scholarly journals Evaluation of Patient Factors Associated With Achieving Goal Hemoglobin A1c in Collaborative Drug Therapy Management Ambulatory Care Clinics by Clinical Pharmacists: A Retrospective Chart Review

2020 ◽  
pp. 875512252094944
Author(s):  
Stefanos Torkos ◽  
Jacqueline M. Burke ◽  
Kathy Zaiken
Keyword(s):  
Drug Therapy ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Positive Impact ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Clinical Factors ◽  
Asian Ethnicity ◽  
Therapy Management ◽  
Drug Therapy Management

Background: Literature has shown the positive impact pharmacists have on diabetic outcome measures through collaborative drug therapy management (CDTM). There is minimal literature evaluating characteristics and clinical factors of patients who benefit from CDTM diabetes clinics by pharmacists. Objective: Identify patient characteristics and clinical factors that may be associated with patients who reach goal hemoglobin A1c (HbA1c) of <7% at discharge by pharmacists practicing under CDTM agreements. Methods: This retrospective chart review included patients referred to pharmacist CDTM clinics for type 2 diabetes with an HbA1c goal of <7%. Data were extracted from the electronic medical record at enrollment and discharge. Results: Of the 228 patients included, 84 achieved a goal HbA1c of <7%. Factors predictive of patient success were Asian ethnicity (odds ratio [OR] = 19.32), baseline HbA1c of 7% to 7.9% (OR = 2.34), enrolled in clinic for 5 to 6 months (OR = 2.06), in-person visit every 4 to <8 weeks (OR = 3.06), not on insulin initially or at discharge (OR = 1.79, OR = 2.02), or discharged on a glucagon-like peptide-1 receptor agonist (OR = 1.83). Factors predictive of not reaching goal were Black or African American ethnicity (OR = 0.42), <5 encounters of any type (OR = 0.44), an encounter of any type every 8 weeks or more (OR = 0.08), or discharged on a sodium-glucose cotransporter-2 inhibitor (OR = 0.27). Conclusion: Several clinical and demographic factors were identified that influenced a patient’s ability to reach a goal HbA1c of <7%. The results of this study may be applied to further advance pharmacist-run clinics in optimizing diabetes care for patients.

Drug therapy management in a pharmacist-run stroke prevention clinic

2016 ◽  
Vol 73 (18) ◽  
pp. 1388-1390 ◽  
Author(s):  
Jennifer Andres ◽  
Charles Ruchalski ◽  
Paul Katz ◽  
Guillermo Linares
Keyword(s):  
Drug Therapy ◽  
Stroke Prevention ◽  
Therapy Management ◽  
Drug Therapy Management ◽  
Prevention Clinic

Patient characteristics and outcomes of an interdisciplinary menopause clinic: a retrospective chart review

Maturitas ◽  
2015 ◽  
Vol 81 (1) ◽  
pp. 178-179
Author(s):  
Beate C. Sydora ◽  
Nicole Veltri ◽  
Christoph P. Sydora ◽  
Justin Marillier ◽  
Lori Battochio ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics

scholarly journals Collaborative Drug Therapy Management by Pharmacists–2003

2003 ◽  
Vol 23 (9) ◽  
pp. 1210-1225 ◽  
Author(s):  
American College of Clinical Pharmacy ◽  
Raymond W. Hammond ◽  
Amy H. Schwartz ◽  
Marla J. Campbell ◽  
Tami L. Remington ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Therapy Management ◽  
Drug Therapy Management

Assessment of Glycemic Control at St. Luke’s Free Medical Clinic: A Prospective-Retrospective Chart Review (Preprint)

2021 ◽  
Author(s):  
Wade Hopper ◽  
Justin Fox ◽  
JuliSu Dimucci-Ward
Keyword(s):  
Glycemic Control ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Care Delivery ◽  
Retrospective Chart Review ◽  
National Standards ◽  
Rank Test ◽  
Medical Clinic ◽  
Free Clinic ◽  
Uninsured Patients

BACKGROUND The free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. Using a multidisciplinary volunteer clinical staff which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke’s Free Medical Clinic (SLFMC) cares for over 1,700 patients annually in Spartanburg, SC. OBJECTIVE This study aims to measure the change, over time, in patient A1c measurements at SLFMC in order to quantify the success of the clinic’s diabetes treatment program. METHODS A prospective-retrospective chart review of patients enrolled at St. Luke’s between January 1, 2018, and January 1, 2021 (n=140) was performed. Patients were stratified as having controlled (<7.0 A1c, n=53) or uncontrolled (≥7.0 A1c, n=87) diabetes relative to a therapeutic A1c target of 7.0 recommended by the American Diabetic Association. For both controlled and uncontrolled groups, baseline A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to published A1c literature from other free clinics. RESULTS Patients with uncontrolled diabetes experienced significant reductions in median A1c at both 6 months (p=.006) and 1 year (p=.002) from baseline. Patients with controlled diabetes showed no significant changes. SLFMC’s wholly uninsured patient population showed a population rate of controlled diabetes (42%) that came close to recent national averages for adults with diabetes (51% to 56%) as published by the National Health and Nutrition Examination Survey (NHANES). The clinic’s Hispanic population (n=47) showed the greatest average improvement in A1c from baseline of any ethnic group. Additionally, 61% of SLFMC’s Black population (n=33) achieved an A1c under 7.0 by the end of the study window, which surpassed national averages for glycemic control. CONCLUSIONS We present free clinic hemoglobin A1c outcomes obtained through chart review. Uninsured patients treated for diabetes at SLFMC show a reduction in hemoglobin A1c that is comparable to national standards although average A1c levels were higher than national averages. Black and Hispanic populations that are more highly represented in the uninsured pool performed well under SLFMC management. These results represent some of the first in the literature to come from a free clinic that is not affiliated with a major medical school.

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

scholarly journals Risk of Complications with the Total Contact Cast in Diabetic Foot Disorders

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Alexandria Riopelle ◽  
Ryan LeDuc ◽  
Michael S. Pinzur ◽  
Adam P. Schiff
Keyword(s):  
Diabetic Foot ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Treatment Algorithm ◽  
Retrospective Chart Review ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Charcot Foot ◽  
Total Contact Cast ◽  
Definition Of

Category: Diabetes Introduction/Purpose: The total contact cast is an important component of the clinical treatment algorithm for diabetic foot ulcers and Charcot Foot Arthropathy. Few studies have reported on the complications associated with this treatment modality. Methods: Over a ten year period, 2265 total contact casts were placed on 384 patients during their treatment for diabetic foot disorders. All of the casts were applied by a Certified Orthopaedic Technologist under the supervision of a University Faculty member. Complications were grouped as: (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change / removal. Complications were then associated with Hemoglobin A1C levels at the time of treatment. Results: Using this very stringent definition of a complication, ten percent of patients had some form of a complication. Most complications resolved following cast change or cast removal. Conclusion: The total contact cast has been demonstrated to be a valuable tool in the treatment of diabetic foot disorders. This retrospective chart review should serve as a valuable reference to assist clinicians when counseling patients during treatment for diabetic foot disorders.

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