Real-World Evaluation of Dosing in Patients Converted From Insulin Glargine (Lantus) to Insulin Glargine (Basaglar).

Background: Basaglar, insulin glargine (BGlar; Eli Lilly, Indianapolis, IN), a follow-on biologic, was developed after the patent for Lantus, insulin glargine (LGlar; Sanofi-Aventis, Paris, France) expired. Objective: To compare the dosing and hemoglobin A1C (A1C)-lowering effects of BGlar compared with LGlar in a real-world setting. Methods: Adult patients, at 5 clinics, with type 1 (T1DM) or type 2 diabetes mellitus (T2DM) who were converted from LGlar to BGlar were included in this retrospective observational study. The primary outcome compared mean basal insulin dose (U/d) from the date of conversion to 6 months. Basal insulin and total daily insulin doses were also compared from baseline to 3- and 12-months postconversion, as also change in A1C, body weight, and estimated monthly acquisition costs of basal insulin. Results: Of the 225 patients included, 56% were male, and 81% had T2DM. The mean conversion dose (U/d) of LGlar was 46.3 ± 32.7. There was no significant difference in the mean BGlar dose (U/d) at 6 months (45.9 ± 33.5; P = 0.52), nor was there a statistical difference at 3 or 12 months. There were no significant differences in change in A1C at any time point. The estimated monthly acquisition cost of BGlar was significantly less than that for LGlar at conversion ($286 vs $341, P < 0.001) and 6 months ($290 vs $351, P < 0.001) respectively. Conclusion/Relevance: The results of this retrospective study suggest that BGlar resulted in similar glycemic outcomes compared with LGlar in a real-world setting and may be a preferable option in a value-based health care environment.

A collaborative program to increase adult pneumococcal vaccination rates among a high-risk patient population receiving care at urgent care clinics.

OBJECTIVE: We report a project that utilized pharmacy students to increase pneumococcal vaccination rates in patients aged 19-64 years with high-risk medical conditions within urgent care clinics. The study also sought to better identify the number of patients previously vaccinated for pneumococcal disease. A total of 1,178 patients were considered eligible for pneumococcal vaccination during the study period, 287 (24.4%) of whom were determined to be previously vaccinated through chart assessment or patient interview. Of the remaining 891 patients, chart documentation of pneumococcal vaccination administered at the time of the urgent care visit was present for 96 patients (10.7%) in the intervention clinics compared with 6 patients in 2 control clinics who received the usual standard of care (P < .0001).

A faculty-led mock residency interview exercise for fourth-year doctor of pharmacy students.

PURPOSE: To determine whether a faculty-led mock-interview activity enhanced pharmacy student preparation for the residency interview process and increased match rates. METHODS: Twenty-eight doctor of pharmacy students volunteered for a 40-minute mock-interview session with 2-person faculty teams. A standard roster of 12 interview questions was derived from published literature and the faculty members' experience. Feedback on the student's interview performance was provided verbally during the session. Following the interview, students were given a 2-part survey instrument. The first part of the survey was administered immediately following the mock-interview session and the second part was administered after the standard date for residency program results (known as "Match Day"). Participant match rates were compared to American Society of Health-System Pharmacists (ASHP) national rates. RESULTS: 82.5% (23 of 27) of students in the mock-interview group matched a postgraduate year 1 (PGY1) program. Compared to national rates (61.9%), more students in our surveyed mock-interview group matched a PGY1 residency (P = .015; odds ratio [OR] 3.546, 95% CI 1.161-12.116). CONCLUSIONS: Higher match rates were seen in the students completing the mock residency interview compared to ASHP national rates. In general, students completing the mock interview found the process helpful and felt better prepared for their residency interviews.

Knowledge and attitudes of American pharmacists concerning sulfonamide allergy cross-reactivity.

OBJECTIVE: Pharmacists are commonly confronted with patients with a history of sulfonamide allergy. Basic immunologic and clinical data suggest a low likelihood of a patient with a history of sulfonamide hypersensitivity developing an allergic reaction to a non-antimicrobial sulfonamide drug. We conducted a survey to describe the knowledge and attitudes of licensed pharmacists concerning sulfonamide allergy cross-reactivity. METHODS: A survey instrument was developed and sent to all licensed pharmacists in the state of Iowa. The survey recorded demographic information and included six patient scenarios designed to elicit responses concerning sulfonamide allergy cross-reactivity with a number of non-antimicrobial sulfonamides. RESULTS: A total of 421 surveys were returned for a 39% response rate. There was a wide discrepancy in approaches to patients with a history of sulfonamide allergy prescribed a sulfonamide containing non-antibiotic. Differences depended on previous history of tolerating the medication in question, the degree of cautionary statements in product literature, and the familiarity the pharmacist had with the product. CONCLUSION: Our survey suggests a significant diversity in knowledge and attitudes of pharmacists concerning cross-reactivity of sulfonamide antimicrobials and other drugs with a sulfonamide moiety. Depth of training in this area may be an associative factor.

Adherence to treatment guidelines in two primary care populations with gout.

Published guidelines for the treatment of gout aim to improve the evidenced-based management of this disorder. Unfortunately, several studies suggest that these guidelines are not routinely followed in clinical practice. Limited data exist comparing different groups of primary care providers regarding compliance with published gout guidelines. We conducted a retrospective study comparing two different general internal medicine (IM) practices and evaluated compliance with these guidelines. All patients with a billing code for gout seen in two large IM clinics (Clinic A, an inner-city urban clinic, and Clinic B, a suburban clinic) between January 2004 and December 2007 were selected for chart review. Patients referred to a rheumatologist for management of gout were excluded. The care received by these patients for gout was compared to recommendations from published guidelines, with the primary outcome assessing the percentage of patients who received at least yearly monitoring of serum uric acid (SUA) levels. In both clinics, yearly monitoring of SUA levels occurred in approximately one quarter of the patients with gout (Clinic A 27.5% vs. Clinic B 28.9%, P = 0.87). Compared to SUA, renal function was monitored more frequently in each of the groups. Listed indications for antihyperuricemic therapy were similar between groups, although gouty flares were reported more frequently in clinic B (P = 0.005). In this retrospective review of gout management in two IM clinics, general care for patients with this condition did not differ significantly. However, overall compliance with recommendations from published guidelines was low.