CONCLUSION: This self-evaluation of the provision of pharmacist consultant services that focus on disease management in addition to DRR found a higher rate of adherence to clinical practice guidelines for 4 of 7 common chronic disease states in long-term-care patients compared with patients who received only traditional DRR services.KEYWORDS: Practice guidelines, Long-term care, Nursing homes, Geriatrics Moines, IA 50316. Tel: (515) Fax: (515) Copyright© 2007, Academy of Managed Care Pharmacy. All rights reserved. ABSTRACT Note: A commentary on the subject of this article appears on pages 68-69 of this issue.We have defined DSM as the provision of therapeutic recommendations to improve CPG adherence for common chronic medical conditions, which we have practiced since we began our LTCF pharmacist consulting service in 2001. In addition, we have delivered the traditional drug regimen review (DRR) process, which is defined in federal regulations as evaluating indications for medication use, effectiveness of therapeutic goal, medication dose, presence of monitoring and duplicate therapy, and potential for adverse drug reactions. 12We previously evaluated physician acceptance and perceived value of the pharmacist consultant interventions for 155 LTCF patients during an 8-month period. 13 Results showed that 523 of 559 recommendations (84.3%) were accepted by physicians and that 45% of recommendations were perceived as important by physicians. While 10.4% of pharmacist recommendations were made in response to federal guidelines in the DRR process, an additional 85.2% of recommendations were initiated as a result of a broader medication review, including DSM activities. These results demonstrated that our pharmacist recommendations were accepted and valued by physicians, but they did not allow us to evaluate the CPG adherence rates for the patients we served.The objectives of this study were to evaluate (1) the end outcome of CPG adherence and (2) the process outcome of the number of care recommendations made for patients from LTCFs who received DSM pharmacy consulting services compared with patients who received traditional DRR pharmacy consulting services.ss Methods Study DesignA retrospective chart review was conducted on 411 patients at 6 LTCFs. Two facilities (107 patients) received DSM consultant pharmacist services (provided by Kristin K. Horning and James D. Hoehns) and 4 facilities (304 patients) received traditional DRR services. The 4 DRR (control) facilities constituted a convenience sample located within 30 miles of the 2 LTCFs that had consultant DSM pharmacy services. These control LTCFs had varying types of pharmacist consulting services, with 2 homes receiving corporate services (218 patients) and 2 homes receiving independent pharmacist consulting services (86 patients). While the homes receiving DSM services were both for-profit, 2 control homes were for-profit and 2 homes were nonprofit. All homes had both Medicare and Medicaid participation. The investigators believed that the control homes ...

Overall efficacy was not demonstrated. However, the findings of possible efficacy for patients with moderate fatigue suggests that further research may be of value.

This study demonstrated that a physician-pharmacist collaborative intervention was effective in reducing mean systolic BP and improving BP control in patients with uncontrolled hypertension with DM and/or CKD, regardless of which BP guidelines were used.

BackgroundAlthough acute cystitis is a common infection in women, the impact of this infection and its treatment on women's quality of life (QOL) has not been previously described.Objectives: To evaluate QOL in women treated for acute cystitis, and describe the relationship between QOL, clinical outcome and adverse events of each of the interventions used in the study.MethodsDesign. Randomized, open-label, multicenter, treatment study.Setting. Two family medicine outpatient clinics in Iowa.Patients. One-hundred-fifty-seven women with clinical signs and symptoms of acute uncomplicated cystitis.Intervention. Fifty-two patients received trimethoprim/sulfamethoxazole 1 double-strength tablet twice daily for 3 days, 54 patients received ciprofloxacin 250 mg twice daily for 3 days and 51 patients received nitrofurantoin 100 mg twice daily for 7 days.Measurements. QOL was assessed at the time of enrollment and at 3, 7, 14 and 28 days after the initial visit. QOL was measured using a modified Quality of Well-Being scale, a validated, multi-attribute health scale. Clinical outcome was assessed by telephone interview on days 3, 7, 14 and 28 using a standardized questionnaire to assess resolution of symptoms, compliance with the prescribed regimen, and occurrence of adverse events.ResultsPatients experiencing a clinical cure had significantly better QOL at days 3 (p = 0.03), 7 (p < 0.001), and 14 (p = 0.02) compared to patients who failed treatment. While there was no difference in QOL by treatment assignment, patients experiencing an adverse event had lower QOL throughout the study period. Patients treated with ciprofloxacin appeared to experience adverse events at a higher rate (62%) compared to those treated with TMP/SMX (45%) and nitrofurantoin (49%), however the difference was not statistically significant (p = 0.2).ConclusionPatients experiencing cystitis have an increase in their QOL with treatment. Those experiencing clinical cure have greater improvement in QOL compared to patients fail therapy. While QOL is improved by treatment, those reporting adverse events have lower overall QOL compared to those who do not experience adverse events. This study is important in that it suggests that both cystitis and antibiotic treatment can affect QOL in a measurable way.