iForumRx.org
Powerful Placebos and Notorious Nocebos: Implications for Ambulatory Care

Powerful Placebos and Notorious Nocebos: Implications for Ambulatory Care

July 17, 2020

Imagine you have recommended statin therapy to a patient with diabetes. A few weeks later, the patient experiences leg pain and stops it. Was this patient’s leg pain caused by the statin? Or was it a nocebo effect? Muscle symptoms in placebo-controlled trials of statin therapy range from 3-5%, while rates in real-world observational studies are between 15-20%. Ambulatory care pharmacists have an important role in recognizing and managing placebo and nocebo effects. Understanding the placebo effect allows clinicians to harness the power of placebos. Reframing risks during patient education may decrease nocebo effects.

Guest Authors:  Sara Wettergreen, PharmD, BCACP and Joseph Nardolillo, PharmD

Music by Good Talk

A CLEAN Sweep: Getting Rid of the Medication Cost Barrier

A CLEAN Sweep: Getting Rid of the Medication Cost Barrier

April 10, 2020

Medication adherence plays a very significant role in achieving positive patient health outcomes and when medication regimens are not followed, patients often fail to reach optimal disease control. This is especially concerning in ambulatory care settings where chronic disease states are most often treated. One of the potential barriers to optimal medication use is cost.

Guest Authors:  Emily Eddy, PharmD, BCACP, BC-ADM; Brittany Long, PharmD, BCACP; and Lindsey Petters, PharmD, BCPS

Music by Good Talk

Don’t Let Numbers Fool You: Levothyroxine Isn’t a Cure-all

Don’t Let Numbers Fool You: Levothyroxine Isn’t a Cure-all

February 29, 2020

Patients with subclinical hypothyroidism often complain of symptoms commonly seen in patients with overt hypothyroidism: cold insensitivity, dry skin, fatigue, constipation, muscle cramps, poor memory, slowed thinking, and depression. Indeed, up to a quarter of people with normal TSH levels report up to two of these symptoms, pointing to the non-specific nature of these symptoms. How then should a clinician decide which patients might benefit from thyroid replacement therapy?

Guest Authors:  Mallory Kuchis, PharmD and Michael P. Kane, PharmD, BCPS, BCACP

Music by Good Talk

A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

A Cause for a PAUSE: Evaluating a Standardized Perioperative DOAC Management Protocol

January 31, 2020

One in six patients with atrial fibrillation (AF), or an estimated six million patients worldwide, will require perioperative anticoagulant management this year.  Ambulatory care pharmacists commonly face the scenario where a patient taking a direct oral anticoagulant (DOAC) for AF requires an elective surgery or procedure. Best practices for periprocedural management of DOACs are unclear and current guidelines differ in their recommended approaches. Having a simple, systematic periprocedural DOAC management protocol would be helpful. But would a straightforward protocol that is easily understood by clinicians and patients be safe and effective? The PAUSE study investigators attempt to establish the standard of care.

Guest Authors:  Maggie Faraj, PharmD and Candice Garwood, PharmD, BCPS, BCACP

Music by Good Talk

Under Pressure: Does Directly Observing Medication Administration Lower Blood Pressure?

Under Pressure: Does Directly Observing Medication Administration Lower Blood Pressure?

November 8, 2019

Treatment-resistant hypertension, the need for 4 or more medications to achieve goal blood pressure (BP), occurs in nearly 1 in 5 patients.1 But is it truly treatment-resistant? Nonadherence is often regarded as the primary cause in many patients.  But how can we distinguish between other causes of hypertension that should prompt additional diagnostic testing or treatment intensification? A recent study suggests there is a simple solution: watch them take their pills.

Guest Authors: Meagan Brown, PharmD, BCACP and Raven Jackson, PharmD

Music by Good Talk

Addressing the Concerns and Needs of Transgender Persons

Addressing the Concerns and Needs of Transgender Persons

August 30, 2019

The transgender/gender nonconforming (TGNC) community faces a variety of challenges including access to healthcare, societal stigma, and discrimination. As a profession, pharmacy is well-positioned to reduce and address the barriers to care faced by TGNC individuals and to provide them with positive experiences within the healthcare system. However, formal instruction about this patient population’s social and medical needs is lacking in most pharmacy school curricula.

Guest Authors: Justin Bachman, PharmD and Abby Frye, PharmD, BCACP

Music by Good Talk

The Power of Pharmacist-to-Pharmacist Handoffs During Transitions of Care

The Power of Pharmacist-to-Pharmacist Handoffs During Transitions of Care

August 16, 2019

Hospital readmissions are often medication-related and potentially preventable. Pharmacists can play a vital role in improving medication outcomes during transitions of care (TOC). Although numerous TOC practice models have been described, it remains unclear what practices will promote optimal continuity of care. A recently published study in the Journal of the American Pharmacists Association (JAPhA) examined the impact of pharmacist-to-pharmacist handoffs using electronic communications to reduce hospital readmissions in high-risk patients.

Guest Authors: Jessica Wooster, PharmD, BCACP and Laressa Bethishou, PharmD, BCPS

Music by Good Talk

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

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

Music by Good Talk

Using Controllers PRN for Mild Persistent Asthma – An Oxymoron?

Using Controllers PRN for Mild Persistent Asthma – An Oxymoron?

September 7, 2018

Two recent studies challenge our current approach to managing patients with mild persistent asthma. When patients with asthma are prescribed inhaled corticosteroids (ICSs), we instruct them to use the medication daily. In patients with persistent asthma, guidelines recommend maintenance therapy, with either an ICS or a combination ICS/long-acting beta-agonist (LABA), plus a short-acting beta-agonist (SABA) as needed for rescue treatment.  The Symbicort Given as Needed in Mild Asthma (SYGMA) 1 and SYGMA 2 trials challenge the traditional approach comparing combination ICS/LABA (budesonide-formoterol) as needed to traditional ICS maintenance with SABA rescue therapy.

Guest Author:  Brittany Schmidt, PharmD, BCACP

Music by Good Talk

Is it Time to “Step Up” Rescue Treatment for Asthma to Prevent Exacerbations?

Is it Time to “Step Up” Rescue Treatment for Asthma to Prevent Exacerbations?

July 13, 2018

We’ve been managing asthma, for the most part, the same way for quite some time now … short-acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first-line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan.  Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher costs, and increased asthma-related morbidity and mortality. Exacerbations can be triggered by acute respiratory infections, exposure to allergens and other environmental conditions, and poor medication use behaviors. Regardless of cause, finding ways to reduce or prevent exacerbations should be a priority.

Guest Author:  Kristen A. Pate, Pharm.D., BCACP

Music by Good Talk

Play this podcast on Podbean App