Pharmacist Involvement Key to Successful Chronic Disease Management

Pharmacists providing care for those with chronic conditions should work as closely as possible with patients and other health care providers.

That was the central theme discussed at the Directions in Pharmacy 6^th Annual CE Conference, which featured 7 live interactive sessions held today at the Crowne Plaza Princeton in Plainsboro, New Jersey.

In particular, pharmacy experts highlighted the pharmacist’s role in treatment strategies for acute coronary syndrome (ACS), chronic obstructive pulmonary disease (COPD), atrial fibrillation, heart failure, opioid-induced constipation (OIC), and type 2 diabetes.

Within those clinically relevant areas, experts outlined the following ways pharmacists can help ensure favorable patient outcomes.

1. To improve adherence to antiplatelet agents for ACS, pharmacists can:

· Tailor the choice of specific antiplatelet therapy following drug-eluting stent implantation to patient-specific variables such as age and comorbidities.

· Employ evidence-based interventions shown to improve adherence, such as telephone reminders, waiving/reducing medication co-payments, unit-dose packaging, and automated refill reminders.

· Conduct smoking cessation counseling, perform medication and drug use evaluations, and provide patient education on nutrition and exercise.

Source: Joel C. Marrs, PharmD, FCCP, FASHP, FNLA, BCPS-AQ Cardiology, BCACP, CLS, Associate Professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

2. To optimize transitions of care for COPD patients, pharmacists can:

· Devise a COPD checklist to assess at time of discharge. This checklist should include a reassessment of inhaler technique, assess the need for long-term oxygen, assure follow-up visits in 4 to 6 weeks, and include instructions regarding completion of steroid therapy and antibiotics, if prescribed.

· Have COPD discharge criteria, which should include ensuring that the patient or caregiver fully understands correct use of the medications. Additionally, pharmacists can ensure confidence among the patient, family, and physician that the patient can, in fact, manage the condition successfully at home.

· Understand the social and economic dimension that often accompanies nonadherence, which may include native language differences, low health literacy, lack of family support, limited access to health care facilities, or elder abuse.

Source: Rupal Mansukhani, PharmD, Clinical Assistant Professor at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey.

3. To improve adherence to direct oral anticoagulants for atrial fibrillation, pharmacists can:

· Ensure that discontinued medications are removed from the medication list and verify that new medications are filled.

· Designate a point person to make sure the patient’s follow-up visits are scheduled and education is continued. Designate a new point person at each transition of care.

· Prioritize patient preferences and allow them to be a part of decision-making processes concerning their care management.

Source: Haley M. Phillippe, PharmD, BCPS, Associate Clinical Professor at the Auburn University Harrison School of Pharmacy.

4. To help patients with heart failure after discharge, pharmacists can:

· Ensure that the treatment regimen reflects optimal medications at appropriate or target doses.

· Proactively review refill data to ensure that the patient is adherent and taking his or her medications correctly.

· Integrate the patient into the care plan by explaining heart failure pathophysiology, symptoms, and potential complications.

Source: Sneha Baxi Srivastava, PharmD, BCACP, Clinical Associate Professor at Chicago State University College of Pharmacy.

5. For patients experiencing OIC, pharmacists can optimize their role by:

· Engaging patients to make them as comfortable as possible to get an accurate assessment of constipation. The assessment should include questions about past and present bowel habits, use of laxatives, and associated symptoms.

· Providing key educational points regarding the importance of OIC prevention, recognizing signs and symptoms of insufficient laxative response, and watching for early signs and symptoms of worsening OIC.

· Visiting a health care practice where providers regularly supply opioid prescriptions and help them identify patients who may be at risk for OIC.

Source: Daniel T. Abazia, PharmD, BCPS, Clinical Assistant Professor at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey.

6. To help patients with type 2 diabetes achieve tight glycemic control, pharmacists can:

· Encourage them to bring list of all their medications—including OTC medicines, vitamins, and herbal supplements—and their exact doses to all of their appointments to discuss with their providers.

· Counsel them about the implications of poorly controlled diabetes, which include periodontal disease, skin complications, and foot issues.

· Educate them on the goals of diabetes control and how to prevent and monitor adverse drug events associated with their medications.

Source: Jennifer Costello, PharmD, BCPS-BC-ADM, Assistant Director of Clinical Services for the Pharmacy Department and PGY-1 Residency Program Director at Saint Barnabas Medical Center.

7. To support patients with type 2 diabetes on long-acting insulin, pharmacists can:

· Provide patient education about insulin administration, self-monitoring of blood glucose, lifestyle modifications, and hypoglycemia avoidance and management.

· Become experts in newer diabetes treatment agents—including glargine U300, insulin degludec U100, and “biosimilar” glargine—in order to help the broader health care provider community understand them.

Source: Jessica Kerr, PharmD, CDE, Associate Professor and Assistant Department Chair of Pharmacy Practice at SIUE School of Pharmacy.