Impact of Community Pharmacist Interventions With Managed Care to Improve Medication Adherence

2019 ◽  
pp. 089719001989650
Author(s):  
Christopher J. Daly ◽  
Kelly Verrall ◽  
David M. Jacobs
Keyword(s):  
Medication Adherence ◽  
Community Pharmacist ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Third Party ◽  
Future Research ◽  
Community Pharmacies ◽  
Improve Medication Adherence ◽  
Converting Enzyme Inhibitors ◽  
The Impact

Background: Nonadherence to medications is a concern due to adverse outcomes and higher costs of care. The Centers for Medicare and Medicaid Services has made adherence a key measurement for Star ratings. Objective: To evaluate the impact of a collaborative pilot program between a third-party payer, local pharmacy organization, and academic institution focusing on improving medication adherence with community pharmacies. Methods: Twenty-five community pharmacies implemented adherence-based interventions in patients ≥65 years old, who were Medicare Advantage Plan members, taking targeted medications (statins, oral diabetic medications, angiotensin-converting enzyme inhibitors [ACE-Is] and angiotensin receptor blockers [ARBs]). Outcome measures were (1) pharmacy intervention completion rate, (2) type of adherence interventions, (3) change in the proportion of days covered (PDC) following pharmacist intervention based on adherence group, and (4) nonadherence barriers. Results: A total of 1263 interventions met the eligibility criteria, and common interventions included explaining the benefit of the medication (n = 453, 35.9%) and provider follow-up (n = 109, 8.6%). Among nonadherent subjects who became adherent, the mean PDC increased by 14% (74%-88%, P < .0001), with a 12% decrease in mean PDC score in the nonadherent who remained nonadherent group (71%-58%, P < .0001). Common patient barriers for nonadherence were forgetfulness (n = 451, 35.7%) and denial (n = 84, 6.7%). System and therapeutic barriers included complexity (n = 155, 12.3%) and adverse side effects (n = 42, 3.3%). Conclusion: This collaborative effort successfully implemented a community pharmacist-led adherence intervention in 25 independent pharmacies. Our findings highlight increased interactions with patients and in some cases improved adherence measures. Future research must include implementation outcomes in order to effectively implement these interventions in the community pharmacy setting.

Abstract P097: Low Medication Adherence is Related to Poor Hypertension Control among Patients with Chronic Kidney Disease

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Suma Vupputuri ◽  
Paul Muntner ◽  
Wolfgang C Winkelmayer ◽  
David H Smith ◽  
Gregory A Nichols
Keyword(s):  
Chronic Kidney Disease ◽  
Medication Adherence ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Medication Possession Ratio ◽  
Uncontrolled Hypertension ◽  
Improve Medication Adherence ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
The Mean

Inadequately controlled blood pressure (BP) is an important risk factor for the progression of chronic kidney disease (CKD). Few data are available on the association between adherence to antihypertensive medications and BP control among patients with CKD. We investigated the association of adherence to angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) with BP levels and BP control among CKD patients (n=3077) at Kaiser Permanente Georgia (an insurer and health care provider). Patients were required to have 2 outpatient diagnoses of CKD in 2008-2009, at least 2 fills of ACEi/ARBs, be 18+ years of age, with at least 1 year of continuous membership and prescription benefits prior to 01/01/08 and have no history of end-stage renal disease. We defined uncontrolled BP as systolic/diastolic of ≥140/90 mmHg and also ≥130/80 mmHg. As a measure of adherence we calculated the medication possession ratio (MPR): # of days medication supplied between the first and last prescription fills Duration from first to last prescription date + days supply from last prescription The mean age of our sample was 64.1 ±11.9 years; 53.1% were female, and 57.6% African-American. In this sample, 22.6% and 8.9% had low and very low medication adherence, respectively; while 25.6% and 58.6% had systolic/diastolic BP of ≥140/90 and ≥130/80 mmHg, respectively. The mean BPs and odds ratios (ORs) for uncontrolled BP associated with level of adherence to antihypertensive medications are given in the table . In conclusion, among patients with CKD, poor medication adherence to antihypertensive medications was consistently associated with uncontrolled hypertension. Targeting interventions to improve medication adherence among patients with CKD may be an important strategy to improve BP control and, in turn, slow the progression of CKD. Medication Adherence p-trend High (MPR: ≥0.8) N=2109 Low (MPR: 0.5 to <0.8) N=694 Very low (MPR: <0.5) N=274 Mean systolic BP, mmHg 131.3 (13.0) 134.0 (14.7) 137.5 (15.4) <0.0001 Mean diastolic BP, mmHg 72.5 (8.12) 75.7 (9.21) 78.7 (10.1) <0.0001 OR for SBP/DBP ≥140/90 mmHg Age, race, sex adjusted 1.0 (ref) 1.40 (1.14, 1.73) 2.30 (1.73, 3.06) <0.0001 Multivariate adjusted * 1.0 (ref) 1.24 (0.97, 1.57) 1.96 (1.40, 2.75) <0.0001 OR for SBP/DBP ≥130/80 mmHg Age, race, sex adjusted 1.0 (ref) 1.21 (1.00, 1.46) 1.81 (1.33, 2.45) <0.0001 Multivariate adjusted * 1.0 (ref) 1.11 (0.89, 1.38) 1.43 (1.01, 2.01) 0.04 * Adjusted for age, race, sex, socioeconomic status, co-morbidities, clinical measures, and number of medication classes.

