An experiment using hypothetical patient scenarios in healthy subjects to evaluate the treatment satisfaction and medication adherence intention relationship.

BACKGROUND: Treatment beliefs and illness consequence have been shown to impact medication adherence in patients with years of asthma experience. These relationships are unknown in patients with early experience. OBJECTIVE: The purpose was to test the relationship between illness consequence, treatment beliefs, treatment satisfaction and medication adherence intentions in healthy subjects exposed to an asthma scenario. METHODS: A 2×2×2 factorial design experiment was conducted in 91 healthy University student subjects. Each student was randomized to receive one scenario with varying levels of illness consequence (high/low), treatment concerns (high/low) and treatment necessity (high/low). After reading the scenarios the students responded to questions about treatment satisfaction and likelihood of using the medication as directed by the physician. A multiple regression model was used to test the impact of factors on treatment satisfaction and medication adherence at the 0.05 level of significance. RESULTS: Treatment satisfaction was significantly predicted by treatment necessity with a moderating effect by illness consequence. Medication adherence intentions were significantly predicted by treatment satisfaction. CONCLUSION: Patients with early diagnosis of asthma are likely to form treatment satisfaction as a result of illness consequence and treatment necessity. Patients' perceptions of illness consequence are likely to influence (moderate) the impact of treatment necessity on treatment satisfaction; and their intentions to take medication as directed are likely to be influenced by treatment satisfaction rather than treatment beliefs or illness consequence early in the patient illness experience. These results are from an experiment that should be tested in a patient population.

Evaluation of a dedicated pharmacist staffing model in the medical intensive care unit.

PURPOSE: Published studies have shown that pharmacists on medical rounds reduce the incidence of preventable adverse drug events (ADEs). However, the impact of a dedicated pharmacist who provides consistent patient care in a critical care unit remains to be evaluated. OBJECTIVE: To determine the impact of a pharmacist who is permanently assigned to the medical intensive care unit (MICU) on the incidence of preventable ADEs, drug charges, and length of stay (LOS) in the MICU. DESIGN: A randomized, experimental versus historical control group design was used. Preventable ADEs were identified and validated by 2 pharmacists and a critical care physician. Information about MICU drug charges and LOS were obtained from the hospital administrative database. RESULTS: The intervention group had fewer occurrences of ADEs (10 ADEs/1,000 patient days) when compared to the control group (28 ADEs/1,000 patient days) at a significance level of .03. No significant differences were found between the 2 groups in MICU drug charges and LOS. The vast majority of the 596 documented recommended interventions (99%) were accepted by the medical team. Nutrition monitoring, medication indicated but not prescribed, and dosage modification were the top 3 problems identified by the pharmacist. CONCLUSION: The addition of a dedicated critical care pharmacist to the MICU medical team improves the safe use of medication. The services of a dedicated critical care pharmacist should be expanded to include weekend hours to ensure the benefits of improved medication safety.

Patient desire to be involved in medication treatment decisions.

OBJECTIVES: To identify unmet needs of patients taking medications for chronic health conditions and identify medication-related services that patients with chronic health conditions would desire. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: Large midwestern state in spring 2010. PARTICIPANTS: 465 patients 45 years or older taking one or more prescriptions for chronic health problems. INTERVENTION: Cross-sectional survey. MAIN OUTCOME MEASURES: Patient-reported usefulness of, satisfaction with, and intention to use medication-related services. RESULTS: Respondents wanted to be highly involved in treatment decisions but found medication information they received to be moderately useful and satisfactory. Medication-related services fell into three groups based on reported intention to use: therapy advice, cost advice, and medication organization. Desire to be involved in treatment decisions was a key factor in predicting reported intention to use therapy advice and cost advice services. The perceived affordability of medications was another important factor in patients' intention to use cost advice and medication organization services. Age, chronic conditions, number of prescription drugs, and the cost of therapy were not important in predicting the intention to use medication-related services in this population. CONCLUSION: Patient desire to be involved in treatment decisions was a key factor in explaining intention to use medication-related services. Identifying individuals with desire for involvement in treatment decisions may increase medication therapy management (MTM) participation. Strategies to provide personalized MTM services to these individuals should be developed and evaluated.

Employer-based patient-centered medication therapy management program: evidence and recommendations for future programs.

