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March 17, 2012

THE NEW VISION OF PHARMACY


It seems that every few years the profession of pharmacy tries to come up with some hot new buzzwords in attempting to explain what pharmacists do on a daily basis. Several years ago, pharmacists took on the title of “managed care specialists.” Unfortunately, somewhere along the way that catchphrase took on a decidedly negative connotation when third-party pharmacy organizations like pharmacy benefit managers and mail-order prescription providers decided they were, in fact, managed care specialists. The term was further watered down to simply “managed care,” which of course over time became a synonym for third-party payers of health care.
Eventually, pharmacists migrated from using the term “managed care” to describe their services and settled on “pharmaceutical care.” The belief was that this phrase better described the pharmaceutical aspect of managing patient care. In some professional circles, however, it was still considered a bit too broad a definition. I think the latest incarnation perfectly describes the services that pharmacists perform: “medication therapy management” (MTM). And the most important component of MTM is making sure a patient is compliant in taking the right medications exactly as prescribed.
According to the World Health Organization, approximately 125,000 patients die annually because of noncompliance with their medication therapies. In fact, noncompliance kills more Americans each year than accidents, influenza, and pneumonia combined and costs society over $175 billion. The New England Health Care Institute estimates that poor adherence to drug therapy imposes as much as $290 billion in annual health care costs, or 14% of all health care expenditures.
In reality, pharmacists have been performing MTM in their daily professional lives forever. But in the last couple of decades many have approached MTM in a more structured manner. New MTM programs have emerged all over the country. The granddaddy of these kinds of programs is known as the Ashville Project. Launched nearly 15 years ago in Ashville, North Carolina, it focused specifically on pharmacists managing drug therapies of city employees with diabetes. The results were inspiring. Job absenteeism due to poor medication control dropped an average of 50%, and the program saved approximately $400 to $600 a year in health care costs per patient, with nearly a 4-to-1 return on the city's investment. It was deemed a huge success and was replicated in many other states.
Pharmacists' involvement with MTM has also caught the attention of the medical community. A recent article published in theArchives of Internal Medicine acknowledged the role that pharmacists play in successfully managing cardiovascular disease risk factors such as hypertension and high cholesterol. According to the authors, while pharmacists have long been recognized for their important role as dispensers of medication, there has been a “transformation of pharmacy practice towards a more clinical, patient-centered role and a collaborative approach toward pharmacist-physician in patient care.” And a position paper from the American College of Physicians stated that it is “committed to fostering effective and productive collaborative relationships between pharmacists and physicians.”
That kind of recognition from the medical community is exhilarating. It is important that pharmacists engage in the practice of MTM as part of their ongoing professional development. Not only is it personally fulfilling, it is quickly becoming the new vision of pharmacy in the eyes of patients and other health care professionals alike. Pharmacists are on the cusp of finally being able to showcase their true professional value and worth to patients, other health care professionals, legislators, and third-party payers. The time to take action is now.
Source: USPharm
by
Akshaya Srikanth
Pharm.D Intern
Hyderabad, India

