A study on diabetic patients by the University at Buffalo School of Pharmacy and Pharmaceutical Sciences identified cost savings with improvements in a key indicator of glucose control in diabetes patients, the hemoglobin A1C measurement. The A1C provides a three-month average of the amount of excess glucose in the blood. Higher A1Cs indicate that a patient is at higher risk for developing long-term complications associated with diabetes, such as kidney disease or vision problems.

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Published last spring in the Journal of the American Pharmacists Association, the UB study of 50 patients with Type 2 diabetes demonstrated that in just six months clinical pharmacists, in collaboration with primary care providers, were able to significantly reduce patients’ A1C levels.

In the UB study, patients’ A1C levels were reduced by an average of 1.1 percent, from an average of 8.5 percent to 7.4 percent, one year after being enrolled in the program, while also improving the overall metabolic profile.

“Our results show that enhancing the patient’s access to care through collaborative physician-pharmacist relationships can yield lower blood glucose levels, improve the overall metabolic profile and reduce costs to the payer,” says Erin Slazak, PharmD, UB clinical assistant professor of pharmacy practice and board certified pharmacotherapy specialist.

These clinical improvements occurred while monthly costs per patient went down by approximately $212, around $2,500 per year, even though there were nominal increases in the cost of medications prescribed.

The key to success?

“Patients had unlimited access to pharmacists throughout the year,” says Slazak.

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Patients referred to the UB program had been identified by their primary care providers as having difficulty controlling their blood sugar. Slazak notes that it was not uncommon to see patients with glucose levels as high as 400 mg/dl (normal levels are below 100 mg/dl).

The UB pharmacists spent an initial one-hour appointment with each patient, where they worked up detailed health records covering dietary information and all medications and disease conditions, and then reviewed them with each patient.

After that, patients could call or make appointments with pharmacists at will.

“We did extensive education with patients about how to manage their conditions,” says Slazak. “In many cases, we were instrumental in getting them to start insulin. There is a lot of resistance to that, and not just because it’s an injection.”

For patients in the initial stages of administering insulin, she says it was common to be contacted once every few days. The pharmacists then made suggestions to physicians about changes in medications, dosages or lifestyle that might be beneficial to their patients.

That kind of individualized attention is far from the norm for diabetic patients.

“Nationwide, the standard of care is that the primary care provider manages diabetes alone,” says Slazak. “Pharmacists typically do not have direct involvement.”

That is partly because some states, including New York, have not yet approved collaborative practice agreements between physicians and pharmacists. In the Buffalo study, for example, physicians were required to review pharmacists’ recommendations and approve all interventions first. Completion of the review process and approval occurred in only half of the cases, potentially limiting the overall benefit to the patient.

“We know there’s a long-term clinical and economic benefit to pharmacists working directly with patients and we think that can continue to grow,” says Scott V. Monte, PharmD, UB clinical assistant professor of pharmacy practice and director of Diabetes and Cardiovascular Research, CPL Associates, LLC, in Buffalo. “Pharmacists can help achieve better outcomes if given the chance.”

The study was conducted through MedSense™, part of the Pharmacotherapy Research Initiative, a collaborative effort between Lifetime Health Medical Group and UB, to study how pharmacists impact patient care. MedSense™ is one of many program sites that are part of the UB Pharmacotherapy Research Initiative in the School of Pharmacy and Pharmaceutical Sciences, which was established to study how pharmacy medication management can improve the health of patients while cutting costs through patient-centered pharmacotherapy.

In addition to Slazak and Monte, other co-authors on the paper include Nicole Paolini Albanese, PharmD, UB clinical assistant professor; Martin Adelman, PhD, chief information officer at CPL Associates, LLC; Gauri Rao, a student in the UB School of Pharmacy and Pharmaceutical Sciences, and Joseph A. Paladino, PharmD, UB professor of pharmacy and director of outcomes research at CPL Associates, LLC.

The program is jointly funded by Lifetime Health Medical Group and the UB School of Pharmacy and Pharmaceutical Sciences.