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

scholarly journals Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology

2020 ◽  
Vol 7 ◽  
Author(s):  
Sherry-Ann Brown ◽  
Svetlana Zaharova ◽  
Peter Mason ◽  
Jonathan Thompson ◽  
Bicky Thapa ◽  
...  
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Management Strategies ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cancer Therapies ◽  
Converting Enzyme ◽  
Cytokine Release ◽  
Converting Enzyme Inhibitors ◽  
The Impact

Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.

scholarly journals A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

2016 ◽  
Vol 25 (01) ◽  
pp. 13-29 ◽  
Author(s):  
J. Abraham ◽  
L. L. Novak ◽  
T. L. Reynolds ◽  
A. Gettinger ◽  
K. Zheng
Keyword(s):  
Information Technology ◽  
Time Series ◽  
Health Information Technology ◽  
Health Information ◽  
Unintended Consequences ◽  
Adverse Outcomes ◽  
Future Research ◽  
Health It ◽  
Recorded Data ◽  
The Impact

SummaryObjective: To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies.Method: Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development.Results: The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients’ withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Conclusion: Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.

scholarly journals SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: a nationwide case-control and cohort analysis

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-215768 ◽  
Author(s):  
Christian Fynbo Christiansen ◽  
Anton Pottegård ◽  
Uffe Heide-Jørgensen ◽  
Jacob Bodilsen ◽  
Ole Schmeltz Søgaard ◽  
...  
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Cohort Analysis ◽  
Case Control ◽  
Adverse Outcomes ◽  
Angiotensin Receptor ◽  
Current Recommendation ◽  
Icu Admission ◽  
Registration Number ◽  
Receptor Blockers ◽  
The Impact

ObjectiveTo examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes.MethodsThis nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use.ResultsThe study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09).Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users.ConclusionsACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic.Trial registration numberEUPAS34887

scholarly journals The quality of life of chronic kidney disease patients with hypertension treated with angiotensin system-related agents

2020 ◽  
Vol 11 (4) ◽  
pp. 6633-6639
Author(s):  
Mohammed Salim KT ◽  
Saravanakumar RT ◽  
Dilip C ◽  
Amrutha KP
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
The Impact

The chronic kidney disease (CKD) co-exist with hypertension in approximately 80 to 85 per cent of patients. The CKD stages can be defined by glomerular filtration rate (GFR), and the deterioration of kidney function or reduction in GFR has observed in those with uncontrolled blood pressure (BP). We had conducted a prospective study to analyse the impact of the angiotensin system-related agents on the quality of life of CKD patients with hypertension. The SF-36 questionnaire, direct patients interview and medical records were the sources for retrieval of information. We observed that male patients were more prone to CKD than female. Hypertension was the primary (77.8%) aetiology behind the incidence of CKD. The angiotensin-converting enzyme inhibitors (ACEI) was responsible for very low (58%) and low (44%) health disabilities to the patients. In contrast, the angiotensin receptor blockers (ARB) even though it has a limited adverse effect, the patients complained of medium (9%) and high disabilities than the ACEIs. The discontinuation of the antihypertensive drugs by the CKD patients was almost negligible (3.4%). The study concludes that a balanced diet and reasonable blood pressure control is essential to prevent the progression of CKD and to improve the quality of life.

