In the midst of curricular revision, remember the importance of over-the-counter and self-care education.

INTRODUCTION: Over-the-counter (OTC) and self-care products are frequently utilized by adult patients as initial treatment for common health issues. This availability of OTC/self-care products, coupled with the accessibility of community-based pharmacists, uniquely positions pharmacists to serve as stewards of appropriate OTC/self-care treatment. As a result, community-based pharmacists must be competent in the practice of providing individualized, patient-specific, OTC recommendations and self-care education to assist patients in achieving optimal self-managed health outcomes. COMMENTARY: Schools and colleges of pharmacy often undergo curricular revision/integration. As a result, it is often necessary to reallocate credit hours dedicated to OTC/self-care content. Curriculum committees should therefore be aware of several best-practice resources that may assist them with this task. IMPLICATIONS: The impact on OTC/self-care content during curricular revision/integration directly effects the preparation of graduate ready student pharmacists and ultimately patient's self-managed health outcomes. Considerations include appointing an OTC/self-care champion to oversee the integration of OTC/self-care content as well as post-revision monitoring to ensure core topic areas are being adequately covered in the didactic curriculum and in accordance with best practices.

Real-world impact on monthly glucose-lowering medication cost, HbA1c, weight, and polytherapy after initiating a GLP-1 receptor agonist.

OBJECTIVE: Glucagon-like peptide-1 (GLP-1) receptor agonists are preferred injectable therapies for type 2 diabetes, but their high cost is an area of concern. This study evaluated monthly glucose-lowering medication cost and clinical impact after initiating a GLP-1 receptor agonist. DESIGN: A retrospective, pre-post cohort study evaluated monthly glucose-lowering medication cost, glycated hemoglobin (HbA1c), weight, and polytherapy impact (name, dose, and number of daily doses or injections) when a GLP-1 receptor agonist was initiated (baseline) and after 6-12 months (follow-up). The population was analyzed overall and as subgroups, based on baseline medication regimen and demographics. SETTING AND PARTICIPANTS: The study was performed at 8 ambulatory care sites (7 federally qualified health centers and a Program of All-Inclusive Care for the Elderly) in the greater Boston, MA, area. Patients were included in the analyses (n = 120) if they had a documented diagnosis of type 2 diabetes, were 18 years of age or older, had an HbA1c ≥ 7.5% measured within 3 months prior to the initiation of a GLP-1 receptor agonist, and an HbA1c measured 6 to 12 months following the initiation of a GLP-1 receptor agonist. OUTCOME MEASURES: Primary outomes were changes in glucose-lowering medication cost, HbA1c, and weight. Secondary outcome analyses included the impact to the glucose-lowering medication regimen in terms of dose, number of medications, and number of daily doses or injections. RESULTS: The study population was largely female, aged 55.8 ± 11.7 years, obese, 76% non-Caucasian, equally English and non-English speaking, had a high tablet and injection burden, and had an average baseline HbA1c of 10%. After the addition of a GLP-1 receptor agonist, monthly glucose-lowering medication cost increased $586.86 (overall), $741.69 (oral only baseline regimen), and $530.55 (insulin ± oral baseline regimen) (all P < 0.001). Mean decrease in HbA1c was 1.7% (18 mmol/mol) (P < 0.001) and was similar across all subgroups. Weight decreased overall (-1.8 kg, P < 0.001), and there was a significant shift toward taking fewer oral agents and insulin and fewer daily injections. No statistically significant differences in the primary outcomes were noted in terms of age, gender, English-speaking status, or race. CONCLUSION: Although a positive impact was observed in glycemic control, weight, and reduced polytherapy 6-12 months after initiating a GLP-1 receptor agonist, the increase in monthly glucose-lowering medication cost was significant and may serve as a barrier to treatment.