedly, demonstrated knowledge retention. Minimal time was devoted to application of the probe making it an easily adaptable CAT.


Asunto(s)
Antropología/educación , Educación en Farmacia/normas , Conocimientos, Actitudes y Práctica en Salud , Autoinforme/normas , Estudiantes de Farmacia , Evaluación Educacional/normas , Estudios de Seguimiento , Humanos
13.
Consult Pharm ; 29(1): 53-7, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24413015

RESUMEN

The prevalence of diabetes is increasing, especially in the elderly population. Unfortunately, many seniors have limited access to ongoing health care, which may hinder improvements in these chronic disease states. Use of social media continues to increase among all populations. Thus, use of this venue to reach patients, including those with diabetes, is a reasonable undertaking. Countryside Diabetes is a Facebook page created and administered by Auburn University Harrison School of Pharmacy faculty and students to reach this growing and often underserved demographic. The aim is to provide ongoing education and support for people affected by diabetes. Information posted on the Web site began addressing usual diabetes-related topics such as nutrition, exercise, and selfcare. Each week the site focused on an individual topic, and specialists collaborated on these efforts, fortifying the site content through a multidisciplinary approach. Membership in the senior population continues to grow and garner participation.


Asunto(s)
Diabetes Mellitus/terapia , Accesibilidad a los Servicios de Salud , Educación del Paciente como Asunto/métodos , Medios de Comunicación Sociales , Anciano , Enfermedad Crónica , Conducta Cooperativa , Docentes , Humanos , Comunicación Interdisciplinaria , Internet , Estudiantes de Farmacia
14.
Am J Pharm Educ ; 76(10): 203, 2012 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-23275668

RESUMEN

OBJECTIVE: To develop and integrate an active-learning diabetes simulation into an advanced pharmacy practice experience to improve pharmacy students' empathy toward patients with diabetes mellitus. DESIGN: Students simulated the experience of having diabetes mellitus by conducting activities commonly prescribed to those with this disease state for 7 days, after which they submitted a standardized diabetes log and narrative reflection. Interpretive phenomenology design with thematic analysis was used to determine the impact of this experience on the students. ASSESSMENT: As shown in student reflections, 95% developed empathy, 97% found the experience beneficial, and 67% improved their ability to relate to and counsel patients. Most (95%) found difficulty adhering to the regimen. On average, students consumed 179 grams of carbohydrates per day and exercised 5 days or 215 minutes per week. Additionally, 69% decided to modify their personal habits to become healthier. CONCLUSIONS: Inclusion of the 7-day active-learning exercise greatly impacted student pharmacists' self-reported empathy toward and ability to relate to patients with diabetes mellitus. Completion of this experience may result in long-lasting personal behavior modifications.


Asunto(s)
Actitud del Personal de Salud , Curriculum , Diabetes Mellitus/psicología , Educación en Farmacia/métodos , Empatía , Aprendizaje Basado en Problemas , Estudiantes de Farmacia/psicología , Femenino , Humanos , Masculino , Farmacias , Relaciones Profesional-Paciente
15.
J Rural Health ; 27(2): 190-5, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21457312

RESUMEN

PURPOSE: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. METHODS: Patients struggling to afford prescription medications were referred to a clinical pharmacist by the physician or nurse practitioner for medication assistance evaluation. Once patients were deemed eligible, the pharmacist assisted in the PAPs completion process, maintained detailed records, and aided in recovery of refills. Patients paid $5 per application to cover office supply costs. An annual retrospective review was performed each December to evaluate the monetary value of free medications provided to patients during this 24-month period. FINDINGS: One hundred forty-two applications were completed, enrolling 31 patients in 22 PAPs. Patients received $138,400 worth of medications; the clinic collected $710 in fees. Antihypertensive, antidepressant, lipid-lowering, antiplatelet, and proton pump inhibitor medications were most frequently prescribed and represented 74% of the total monetary value of free medications provided to patients. Clopidogrel (Plavix) and esomeprazole (Nexium) were the most commonly requested medications, representing 16% of the monetary value. CONCLUSIONS: PAPs offer an avenue to obtain medications when cost may lead to non-adherence. PAP services helped rurally isolated Alabamians receive needed therapies they otherwise likely would not have purchased. Similar programs offering assistance services for merely cardiovascular products would provide a substantial public health impact. Providers interested in initiating similar services should identify a program coordinator, designate a private location for patient interviews, and develop systems to ensure patients receive their PAP medications.


