RESUMO
OBJECTIVE: To describe outpatient prescription treatment for active-duty military members with posttraumatic stress disorder (PTSD). Medical records were screened for drug-drug interactions with PTSD-related medications and for adverse drug events. METHOD: A retrospective chart review was conducted of the medical records of active-duty service members aged 18 to 65 years who had a diagnosis of PTSD (ICD-9 criteria) and received psychiatric treatment at Naval Hospital Camp Pendleton, Camp Pendleton, California, between October 1, 2010, and October 31, 2010. Prescription medication treatment over a 6-month period (October 1, 2010, through March 31, 2011) was reviewed. RESULTS: Among 275 patients, 243 (88.4%) had at least 1 prescription dispensed and 219 (79.6%) had at least 1 PTSD-related medication dispensed. More than 1 PTSD-related medication was dispensed to 153 (55.6%) patients. The most common medication classes dispensed were selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (35.1%), novel antidepressants (15.6%), and anticonvulsants (15.0%). The most frequently dispensed PTSD-related medications were zolpidem: 149 (9.8%), sertraline: 147 (9.7%), gabapentin: 134 (8.8%), prazosin: 111 (7.3%), and trazodone: 110 (7.2%). In the subgroup of 219 patients who received PTSD-related medications, overlapping periods of treatment between an SSRI and another PTSD-related medication occurred in 58 (26.5%) patients. Potential drug-drug interactions with this combination involved 44 (20.1%) patients; no adverse drug events were reported. Among these 44 patients, 55 different potential drug-drug interactions were identified. CONCLUSIONS: Patients receiving medications for PTSD are frequently treated with SSRIs or SNRIs and are likely to be prescribed more than 1 PTSD-related medication.
RESUMO
OBJECTIVE: To evaluate the effect of clinical pharmacists embedded in primary care at a military facility by reviewing laboratory assessments following pharmacist management of referred patients with diabetes and hyperlipidemia. METHODS: Electronic medical records of patients who were referred to clinical pharmacists for control of diabetes and/or hyperlipidemia were reviewed for those with at least two encounters during a 6-month period with baseline and follow-up laboratory assessments. As appropriate to patient diagnoses, glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and body mass index (BMI) were included in assessments. Paired t tests were used to determine the statistical significance of mean changes between the beginning and end of the 6-month period. RESULTS: In the cohort of patients with diabetes (n = 46), mean A1C decrease over 6 months was 0.9 points (P = 0.004). In the cohort of patients with hyperlipidemia (n = 15), mean LDL-C decrease was 20 mg/dL (P = 0.004). Changes in mean LDL-C, TGs, and BMIs were observed in each group but were not statistically significant. CONCLUSION: Although small sample sizes limited statistical power in this analysis, results suggest that referral of ambulatory patients to a clinical pharmacist in a military medical home for diabetes and/or hyperlipidemia improved care management.