Pharmacists Improve Care of Diabetics While Cutting Costs, Research Shows is a post from: Pharmacy in jobs, news, schools

The Massachusetts College of Pharmacy and Health Sciences has banned students, faculty, and staff from covering their faces on its three campuses in an effort to ensure public safety, a college spokesman said yesterday.

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But there were dozens of other events both big and small that helped weave the local fabric of 2009. Gov. Deval Patrick spent a day here visiting with business, government and arts representatives. The Provincetown Cemetery filled up, leading to a discussion on how to expand the burial grounds. A new ladder truck was delivered, replacing the one destroyed in an accident last year. The Bradford pear trees that line the sidewalk to Town Hall were saved. And off-leash beach rights were restored to dog owners.

Here is a look at some of the stories that had a significant impact on life in Provincetown over the past year.

Reworking a school system
After years of avoiding the subject, town residents and a new school superintendent convinced the school committee to directly address restructuring the school district. As the student population continued to decrease, residents overwhelmingly voted at the April Annual Town Meeting to establish a regional school district planning committee to explore the possibility of merging Provincetown’s schools with the Nauset Regional School District. The three-person committee’s report is supposed to be presented at the 2009 ATM.
However, it took until Oct. 13 for the committee to hold its first meeting, a delay that concerned both selectmen and Town Moderator Irene Rabinowitz, who appointed the committee. As a result, selectmen voted unanimously in July to send a letter to the school committee urging action. Since then, school committee chair Peter Grosso stepped forward to be the district’s representative on the committee and two residents, Alex Brown and Barbara Rushmore, volunteered to serve.

Shortly after that, in November, the new school superintendent, Dr. Beth Singer, proposed that the school committee hold its own talks about the future of the school district. After a lengthy and often emotional discussion, committee members agreed to organize a series of workshops open to the public that begin planning for the future of a different school district.

In tourism
The 2009 tourism season in Provincetown was a mixed bag but there were some sighs of relief that it wasn’t worse in this uncertain economy.
Booking rates for vacation rental homes on Cape Cod and the Islands were down 5.7 percent over the 2008 season, according to WeNeedaVacation.com, an Internet vacation booking site. A cold and wet June and half of July discouraged visitors but great weather through the rest of the summer and into the fall helped increase those numbers.

Still, the tourists who did arrive kept a strong grip on their wallets, cutting back on shopping across the board from artwork to fudge, based on reports from several local business owners, And many visitors who normally would have booked a week’s stay in town reduced that to four or five nights; there were often last-minute weekend vacancies available.

Retail stores reported revenue declines between 20 and 30 percent. But based on anecdotal evidence, it seems that the number of daytrippers was about even with last year. At the town’s municipal parking lots, the number of drivers was almost flat compared with the same April through August period in 2008.

“The overall picture was not great,” Provincetown Chamber of Commerce Executive Director Candy Collins-Boden said, referring to visitor spending. “But Provincetown could have done worse.”

Town Hall restoration
The last phase of the $6.54 million repair and restoration of the 123-year-old building began on Aug. 25, after voters approved funding at both the April Annual Town Meeting and the June Special Town Meeting. Phase 2, which will renovate and restore the interior of the historic building, as well as replace outdated electrical and heating systems, will take approximately one and a half years to complete.

Park project
Ambitious planning on the part of town leaders ran into resistance from some residents over a proposal to turn the municipal parking lot into a waterfront park, transportation gateway and visitors center. As part of that proposal, public parking would be moved to a proposed parking structure to be built on the site of the Duarte’s parking lot at the corner of Bradford and Standish streets. The idea of adding a 700-car, multi-level parking facility on the Duarte’s property — assuming the town was successful in purchasing it — worried some residents but selectmen said no design would be finalized without a series of public forums. In the meantime, the town is waiting to hear if its application for $25 million in federal stimulus money to pay for the project will be approved, a decision that is expected in February.

