Pharmacist's in Primary Care?

The decrease in the number of physicians that pursue primary care has been noted over the past few years. The impact of this has contributed to increasing health care costs, and and a decrease in patients seeking primary and preventative care. This dearth of primary care physicians essentially created the market for nursing practitioners and physician assistants. However, this has still not solved the problem.

So, could pharmacists help out? We know that we are trained in disease management-particularly those that are often controlled primarily by medication therapy-diabetes, anti-coagulation, asthma, heart failure....ummm...there's probably more but I read too good. Well, the good folks at JAMA thought they would take a look at what pharmacists can do in the CHF. They have a spin-off mag called the Archives of Internal Medicine. It's pretty good, no People magazine or anything, but I like it.

Anyways, here's the article that they printed in Internal Medicine. I heard about it, where else, but on the Wall Street Journal Blog. Check out the links in the article too-they talk about the decrease in utilization of primary care and increase in specialty reimbursement mentioned above. They also discuss the 10 City Challenge sponsored by the APhA Foundation.

Short rant here: Stupid WSJ also is now making you pay for their Health page. At the least, they still give you access to their blog. But come on, Rupert Murdoch (who recently purchased the WSJ from the Hathaways) let me have access to the WSJ!!! I'm looking for some kind of online petition to make it all free, but I haven't found it yet. Let me know if you do, please.

Will drug companies write my papers?

No, really-will they. Cuz that'd be sweet. Now why do I say drug companies instead of, oh, English Majors? Well, according to JAMA it seems that they are more than willing to write them for academia studying their drugs. CNN has the shortened version of this and some discussion on it. One journal official who looked into it said: "The manipulation is just disgusting. I just didn't realize the extent." Merck counters that 5 of the 6 authors were involved in the Vioxx case against Merck. Slight bias. Great article. Less filling.

Students stepping up...and more

First off: Thanks to Kassy Bartelme and Colleen Flaherty for these next articles. Also, they tipped me off to Pharmacy Practice News. There are two things in life that make me happy: Spring and new pharmacy related news websites. I should probably say Laura too, but she doesn't read this anyways, so whatever.

Ok, back to real news. Medication Reconciliation is one of the goals within JCAHO. Goal 8 if you really want to know. If you work in a hospital, you've likely heard of "Med Rec" and 1) know it's important 2) know it's difficult to get accurate and 3) likely know that pharmacy isn't always involved. Last year at APhA2007, APhA-ASP brought this up and wanted to make it a priority for pharmacists and student pharmacist to the be the health care practitioner that provides this care.

Well, it looks like students CAN make a difference. Proof? Here. By the way, you have register with Pharmacy Practice News, but, ummm....we're entering pharmacy practice, so why not learn about the news within pharmacy practice. Plus, it's free.

Ok, lots of comments could be made on this. Let's do a pro/con debate. Against myself. Or for myself. I get confused. I'd go on Zyprexa, but I might get diabetes.

Pro: Students are learning about med rec. They are engaging patients in the role of a pharmacist, and are showing patients that we can do more than dispense. Patient outcomes are improving.

Con: Students shouldn't be used to do work pharmacists should be using. Hospitals should find a better way to do med rec. Interns should also be trained to do this (who are being paid) not students (who are paying)

Comment below-you can do that you know.

My greatest fear...

I always knew this blog was a bad idea....

What happens in Vegas, stays in Vegas

Ok, this has no connection at all to current events, in fact, it's probably from before many of you were born, but I'm going to post it anyways.

For Outcomes, one of our drug info questions dealt with the use of Cialis and nitrates. Through my research into the subject-I ran across this article on ED. Read the first paragraph in Editorial Comment 1. My only thought is, I guess urologists must be pretty used to displays like this.

Also, here's an article on Cookie Monster. Hey, I'm just trying to liven this place up. IS ANYONE OUT THERE!!!???

Pick your vices wisely

So...in college, we called this idea the buffalo effect, and it pretty much follows evolution: The weak brain cells die, and the strong survived. Yeah, turns out we were wrong back then, according to this article.

But, there is hope for using daily diuretics. Though alcohol is bad, caffeine might be good. According to this article, caffeine was neuroprotective. Well, in rabbits, no testing in humans yet. But whatever-I likes me my macchiatto.

Ziagen and Videx raise heart risk

A study in the Lancet found that the use of Ziagen (abacavir) and Videx (didanosine) raised heart risk. During the anti-viral section in Pharmacotherapy IV, some discusiong alluded to this: As people with HIV and AIDS live longer, the complications associated with long-term drug therapy will be a more significant risk than their actual AIDS. I'm obviously not an AIDS expert (no comment on my grade for the module...) but I think there will be a lot more information coming out on the issues of long-term AIDS therapy.

Just as a reminder, or to let you know for the first time, abacavir was developed right here at the University of Minnesota by Dr. Robert Vince. That's pretty cool.

Residency Talk

For those that attended APhA2008 or have heard other talk of this, one of the hottest topics within pharmacy is the expectation that by 2020, all pharmacists who wish to enter into patient care will have completed a one-year residency. This is a controversial topic for many reasons, not the least of which is whether or not there are enough residencies (commentary on that topic here) There are numerous articles discussing this-and I suggest you keep your eyes open for further discussion on it. For background, try googling "JCPP Future Vision of Pharmacy." I think this will lead you to many easily accessible discussion of what the future will hopefully be. Here's a copy of the original statement as well.

What reminded me of all of this was an article discussing nurses pushing for a doctorate in nursing to act as primary-care practitioners. I won't delve too much into this article-but one line caught my attention: By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners. Seeing all of the discussion that pharmacy is having, I felt this was a bold statement and prediction for them to make. Think of the impact that this would have on nursing education, and how closely this likely mimics the discussions that pharmacy is having right now.

I won't belabor this too much more, and I don't know how I feel on either way of advocating for residencies or not. But when we discuss, as a profession, what we want our future to look like, I think we need to remember that we need to find the best way for us to be the best medication experts for patients available and decide how we are going to get there, or other professions will decide for us.