March 16, 2012

FORMULAS AND RULES FOR PREVENTION OF HEART ATTACKS


One can prevent heart attacks. Nine preventable risk factors are responsible for 90% of heart attacks. They are (in order of importance)
  1. Increased LDL/HDL ratios (elevated bad LDL and low good HDL cholesterol levels)
  2. Smoking
  3. Diabetes
  4. Hypertension
  5. Abdominal obesity
  6. Psycho-social (stress or depression)
  7. Failure to eat fruits and vegetables daily
  8. Failure to exercise
  9. Failure to drink adequate water
One can prevent heart attack by following Doctors excellence formula of eighty
  1. Keep lower BP, bad cholesterol levels, resting heart rate, fasting sugar and abdominal girth levels all less than 80.
  2. Keep kidney and lung functions more than 80%
  3. Engage in recommended amounts of physical activity (minimum 80 minutes of moderately strenuous exercise per week). Our recommendation is to walk 80 minutes a day and for 80 minutes per week the speed should be 80 steps per minute  
  4. Eat less and not more than 80 gm or ml of caloric food each meal.  Follow a healthy diet (high fiber, low saturated fat, zero trans fat, low refined carbohydrate, low salt, high in fruits). Refined carbohydrates are white rice white maida and white sugar. 
  5. Observe cereal fast 80 days a year.
  6. Doing 80 cycles of pranayama (meditation) a day
  7. Spend 80 minutes to yourself every day (relaxation, meditation, helping others etc)
  8. Do not smoke or be ready to spit out 80,000 Rs for treatment. Not smoking or else you will have to spend 80,000 on your illness.
  9. Those who drink, does not want to stop and there is no contraindication, limiting alcohol use to no more than 80 ml per day for men (50% for women) or 80 grams per week. 10 grams of alcohol is present in 30 ml or 1 oz of 80 proof liquor.
  10. Take 80 mg of aspirin if prescribed for prevention.
  11. Tale 80 mg atorvastatin for prevention when prescribed.
One can prevent diabetes by controlling five lifestyle factors
They are
  1. Follow a healthy diet
  2. Maintain an optimal body weight (less than 23 x height in meters x height in meters)
  3. Engage in recommended amounts of physical activity.
  4. Limiting alcohol to recommended amount.
  5. Not smoking.
Rules
  1. Rule of 30 seconds: Chest pain, burning, discomfort, heaviness in the center of the chest lasting for over 30 seconds and not localized to a point unless proved otherwise is a heat pain.
  2. Rule of pin pointing finger: any chest pain which can be pin pointed by a finger is not a heart pain.
  3. Rule of forty: First onset acidity or first onset asthma after the age of 40, first rule out heart attack or heart asthma
  4. Rule of 300:  Chew a tablet of water soluble 300 mg aspirin and take 300 mg Clopidogrel tablet at the onset of cardiac chest pain. You will not die.
  5. Rule of ten:  Within ten minute of death for the next ten minutes do effective chest compression with a speed of (10 x10) 100 per minute. 80% people can be saved.
  6. Rule of 180: Reach hospital within 180 minutes in heart attack for receiving clot dissolving angioplasty or clot dissolving drugs
by
AKSHAYA SRIKANTH
Pharm.D Intern
Hyderabad, India

March 14, 2012

EVIDENCE BASED MEDICINE: RESEARCH DESIGNING

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
The ability to incorporate Evidence-Based Medicine into clinical care requires a basic understanding of the main research designs underlying the published evidence. Some research designs provide a stronger level of evidence than others based on their inherent characteristics. This hierarchy is often shown graphically as a pyramid:


Levels of Evidence
The pyramid represents the quality of research designs by level, as well as the quantity of each study design in the body of published literature. Systematic reviews (higher quality), for instance, are the most time-intensive articles to write and are therefore rarer (lower quantity) than other types of studies.
More detailed levels of evidence have been developed by the Oxford Centre for Evidence-Based Medicine. They use a numbering scheme ranging from 1a, homogenous systematic reviews of randomized controlled trials, to 5, expert opinion. This system can be especially useful when comparing articles with similar study designs. Equivalent research designs do not always produce results of equal quality.
Though finding research studies high on the pyramid is preferred, Evidence-Based Practice may need to draw on research designs lower in the evidence hierarchy than case series. Occasionally, nothing but case reports or even bench research may exist on a topic. When making evidence-based decisions for patient care, it is essential to select the highest level research design available for the specific question of interest.
Systematic reviews
Systematic reviews provide the strongest type of evidence, as the authors attempt to find all research on a topic, published and unpublished. The authors then combine the research into a single analysis. Keep in mind that systematic reviews are different than review articles. While systematic reviews are conducted to answer a specific clinical foreground question, review articles provide a broad overview on a topic to answer background questions. Another difference is that the literature search for review articles does not attempt to find all existing knowledge on a topic.
Meta-Analysis
A meta-analysis is a particular type of systematic review that attempts to combine and summarize quantitative data from multiple studies using sophisticated statistical methodology. Such a strategy strengthens evidence as it makes the small sample size of individual studies much larger, giving the results more statistical power and, therefore, more credibility than the individual studies. Meta-analyses are not comprehensive, as only compatible data may be combined into a larger data set.
Authors should clearly specify the criteria for inclusion or exclusion of individual studies somewhere in a systematic review or meta-analysis.
Randomized controlled trials (RCT)
A randomized controlled trial is an experimental, prospective study in which "participants are randomly allocated into an experimental group or a control group and followed over time for the variables/outcomes of interest."
Study participants are randomly assigned to ensure that each participant has an equal chance of being assigned to an experimental or control group, thereby reducing potential bias. Outcomes of interest may be death (mortality), a specific disease state (morbidity), or even a numerical measurement such as blood chemistry level.
A typical RCT that represents the flow of participants from the start of the study through the study outcome. Notice in all diagrams the study start; studies progressing from left to right represent prospective studies, “collecting data about a population whose outcome lies in the future”.
Frequently RCTs are used to measure the effectiveness of a particular therapy, especially drug therapy.
Cohort studies
A cohort study is an observational, prospective or retrospective study. A cohort study "involves identification of two groups (cohorts) of patients, one that received the exposure of interest, and one that did not, and following these cohorts forward for the outcome of interest."
While at first glance a cohort study looks similar to a RCT, it differs in one very significant way: the researchers do not assign the exposure or randomize the groups in any way. RCTs are experimental, while cohort studies are observational.
Cohort studies may be prospective or retrospective. Retrospective studies “begin and end in the present but involve a major backward glance to collect information about events that occurred in the past.”
Case-control studies
A case-control study is an observational, retrospective study which "involves identifying patients who have the outcome of interest (cases) and control patients without the same outcome, and looking back to see if they had the exposure of interest."
Retrospective case-control studies rely on people’s memories, making them prone to error. Also, it may be difficult to measure the exact amount of an exposure in the past. This method is inexact at best.
Case series
A case series is a descriptive report "on a series of patients with an outcome of interest. No control group is involved.”
Case series provide the weakest evidence of the study types examined so far, since they describe a relatively small number of patients and no experimental manipulation is involved. Case reports are simply descriptive reports of single patients. However, these study designs should not be ignored; case series and case reports often are used to introduce practitioners to unusual and rare conditions, or to point out “exceptions to the rule”. Furthermore, they are often the basis for future research using strong evidence study designs.
by
Akshaya Srikanth,
Pharm.D Internee,
FIP-YPG Associate,
Hyderabad, India

