Association between the North Carolina Medical Board opioid guideline update and opioid prescriptions in Medicare Part D beneficiaries.

OBJECTIVE: To examine if North Carolina (NC) opioid prescribing guidelines were associated with changes in opioid prescribing. METHOD: Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets from 2013 to 2015. PARTICIPANTS: Providers who prescribed at least one opioid from 2013 to 2015 and paid by Medicare Part D. MAIN OUTCOME MEASURE: Per-prescriber Medicare-population adjusted number of analgesic opioid claims and per-prescriber average day supply. Generalized estimating equations (GEE) were used to analyze the data. RESULTS: There were significantly higher per-prescriber Medicare adjusted opioid claims in 2014 compared to 2015 (p < 0.001) but no difference between 2013 and 2015 (p = 0.584). GEE results also indicated that there was a significant increase in 2015 in per-prescriber average day supply, compared to 2013 and 2014 (both p < 0.0001). CONCLUSIONS: State opioid prescribing guidelines published in mid-2014 may have slowed the escalation of numbers of opioid prescriptions in NC. Future research should examine whether the guidelines were associated with changes in morphine equivalent dosing in NC during the same timeframe.

Emergency Providers' Opioid Prescribing Behaviors Among Medicare Part D Beneficiaries in North Carolina, 2013-2014: Medication Utilization and Costs.

BACKGROUND This study sought to quantify utilization and costs associated with opioid prescribing by emergency providers for Medicare Part D beneficiaries in North Carolina and the United States from 2013 to 2014.METHODS This was a retrospective examination of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets from 2013-2014. The main variables of interest were total number of prescription claims and total Medicare Part D medication costs for opioid analgesic medications. Generalized estimating equations were used to analyze the data.RESULTS Excluding North Carolina, there were 2,030,108 (678.49 per 100,000) opioid claims in the United States in 2013, costing more than $28.3 million. In 2014, also excluding North Carolina, there were 2,061,992 (689.15 per 100,000) claims for opioids, costing almost $35.8 million. In North Carolina, there were 67,570 (708.62 per 100,000) opioid claims from emergency providers in 2013 and 72,881 (764.31 per 100,000) opioid claims in 2014 for Part D beneficiaries. Total Part D drug costs associated with opioids from North Carolina increased from $545,574 to $764,016, more than a 40% increase. In North Carolina, there was a statistically significant increase in costs (P < .001), but not a significant increase in numbers of claims (P = .051).LIMITATIONS This study did not examine patient-level data and could not examine diagnoses leading to opioid prescriptions, or opioid misuse or overdoses.CONCLUSION Almost 1 out of every 4 Part D prescriptions from emergency department providers in North Carolina was for an opioid medication. Given the recent focus on controlling opioid prescribing, future research should examine if the new opioid-prescribing guidelines reduced opioid prescription by these providers.

Results of a Pharmacist Intervention on Weight Parameters and A1c Compared to Standard Patient Care.

Obesity is linked to many accompanying comorbidities and has a substantial effect on the cost of health care. Pharmacist are able to provide management and intervention for the treatment of these disease states. This study examined outcomes 12 months prior to pharmacist intervention and 6 months postintervention. The primary outcome was to determine if pharmacist service intervention resulted in improved markers of weight and diabetes. This study revealed significant improvement in the HgbA1c and body mass index (BMI) from baseline (A1c 7.9%, BMI 35.3 kg/m2) to postintervention (A1c 7%, BMI 34.1 kg/m2). These results were statistically significant (P < .001, Bonferroni correction applied for multiple comparisons), indicating the clinical importance of adding pharmacists to the health care team in obesity and diabetes management.

Alternative Agents in Type 1 Diabetes in Addition to Insulin Therapy: Metformin, Alpha-Glucosidase Inhibitors, Pioglitazone, GLP-1 Agonists, DPP-IV Inhibitors, and SGLT-2 Inhibitors.

Insulin is the mainstay of current treatment for patients with type 1 diabetes mellitus (T1DM). Due to increasing insulin resistance, insulin doses are often continually increased, which may result in weight gain for patients. Medications currently approved for the treatment of type 2 diabetes offer varying mechanisms of action that can help to reduce insulin resistance and prevent or deter weight gain. A MEDLINE search was conducted to review literature evaluating the use of metformin, alpha-glucosidase inhibitors, pioglitazone, glucagon-like peptide 1 agonists, dipeptidyl peptidase, and sodium-dependent glucose transporter 2 inhibitors, in patients with T1DM. Varying results were found with some benefits including reductions in hemoglobin A1c, decreased insulin doses, and favorable effects on weight. Of significance, a common fear of utilizing multiple therapies for diabetes treatment is the risk of hypoglycemia, and this review displayed limited evidence of hypoglycemia with multiple agents.

