The Vitals - July 2015

Examining the News Affecting Pharmacy & Clinics
July 2015, Vol 3, No 7 - The Vitals

In This Article

Pharmacy Immunization for Pediatric Patients Expanding in Pennsylvania

Tom Wolf, governor of Pennsylvania, recently signed a bill allowing pharmacists to vaccinate children as young as 9 years old using injectable and needle-free methods, expanding access to the influenza vaccine in pediatric patients.

House Bill 182 was introduced by Rep Seth Grove, and amends the Pharmacy Act (PL 1700, No 699) by further providing authority for pharmacists to administer injectable medications and biologics in patients aged ≥18 years, in addition to immunizations in children. Previously, physicians were the only healthcare providers allowed to vaccinate school-aged children.

  1. The General Assembly of Pennsylvania. House Bill No. 182 Session of 2015. CFDOCS/Legis/PN/Public/btCheck.cfm?txt Type=PDF&sessYr=2015&sessInd=0&billBody=H&billTyp=B&billNbr=0182&pn=1071. Updated April 1, 2015. Accessed July 7, 2015.
  2. McCabe C. New law allows pharmacists to vaccinate children. The Philadelphia Inquirer. June 27, 2015. Accessed July 7, 2015.

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Opioids, Barbiturates Overprescribed

Recent data from the 57th Annual Scientific Meeting of the American Headache Society suggest that primary care physicians, as well as emergency department physicians and specialists, are the most frequent prescribers of migraine medications, including barbiturates and opioids. Mia T. Minen, MD, MPH, Director of Headache Services, NYU Langone Medical Center, New York, NY, and colleagues found that approximately 20% of patients who visited their center reported that they were currently using either one or both of these drugs.

The study authors reviewed surveys from 218 patients with headaches; most of the patients were diagnosed with migraines. In addition, more than half of the patients reported being prescribed an opioid or a barbiturate, and approximately one-fifth of the patients were taking both medications at the time of the survey.

Moreover, Dr Minen and colleagues found that the most frequent first prescribers of opioids were emergency department physicians, whereas neurologists were the most frequent first prescribers of barbiturates. Primary care physicians were also identified as first prescribers.

These findings are concerning because opioids and barbiturates have been shown to worsen headaches, be ineffective, and have dependency and withdrawal risks. They have also been labeled as an inappropriate first-line treatment for patients with migraines by the American Board of Internal Medicine’s “Choosing Wisely” campaign. Prescribers should consider nonprescription pain medications, or triptans—a class of prescription drugs specifically for migraines—as first-line treatments for patients with migraines.

Community pharmacists and clinicians in retail clinics are in a unique position to educate patients about these medications, and to consult with prescribers about their use.

  1. Minen M, Lindberg K, Wells RE, et al. Survey of Opioid and Barbiturate Use Among Patients Evaluated in a Headache Clinic. Paper presented at: 57th Annual Scientific Meeting of the American Headache Society; June 18-21, 2015; Washington, DC.

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Adding Care Coordinators Effective in Elderly Patients with Depression

Providing patients with access to care and the appropriate time needed to treat their conditions is a growing issue among healthcare professionals. With the aging population growing, this is also an increasing concern for elderly patients.

Preliminary data recently published online in the Journal of the American Geriatrics Society suggest that adding care coordinator assistants to the care team of elderly patients with depression and dementia is a feasible and effective method to alleviate symptoms associated with their condition. Care coordinator assistants who are high school graduates or have obtained a 2-year college degree are selected based on their compatibility to work with older adults. They have been trained in the care of older adults with either or both of these conditions, and complete a 2-week session that includes interactions with simulated patients, lectures, discussions, observing home visits, and initially working with more experienced members of the care team.

Twenty full-time clinical staff were hired, trained, and deployed to deliver a collaborative care intervention in the first year of the program. An average of 13 visits was provided by each assistant in the first 18 months.

Michael A. LaMantia, MD, MPH, Center for Aging Research, Indiana University, Indianapolis, and colleagues recruited 1650 patients with dementia, depression, or both conditions; the mean age of the study population was 74.6 years, 77.7% of patients were women, and 46.5% were African American. Patients with dementia accounted for 30% of the study group, and patients with depression, 77%; 117 patients were diagnosed with depression and dementia. Overall, 66% of patients with high depression scores had >50% reduction in symptoms within 6 months; 51% of caregivers of patients with dementia experienced >50% reduction in caregiver stress symptoms.

  1. LaMantia MA, Alder CA, Callahan CM, et al. The Aging Brain Care Medical Home: preliminary data. J Am Geriatr Soc. 2015;63:1209-1213.

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More Awareness Needed to Entice Prospective Pediatric Nurse Practitioners

The number of student applicants to pediatric nurse practitioner (PNP) and neonatal nurse practitioner (NNP) programs is dropping, according to results from recent surveys. Marketing is needed to raise awareness among prospective applicants about employment opportunities available after graduation, the authors noted in the Journal of Professional Nursing.

Gary L. Freed, MD, MPH, and colleagues, on behalf of the Research Advisory Committee of the American Board of Pediatrics, conducted a telephone survey including all PNP educational programs to determine whether the marginal increase in the pipeline for PNPs is related to a limit in the capacity of educational programs, or whether unfulfilled student openings exist.

Among the responses collected, approximately 10% of PNP programs that were surveyed were either closed, put on hold, or did not have new graduates within the past 3 years. In addition, more than 25% of active PNP programs did not fill all available vacancies for the class entering in 2012, and approximately 25% of NNP programs surveyed have closed in recent years.

“Despite evidence that demonstrates plans by employers to hire a greater number of PNPs in a variety of clinical venues including pediatric hospitals, primary care and subspecialty pediatric practices, the PNP pipeline has remained relatively stagnant,” the study authors concluded.

  1. Freed GL, Moran LM, Dunham KM, et al. Capacity of, and demand for, pediatric nurse practitioner educational programs: a missing piece of the workforce puzzle. J Prof Nurs. 2015 Jan 7. Epub ahead of print.

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Health & Wellness

Neighborhood Resources Linked to Lower Risk for Diabetes

The risk for type 2 diabetes may be influenced by neighborhood environments.

Paul J. Christine, MPH, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, and colleagues evaluated data from the Multi-Ethnic Study of Atherosclerosis—a population-based cohort study of adults (aged 45-84 years) from July 2000 to August 2002—and found that long-term exposure to residential environments with greater resources for physical activity was associated with a lower incidence of type 2 diabetes. The study, published online first in JAMA Internal Medicine, included 5124 participants, of which 616 (12%) developed type 2 diabetes during a median follow-up of 8.9 years.

Patients who had a greater cumulative exposure to indicators of neighborhood healthy foods and physical activity had a lower risk for diabetes (12% and 21%, respectively). Neighborhood social environment was not associated with the occurrence of type 2 diabetes.

  1. Christine PJ, Auchincloss AH, Bertoni AG, et al. Longitudinal associations between neighborhood physical and social environments and incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis (MESA). JAMA Intern Med. 2015 Jun 29. Epub ahead of print.

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Last modified: July 28, 2015
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