As the market turns
Although the takeover of the former Grand Union grocery store on Shank Painter Road by Stop & Shop actually took place on Dec. 12, 2008, the impact of the renovation of the town’s only grocery store was fully felt in 2009. The produce was fresher, there were more items available and a new, expanded pharmacy was built this past year. There were some complaints that it was taking longer to fill drug prescriptions over the summer months, however, prompting selectmen to write a letter of concern to the new managers.

Pharmacy no more
The reason there was a crush at the Stop & Shop pharmacy was largely due to the new market buying the prescription business of long-time Adams Pharmacy, which took the word “pharmacy” off of its sign. Adams, in business in Provincetown since 1875, sold that part of its business to Stop & Shop in March.

Art barn
Another change in a long-time fixture in Provincetown was the sale of the barn that housed the legendary Hawthorne School of Art and gave birth to Provincetown’s reputation as an international art colony. It was sold by its long-time owner Olga Opsahl-Gee, who with her late husband, Peter Gee, operated the art school since 1994. The new owner, Joshua Prager, has not revealed what he plans to do with the barn, although he said he would use it as a residence part of the year and have arts programming there the rest of the time.

Pru Sowers can be reached at psowers@provincetownbanner.com

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It goes something like this, “Now that I’m out of a job, I might as well go back to school,” according to Jay Walls, a representative of the University of North Texas graduate school.

The turnout Wednesday for the Graduate & Professional School Fair held on the campus of Abilene Christian University bore out that thinking.

A steady flow of prospects began circulating through the exhibit room shortly after the fair started. Walls wasn’t surprised.

“Enrollment has gone up because of the economy,” he said. “Schools tend to do better when the economy is down.”

Wednesday’s fair was sponsored by the West Central Texas Career Consortium, which consists of eight local colleges and universities and Dyess Air Force Base.

Ben Klein, who is on schedule to receive a master’s degree in clinical psychology from ACU in May, credited the economy with forcing him to make some decisions. Klein browsed the tables set up by about 25 institutions, picking up literature and learning about their doctoral programs.

“If more jobs were out there and more money was out there, I might just stop with my master’s,” Klein said.

But because of limited well-paying positions for clinical psychologists with only a master’s degree, Klein decided to check out doctoral programs.

And, he is looking into possibly joining the military as a means of paying for the degree. At least two branches of the service — Army and Air Force — offer scholarships for doctoral degrees with a military commitment after graduation, Klein said.

Deciding to go directly into a doctoral program, rather than working first, and getting the military to pay for it is a direct result of a slumping economy, Klein said.

Jace Jones, who was manning a table for the University of North Texas School of Public Health, faced the same situation as Klein. He has a master’s degree in health policy and management, but a doctorate is needed for higher-paying jobs.

So, Jones decided to increase his value by working on a doctorate. He would have started work with the master’s degree if good jobs had been available.

“There just weren’t that many out there,” he said.

On the flip side, the recruiting is picking up.

“It’s been kind of good for graduate schools,” he said.

Another man with an easy job Wednesday was Make Nall, who represented the Texas Tech University School of Pharmacy in Abilene.

The school has enrolled 40 students each year since opening, with a current enrollment of 120. Next year’s 40 will bring the school to its maximum enrollment. Even without a bad economy, the pharmacy schools gets more applicants than it can handle, Nall said.

Last year, between 600 and 700 people applied. But the economic downturn has brought some unusual applicants such as a chiropractor and a few physicians. The physicians are applying from rural areas, Nall said, because small clinics are hiring more physician’s assistants than doctors. Physicians leaving those clinics are enrolling in pharmacy schools because the entry level pay for a pharmacist can be as high as $140,000 a year, Nall said.

Another recruiter not having any trouble Wednesday was Mark Cortez, field representative for Walden University, an accredited online institution of higher learning. The flexibility offered by an online education draws working people and other nontraditional students, Cortez said. The poor economy just adds to the mix.

“It’s been big,” Cortez said. “People have been having a hard time finding a job.”

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