The effect of food access on type 2 diabetes control in patients of a New Orleans, Louisiana, clinic.

BACKGROUND: The U.S. Department of Agriculture (USDA) classifies numerous neighborhoods in New Orleans, Louisiana, as food deserts or areas with inadequate access to good quality foods. With approximately 35% of all patients with type 2 diabetes (T2DM) establishing disease control, we hypothesize those living in food deserts will have increased difficulty in controlling T2DM. The purpose of this study is to evaluate the effect of food deserts on glycemic control in patients with T2DM. OBJECTIVE: The purpose of this study is to analyze the effect of food access on T2DM control in patients at a diabetes management clinic compared with the national average of T2DM control. METHODS: Eligible records for review included patients residing in a USDA-determined food desert with a T2DM diagnosis. The primary end point was the proportion of patients with controlled T2DM. T2DM control was defined as glycosylated hemoglobin values less than 7% and less than 7.5% in patients older than 65 years. Records were retrieved for review between the dates of February 2017 and February 2020. RESULTS: A total of 109 patient records were reviewed. Of these, 23 patients (21%) achieved glycemic control. There was a 14% difference (35%-21%) between the food desert patients with T2DM and the general United States population of patients with T2DM (P = 0.030). CONCLUSION: This study underscores the potential implications of limited food access on patients' abilities to manage chronic conditions like T2DM. Clinicians who work in resource-limited settings or with marginalized patient populations have a responsibility to consider food access and other health disparities when creating realistic and feasible treatment goals.

Impact of body mass index on 90-day warfarin requirements: a retrospective chart review.

BACKGROUND: Rates of obesity continue to rise worldwide as evidenced in the 2017 Centers for Disease Control and Prevention (CDC) report that indicated over 35% of United States (US) citizens are obese, with Louisiana ranked as the fifth most obese state in America. Since large clinical trials tend to exclude obese patients, health care providers are faced with concerns of under- or overdosing these patients on warfarin. METHODS: This retrospective chart review evaluated patients who reported to a community anticoagulation clinic for warfarin management between 1 June 2017 and 30 September 2017. Along with baseline demographics, chronic use of drugs that have clinically significant interactions with warfarin, social activity such as tobacco use and alcohol consumption, were collected. Body mass indexes (BMI) were collected and categorized according to the World Health Organization definitions as follows: Normal (BMI 18-24.9 kg/m2), Overweight (25-29.9 kg/m2), Obesity Class I (30-34.9 kg/m2), Obesity Class II (35-39.9 kg/m2), Obesity Class III (⩾40 kg/m2). The primary outcome was the mean 90-day warfarin dose required to maintain "intermediate control" or "good control" of international normalized ratio (INR), stratified by BMI classifications. The secondary outcome was the time in therapeutic range (TTR) stratified by BMI classifications. RESULTS: A total of 433 patient encounters were included in this study. There was a total of 43 encounters in the Normal BMI category, 111 Overweight encounters, 135 Obesity Class I encounters, 45 Obesity Class II encounters, and 99 Obesity Class III encounters. Approximately 63% of the study population were male, and over 90% the patients were African American. The Obesity Class I and Obesity Class II class required an average of 11.47 mg and 17.10 mg more warfarin, respectively, to maintain a therapeutic INR when compared with the Normal BMI category. These findings were statistically significant with p values of 0.007 and <0.001, respectively. Additionally, upon comparing the Overweight BMI category with the Obesity Class II category, there was a mean warfarin dose difference of 11.22 mg (p = 0.010) more in Obesity Class II encounters to maintain a therapeutic INR. In the secondary analysis of TTR, Overweight category encounters had the highest TTR, whereas encounters in the Normal BMI category had the lowest TTR. CONCLUSION: As BMI increases, there is an increased chronic warfarin requirement to maintain "intermediate control" or "good control" of INR between 2 and 3 in an ambulatory care setting.

Patients' perception of community pharmacists as healthcare providers and willingness to participate in pharmacist services: a pilot study.

OBJECTIVES: To explore the extent to which patients identify community pharmacists as healthcare providers and the relationship of this perception to a willingness to engage in pharmacist-provided services. METHODS: A cross-sectional survey was conducted at a retail pharmacy and a patient centered medical home (PCMH) in the New Orleans, Louisiana metropolitan area. The survey assessed patients' perception of community pharmacists and their roles in the provision of healthcare, as well as willingness to participate in commonly offered pharmacist-provided services. RESULTS: This study included 49 participants who interacted with pharmacy personnel to receive prescriptions regularly. Of the 49 patients surveyed, 91.8% perceived community pharmacists to be healthcare providers and this perception significantly impacted patient willingness to participate in medication therapy management, medication optimization, and travel vaccination services. Other services were not significantly impacted by perception. CONCLUSION: A greater percentage of patients perceived community pharmacists as healthcare providers. This affirmative perception positively impacted patient willingness to participate in several pharmacist-provided services. Since no comparative studies are available, further study is needed to assess consistency of observations and assess innovative ways to highlight pharmacists' cognitive attributes and increase participation in pharmacist-provided services.