OBJECTIVE: To evaluate a patient-centered employer-based medication therapy management (MTM) program. DESIGN: Randomized controlled study. SETTING: Health promotion program at the University of Michigan from June 2009 to December 2011. PARTICIPANTS: Employees, retirees, and their dependents taking seven or more prescription medications. INTERVENTION: Focus on Medicines (FOM) was a two-visit, patient-centered service with a 4-month follow-up. A comprehensive medication review occurred during the first visit. Pharmacists provided recommendations and a medication action plan at the second visit. The MAP incorporated patient preferences for problem resolution. MAIN OUTCOME MEASURES: Patient uptake, medication cost, medication adherence, patient satisfaction with treatment, patient reasons for participation, patient satisfaction with the FOM program, drug-related problems, pharmacist recommendations, implementation of recommendations. RESULTS: The FOM program attracted 128 individuals wanting information about their medications and an individualized drug regimen assessment to ensure that their therapy was safe and effective and that all medications were necessary. On average, 3.3 medication therapy problems were identified per patient; most were safety related. Overall, 63% of pharmacist recommendations were implemented. When a prescriber was contacted, 83% of pharmacist recommendations were implemented. A reduction in drug cost for patients and the employer was shown. Patients reported improved convenience in taking medications and rated the program favorably. CONCLUSION: A personalized dialogue about medication use appears to meet a need among individuals taking large numbers of medications. Understanding why patients participate in MTM programs and what program features patients appreciate is useful in designing quality MTM programs.

Risks, benefits, and issues in creating a behind-the-counter category of medications.

OBJECTIVE: To examine the issues surrounding the development and implementation of a behind-the-counter (BTC) category of medications. DATA SOURCES: Testimony from organizations submitting comments to the Food and Drug Administration (FDA) panel hearings in November 2007, the 2009 final report of the U. S. General Accounting Office regarding a BTC drug category, literature review of research that has been conducted, experiences from other countries, and publically available information from agencies in charge of regulating medications similar to BTC. SUMMARY: Based on evidence attained from the current work, the following six recommendations regarding a BTC category of medications are provided. (1) Demonstration needs to occur that the risks and/or costs of BTC are outweighed by benefits, positive measurable outcomes, and financial savings to society. (2) Sufficient resources, including personnel, equipment, and facilities, need to be available for the appropriate provision of BTC services and to ensure ongoing monitoring and controls. (3) An appropriate compensation structure needs to be developed. (4) Encounters and outcomes should be documented in an electronic record, the information should be shared with other health care providers involved in patients' care, and interprofessional collaboration and communication should occur. (5) Criteria for designating candidates for transition, ongoing review for safety, and reverse transition must be developed. (6) Applicable lessons learned from other countries should be incorporated into BTC strategies. In addition to implementation recommendations, we also summarize additional evidence that needs to be gathered to optimize the BTC model. CONCLUSION: Based on the accumulated evidence, comments to FDA's request, and information from other countries, implementation of a BTC model probably is feasible in the United States. However, the optimal model remains uncertain and various aspects of a program need to be prioritized and rigorously tested.

Evaluating medication-related services in a hospital setting using the disconfirmation of expectations model of satisfaction.

BACKGROUND: Patient satisfaction is considered an important outcome measure of services and associated with behavioral intentions. The appraisal process commonly used in satisfaction models is the disconfirmation of expectations. A patient compares his or her experience to preexisting expectations. The resulting satisfaction from this comparison is dependent on whether the patient's expectations are superior, inferior, or just as expected. OBJECTIVES: The aims of this study were to (1) determine the relationship between disconfirmation of expectations with medication-related services and patient satisfaction with medical care; and (2) determine if patient satisfaction is related to the likelihood to say good things about the medical care provided at the hospital to family and friends. METHODS: A cross-sectional, nonexperimental study design was implemented to test the disconfirmation of expectations model. Patients on warfarin therapy and recently discharged from an acute care hospital to their homes were surveyed by mail. The survey asked about how well the hospital services related to medication therapy met patient expectations. Satisfaction with medical care and the likelihood of positive word of mouth regarding the medical care were also measured. Structural equation modeling (SEM) was used to test the model. RESULTS: The survey response rate was 34% (n=187). Factor analysis of the 7 disconfirmation of expectation items resulted in a 2-factor solution: (1) medication counseling and (2) discharge medication services. The SEM demonstrated that the model was significant; however, the disconfirmation of expectation items did not significantly relate to the 1-item satisfaction measure. Patient satisfaction and the behavioral intentions measures were significantly related. A post hoc analysis using SEM demonstrated that the disconfirmation of expectations factors did significantly relate to a higher-order latent construct. This construct also related to patient satisfaction. CONCLUSION: The disconfirmation of expectations has a role in a postservice experience response expressed by the patient, but not as a direct antecedent to patient satisfaction. Opportunities to improve the model are the use of a multi-item satisfaction measure and the inclusion of patient affect.

Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units.

BACKGROUND: Previous studies found that medication errors result from lack of sufficient information during the prescribing step. Therefore, it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events (ADEs). The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process. METHODS: A single-blind, standard care-controlled study design was used to compare patients receiving care from a rounding team including a pharmacist with patients receiving standard care (no pharmacist on rounding team). Patients admitted to and discharged from the same general medicine unit were included in the study. The main outcome measure of this study was preventable ADEs. Patient records were randomly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician. Interventions made by the pharmacists in the treatment group were documented. RESULTS: The rate of preventable ADEs was reduced by 78%, from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days. There were 150 documented interventions recommended during the rounding process, 147 of which were accepted by the team. The most common interventions were (1) dosing-related changes and (2) recommendations to add a drug to therapy. CONCLUSION: Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs.

Evaluation of pharmacists' services for hospital inpatients.

Patient satisfaction with pharmacist-conducted weekly medication-education classes and the underlying factor structure of the evaluation items are described. The pharmacist service consisted of weekly, one-hour classes for headache sufferers in a tertiary headache clinic's hospital unit. One pharmacist taught all of the classes and conducted them in the same manner each week, using the Indian Health Service patient-counseling technique. The classes included both lecture and one-on-one interactions. Any patient admitted to the hospital's headache unit was eligible to participate in the study. Patients were asked to complete a survey at the end of the class, evaluating the service in terms of performance, disconfirmation of expectations, affect, equity, and self-efficacy by rating three statements about each of these on a 7-point scale, where 1 = very strongly disagree and 7 = very strongly agree. Exploratory factor analysis was used to investigate the degree to which these five evaluation areas were distinct constructs. A total of 157 patients attended a medication-education class during the study period. Of these, 153 (97%) provided usable data. Respondents favorably evaluated the pharmacist service, as the means were significantly greater than the scales' midpoint scores (p < 0.001). Factor analysis results suggested that covariation in the data was best described by four factors rather than five: (1) performance, (2) disconfirmation of expectations, (3) equity, and (4) self-efficacy. Inpatients attending pharmacist-conducted weekly medication-education classes favorably evaluated the pharmacist service. Four different conceptualizations of patients' evaluations were identified.

A review of published studies of patients' illness perceptions and medication adherence: lessons learned and future directions.

BACKGROUND: Patients who seek medical care and who are prescribed medication may choose to either accept or not accept the prescriber's recommendations to use the prescribed medication. The Common Sense Model (CSM) is one behavioral model that can help researchers and practitioners to identify patients' illness perceptions that drive their decisions. OBJECTIVE: This article reviews published research that evaluated the impact of illness representations (as defined in CSM) with medication adherence. METHODS: A narrative review of published research in illness representation and medication adherence was conducted. Articles were searched using MEDLINE, PreMEDLINE, evidence-based medicine reviews, and the International Pharmaceutical Abstracts databases and using the search terms medication adherence, compliance, illness perception, self-regulation theory, and common-sense model. RESULTS: Eleven published studies were identified that compared illness representation (or illness perception) and medication adherence. Each illness representation factor, with the exception of illness coherence, directly or indirectly impacted medication adherence. Illness identity, where symptoms are used to label a health condition, can impact medication adherence, even with asymptomatic conditions such as hypertension. Patient age, disease condition, and culture may impact patient response to illness perceptions. Recommendations for future research are to (1) use longitudinal studies to evaluate the cause-effect relationships between illness perceptions and medication adherence, (2) study patients' early experiences with their illness, (3) recruit patients who are nonadherent, (4) use clinical outcome measures in addition to the self-report medication adherence measures, and (5) include patient age and culture in the model. CONCLUSIONS: Although the CSM is a well-known patient behavior model, its use to explain medication adherence has been limited to cross-sectional studies across various health conditions. Further research is needed to elucidate the relationships between illness perceptions and patient medication adherence, which can help practitioners to better engage and communicate with patients.

Exploring patient experiences with prescription medicines to identify unmet patient needs: implications for research and practice.

