The effect of mail order pharmacy outreach on older patients with diabetes

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

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Mail-Order Pharmacy

American Pharmacy ◽

10.1016/s0160-3450(15)31713-x ◽

1989 ◽

Vol 29 (8) ◽

pp. 22-25

Author(s):

Martin J. Jinks ◽

Lynette M. Evenson ◽

R. Keith Campbell ◽

Stan Bye

Keyword(s):

Mail Order ◽

Mail Order Pharmacy

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Duplicate Prescriptions of Inhaled Medications for Obstructive Lung Diseases

Pneumologie ◽

10.1055/a-1083-7961 ◽

2020 ◽

Vol 74 (03) ◽

pp. 149-158

Author(s):

P. Kardos ◽

F. Geiss ◽

J. Simon ◽

C. Franken ◽

U. Butt ◽

...

Keyword(s):

Lung Diseases ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Dry Powder Inhalers ◽

Mail Order ◽

Inhaled Corticosteroid ◽

German Market ◽

Metered Dose ◽

Mail Order Pharmacy ◽

Dose Combination

Abstract Introduction Inhalative treatments with metered dose aerosols and dry powder inhalers are the backbone of the pharmacotherapy for asthma and COPD. In the last decade many new and generic inhalative bronchodilators were launched at the German market, both monotherapies and fixed dose double bronchodilator (LABA/LAMA, beta adrenergic and antimuscarinic) or LABA and inhaled corticosteroid (ICS) and triple (LABA/LAMA/ICS) combinations. According to two surveys in 2015 among respiratory physicians we expected a high proportion of patients receiving duplicate prescriptions, e. g. a fixed dose new LABA/LAMA combination in addition to an existing ICS/LABA fixed dose combination. Methodology We searched the database of a large mail order pharmacy (DocMorris) to identify duplicate prescriptions of inhalative drugs for a patient by the same or by two or more different physicians during a 3 months period. Results Unexpectedly, we found as little as around 1 % duplicate prescriptions for the same patient. Duplicate prescriptions involving combination products were found to be much more common than duplicate prescriptions of different mono-products. Irrespective the low percentage number of all prescriptions we saw in just one large mail order pharmacy several thousands of erroneous prescriptions. Conclusion At least in the setting of this mail order pharmacy duplicate (i. e. contraindicated and potentially dangerous) prescriptions are relatively rare. Prescribers and pharmacists should be aware of the issue of duplicates – especially when prescribing or filling prescriptions with combination products.

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