A Randomized Study to Assess the Impact of Pharmacist Counseling of Employer-Based Health Plan Beneficiaries With Diabetes

2011 ◽  
Vol 25 (2) ◽  
pp. 169-179 ◽  
Author(s):  
Dale F. Kraemer ◽  
Wayne A. Kradjan ◽  
Theresa M. Bianco ◽  
Judi A. Low
Keyword(s):  
Diabetes Management ◽  
Statistical Significance ◽  
Glycosylated Hemoglobin ◽  
Randomized Study ◽  
Intervention Group ◽  
Control Group ◽  
Counseling Intervention ◽  
Care Plans ◽  
Pharmacist Counseling ◽  
The Impact

Objective: To assess the impact of pharmacist counseling on empowering people with diabetes to better self-care. Introduction: Community-based pharmacists can play a key role in educating and empowering people in such programs. Methods: A randomized trial compared the effects of pharmacist counseling (intervention group) with printed materials (control group) in diabetic beneficiaries of several employer-based health care plans. All participants also received waiver of out-of-pocket expenses for diabetic-related medications and supplies. Clinical, humanistic, and claim outcomes were evaluated at baseline and at 1 year follow-up. Results: Sixty-seven beneficiaries participated in this study. The 0.50% decrease from baseline in glycosylated hemoglobin (A1c) was statistically significant ( P = .0008) in the intervention group and the difference between the groups approached statistical significance ( P = .076). Beneficiaries in both groups had greater claim costs for diabetic-related medications and supplies during the study year. Both groups also improved in ability to manage their diabetes with the counseling group showing a significantly better understanding of diabetes ( P = .0024). Conclusion: There was a trend toward improvement in A1c in patients counseled by pharmacist with an increased utilization of diabetes-related medications and supplies. Counseling also improved diabetes knowledge and empowered patients to better diabetes management.

scholarly journals Pharmacist counseling intervention to improve patient antibiotic compliance

2018 ◽  
Vol 6 (2) ◽  
pp. 128
Author(s):  
I Gusti Ayu Rai Widowati ◽  
I Made Ady Wirawan ◽  
Ni Made Sri Nopiyani ◽  
Komang Ayu Kartika Sari
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Control Group ◽  
Counseling Intervention ◽  
Method Of Payment ◽  
Pharmacist Counseling ◽  
Pharmacy Setting

Background and objectives: Reported microbial resistance to antibiotics is increasing. One of the main factors is patient non-compliance in use of antibiotics. Pharmacist counseling has been shown to be effective in increasing compliance with the use of several types of medications, but its effectiveness of on compliance with antibiotic use has not been widely published. The purpose of this study was to determine the effectiveness of pharmaceutical counseling in a pharmacy setting to increase compliance with antibiotic use.Method: A randomized controlled trial was conducted on 104 adult patients aged 18 years and over who purchased antibiotics by prescription at a pharmacy in Denpasar City, Bali Province. The number of subjects was determined with a confidence level of 95% and a power of 90% with the effect size of 20%. Subjects were divided into two groups using the block randomization method, namely 52 subjects in the intervention group and 52 subjects in the control group. The intervention group was provided with pharmaceutical counseling by a pharmacist at the time of delivery of the drug at the pharmacy, while the control group was provided drug information according to the pharmacy service standard. Subject compliance was measured by telephone interview using the Morisky Medication Adherence Scale-8 questionnaire within 3-5 days after purchasing the medication. Statistical analysis with the Mann Whitney U Test was performed to determine the difference in mean rank of compliance scores between the intervention group and the control group. The proportion of compliance among the intervention group was divided by proportion of compliance in the control group to get the compliance ratio. Logistic regression analysis was conducted to determine the adjusted compliance ratio.Results: The number of subjects analyzed was 98, as 5 subjects could not be contacted by telephone and 1 subject was hospitalized. The mean rank of compliance scores in the intervention group (61.05) was significantly higher (p<0.001) than the comparison group (37.95). The proportion of compliance in the intervention group was 65.3% and the control group was 18.4%, with the proportion ratio (PR) of 3.56 (95%CI=1.90-6.64). Logistic regression analysis showed that variables which significantly increased compliance with antibiotic use were pharmacist counseling (APR=9.33; 95%CI: 3.24-26.87), frequency of taking medication (APR=6.94; 95%CI: 2.01-23.92) and method of payment (APR=4.30; 95%CI: 1.18-15.66).Conclusion: Pharmaceutical counseling at a pharmacy setting was found to increase compliance of antibiotic use. Compliance of antibiotic use is also influenced by the frequency of taking medication and the method of payment. Pharmacist counseling when accessing medication at a pharmacy is crucial for improving patient compliance of antibiotic use.