BACKGROUND: Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients' unmet needs when taking prescribed medications. OBJECTIVE: To identify and characterize patients' unmet needs related to using prescribed medication for chronic conditions. METHODS: Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis. RESULTS: Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved. CONCLUSION: The results were consistent with Dowell's therapeutic alliance model (TAM) and Leventhal's common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients' desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients' perceptions of illness and desired coping strategies.

Prevalence and predictors of utilization of community pharmacy generic drug discount programs.

BACKGROUND: Since 2006, select pharmacies in the United States have been offering programs where prescriptions for certain generic medications can be filled at very low cost (e.g., a 30-day supply for $4). However, limited knowledge exists on the characteristics of patients who have used these services. OBJECTIVE: To examine the prevalence of use of community pharmacy generic drug discount programs and the characteristics of patients using these programs. METHODS: Two cross-sectional surveys of patients in a university-affiliated health system general medicine clinic were conducted over an approximately 4-week period in the summers of 2008 and 2010. The survey measured self-reported information in 3 parts: a listing of current medications, questions about program use, and patient demographics. The survey was administered to patients as they were waiting to see their physicians with a research assistant on-site for assistance and to collect the completed surveys. Medications listed by patients were classified as acute or chronic by pharmacists on the research team. Descriptive statistics (Pearson chi-square or Student's t-tests) were used to compare subjects across years and between groups of discount program users and nonusers. Logistic regression models were constructed to identify significant predictors of program use, testing demographic factors, prescription drug coverage, number of medications, monthly out-of-pocket payments, and year of the survey. RESULTS: The convenience sample included 414 individuals overall, 203 in 2008 and 211 in 2010. After excluding respondents who did not answer all survey questions, the sample size was 311 (n = 148 in 2008 and 163 in 2010). The sample was mostly Caucasian; most patients had prescription coverage; and a large majority of medications filled were for chronic use. Patient characteristics were similar in the 2 groups except for a higher mean number of self-reported medications in 2010 than 2008 (4.2 vs. 3.4, respectively, P = 0.01). Use of a discount medication program was reported by 52 (31.9%) of those surveyed in 2010 compared with 7 (4.7%) in 2008 (P less than 0.001). When both groups were combined, factors associated with use of generic drug discount programs included filling prescriptions for a higher number of medications (odds ratio [OR] =1.13, 95% CI =1.01-1.27, P =0.036) and the year of the survey (OR for 2010 =9.02, 95% CI =3.8221.29). Differences in program use were also observed among categories of age and income. CONCLUSIONS: Over a 2-year period, there was an increase in the use of discount generic medication programs in this university clinic population. Patients who take more prescription medications are more likely to choose such plans, and differences in program use were observed between ranges of age and income. More extensive analysis is needed to better predict patient use of such services.

Examining determinants of self management behaviors in patients with diabetes: an application of the Theoretical Model of Effortful Decision Making and Enactment.

OBJECTIVE: This study examined determinants of self-monitoring of blood glucose (SMBG) in patients with diabetes based on a theoretical model. The model focuses on two equally important components of the decision process within a single framework: (1) making a decision and (2) enacting the decision. METHODS: Diabetes patients with HbA1c >7% and requiring insulin therapy were recruited from a southeastern Michigan healthcare system. Responses were elicited using a mail-in questionnaire. SMBG was measured using a two-week diary and two recall measures. The applicability of the theoretical model as it relates to SMBG was tested using structural equation modeling (SEM). RESULTS: The SEM analysis demonstrated that goal desire is an antecedent to goal intentions and that implementation desire and implementation intentions mediate the path between goal intentions and SMBG. Further, implementation intentions are a significant predictor of SMBG. CONCLUSION: Consistent with the theoretical model, results indicated that implementation desire and implementation intentions mediate the relationship between strength of goal intention and performing specific behaviors to achieve the goal. PRACTICE IMPLICATIONS: It is evident that in order to be more effective, educational programs or interventions should consider incorporating implementation and action plans to help patients translate decisions and intentions into behavior.

Integrating medication therapy management in the primary care medical home: A review of randomized controlled trials.

