Pharmacist impact on health outcomes in a homeless population.

OBJECTIVE: The aim of this study was to analyze the effect of clinical pharmacy services on health outcomes and medication adherence concerning hypertension and diabetes in the homeless population. METHODS: This was a retrospective quasi-experimental study conducted between January 1, 2015, and December 31, 2016. The primary outcomes included median blood pressure and median glycosylated hemoglobin (A1C) change from baseline. The secondary end points included adherence to hypertension and diabetes medication, in addition to the differences in the number of admissions to urgent care clinics, emergency departments, or hospitals pre- and postpharmacist clinic visit. RESULTS: One-hundred ninety-eight homeless patients were seen by a pharmacist over the study time frame, and 116 of these patients were included. There was a decrease in systolic and diastolic blood pressure in the 6-months postpharmacist visit (139 mm Hg vs. 135 mm Hg, P = 0.413, and 85 mm Hg vs. 82 mm Hg, P = 0.197, respectively). The percentage of patients who met the blood pressure goals increased from 55% to 66% (P = 0.093). A statistically significant decrease in A1C was found (7.7% vs 7.2%, P = 0.038). The number of patients who met the A1C goal increased from 20% to 41% (P = 0.267) after pharmacist intervention. No medication class was associated with a median proportion of days covered of 80% or greater. However, differences were seen with biguanides (34% vs. 43%, P = 0.004), calcium channel blockers (44% vs. 59%, P < 0.001), and thiazides (28% vs. 39%, P = 0.039) pre- and postintervention. There was no difference in the number of visits to emergency departments or urgent care clinics, or hospitalizations. CONCLUSION: Homeless patients with hypertension and type 2 diabetes who had at least 1 visit with a pharmacist showed some improved health outcomes. Statistically significant benefits were seen in diabetes management, but not for blood pressure control.

Evolving Frontier: A Review of the Role of Mobile Medical Application Prescribing.

Objective: To describe the continuum of medical app prescribing. Data Sources: A review of literature was conducted using PubMed and MEDLINE. Search terms included medical app, prescribing, healthcare apps, medical phone apps, and mobile medical apps. Studies published in English from 2005 to December 2015 were included. Study Selection and Data Extraction: A total of 2264 articles were uncovered in the initial search. The publications included studies conducted in the United States and Europe within the past 10 years. Studies with a mobile app intervention were preferred. However, studies lacking a mobile app intervention were also included. No restrictions on the type of health application discussed in studies were chosen. Non-English language publications were excluded from the review. A total of 15 articles were selected based on the inclusion criteria and reviewer screening. Data Synthesis: The literature review identified that this is an area that requires further study to analyze the extent to which prescribers recommend apps for their patients. A concern over the lack of evidence in the effectiveness of the apps still remains. Prescribing mobile apps by providers to help keep track of their patients' symptoms and provide real-time advice on treatment and medication can be beneficial to control costs, reduce errors, and improve patients' experiences. Conclusion: The presence of mobile technology has enabled patients to become more engaged in the decision making regarding their health care. Additional resource allocation can be recommended to increase the quantity and quality of medical apps recommended by prescribers for their patients.