T he risk of developing cardiovascular disease (CVD) can be greatly reduced through lifestyle and medical therapies that address diet, overweight and obesity, smoking, dysplipidemia, hypertension, and diabetes mellitus. Irrespective of which factors are contributing on an individual's risk for the development of CVD, treatment with statins safely and effectively reduces morbidity and mortality from CVD. 1,2The recent American College of Cardiology/American Heart Association cholesterol treatment guideline emphasizes identifying and treating individuals at risk for developing CVD. 3 However, fewer than half of high-risk individuals are treated with statins. 4,5 Statin use is lower among blacks, 4,6 Hispanics, 5,6 the uninsured, 7 and poorer individuals. 8,9 Reducing the population burden of CVD and decreasing disparities will require maximizing the use of preventive strategies among all individuals likely to benefit from them.Statins may be underused for primary prevention for several reasons. Clinicians and patients may not readily appreciate increased CVD risk, particularly when risk comes from factors other than elevated cholesterol. 10,11 Patients may also Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states.Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, [12][13][14] Outreach interventions focused on addressing this risk could increase the number of high-risk patients who seek out treatment. 15Implementing population health management strategies in settings that serve large numbers of patients from low income and minority populations may be an effective way to reduce disparities. 16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.We hypothesized that m...

Updated cholesterol guidelines emphasize multivariable cardiovascular disease (CVD) risk estimation to guide treatment decision-making in primary prevention. This study tested the preliminary feasibility, acceptability and efficacy of point-of-care testing (POCT) and quantitative CVD risk assessment in high-risk adults to increase guideline-recommended statin use in primary prevention. Participants were aged 40–75 years, without CVD or diabetes mellitus, and potentially-eligible for consideration of statins based on estimated 10-year CVD risk from last-measured risk factor levels in the electronic health record. We performed POCT to facilitate quantitative CVD risk assessment with the Pooled Cohort Equations immediately before a scheduled primary care provider (PCP) visit. Outcomes were: physician documentation of a CVD risk discussion and statin prescription on the study date. We also assessed acceptability of the intervention through structured questionnaire. We recruited 18 participants (8 from an academic practice and 10 from a federally-qualified health clinic). After the intervention, 83% of participants discussed CVD risk with their PCP, 47% received a statin recommendation from their PCP, and 29% received a new statin prescription during the PCP visit. Participants reported high levels of satisfaction with the intervention. This study demonstrates that in initial testing pre-visit POCT and quantitative CVD risk assessment appears to be a feasible and acceptable intervention that may promote guideline-recommended statin initiation in primary prevention. Future research with an adequately powered trial is warranted to determine the effectiveness of this approach in clinical practice.

This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.

We sought community health center (CHC) patients' feedback regarding an outreach intervention promoting primary prevention of cardiovascular disease to patients at increased risk. We performed a telephone survey that assessed whether patients recalled receiving the intervention, what actions occurred in response to the intervention, and patient attitudes regarding receipt of preventive service messages from their CHC. Participants (n = 80) were 89% male, and 59% were black. Among the 88% of respondents who reported a healthcare visit, 84% reported a discussion about cholesterol or heart disease risk with their provider, of these 44% reported a statin was recommended and 89% reported currently taking it. Participants reported high acceptability of receiving preventive service messages, but were less likely to agree that they wanted to receive preventive service messages via text or email compared to other modes of contact. Our results show that outreach programs to promote indicated preventive services were viewed positively by this patient group. We also identified areas where the CVD prevention program may have lost effectiveness.

