Assessing Changes in Statin Prescribing Patterns Surrounding the 2013 American College of Cardiology/American Heart Association Lipid Guidelines.

PURPOSE: The American College of Cardiology (ACC) and the American Heart Association (AHA) introduced new lipid guidelines in late 2013 that were a vast departure from older guidelines. Concerns were raised regarding the likely increase in the number of adults who would be eligible for lipid-lowering therapy, namely moderate to high intensity statins. We sought to determine whether, in the first year after the ACC/AHA guideline release, more patients were prescribed statins, prescribed moderate- to high-intensity statins, and eligible for statins compared with the previous year. METHODS: This study was a retrospective, cross-sectional, observational analysis of National Ambulatory Medical Care Survey collected by the Centers for Disease Control and Prevention during the years 2013 and 2014. Survey participants who were younger than 40 years or older than 75 years, were pregnant, or had triglyceride levels ≥400 mg/dL were excluded. Descriptive analyses and χ2 tests of homogeneity (and associated odds ratios [ORs] and CIs) were constructed and reported. FINDINGS: Compared with 2013, a higher percentage of patients in 2014 were prescribed a statin and were eligible to receive a statin. In fact, patients in 2014 were significantly more likely to be prescribed a statin (OR = 1.22; 95% CI, 1.00-1.48) and to be eligible for a statin (OR = 9.26, 95% CI 7.54-11.37) compared with 2013. Although a higher percentage of patients in 2014 were prescribed a higher-intensity statin, the difference was not statistically significant (OR = 1.17; 95% CI, 0.90-1.52). IMPLICATIONS: In the first year after the ACC/AHA guideline introduction, more patients in the United States were prescribed a statin. However, it is unclear whether the new guidelines were strictly adhered to regarding intensity of statin therapy.

Pharmacy student involvement in a transition of care program.

BACKGROUND AND PURPOSE: Cape Fear Valley Medical Center (CFVMC) implemented a Community Paramedic Program (CPP) to improve the transition of hospitalized patients to the home setting. In this program, paramedics conduct home visits for 30 days after qualifying patients are discharged. This article describes pharmacy services provided to CPP patients by fourth-year pharmacy students on Advanced Pharmacy Practice Experiences (APPE) that assisted with home visits. EDUCATIONAL ACTIVITY AND SETTING: Students were oriented to the CPP and patient interview technique was assessed through a role-play scenario. A standardized form was created to record drug-related problems (DRP) identified and patient education provided to patients. The primary outcome describes types of DRP identified and education provided. Secondary outcomes compare the types and average number of DRP per patient identified by students as compared to the standard of care (pharmacist review of medications electronically) and trends in patients readmitted within 30 days following discharge. FINDINGS: Eleven students visited 124 patients and recorded 145 DRP. Extra/continuation of medications stopped at discharge and issues related to medication safety were the most common DRP. The most frequent type of education provided was medication use related. On average, students provided one counseling session per patient. DISCUSSION AND SUMMARY: Student involvement is an added benefit to the CPP by providing face to face education and re-assessment of medications at follow-up visits. This article summarizes a unique teaching platform utilizing students to extend care. Real world experiences in programs like the CPP provide students the opportunity to sharpen critical thinking and problem-solving skills necessary for maturing professionally.