scholarly journals Practical considerations for cardiovascular care during COVID-19 pandemic

2021 ◽  
Author(s):  
Dnyanoba Kishanrao Bhaskar ◽  
Vishal Madanlal Chaudhari ◽  
Medha Ajit Oak
Keyword(s):  
Information Overload ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Routine Care ◽  
Adverse Outcomes ◽  
Converting Enzyme Inhibitors ◽  
Global Pandemic ◽  
Drug Classes ◽  
Receptor Blockers

Coronavirus disease 2019 (COVID-19), caused by a strain of coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global pandemic affecting billions of lives and posing a stiff challenge to the delivery of routine healthcare across the world. The new second wave of COVID-19 in India presents with higher rate of infection and percentage of asymptomatic and mildly symptomatic cases is much higher than before, which means more people are spreading the disease. People with co-morbidities such as pre-existing cardiovascular conditions are at risk of suffering from severe complications of COVID-19 including acute respiratory distress and multi-organ failure. The pandemic has also resulted in people deferring routine care for conditions such as hypertension, diabetes and other cardiometabolic diseases. Initial reports also linked major CV drug classes such as the angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) to adverse outcomes in COVID-19 patients. While subsequent reports have disproved these earlier findings, the science is rapidly evolving and the information overload has served to confuse general practitioners and consultant physicians alike. This review examined the practical considerations in terms of cardiocascular complications, effect of drugs, older adults and tele-consultation for CV care during COVID-19 pandemic.

scholarly journals Medication adherence in cardiovascular medicine

BMJ ◽  
2021 ◽  
pp. n1493
Author(s):  
Steven T Simon ◽  
Vinay Kini ◽  
Andrew E Levy ◽  
P Michael Ho
Keyword(s):  
Cardiovascular Disease ◽  
Medication Adherence ◽  
Behavioral Interventions ◽  
Healthcare Team ◽  
Improve Medication Adherence ◽  
Team Members ◽  
Medication Costs ◽  
Dosing Regimens ◽  
Cognitive Behavioral Interventions ◽  
The Impact

AbstractCardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.

scholarly journals Delayed viral clearance and exacerbated airway hyperinflammation in hypertensive COVID-19 patients

2020 ◽  
Author(s):  
Saskia Trump ◽  
Soeren Lukassen ◽  
Markus S Anker ◽  
Robert Lorenz Chua ◽  
Johannes Liebig ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Immune Cell ◽  
Angiotensin Receptor Blockers ◽  
Treatment Options ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Sequencing Data ◽  
Converting Enzyme Inhibitors ◽  
Altered Expression ◽  
The Impact

In COVID-19, hypertension and cardiovascular diseases have emerged as major risk factors for critical disease progression. Concurrently, the impact of the main anti-hypertensive therapies, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB), on COVID-19 severity is controversially discussed. By combining clinical data, single-cell sequencing data of airway samples and in vitro experiments, we assessed the cellular and pathophysiological changes in COVID-19 driven by cardiovascular disease and its treatment options. Anti-hypertensive ACEi or ARB therapy, was not associated with an altered expression of SARS-CoV-2 entry receptor ACE2 in nasopharyngeal epithelial cells and thus presumably does not change susceptibility for SARS-CoV-2 infection. However, we observed a more critical progress in COVID-19 patients with hypertension associated with a distinct inflammatory predisposition of immune cells. While ACEi treatment was associated with dampened COVID-19-related hyperinflammation and intrinsic anti-viral responses, under ARB treatment enhanced epithelial-immune cell interactions were observed. Macrophages and neutrophils of COVID-19 patients with hypertension and cardiovascular comorbidities, in particular under ARB treatment, exhibited higher expression of CCL3, CCL4, and its receptor CCR1, which associated with critical COVID-19 progression. Overall, these results provide a potential explanation for the adverse COVID-19 course in patients with cardiovascular disease, i.e. an augmented immune response in critical cells for the disease course, and might suggest a beneficial effect of clinical ACEi treatment in hypertensive COVID-patients.

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