No abstract

BackgroundThe process of distributing drugs to hospitalised patients is complex, which is why it is necessary to establish improvement strategies in hospitals to ensure patient safety, monitoring every point in the process of the distribution of drugs: prescription, validation, preparation and dispensing.1 PurposeTo detect and analyse medication errors (ME) in dispensing inpatients. To assess the impact of pharmaceutical intervention after implementation of corrective measures.Material and methodsFollow-up study pre-post intervention (pre-intervention phase: October 2014 to June 2014 and post-intervention phase: March 2014 to November 2015). The intervention involved implementation of corrective measures in the distribution system of drugs in unit doses to improve the safety of hospital patients. These corrective measures were aimed at all healthcare professionals involved. Corrective measures were: incorporating medication carts (MC) with safety systems, implementing protocols for filling and emptying of MC and implementation of a medication dispensing protocol omitted from clinical units. The amount (%) and type of ME were compared before and after the implementation of corrective measures. Monitoring of ME in dispensing was performed by daily selection of 5 MC.Results160 medication carts (80 pre-intervention phase and 80 post-intervention phase) and 31 360 (15 102 pre-intervention phase and 16 258 post-intervention phase) treatment lines were monitored. 13.10% and 4.37% of ME in the pre-intervention and post-intervention phases were detected, respectively. 5 types of ME were detected in the pre-intervention phase (4.98% missing drugs, 4.71% non-prescription drugs, 2.62% excess drugs, 0.65% deficit drugs, 0.14% repackaging) and 3 in the post-intervention phase (2.18% missing drugs, 1.44% deficit drugs, 0.75% excess drugs). We obtained a reduction in ME of -8.73%. A decrease was observed in ME non-prescription drugs, 88 (-4.71%) and ME with excessive drugs (-1.97%).ConclusionThe main medication errors detected during filling corresponded to missing drugs and excessive drugs. The implementation of standardised protocols in dispensing drugs in individualised doses reduces medication errors and increases safety for hospitalised patients.References and/or AcknowledgementsKa-Chun Cheung, et al. Medication errors: the importance of safe dispensing. Br J Clin Pharmacol 2009;67:676–80No conflict of interest.

BackgroundMedical gases (MG) have traditionally been managed by maintenance units. With the new legislation, this management has been taken over by the pharmacy departments.PurposeTo measure the economic impact and describe the efficiency measures implemented in the management of MG.Material and methodsFollow-up study pre-post intervention (pre-intervention phase January to October 2014 and post-intervention phase January to October 2015). The procedure was performed by the pharmacy of a hospital to improve efficiency in the management of MG (oxygen, nitrous oxide and medical air). The efficiency measures implemented were: (1) development of a protocol to standardise management of medical gases; (2) development of software to follow the traceability of distributed bottles of oxygen, reduce stock and know immobilised stocks in real time; (3) reduction of oxygen delivery pressure from 6 bar to 4.5 bar; and (4) incorporation of oxygen cylinders with a digital gauge that allows easy real time reading of gas consumption. The economic impact was obtained after comparing the costs (€) associated with the consumption of MG before and after the intervention of pharmacy services in the management of MG.ResultsThe costs associated with the use of MG in the pre-intervention phase were: €152 621 oxygen, €96 140 nitrous oxide and €7490 medical air, and in the post-intervention phase were: €114 814 oxygen, €60 973 nitrous oxide and €8728 medical air. Following the implementation of efficiency measures, the costs of oxygen consumption (€-37 807) and nitrous oxide (€-35 176) decreased. However, they increased for medical air (+€1238). Total gas consumption costs from January to October 2014 were €256 252 and from January to October 2015 €192 892, reducing the total costs by 24.7%. The management carried out by technical services during the pre-intervention phase did not generate additional costs for the hospital, nor did the services carried out by pharmacy in the post-intervention phase. Therefore, these costs (ie, personnel) were not included in the analysis. There were no differences in the quality or price of MG before and after the intervention as the MG supplier was the same.ConclusionThe intervention of the pharmacy services led to a considerable reduction in the overall cost of consumption of MG, greater traceability in the distribution of bottles, reduction of stock and greater efficiency in the management of MG.References and/or AcknowledgementsDomínguez-Gil Hurlé A. Farm Hosp 2005;29:300-222No conflict of interest.