Asunto(s)
Medicina Familiar y Comunitaria , Asistencia Médica/economía , Medicamentos bajo Prescripción , Población Rural , Industria Farmacéutica/economía , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Pobreza , Estudios Retrospectivos , Estados Unidos
16.
Am J Pharm Educ ; 74(6): 101, 2010 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-21045943

RESUMEN

OBJECTIVES: To develop and integrate a student-centered, active-learning public health discussion series into an existing advanced pharmacy practice experience (APPE) to enhance knowledge and encourage integration of public health activities into students' future careers. DESIGN: Students participated in 3 hour-long discussions to define and identify the scope of public health and to examine public health initiatives outside of and within health care. ASSESSMENT: Improvement in the ability to accurately define public health was observed after students participated in the discussion series compared to baseline. Post-discussion definitions were more broad and accurate. Unsolicited comments about the discussion series documented in post-APPE reflections described students' initial lack of knowledge, improved knowledge base, and improved interest in participating in public health initiatives. CONCLUSIONS: Time devoted to public health discussions during an APPE can substantially impact student pharmacists' knowledge base and interest in public health. Additionally, this active-learning technique aids in meeting the Accreditation Council for Pharmacy Education (ACPE) public health standards.


Asunto(s)
Educación en Farmacia/métodos , Salud Pública/educación , Estudiantes de Farmacia , Acreditación , Educación en Farmacia/normas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Aprendizaje Basado en Problemas/métodos , Estados Unidos
17.
J Am Pharm Assoc (2003) ; 50(4): 485-9, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20621866

RESUMEN

OBJECTIVE: To assess patient knowledge regarding acetaminophen dosing, toxicity, and recognition of acetaminophen-containing products. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: Alabama, January 2007 to February 2008. PATIENTS: 284 patients at four outpatient medical facilities. INTERVENTION: 12-item investigator-administered questionnaire. MAIN OUTCOME MEASURES: Degree of patient knowledge regarding acetaminophen safety, dosing recommendations, toxicity, alternative names and abbreviations, and products. RESULTS: Two-thirds of the 284 patients completing the survey reported current or recent use of pain, cold, or allergy medication. Of these, 25% reported knowing the active ingredient. Of patients, 46% and 13% knew that "acetaminophen" and "APAP," respectively, were synonymous with "Tylenol." Several patients (12%) believed that ingesting a harmful amount of acetaminophen was difficult or impossible. One-third of patients correctly identified the maximum daily dose, 10% reported a dose greater than 4 g, 25% were unsure of the dose, and 7% were unsure whether a maximum dose existed. One-half recognized liver damage as the primary toxicity. Results were similar between acetaminophen users and nonusers. CONCLUSION: Deficiencies were found in patient knowledge regarding acetaminophen recognition, dosing, and potential for toxicity. The development of effective educational initiatives is warranted to ensure patient awareness and limit the potential for acetaminophen overdose.


Asunto(s)
Acetaminofén/administración & dosificación , Acetaminofén/efectos adversos , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Etiquetado de Medicamentos , Conocimientos, Actitudes y Práctica en Salud , Adulto , Anciano , Anciano de 80 o más Años , Alabama , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Encuestas y Cuestionarios , Adulto Joven
18.
Pharm. pract. (Granada, Internet) ; 7(4): 213-217, oct.-dic. 2009. tab, ilus
Artículo en Inglés | IBECS | ID: ibc-75186

RESUMEN

Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution. Methods: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC) Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED) visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. Results: A total of 145 patients were included in the data collection from the two clinics. The majority (41%) of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 %) of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post- implementation of POCT device. Conclusion: The results of this study demonstrate improvement in patient satisfaction with POCT compared to venipuncture, with limited value in clinical outcomes (AU)


