Impact of clinical pharmacy specialists on glycemic control in veterans with type 2 diabetes.

PURPOSE: The results of a study to determine the impact that Patient Aligned Care Team clinical pharmacy specialists (CPSs) have in improving glycemic control among veterans with type 2 diabetes are reported. METHODS: Reductions in glycosylated hemoglobin (HbA1c) values in diabetic patients are associated with improved outcomes related to vascular complications. Current diabetes management strategies at the Cincinnati Veteran Affairs Medical Center (VAMC) involve a multidisciplinary approach that includes visits with a CPS by veterans referred by a primary care provider. A retrospective chart review-based study of veterans who received CPS care for diabetes management was conducted. The primary outcome was HbA1c reduction after up to 18 months of CPS care; subgroup analyses by type of clinic visit (face-to-face versus telephone), age group, Care Assessment Need (CAN) Score, and number of visits within an 18-month time frame were performed. RESULTS: There was a 2.2% absolute reduction in the mean HbA1c value among veterans receiving CPS care for up to 18 months. There was no statistically significant difference in absolute HbA1c reduction by type of clinic visit. The greatest absolute HbA1c reduction was observed in the following subgroups: 60- to 69-year-old veterans, veterans with a CAN score of ≥90, and veterans who had 5 or more CPS visits. CONCLUSION: CPSs at the Cincinnati VAMC significantly reduced the HbA1c of uncontrolled, complex diabetic veterans. The reduction in HbA1c was greatest in patients who had more than 5 encounters with a CPS over the 18-month data collection period.

Validation of the male osteoporosis knowledge quiz.

The purpose of this study was to validate the six-item Men's Osteoporosis Knowledge Quiz (MOKQ). The MOKQ asks questions about risk factors that are pertinent to men, such as the risk for developing low bone mass related to hormone treatment for prostate cancer and the importance of testosterone for bone mass. A survey was sent to 242 men with a mean age of 83.2 years. The mean number of questions answered correctly in response to the six-item MOKQ was 2.37. Convergent validity was examined by correlating the score achieved on the MOKQ with the score achieved on the total Facts on Osteoporosis Quiz. The Pearson correlation coefficient for the MOKQ and the Facts on Osteoporosis Quiz was r = .76. Reliability was demonstrated by computing a Cronbach's alpha for the MOKQ (r = .72). The MOKQ was found to have adequate reliability and validity in assessing older men's knowledge about osteoporosis.

Older men's knowledge of osteoporosis and the prevalence of risk factors.

It has been estimated that up to 45% of men in the United States have low bone density. Yet, only a few studies have examined men's knowledge of bone health and disease. Men's knowledge of sex-specific issues related to osteoporosis is especially not well understood. We surveyed 1535 community-dwelling men with a mean age of 79 yr. The assessed risk factors included a current diagnosis of low bone mass, positive history for fracture, recent level of physical activity, and current medications with the potential to affect bone health. Knowledge about male risk factors for osteoporosis was also assessed, including the effects of advancing age, frame size, fracture risk, calcium and Vitamin D supplementation, low testosterone level, and treatment for prostate cancer. Within this sample, only 11% of the men reported a current diagnosis of low bone mass, whereas 11% reported a prior hip fracture. Only 5% of the sample reported taking some type of Food and Drug Administration-approved medication for osteoporosis. In the aggregate, the participating men answered only 39% of the 6 male osteoporosis-knowledge questions correctly. It is imperative that bone health promotion campaigns that have educated many women effectively now expand their focus to advance the bone health of men also.

Implementation of a patient perception survey in a pharmacist-managed primary care clinic and analysis with a unique HFMEA method.

OBJECTIVES: To develop and implement a patient-based pilot survey that measures patient perceptions regarding the quality of education given to them by clinical pharmacists in primary care clinics and to incorporate a unique method for analyzing the survey data. METHODS: The survey addressed 12 components of education within three categories: medication-related education, disease-related education, and delivery of education provided. The 12 components were repeated in two sections of the survey. Section 1 assessed patients' perceptions of pharmacist performance in each component, while section 2 measured patients' perceptions regarding the importance of each component of education. Results were analyzed with standard statistical techniques and an adaptation of the health care failure mode and effect analysis (HFMEA) process to identify areas of improvement that patients value most. RESULTS: The survey was successfully developed and implemented, and results were analyzed with the HFMEA tool. A total of 60 patients completed surveys, with 75% (45 of 60) scoring an overall rating of excellent. Initial results from the HFMEA identified no areas of improvement. A secondary analysis was used to identify five areas for improvement, including (1) discussing adverse effects of medications, (2) discussing resources available, (3) providing benefits of treating medical problems, (4) answering questions completely, and (5) discussing goals of treatment. CONCLUSION: A survey focused on pharmacist-driven education with primary care patients was successfully developed and implemented. The unique HFMEA tool implemented provided a means of prioritizing results for future quality improvements.

Dual-Energy X-Ray Absorptiometry Technical issues: the 2007 ISCD Official Positions.

At the 2007 Position Development Conference, the Dual-Energy X-ray Absorptiometry Technical Task Force investigated three major areas of bone density testing. Although bone mineral density (BMD) testing in men had previously been reviewed at the 2005 Position Development Conference, we reviewed the most recent data in men to develop appropriate indications for bone density testing in men. We continue to recommend screening at age 70 and discuss the clinical risk factors that may be an appropriate indication for earlier BMD testing. Menopausal transition (perimenopause) was considered an important time to consider BMD evaluation because bone loss may be significant prior to menopause. However, because fracture risk is inherently low in women of this age without other risk factors, screening BMD testing is not appropriate. We discuss the risk factors that are strong indicators of fracture risk that may be increased during the menopause transition. The presence of these risk factors are appropriate indications for BMD testing with applicability of WHO diagnostic categorization. The issue of establishing a high threshold for BMD was investigated thoroughly and the current literature was reviewed. Despite the fact there is agreement that all BMD values greater than T-score -1.0 are not normal, it was felt that because of the paucity of sensitivity data and confounding factors such as high body mass index, an upper threshold could not be established or recommended at this time. This was felt to be an important area for further research.