The role of the clinical pharmacist in the care of patients with cardiovascular disease. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011. Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Vocalizing your support will allow pharmacists’ unique skills to be better leveraged in the prevention of polypharmacy harms. Support from physician organizations will be key to the success of these efforts. National pharmacy organizations are pushing for legislation to allow pharmacists to bill for clinical services under Medicare Part B in team-based models of care. Most impressive was the decreased risk for adverse drug events (OR = 0.53, 95% CI = 0.33-0.83, p=0.01).5 With polypharmacy and risk for drug interactions on the rise, pharmacists must become fully engaged members of healthcare teams. Significant improvements in hemoglobinA1c, low density lipoprotein, blood pressure, medication adherence, patient knowledge, and quality of life were associated with pharmacist intervention. These services generally targeted chronic medical problems that lead to polypharmacy, including hypertension, diabetes, and lung disease. Pharmacist interventions ranged from patient education regarding drugs and diseases to comprehensive medication management with prescriptive authority. A 2010 meta-analysis of randomized controlled trials demonstrated the profound impact of engaging pharmacists as team members on therapeutic, humanistic, and safety outcomes. They delineated the role of clinical pharmacists in providing team-based care for patients with cardiovascular disease but cited the same barriers to implementation as the 2011 report.4 Despite these public and private sector appeals, patient access to clinical services provided by pharmacists remains limited. Policy, legislation, and compensation were noted as barriers to implementation in the private sector.3 In 2015, the Cardiovascular Team and Prevention Councils of the American College of Cardiology authored a similar call to action. This recommendation was supported by decades of experience with federal pharmacists providing clinical services. As the most accessible healthcare professional, pharmacists have the unique skillset and perspective necessary to prevent polypharmacy harms.3 A 2011 report to the United States Surgeon General from the Office of the Chief Pharmacist advocated for enhanced utilization of pharmacists as advanced practice providers. In response, Steinman offered a thought-provoking commentary from the perspective of a seasoned geriatrician.2 While both articles recommended policy changes, the pivotal role of pharmacists was overlooked. In the April 2016 issue of JAMA Internal Medicine, Qato et al presented striking data regarding the state of polypharmacy in older adults.1 From 2005 to 2011, the number of older adults taking at least five medications or supplements increased substantially and the proportion at risk for a major drug-drug interaction nearly doubled. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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