Follow-up Intervention: Its Effect on Compliance Behavior to a Diabetes Regimen

1990 ◽  
Vol 16 (4) ◽  
pp. 291-295 ◽  
Author(s):  
Angela L. Estey ◽  
Meng H. Tan ◽  
Karen Mann
Keyword(s):  
Home Visit ◽  
Diabetes Management ◽  
Glycosylated Hemoglobin ◽  
Intervention Group ◽  
Dependent Diabetes Mellitus ◽  
Control Group ◽  
Standard Protocol ◽  
Weight Changes ◽  
Telephone Calls

This study tested the hypothesis that follow-up intervention (by telephone calls and home visit) affects compliance in patients with non-insulin-dependent diabetes mellitus (NIDDM). Sixty NIDDM patients were randomly assigned to two groups—a control group, which received the standard protocol (3-day educational program and a review session 1 month after the program); and an intervention group, which received the standard protocol as well as a series offour telephone calls and one home visit by a registered nurse over a 3-month period. Compliance to prescribed regimens was determined by analyzing three sets of data: changes in pre- to poststudy glycosylated hemoglobin (HbA1c) values; changes in pre- to poststudy weight; and frequency with which self-monitoring of blood glucose (SMBG) was practiced. Results showed that SMBG practice was significantly better for the intervention group. No significant differences were seen in poststudy HbA 1c values and weight changes between the two groups. Follow-up inter vention by telephone calls and home visit can enhance patient compliance to certain aspects of the prescribed diabetes management plan.

Abstract 1822: Impact on Anxiety of an Education and Counseling Intervention Designed to Decrease Treatment Seeking Delay in Response to Acute Coronary Syndrome (ACS) Symptoms

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Debra K Moser ◽  
Sharon McKinley ◽  
Barbara Riegel ◽  
Lynn V Doering ◽  
Hendrika Meischke ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Intervention Group ◽  
Patient Delay ◽  
Treatment Seeking ◽  
Control Group ◽  
Time Points ◽  
Counseling Intervention ◽  
Coronary Syndrome ◽  
The Impact ◽  
Delay In Seeking Treatment

Background: Patient delay in seeking treatment for ACS symptoms remains a substantial problem with most people delaying more than 2 hours before they seek treatment. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that such interventions not increase anxiety. Given that these interventions seek to decrease patient denial of the seriousness of symptoms, it is possible that they may increase anxiety. Purpose: To determine the impact on anxiety of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for ACS symptoms. Methods: This was a multicenter randomized (intervention vs. usual care) controlled trial of the intervention in which anxiety data were collected (using the Multiple Affect Adjective Checklist) at baseline, 3-months and 12-months after the intervention. A total of 3522 patients with confirmed coronary artery disease (CAD) who were at risk for ACS were enrolled; data from 2597 patients with complete anxiety data at all three time points are included here. There were no differences in patients completing all three time points and those who did not. The intervention consisted of a 45 minute education and counseling session, reinforced by a phone call one month later in which the social, cognitive and emotional responses to ACS symptoms were discussed as were barriers to early treatment seeking. Repeated measures ANCOVA was used to compare anxiety levels across time between the groups controlling for age and gender. Results: There were significant differences in anxiety by group (p = 0.014). Anxiety level was stable in patients in the control group, but decreased by 10% at 3 months in the intervention group and remained at this reduced level at 12 months. Conclusion: An intervention designed to reduce patient delay in seeking treatment for ACS symptoms did not increase anxiety, but rather was associated with a reduction in anxiety. Interventions in which CAD patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.