PURPOSE: Randomized controlled trials (RCTs) that evaluated the effect of medication therapy management (MTM) on patient outcomes in the primary care medical home were reviewed to determine how these services may be integrated into the primary care medical home. METHODS: A literature search was conducted to identify RCTS published between 1989 and 2009 that evaluated the impact of MTM services on patient outcomes. To qualify as MTM services, the interventions had to include both a review of medication therapy and patient interactions, including educating patients about drug therapy, identifying potential barriers to medication adherence, and helping patients manage their diseases. The internal validity of the studies was evaluated using previously published criteria. The description, specification, and appropriateness of study objectives, study population, intervention, randomization, blinding, outcome measures, statistical analysis, and conclusions were evaluated. RESULTS: A total of 1795 publications were identified, but only 8 met the inclusion criteria. These studies targeted patients with specific medical conditions or patients with multiple medications without specifying a medical condition. The interventions varied in intensity (i.e., frequency and length of patient contact), ranging from a single patient contact in a community pharmacy setting to multiple visits with an ambulatory care pharmacist practicing in a collaborative care model. Two of the 8 studies obtained expected results. These studies targeted patients with unrealized therapeutic goals, and the interventions involved collaboration between pharmacists and physicians and extensive patient follow-up. CONCLUSION: Of 1795 publications identified, 8 were RCTs meeting selection criteria for evaluation of the effect of MTM services on patient outcomes. Two service elements that benefit patient care were identified: (1) selecting patients with specific therapeutic problems and (2) implementing MTM services that involve timely communication with primary care providers to discuss therapeutic problems, along with routine patient follow-up to support medication adherence to changes in therapy.

A simple and promising tool to improve self-monitoring of blood glucose in patients with diabetes.

AIM: To examine patient formation of implementation plans, a volitional strategy, and its influence on self-monitoring of blood glucose (SMBG). METHODS: A randomized experimental-control design over a 2-week time period was used. The study population was diabetes patients with HbA1c >7% and requiring insulin therapy. Patients were recruited from a southeastern Michigan healthcare system. A self-administered intervention was designed to assist patients to formulate plans to perform SMBG. The primary outcome measure was SMBG rates. Three control groups were used to control for testing effects. Hypotheses were tested using ANOVA at a significance level of 0.05. SMBG was measured using a 2-week diary and two recall measures. RESULTS: There were 402 patients with diabetes recruited for the study. Analyses indicated that making implementation plans increased SMBG rates as assessed by a diary and two recall measures. The patients in the experimental group checked their blood sugar up to 7.77 times more than the control groups (sig<0.05) over a 2-week time period as measured by the diary. CONCLUSIONS: Patient behavior can be impacted by using an implementation planning tool. This technique can help improve patient self-monitoring behavior.

Using self-regulation theory to examine patient goals, barriers, and facilitators for taking medication.

BACKGROUND: : Self-regulation theory predicts that patient behavior is determined by the patient's assessment of his/her condition (illness presentation) and related health goals. Patients will adapt their behavior to achieve those goals. However, there are multiple levels of goals. In such cases, those lower-level goals (health goals) that are strongly correlated with higher-level goals (i.e. quality of life [QOL]) are more likely to drive patient behavior. Medication non-compliance is a health behavior that challenges healthcare practitioners. Thus, the primary aim of this paper is to explore the relationship between the lower-level goals for taking medication with higher-level goals. This paper also identifies patient-perceived barriers and facilitators toward achieving goals as they may relate to patients' illness representation. OBJECTIVES: : To identify lower- and higher-level goals associated with medication use for chronic conditions. To determine if there is a relationship between higher-level (global) goals and lower-level (health-related) goals. To identify patient-perceived facilitators and barriers to achieving those goals. METHODS: : This was a prospective, observational study using a mailed survey. The setting was a US Midwestern state-wide survey. Participants were patients living in the community with hypertension, heart disease, diabetes mellitus, or arthritis, and taking prescription medication for any one of those conditions. The main outcome measures were lower- and higher-level goals related to medication use. The survey asked the participants if they had achieved their goals and to identify factors that may pose as barriers or facilitators to achieving them. Pearson correlation was used to test the relationship between the lower- and higher-level goals at p < 0.05. RESULTS: : Responses from 292 qualifying patients were obtained. A significant relationship between lower- and higher-level goals existed (p = 0.03). Preventing future health problems was the most important lower-level goal for almost half of the respondents. Approximately 43% of the respondents said 'improving or maintaining quality of life' was their most important higher-level goal. Elderly respondents (65 years or older) said that being able to carry out daily activities on their own was their most important higher-level goal. To achieve this goal, they identified 'preventing future health problems' as the associated lower-level goal. One-third of the respondents stated that they had not yet achieved their medication-related goals. Patients identified good communication with their physicians (35%), the effectiveness of the drug product (32%), and their ability to monitor their condition (20%) as important factors toward helping them achieve their goals. Medication costs (30%), drug adverse effects (25%), and the lack of drug effectiveness (22%) were factors that patients identified as barriers to achieving their goals. CONCLUSION: : There is a significant and positive relationship between the lower- and higher-level goals. Healthcare providers can work with their patients to achieve their goals. Both good communication with the prescriber and the effectiveness of the drug product were identified as the most important facilitator by one-third of the respondents. Future research should study if relating the impact of good symptom control or the reduction of future health risks to QOL or longevity, as deemed relevant by the patient, influences medication adherence behavior.

