Use of statins and gemfibrozil in patients with type 2 diabetes mellitus and cardiovascular risk factors attending adult day health care centers: an opportunity for pharmacists.

OBJECTIVE: Identify the extent of statin use for primary prevention of macrovascular complications, the extent of statin or gemfibrozil use for the secondary prevention of cardiovascular morbidity and mortality, and the statin doses used in patients with type 2 diabetes and other cardiovascular risk factors. DESIGN: Retrospective chart review. SETTING: Three adult day health care centers in Brooklyn and Queens, New York. PATIENTS: Patients with a diagnosis of type 2 diabetes and either a history of coronary artery disease or at least one other significant cardiovascular risk factor as defined by the American College of Physicians guidelines (i.e., age greater than 55 years, hypertension, left-ventricular hypertrophy, previous cerebrovascular disease, or peripheral arterial disease). MAIN OUTCOME MEASURES: Percentage of patients prescribed a statin for primary prevention of macrovascular complications of type 2 diabetes, percentage of patients prescribed a statin or gemfibrozil for secondary prevention of cardiovascular mortality and morbidity, and the percentage of patients on at least moderate doses of statins. RESULTS: Ninety-three patients were evaluated-51 in the primary-prevention group and 42 in the secondary-prevention group. In the primary-prevention group, 33 (64.7%) patients were prescribed a statin, while in the secondary-prevention group, 26 (61.9%) patients were on statins, a nonsignificant difference (P = 0.8308). No patients were prescribed gemfibrozil. Of all patients prescribed statins, 63.2% were at least on moderate doses. CONCLUSION: This study demonstrates suboptimal treatment with statins in patients with type 2 diabetes and cardiovascular risk factors.

Current status of pharmacist-operated drug information centers in the United States.

PURPOSE: Pharmacist-operated drug information centers (DICs) in the United States and Puerto Rico were surveyed, and the results were compared with those of similar surveys conducted over the past 30 years. METHODS: In January 2003, surveys were mailed to 151 institutions that were thought to have an organized DIC, defined as a center that regularly accepts a broad scope of requests from health care professionals, regardless of the location or affiliation of those professionals. The survey covered such topics as affiliations, staffing, services, resources, quality assurance, involvement in education, and funding. RESULTS: One hundred nineteen DICs responded (79%), of which 81 met the criteria. Hospitals and medical centers and colleges and schools of pharmacy continued to be the most commonly reported affiliations. The number of DICs declined in the past decade, and the number of DIC pharmacists and other personnel was the lowest reported in the past 30 years. Drug information pharmacists appeared to be better trained than in the past, and a larger percentage had advanced degrees. Services provided by DICs remained consistent with previous findings, except for greater participation in the training and education of pharmacy students and residents. The resource most commonly reported by DICs as useful was Micromedex Healthcare Series, followed by MEDLINE and AHFS Drug Information. The percentage of DICs with formal quality assurance programs did not change significantly in the past decade. Funding sources and fee-for-service activities remained the same. CONCLUSION: The number of DICs has declined steadily since 1986, and the number of drug information pharmacists is at its lowest in 30 years. DIC services continue to be comprehensive. Only half of the DICs surveyed had a formal quality assurance program.

Update on the status of 89 drug information centers in the United States.

PURPOSE: Previously identified U.S. drug information centers (DICs) were surveyed to determine whether they were still in existence and whether changes had occurred in the DICs since 2003. METHODS: Eighty-nine DICs identified in a 2003 survey were surveyed in April 2008. For DICs still in existence, questions were designed to determine whether there were changes in the mission, time spent on activities, staffing, and drug information questions (number, complexity, and time required to answer) compared with five years earlier. Respondents' projected need for their DIC over the next five years was also surveyed. RESULTS: Seventy-five (84%) of the 89 DICs were still active. The most notable changes in activities were increases in time spent on educating health-professions students (53%), supporting the institution's medication safety program (44%), and providing information-systems support (36%). The majority of respondents (73%) reported no change in the number of employed drug information personnel. The percentages of DICs reporting an increase, decrease, and no change in the number of drug information requests received were 29%, 42%, and 29%, respectively. Seventy percent reported an increase in the number of complex questions, while 53% reported an increase in the time required to answer each question. Ninety-seven percent of respondents projected no change or an increase in the need for their DIC over the next five years. CONCLUSION: Eighty-four percent of the previously identified DICs were still in existence. The most notable changes in these DICs were increases in the number of DICs focusing on educating health-professions students, the complexity of drug information questions, and the amount of time required to answer each request.