Abstract P211: Stroke Recovery Navigator to Improve Post Stroke Recovery

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Erin Rindels ◽  
Anna Taylor ◽  
Aurora Quigley ◽  
Keyword(s):  
Social Support ◽  
Caregiver Burden ◽  
Statistical Significance ◽  
Intervention Group ◽  
Demographic Characteristics ◽  
Stroke Recovery ◽  
Control Group ◽  
Post Discharge ◽  
Additional Information ◽  
The Impact

Social support impacts recovery after stroke. Patient centered navigation programs provide social support and have shown benefit with other patient populations. The purpose of this study is to determine if there is a difference in outcomes for stroke survivors and caregivers who receive navigation services post-discharge. The study used a multi-center quasi-experimental before-after design to examine the impact of a telephone-based stroke navigation. Selected recruitment sites were nine facilities without navigation programs. Facilities provided information to survivors and caregivers about Stroke Recovery Navigator (SRN) prior to discharge and made referrals to the program. Participants were randomized into control and intervention groups using a computer-generated coin flip. Navigators completed telephone assessments within a week of referral. Navigators received the following trainings: Patient Navigation Fundamentals, motivational interviewing, and mental health first aid. The Reintegration to Normal Living (RNLI) scale was completed by all survivors and the Zarit Caregiver Burden scale was completed by all caregivers. The control group completed the initial and final assessments using these tools. In addition to these assessments, the intervention group received an individualized navigation plan and weekly contact by the SRN. The study randomized 301 individuals (82 caregivers, 219 survivors), with completion rate of 32%. Caregiver demographic characteristics and baseline caregiver burden scores were not statistically significant. Caregiver burden in the intervention group were lower compared to the control group, but not statistically significant (p=0.25). Demographic characteristics for survivors were similar between groups. RNLI score for survivors was slightly higher for the intervention group (p<0.10). To achieve statistical significance additional participants were needed. In conclusion differences in quality of life for survivors and caregivers were not statistically significant between the groups. Additional information on the benefits of an SRN program is needed to support its implementation. However, important lessons were learned to improve such program and its design.

Physical activity and prenatal depression: going beyond statistical significance by assessing the impact of reliable and clinical significant change

2020 ◽  
pp. 1-6
Author(s):  
Marina Vargas-Terrones ◽  
Taniya S. Nagpal ◽  
Maria Perales ◽  
Harry Prapavessis ◽  
Michelle F. Mottola ◽  
...  
Keyword(s):  
At Risk ◽  
Exercise Intervention ◽  
Statistical Significance ◽  
Intervention Group ◽  
Prenatal Depression ◽  
Control Group ◽  
Post Intervention ◽  
Point Change ◽  
Significant Change ◽  
The Impact

Abstract Background Previous literature supports exercise as a preventative agent for prenatal depression; however, treatment effects for women at risk for prenatal depression remain unexplored. The purpose of the study was to examine whether exercise can lower depressive symptoms among women who began pregnancy at risk for depression using both a statistical significance and reliable and clinically significant change criteria. Methods This study is a secondary analysis of two randomized controlled trials that followed the same exercise protocol. Pregnant women were allocated to an exercise intervention group (IG) or control group (CG). All participants completed the Center for Epidemiological Depression (CES-D) scale at gestational week 9–16 and 36–38. Women with a baseline score ⩾16 were included. A clinically reliable cut-off was calculated as a 7-point change in scores from pre- to post-intervention. Results Thirty-six women in the IG and 25 women in the CG scored ⩾16 on the CES-D at baseline. At week 36–38 the IG had a statistically significant lower CES-D score (14.4 ± 8.6) than the CG (19.4 ± 11.1; p < 0.05). Twenty-two women in the IG (61%) had a clinically reliable decrease in their post-intervention score compared to eight women in the CG (32%; p < 0.05). Among the women who met the reliable change criteria, 18 (81%) in the IG and 7 (88%) in the CG had a score <16 post-intervention, with no difference between groups (p > 0.05). Conclusions A structured exercise program might be a useful treatment option for women at risk for prenatal depression.