Preceptor perceptions of fourth year student pharmacists' abilities regarding patient counseling on therapeutic lifestyle changes.

OBJECTIVE: Advanced pharmacy practice experiences (APPEs) provide an opportunity for students to showcase health and wellness knowledge and skills attained during didactic education. The primary objective of this study was to assess preceptor perceptions of how well pharmacy year four (PY4) students are prepared to provide guideline-based and patient-specific therapeutic lifestyle change (TLC) counseling at onset of an APPE rotation. A secondary objective included assessment of differences in counseling abilities if the preceptor considered the student normal weight versus overweight or obese, or if they were a known smoker. METHODS: A questionnaire containing Likert questions about perceptions regarding TLC counseling was distributed electronically in October 2014 to 708 PY4 preceptors from two pharmacy schools. Only preceptors who routinely provided TLC counseling were included in data analysis that were done using descriptive statistics. The project was approved by both universities' institutional review boards. RESULTS: The survey was completed by 165 PY4 preceptors (response rate = 23.3%), and 67 met inclusion criteria. Regarding nutrition counseling, a greater percentage of preceptors agreed that students more adequately provided counseling per guidelines (79.1%) versus individual patient needs (62.6%). Preceptors perceived students of normal weight were more likely to provide adequate lifestyle-modification counseling to overweight/obese patients (81%) compared to students that were overweight/obese themselves (69%). Students of normal weight were perceived to be more likely to adequately counsel normal weight patients on lifestyle modifications (81%) compared to students that were overweight/obese (64%). Students who smoked were perceived to adequately counsel about not smoking, though, to a lesser degree than students who were non-smokers. IMPLICATIONS: While students are perceived as adequately equipped to provide guideline-based recommendations, there is room for improvement in providing patient-specific counseling. Additionally, it is perceived that student health status related to weight impacts TLC counseling.

Pharmacy students' ability to identify plagiarism after an educational intervention.

Objective. To determine if an educational intervention in a doctor of pharmacy (PharmD) degree program increases pharmacy students' ability to identify plagiarism. Methods. First-year (P1), second-year (P2), and third-year (P3) pharmacy students attended an education session during which types of plagiarism and methods for avoiding plagiarism were reviewed. Students completed a preintervention assessment immediately prior to the session and a postintervention assessment the following semester to measure their ability. Results. Two hundred fifty-two students completed both preintervention and postintervention assessments. There was a 4% increase from preintervention to postintervention in assessment scores for the overall student sample (p<0.05). The mean change was greatest for P1 and P2 students (5% and 4.8%, respectively). Conclusion. An educational intervention about plagiarism can significantly improve students' ability to identify plagiarism.

Evaluating second-line treatment options for type 2 diabetes: focus on secondary effects of GLP-1 agonists and DPP-4 inhibitors.

OBJECTIVE: To discuss the controversy surrounding selection of second-line type 2 diabetes mellitus (T2DM) therapy by reviewing available data regarding secondary effects of glucagon-like peptide-1 receptor (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, which include low hypoglycemia risk, weight loss, and cardiovascular (CV) and ß-cell function benefits. DATA SOURCES: A MEDLINE search (1966-March 2013) was conducted using the following key terms: ß-cell protection, blood pressure, DPP-4 inhibitors, exena tide, exenatide extended-release, GLP-1 agonists, hypoglycemia, lina glip tin, lipid, liraglutide, pancreatitis, saxagliptin, sitagliptin, and type 2 diabetes. STUDY SELECTION AND DATA EXTRACTION: Identified articles published in English were evaluated for inclusion, with priority given to randomized controlled trials in humans receiving incretin monotherapy or incretin combination therapy with metformin. References identified in these articles were reviewed for additional trials. DATA SYNTHESIS: Most patients with T2DM use combination therapy; however, determination of the second-line agent that is most appropriate is debatable. Prior to the use of incretin therapies, traditional second-line agents included sulfonylureas, thiazolidinediones, and basal insulin, all of which demonstrate undesirable adverse effects. In addition to improving glycemic control, incretin therapies have demonstrated benefits concerning hypoglycemic risk and weight loss in addition to potential improvements in CV risk factors and ß-cell function. While there are risks associated with using incretins, most patients with T2DM are good candidates for incretins and could benefit from their potential secondary effects. Cost remains a barrier to initiating these agents. CONCLUSIONS: Demonstrated secondary benefits in addition to efficacy may make GLP-1 agonists and DPP-4 inhibitors a more favorable option than other second-line T2DM therapies.