Not All Pharmacies Have Naloxone for Opioid Overdose in Stock

MedicalResearch.com Interview with:

Talia Puzantian,  PharmD, BCPP Associate Professor of Clinical Sciences,  School of Pharmacy and Health Sciences Keck Graduate Institute 

Dr. Puzantian

Talia Puzantian,  PharmD, BCPP
Associate Professor of Clinical Sciences,
School of Pharmacy and Health Sciences
Keck Graduate Institute  

MedicalResearch.com: What is the background for this study?

Response: Naloxone has been used in hospitals and emergency rooms since the early 1970s. Distribution to laypersons began in the mid-1990s with harm reduction programs such as clean needle exchange programs providing it, along with education, to mostly heroin users. In the years between 1996-2014, 152,000 naloxone kits were distributed in this way with more than 26,000 overdoses reversed (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm).

We have data showing that counties in which there was greater naloxone distribution among laypeople, there were lower opioid death rates (Walley AY et al BMJ 2013). However, not all opioid users at risk for overdose will interface with harm reduction programs, particularly prescription opioid users, hence more recent efforts to increase access to laypersons through pharmacists. Naloxone access laws have been enacted in all 50 states but very little has been published about how they’ve been adopted by pharmacists thus far. One small study (264 pharmacies) from Indiana (Meyerson BE et al Drug Alcohol Depend 2018) showed that 58.1% of pharmacies stocked naloxone, only 23.6% provided it without prescription, and that large chain pharmacies were more likely to do so.

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D-PRESCRIBE: Pharmacist-Led Intervention Can Reduce Inappropriate Medications in Older Adults

MedicalResearch.com Interview with:
Cara Tannenbaum, MD, MSc Director | Directrice Canadian Deprescribing NetworkCara Tannenbaum, MD, MSc

Director | Directrice
Canadian Deprescribing Network

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The D-Prescribe trial was driven by the need to show that seniors can cut down on their medication in a safe and effective manner. Pharmacists intervened in a proactive way to flag patients who were on potentially risky meds such as sleeping pills, NSAIDs and glyburide and to inform them of the risks, using an educational brochure. Pharmacists also communicated with their physician using an evidence-based pharmaceutical opinion to spark conversations about deprescribing. As a result, 43% of patients succeeded in discontinuing at least one medication over the next 6 months.
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Physician-Pharmacist Collaboration in Primary Care Offices Improved Blood Pressure Control

Barry L. Carter, PharmD Professor of Pharmacy Professor of Family Medicine U Iowa Carver College of MedicineMedicalResearch.com Interview with:
Barry L. Carter, PharmD
Professor of Pharmacy
Professor of Family Medicine
U Iowa Carver College of Medicine

Medical Research: What is the background for this study? What are the main findings?

Response: Numerous studies and meta-analyses have found physician-pharmacist collaborative models can improve blood pressure (BP) control.  In these models, pharmacists are located within primary care offices to assist with patient management. The physician delegates responsibility to pharmacists to perform a medication history, identify problems and barriers to achieving disease control, perform counseling on lifestyle modification and adjust medications following hypertension guidelines.  However, it was not known if this model would be implemented in a large number of diverse primary care offices, if the effect could be sustained after discontinuation and if the intervention was as effective in under-represented minorities as in Whites. In this study, 32 clinics from throughout the U.S. were randomized to a 9 month intervention that was discontinued, a 24-month pharmacist intervention our usual care.  All subjects received structured research measured blood pressure at baseline, 6, 9, 12, 18 and 24 months.  We enrolled 625 subjects and 53% were from minority groups, 53% had < 12 years of education, 50% had diabetes or chronic kidney disease and 25% had Medicaid or self-pay for their care payments.  All of these variables typically make it much more difficult to achieve BP control.  BP control was 43% in the intervention groups and 34% in the control group at 9-months (adjusted OR 1.57 [95% CI 0.99-2.50], p = 0.059). However, when using the higher BP goals in the 2014 guidelines, blood pressure control was achieved in 61% of intervention subjects and 45% of control subjects at 9 months [(adjusted OR, 2.03 [95% CI 1.29-3.22], p=0.003). Of importance was the finding that the degree of systolic BP reduction (6 mm Hg) with the intervention compared to usual care was not only statistically significant but also the same in minority subjects (2/3 Black and 1/3 Hispanic) compared to all subjects. Interestingly, BP control seemed to be maintained in the subjects from minority groups at 18 and 24 months in both the group with the short (9-month) or sustained (24 month) intervention. In contrast, blood pressure control deteriorated slightly in non-minority subjects in all three groups.

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Pharmacist Intervention Reduced Emergency Room ReVisits

Anna Alassaad Pharmacist, PhD Student, Department of Medical Sciences, Uppsala University Uppsala, Sweden, Uppsala University Hospital, Uppsala, SwedenMedicalResearch.com Interview with:
Anna Alassaad
Pharmacist, PhD Student,
Department of Medical Sciences, Uppsala University
Uppsala, Sweden, Uppsala University Hospital, Uppsala, Sweden

Medical Research: What is the background for this study? What are the main findings?

Response: The main findings from our study are that patients with a low number of prescribed drugs benefited more from a comprehensive clinical pharmacist intervention than patients with a higher number of drugs. There was no difference in effect between the patients with higher and lower levels of inappropriate prescribing, as measured by two validated tools for inappropriate prescribing.

Clinical pharmacist interventions have in several studies shown positive effects on inappropriate prescribing and clinical outcomes. Since the concomitant use of a large number of drugs is associated with an increased risk of adverse drug events, it is often assumed that patients receiving a larger number of drugs would benefit most from interventions aiming to improve the quality of drug use. However, differences in the effects of clinical pharmacist intervention between different subgroups of patients have rarely been analyzed.

We have, in a randomized controlled trial, previously demonstrated that a clinical pharmacist intervention at an acute internal medicine hospital ward reduces emergency department visits by 47%, revisits to hospital by 16%, and drug-related readmissions by 80% for patients aged 80 years or older. We aimed to investigate whether there was any difference in treatment effect of the clinical pharmacist interventions on number of subsequent revisits to the emergency department between the patients with less than five drugs and those with five or more drugs on admission to hospital. We also explored whether the effect of the intervention was consistent for patients with a high or low level of inappropriate prescribing.

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