scholarly journals Impact of Pharmacist-Led Diabetes Management in Primary Care Clinics

2018 ◽  
Vol 9 (2) ◽  
pp. 17
Author(s):  
Benjamin Pontefract ◽  
Benjamin S. King ◽  
Cynthia A. King ◽  
David M Gothard
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Usual Care ◽  
Diabetes Management ◽  
Intervention Group ◽  
Control Group ◽  
Original Research ◽  
Diabetic Patients ◽  
Primary Care Clinics ◽  
The Impact

Purpose: Current literature supports that pharmacists effectively lower hemoglobin A1c (HbA1c) in diabetic patients. Little data exists on pharmacists’ effects on comorbidity management, patient satisfaction, or financial viability of these positions. This study looked to assess the impact of pharmacists on diabetes management compared to usual care. Methods: This multi-site, two-part study includes a retrospective chart review of patients referred to the pharmacist versus usual care within a large academic health system. The pharmacists collaborated under a consult agreement with primary care physicians. The second part of the study assessed patient satisfaction through an abbreviated CG-CAHPS survey. Results:A total of 206 patients with diabetes for an average of 12 years were included. The average patient age was 62 years with 60% of patients identifying as female and 81% as African-American. Patients were enrolled in a 2:1 fashion with 138 patients in the intervention group. Average baseline HbA1c was 10.1% in the intervention group and 9.3% in the control group (p= 0.0125). At 6 months, the mean change in HbA1c was -2.17% and 0.48% for the intervention and control groups respectively (p Conclusion: Pharmacists are effective at lowering HbA1c in primary care clinics, and patients were highly satisfied with these services. While direct revenue from this service did not meet cost, the pharmacist did positively affect outcomes that contribute to reimbursement. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Research

scholarly journals Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents

2021 ◽  
Vol 8 ◽  
Author(s):  
Théo Pezel ◽  
Anne Bernard ◽  
Yoan Lavie Badie ◽  
Julien Dreyfus ◽  
Etienne Audureau ◽  
...  
Keyword(s):  
Randomized Study ◽  
Intervention Group ◽  
Medical Residents ◽  
Control Group ◽  
Traditional Teaching ◽  
Single Center ◽  
Simulation Based ◽  
Simulator Study ◽  
And Performance ◽  
The Impact

Introduction: Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology.Materials and Methods: Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of &gt;70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition.Results: All residents will undergo both a theoretical test (0–100 points) and a practical test on a TEE simulator (0–100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training.Conclusion: Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.

Abstract 141: Depression and Cardiovascular Disease: Improving Patient Care

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Linda Gordon ◽  
Nicole Ansani-Jankowski
Keyword(s):  
Goal Attainment ◽  
Current Practice ◽  
Intervention Group ◽  
Standard Of Care ◽  
Depression Screening ◽  
Control Group ◽  
Care Plans ◽  
Depression Education ◽  
The Impact

