The Fall Risk with Alpha blockers Given InitiaL dose or Elderly status (FRAGILE) Study.

Background: α-1 adrenergic antagonists are commonly prescribed, but there is question regarding their safety in patients at increased fall risk. Objective: The purpose of the FRAGILE study was to determine the risk for developing adverse drug events (ADEs) in veterans prescribed α-1 blockers. Methods: A single-center, retrospective, observational cohort analysis was conducted of veterans newly initiated on α-1 antagonists. Veterans were categorized into at-risk (patients who met at least 1 of 2 criteria: age 65 or older or high initial dose of α blockade) or control (veterans without either risk factor) groups. The primary outcome was the composite all-cause ADEs, including hospitalizations or emergency department (ED) visits. Secondary outcomes included number of fall-related ADEs and medication discontinuation rates with follow-up for 12 months. Results: A total of 300 veterans were evaluated. There was no significant difference in the composite outcome of all-cause ED visits between at-risk (n = 169) versus control (n = 131) groups (0.81 vs 1.17, P = 0.09) or all-cause hospitalizations (0.28 vs 0.39, P = 0.25). Seventy-three veterans in the at-risk group experienced an all-cause ADE versus 64 in the control group (P = 0.36). No significant differences in secondary outcomes were found. Fall-related side effects occurred in 8% of the total cohort. Conclusion and Relevance: Rates of all-cause or fall-related ADEs were not significantly different. An 8% discontinuation rate resulting from fall-related ADEs and high rates of coadministered medications that could increase fall risk. Pharmacists can play a key role in optimizing α-1 blocker administration.

Implementation of a pharmacist-led transitional care clinic.

PURPOSE: To describe a pharmacist-led transitional care clinic (TCC) for high-risk patients who were recently hospitalized or seen in the emergency department (ED). SUMMARY: The Memphis Veterans Affairs Medical Center (VAMC) established a pharmacist-led face-to-face and telephone follow-up TCC to improve posthospitalization follow-up care through medication optimization and disease state management, particularly for veterans with high-risk disease states such as chronic obstructive pulmonary disease (COPD) and heart failure (HF). The clinic's clinical pharmacy specialists (CPSs) ordered diagnostic and laboratory tests, performed physical assessments, and consulted other providers and specialty services in addition to performing medication reconciliation, compliance assessment, and evaluation of adverse drug events. TCC patients were typically seen within 2 weeks of discharge and subsequently referred back to their primary care provider or a specialty care provider for continued management. A retrospective review of 2016 TCC data found that 7.8% of patients seen in the TCC were readmitted within 30 days of discharge; readmission rates for COPD and HF were reduced to 13% and 10%, respectively, compared to hospital-wide readmission rates of 17% and 24%. A separate observational analysis found that 30-day readmissions for COPD and HF were reduced in TCC patients, with pharmacists documenting an average of 6.2 interventions and 3.3 medication-related problems per patient. To reduce clinic appointment no-shows, the CPSs worked with inpatient providers and schedulers to emphasize to patients the importance of clinic attendance; also, TCC services were expanded to include telehealth appointments to increase access for rural and/or homebound patients. CONCLUSION: A pharmacist-led TCC effectively reduced readmissions and prevented medication-related problems for high-risk patients who were hospitalized or seen in the ED.

Outpatient influenza antiviral prescription trends with influenza-like illness in the USA, 2008-2010.

The 2009 novel H1N1 influenza A virus (H1N1) became a global pandemic. Data on antiviral prescriptions by location from 2008 to 2010 have not been reported. The purpose of this study was to assess antiviral geographic trends and correlation with influenza-like illness (ILI) over 3 years. Percent of outpatient ILI visits and antiviral prescriptions from 1 January 2008 to 31 December 2010 were included. Linear regression was used to assess correlation. In total, 14 million antivirals were dispensed during this period. A 115% increase was observed in 2009 compared with prescriptions dispensed in 2008, and an 84% decrease was observed in 2010 compared with 2009. The rate of antivirals was 1.32 prescriptions/100 persons in 2008, 2.85/100 persons in 2009 and 0.435/100 persons in 2010. 2009 regional growth was observed in most states and was highest in the West (293%) and the Northeast (272%). A positive correlation was observed between antivirals and ILI visits (R(2)=0.7853; P<0.0001). With the 2009 H1N1 pandemic, antivirals increased compared with 2008 or 2010. Without the concern of H1N1, antivirals decreased in 2010 to levels lower than 2008. Geographic trends were also observed, which may be a result of the different intensity of influenza transmission and difference practice patterns. ILI diagnoses correlate with influenza antiviral prescription use in the USA.