Hasta hace poco, las mediciones del tiempo de protombina/Ratio normalizado internacional (TP/RIN) se utilizaban típicamente para monitorizar pacientes con warfarina mediante laboratorios institucionales vía extracción venosa. Los aparatos de test en punto de atención (POCT) han revolucionados los procesos de cuidados de los pacientes permitiendo los análisis fuera del laboratorio central. Objetivo: Analizar los resultados humanísticos y clínicos en pacientes actualmente tratados con warfarina y monitorizados en una clínica de anticoagulación que usa aparatos de test en punto de atención (POCT) contra la venopunción en clínicas ambulatorias en nuestra institución. Métodos: Se incluyó a todos los pacientes tratados con warfarina que eran seguidos por farmacéuticos para monitorización de la anticoagulación en Centro de Medicina Familiar y en el Centro de Diagnóstico Universitario de la Universidad Médica de Carolina del Sur (MUSC). Se pidió a los pacientes que rellenasen un cuestionario de satisfacción relativo a su monitorización de anticoagulación. Además, se recogieron los datos relativos a las visitas a urgencias, hospitalizaciones y porcentaje de tiempo con RIN en margen terapéutico durante los 6 meses pre- y post-implantación del aparato POCT. Esta información se obtuvo a través de la base de datos electrónica de información de pacientes, Oacis. Resultados: Se recogió información de un total de 145 pacientes entre las dos clínicas. La mayoría (45%) de estos pacientes utilizaban la warfarina para fibrilación auricular. Los cuestionarios de satisfacción fueron completados por 86 (59%) pacientes. Los cuestionarios revelaron que el aparato de POCT era preferido sobre la venopunción por el 95% de os pacientes. Los motivos de preferencia incluyeron una interacción más personalizada, menor tiempo de espera, menos dolor, menos sangre requerida, y resultados más rápidos. De los 145 pacientes incluidos en el análisis de datos objetivos, no hubo diferencias significativas en el número de hospitalizaciones, visitas a urgencias, ni porcentaje de tiempo en el margen terapéutico de RIN pre- y post-implantación del aparato de POCT. Conclusión: Los resultados de este estudio demuestran un incremento en la satisfacción del paciente con el POCT comparado con la venopunción, con una escasa influencia en los resultados clínicos (AU)


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Satisfacción del Paciente , Monitoreo de Drogas/métodos , Monitoreo de Drogas/tendencias , Servicios Farmacéuticos/organización & administración , Servicios Farmacéuticos , Estudios de Evaluación como Asunto , Estados Unidos/epidemiología , Warfarina/uso terapéutico , Encuestas y Cuestionarios
19.
Pharm Pract (Granada) ; 7(4): 213-7, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25136396

RESUMEN

UNLABELLED: Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. OBJECTIVE: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution. METHODS: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC) Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED) visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. RESULTS: A total of 145 patients were included in the data collection from the two clinics. The majority (41%) of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 %) of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post-implementation of POCT device. CONCLUSION: The results of this study demonstrate improvement in patient satisfaction with POCT compared to venipuncture, with limited value in clinical outcomes.

20.
Int Med Case Rep J ; 1: 3-5, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-23745054

RESUMEN

PURPOSE: To describe a case of hypoglycemia induced by off-label use of sitagliptin in an adult patient with type 2 diabetes. CASE SUMMARY: Addition of sitagliptin to metformin, glimepiride, and NovoLog(®) 70/30 Mix induced hypoglycemia in a 55-year-old Caucasian female. Hypoglycemia improved, although still occurred periodically, following sulfonylurea discontinuation and a 28% insulin dose reduction. Hypoglycemic symptoms were absent during a 3-day dechallange but occurred again upon sitagliptin reinitiation. DISCUSSION: Although the mechanism of action of sitagliptin does not predispose patients to hypoglycemic events, when combined with hypoglycemia-inducing medications, eg, sulfonylureas or insulin, and possibly meglitinides, the incidence likely increases. CONCLUSIONS: Caution should be used when combining sitagliptin with either sulfonylureas or insulin, and possibly meglitinides, for the treatment of type 2 diabetes as hypoglycemia may ensue. Hypoglycemia due to off-label combinations with insulin and sitagliptin may be prevented by reducing meal-time insulin doses. Prescribers and patients should vigilantly monitor for hypoglycemic events when using sitagliptin off-label with similar pharmacologic combinations such as meglitinides and other rapid-acting insulin products. Additionally, clinicians may encounter resistance from insurance companies to cover such off-label combinations.

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