Chronic Obstructive Pulmonary Disease, Part 2: A Review of Pharmacotherapy Options.

The Global Initiative for Chronic Obstructive Lung Disease Report provides guidance on prevention and management of chronic obstructive pulmonary disease (COPD), a pulmonary syndrome largely impacting older adults. Management of COPD in this patient population is often further complicated because of medication and disease state interactions. Pharmacists are in a unique position to impact patients with COPD through counseling on proper medication selection, disease state education, adherence, and proper inhaler technique.

Outcomes of Pharmacist-Conducted Admission Medication-Regimen Reviews in Long-term Care Facilities.

Objective To assess the outcomes of pharmacist-completed aMRRs. The 2018 installation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act requires medication regimen reviews (aMRR) upon admission to long-term care (LTC) hospitals, nursing facilities, and inpatient-rehabilitation facilities. While the legislation does not require that pharmacists perform the reviews, pharmacists are aptly suited to add value to this practice. Design Retrospective analysis of residents admitted to LTC facilities. Setting Twenty-four LTC facilities located in Arizona served by one pharmacist-consult service. Patients, Participants Cohort of 603 LTC residents whose medical records were reviewed by consultant pharmacists during March 2020. Results For 603 residents, 1092 aMRRs were completed and 921 interventions were made. The most prevalent interventions were medication monitoring (N = 276), medications without appropriate indication (N = 130), and overdosage (N = 116). Of 921 interventions, 41 were classified as ECA Level 6, avoided hospital admission, and 30 as Level 7, avoided life-threatening event. Of 165 recommendations rated by both pharmacy student assessors and a supervising postgraduate year 2 resident, agreement occurred in 161 (97.6% agreement, kappa reliability = 0.934). Conclusion Pharmacist-conducted aMRRs identified clinically important threats to patient safety. Study results demonstrate potential for positive economic and resident care outcomes from pharmacist-performed aMRR interventions.

Rates and Predictors of Physician-Recommended and Self-Reported Aspirin Use in 2015.

OBJECTIVE: This study assesses the rate of providerrecommended aspirin use through the National Ambulatory Medical Care Survey (NAMCS) database versus self-reported aspirin use through the Behavioral Risk Factor Surveillance System (BRFSS) database and identifies factors that predict initiation of aspirin. This study provides insight into the rate of providerrecommended aspirin use versus self-reported aspirin use prior to the 2016 United States Preventive Service Task Force primary prevention recommendation update.
DESIGN: Retrospective, cross-sectional analysis of US population data obtained from medical records (NAMCS) and community-dwelling residents in four states (BRFSS) in 2015.
SETTING: Physician offices (NAMCS) and households or telephone (BRFSS).
PATIENTS, PARTICIPANTS: NAMCS: visits made by patients 40 years of age or older to physicians who permitted federal employees to abstract officevisit data. BRFSS: household or telephone interview respondents 40 years of age or older.
INTERVENTIONS: Comparisons of persons with (secondary prevention) versus without (primary prevention) cardiovascular disease.
MAIN OUTCOME MEASURED: Recommended (NAMCS) or self-reported (BRFSS) use of aspirin.
RESULTS: The sample included 19 170 patients (NAMCS), with 2 205 having a history of cardiovascular disease and 14 872 respondents (BRFSS) with 2 024 having a history of cardiovascular disease. For both primary and secondary prevention, respondents from BRFSS reported higher rates of aspirin use (27.7% primary, 65.6% secondary prevention) compared with prescribed rates from NAMCS (11.7% primary, 45.6% secondary prevention).
CONCLUSIONS: Study results highlight the value of obtaining a complete medication history, including aspirin use, from all patients.