Background: Depression affects up to 20% of patients with coronary artery disease (CAD), diabetes mellitus (DM), and congestive heart failure (CHF); and is associated with poorer health outcomes. HEDIS Depression Care Measure Set includes the utilization of PHQ-9 survey to monitor depression and appropriate treatment and follow-up. The goal of this program is to design, implement, and measure the success of a quality improvement (QI) initiative addressing HEDIS depression measures in the cardiovascular (CV) population. Methods: First an analysis of current practice and HEDIS compliance was conducted; 2. A plan was developed to address gaps in care; 3. A QI program was executed in the cardiac catheter lab; and 4. Outcome measures and methods to determine program success were designed. Results: Current practice analysis of the catheter lab revealed that depression screening, monitoring, and follow-up were not routinely conducted. Further, it was identified that the PHQ-9 screener was available in the EMR system but not being utilized. Therefore, a QI program was designed with the following components: 1. Patients > 18 years old receive the PHQ-9 upon discharge from the catheter lab; 2. If a patient scores > 10 on the PHQ-9 they receive education and are scheduled for follow-up; 3. A clinical database collects information on Framingham risk scores, CV risks, PHQ-9 scores, medical history, and biometric data. These data are then used to provide customized CV care plans including depression education; 4. A shared medical appointment (SMA) format provides additional depression education and follow-up. This program was executed in January 2014. The outcomes plan evaluates the impact of this QI program on HEDIS goal attainment and CV care. A control group receives screening, initial education, and standard of care. The intervention group receives screening, initial education, entry into the disease management database, customized education, therapeutic lifestyle counselling, and participation in the SMA focusing on depression. Currently 39 patients are enrolled in each arm. Interim analysis reveals 100% depression screening in both groups and high rates of follow-up in the intervention group (2 initial components of the HEDIS goals). Conclusions: Implementing a multi-faceted depression screening and follow-up QI program addresses HEDIS goals and has shown initial success in closing identified gaps in care. Future implications include a comparative analysis of the QI program to standard of care on composite HEDIS depression measures and CV goal attainment.

scholarly journals Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vivien Berthoud ◽  
Maxime Nguyen ◽  
Anouck Appriou ◽  
Omar Ellouze ◽  
Mohamed Radhouani ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Primary Outcome ◽  
Randomized Study ◽  
Intervention Group ◽  
Prospective Randomized Study ◽  
Control Group ◽  
Standard Group ◽  
Postoperative Course ◽  
The Impact

AbstractPupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

scholarly journals Effectiveness of an Intervention of Dietary Counseling for Overweight and Obese Pregnant Women in the Consumption of Sugars and Energy

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 385 ◽  
Author(s):  
Elisa Anleu ◽  
Marcela Reyes ◽  
Marcela Araya B ◽  
Marcela Flores ◽  
Ricardo Uauy ◽  
...  
Keyword(s):  
Energy Consumption ◽  
Pregnant Women ◽  
Randomized Study ◽  
Intervention Group ◽  
Control Group ◽  
Food Groups ◽  
Dietary Counseling ◽  
Total Sugars ◽  
Counseling Intervention ◽  
Before And After

Objective: Evaluate if an intervention based on nutritional counseling decreases total sugars and energy consumption in overweight and obese pregnant women, compared to their previous consumption and compared to women who only received routine counseling. Methods: Randomized study of two groups: dietary counseling (Intervention Group: IG) and routine counseling (Control Group: CG). The intervention consisted of three educational sessions focused on decreasing intake of foods that most contribute to sugars consumption. Changes in sugars and energy consumption were evaluated by a food frequency questionnaire before and after the intervention. Results: We evaluated 433 pregnant women, 272 in IG and 161 in CG, who before intervention had a mean consumption of 140 g total sugars and 2134 kcal energy per day. At the end of the intervention, the IG showed 15 g/day lower consumption of total sugars (95% CI: −25 and −5 g/day), 2% less total energy from sugars (95% CI: −3% and −1% g/day), and 125 kcal/day less energy than the CG (95% CI: −239 and −10 kcal/day). Table sugar, sweets, and soft drinks had the greatest reduction in consumption. Conclusions: The intervention focused on counseling on the decrease in consumption of the foods that most contribute to sugars consumption in overweight and obese pregnant women was effective in decreasing total sugars and energy consumption, mainly in the food groups high in sugars. Future studies should examine if this intervention has an effect on maternal and fetal outcomes.

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