Satisfaction with current health status in patients with a history of acute coronary syndrome.

OBJECTIVE: To describe satisfaction with current health status in patients with a recent history of an acute coronary syndrome (ACS) event and to determine the association between satisfaction and patient-specific variables. RESEARCH DESIGN AND METHODS: Patients from an ACS registry who were discharged from a university affiliated hospital over a 3-year period were mailed the study questionnaire. MAIN OUTCOMES MEASURES: Data included demographics, cardiac-specific measures, and general health status (SF-8 PCS, MCS and the EQ-5D VAS) and health status preference weight (EQ-5D Health Index). Satisfaction with current health status was assessed by a single question derived for this study with a 5-point Likert scale from 'not satisfied at all' to 'highly satisfied.' ANOVA determined the association between levels of satisfaction and health status scores. A multivariate linear regression model determined the association of patient, disease, and treatment variables with satisfaction. Independent variables were determined to be significant if the p-value in the model was <0.05. RESULTS: Respondents (490, 40.3% response rate) averaged 65.2 +/- 11.3 years of age; 71% male; 92% Caucasian; 64% with MI history; and 17% had their most recent cardiac event within 6 months. 63% of respondents were either mostly satisfied or highly satisfied with there current health status. Based on level of satisfaction, the mean PCS ranged from 36.9 +/- 8.9 to 63.0 +/- 6.2; mean MCS from 38.3 +/- 13.1 to 55.7 +/- 5.7; mean EQ-5D VAS from 37.0 +/- 21.7 to 90.8 +/- 20.7, and mean EQ-5D Health Index from 0.38 +/- 0.3 to 0.93 +/- 0.14, all ANOVA models p < 0.001. Statistically significant independent variables in the multivariate linear regression model included the number of symptoms, DASI cardiac function score, perceived severity of disease, and age. Satisfaction with current health state was associated with older age, fewer symptoms, better DASI cardiac function scores, and lower perceived severity of illness. CONCLUSION: Health-related quality of life, or health status, and satisfaction with health status have a direct, positive association. Greater burden of illness and younger age were significantly associated with dissatisfaction with health status. Extrapolation of results is limited to determining association but not causation due to the cross sectional study design.

Impact of the clinical pharmacist on readmission in patients with acute coronary syndrome.

BACKGROUND: Previous studies have reported a positive impact of pharmacists on care of patients with chronic illnesses. The impact of the clinical pharmacist on hospital readmission in patients with acute coronary syndromes (ACS) has yet to be evaluated, as of this writing. OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on cardiac-related readmission in patients admitted to the general cardiology unit with ACS. METHODS: A prospective, nonrandomized observational study compared patients who received standard practice care with patients admitted to a service with a clinical pharmacist to provide care at the bedside. Patients admitted to and discharged from the general cardiology unit for ACS were included. The primary endpoint of the study was cardiac-related readmission at 30 days following hospital discharge. Secondary endpoints included length of stay and medication utilization. Interventions provided by the clinical pharmacist in the study group were documented. RESULTS: Cardiac readmission at 30 days was similar between the groups (p = 0.59). In the subset of patients with unstable angina, readmission in the study group was significantly lower than in the control group (1.3% vs 9.1%; p = 0.04). Patients in both groups were similarly managed using drug therapy and invasive coronary interventions. The medical staff's rate of acceptance of recommendations provided by the pharmacist was 94.4%. The most common interventions were medication education and identification of indicated therapy. CONCLUSIONS: The addition of pharmacists did not decrease readmission in patients with ACS. The finding of significant reduction in readmission in the subset of patients with unstable angina should be considered "hypothesis generating" for future randomized studies to confirm the results.