March 12, 2012

Pharm.D The Future..is No.1

Many physicians, pharmacists, students and their parents have a lot of questions in their mind about this curriculum. But still I believe that Pharm.D is going to be the No.1 employer in the Healthcare.
Pharm.D is short form of ''Doctor of Pharmacy.'' It is the professional pharmacy doctoral program. In India, it is a total six years program after 10+2 or Pharm.D which includes five years of academic study and one year of internship. It is slightly different that of M. Pharm (Pharmacy Practice). 
The academic study includes the same subjects such as B. Pharm, in addition the pharmacy practice components are emphasized such as Hospital Pharmacy, Community Pharmacy, Pharmacotherapeutics, Clinical Pharmacy, Biostatistics and Research Methodology, Clinical Toxicology, Clinical Research, Pharmacoepidemiology, Pharmacoeconomics, Clinical Pharmacokinetics and Pharmacotherapeutic Drug Monitoring. Further to add, in the fifth year of the course the candidate has to perform a project work for six months. Pharm.D is the only course which offers the prior exposure towards patient handling modules in the hospital setup and one year internship is surely going to help them implementation of clinical pharmacy services and can work on different research projects in hospital too. 
Some unique features of Pharm D include- eligibility to register for Ph.D., prefix 'Dr.' to name and a registrable qualification after completion of course.
The pharmacists can provide the clinical pharmacy services like ..
Out of the services patient medication counseling is considered to be the most important part from a patient's point of view. The information that may be discussed while a counseling session purpose, expected action, storage, method of administration of drugs and medical devices. Overall skills required to provide better clinical pharmacy services are up-to-date knowledge of clinical aspects of drugs and good communication skills.

After completion and during the course Pharm D candidate may provide the clinical pharmacy services in the hospital, work in the areas Clinical research organizations (CRO), Pharmacovigilance, Pharmaco-economics, community services, research and academics.
As we know it is a newly launched curriculum in India, it will take time to get it well established. Pharm.D candidates need to work hard and get recognized in the society for patient-care by clinical pharmacy services. They have to create a rapport with other healthcare providers such as physicians, nurses, and also with patients. Pharm.D candidates have to generate the need of clinical pharmacy services in the society and prove its importance. 
As the Pharm.D is mostly patient-centered curriculum, therefore, patients will be benefited the most. The patients would be able to know all the information about their disease, drugs and lifestyle modifications for the disease in future which would definitely increase prognosis of the patients. The clinical pharmacy services would also minimize the work-load of physicians from their busy schedule as well as it would decrease the load on the Indian health-care system. 
As a summary, it can be expected that the Pharmacists, i.e., Pharm.D would play a major role in Indian health care system and Industry in future. This course will give an opportunity to pharmacists to work more prominently in Indian health care system.
So, "Be THE BEST VERSION OF YOU" 
Doctors, Medicos, Nurses, Pharmacists and others Healthcare professional are our best friends and we all here learning and working for a single goal of wellness of patient. 
GIVE HELP, TAKE HELP
by
Akshaya Srikanth,
Pharm.D Internee,
Hyderabad, India