Is a Team-Based Approach in Primary Care Worth It?

March 9, 2019

A team-based approach to patient care is well established in acute care settings, but not as widely adopted in primary care settings.  Working within a team could have a positive impact on the efficiency of visits, quality of care, workload, job satisfaction, and patient satisfaction. Previous studies in acute-care hospital settings reveal positive outcomes, but there have been mixed results in primary care settings. Are the extra time, effort, and money necessary to change to a collaborative team-based approach worth it? Will it positively impact health care utilization, quality, and cost?

Guest Authors:  Lily Van, PharmD and Courtney Davis, PharmD, BCACP

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Cardiovascular Risk with Elevated Triglycerides - Does Icosapent Ethyl REDUCE-IT?

February 22, 2019

Although hypertriglyceridemia has consistently been associated with increased CV events, medications that lower triglycerides have failed to reel in a significant reduction in major CV events when combined with statin therapy. Could purified fish oil derivatives be the answer? Or just another red herring? The Reduction of CV Events with Icosapent-Ethyl Intervention Trial (REDUCE-IT) sought to clarify the utility of icosapent ethyl, a highly purified EPA derivative.

Guest Authors: Melissa Norton, PharmD and Elizabeth A. Cook, PharmD, AE-C, BCACP, CDE

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Another Case of Newer Isn’t Always Better! Gabapentin vs. Pregabalin for Chronic Sciatica

February 8, 2019

Sciatica is a form of neuropathic pain which can be particularly frustrating for patients and difficult to manage. With a lack of evidence to guide treatment and opioid use becoming increasingly under the microscope, data supporting the use of alternative pain regimens are needed. Gabapentin and pregablin are GABA analogs often used to treat sciatic pain, but is one superior to the other? Pregabalin is newer and available as a branded product only, but is it more effective than generically available gabapentin?  A recently published study attempts to answer this question.

Guest Authors:  Austin Morgan, PharmD and Frank Fanizza, PharmD

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Fall Risk and Benzos – Is Trazodone Really the Knight in Shining Armor?

January 18, 2019

Older adults are often tormented by insomnia, pain, and other comorbidities that impact their quality of life.  Medication therapy is often sought to treat and manage these diseases, but healthcare providers often overlook the risks of prescribing medications to patients who are older, frail, and at high risk for falls.  Trazodone is increasingly prescribed for insomnia instead of benzodiazepines presumably because it is considered to be safer and it does not appear on either the Beers or STOP/START lists.  But is trazodone really safer for patients than benzodiazepines?

Guest Authors:  Anthony M. Todd, PharmD and Nicole A Slater, PharmD, BCACP

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Top Ten Things Every Clinician Should Know About the 2018 Cholesterol Guidelines

January 9, 2019

The American Heart Association / American College of Cardiology (AHA/ACC) Task Force recently published the 2018 Guideline on the Management of Blood Cholesterol. The guidelines writing committee had representation from 12 organizations, including the National Lipid Association, American Diabetes Association, and the American Pharmacists Association — all of whom endorsed the guidelines. The previous guidelines (published in 2013) were intended to answer some specific clinical questions and significantly changed our approach to treatment. The 2018 guidelines provide a more comprehensive set of recommendations, akin to the (older) National Heart, Lung, and Blood Institute Adult Treatment Panel (ATP) III guidelines last published in 2002!

Guest Authors:  Dawn Fuke, Pharm.D., BCPS, and Zach Conroy, PharmD, BCACP

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Another Attempt to ARRIVE at an Answer Using Aspirin for Primary Prevention

December 14, 2018

Daily low-dose aspirin has long been considered a “wonder drug” for its cardioprotective effects, particularly in patients with pre-existing cardiovascular and cerebrovascular disease; however, despite decades of research, the use of aspirin to prevent a first event is less certain. In 2014, the Food and Drug Administration (FDA) responded to a citizen petition requesting the labeled indications for low dose aspirin be updated to include primary prevention. The FDA concluded that the evidence “fail[ed] to establish that aspirin reduces the risk of primary myocardial infarction (MI) in patients with a coronary heart disease (CHD) risk of 10% or more for over 10 years.” The Asprin to Reduce Risk of Initial Vascular Events (ARRIVE) study is intended to address this gap in our knowledge.

Guest Authors:  Amy St. Amand, PharmD, BCPS and Christine Borowy, PharmD, BCPS

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Does a “One-Size-Fits-All” Aspirin Dosing Approach Still Hold WEIGHT?

December 7, 2018

Personalized medicine is at the forefront of health care today, focusing on how best to tailor the treatment approach to each person. But should we be thinking about personalizing the approach for prevention as well?  The one-dose-fits-all approach has been used in nearly all aspirin studies.  What is poorly understood is the influence of body weight.  Perhaps the reason why aspirin has resulted in only modest benefits in clinical trials might be related to under (and over) dosing based on patient weight.

Podcast Case:  Weight-based Dosing of Aspirin

Guest Author:  Marina Maes, PharmD, BCPS

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Aspirin for Primary Prevention of CV Events in Diabetes - Is the Evidence ASCENDing?

November 23, 2018

Aspirin is no doubt beneficial in patients with overt vascular disease for the secondary prevention of myocardial infarction, stroke, or cardiovascular death. However, evidence supporting use of aspirin for primary prevention in patients who have not had a cardiovascular event is far less compelling. The clinical uncertainty of aspirin use for the primary prevention of CV events in patients with diabetes is reflected in the different recommendations in current guidelines. The investigators of the ASCEND (A Study of Cardiovascular Events in Diabetes) trial set out to determine the safety and efficacy of daily aspirin use in patients with diabetes without known occlusive arterial disease.

Podcast Case:  ASA Use in DM - Evidence ASCENDing?

Guest Author:  Kirstie Perry, Pharm.D.

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LDL Limbo: How Low is Too Low?

October 26, 2018

There has been significant debate regarding the safety of achieving very low LDL-C levels, including a potential negative impact on cognitive function. The current ACC/AHA guidelines (circa 2013) suggest decreasing the statin dose in patients with two consecutive LDL-C levels below 40 mg/dL based on expert opinion. The lack of evidence has been a major challenge for clinicians and it is unclear whether medication doses should be reduced in high-risk patients who may benefit from very low LDL-C levels.  A recently published meta-analysis sought to address this clinical dilemma.

Podcast Case: Very Low LDL Case

Guest Authors:  Apryl Anderson, PharmD and Dave Dixon, PharmD, BCPS, BCACP, CLS, CDE

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Top Ten Things Every Clinician Should Know About the 2018 Antithrombotic Therapy Atrial Fibrillation Guidelines

October 12, 2018

The American College of Chest Physicians (ACCP) recently updated their guideline recommendations for the use of antithrombotics for the prevention of stroke in patients with atrial fibrillation (aka the Chest Guidelines).  Find out what's new, who shouldn't receive treatment based on the CHA2DS2-VASc score, and why the guideline panel recommends calculating a patient's SAME-TTR score.

Guest Author:  Dylan Lindsay, PharmD

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