HEALTH

OTC products aid in patient transition and independence

BY Michael Johnsen

Over-the-counter medicines can play a significant role in the transition of patients from hospital to home by helping to prevent infections and complications, as well as helping patients to remain adherent with their therapies.

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Beyond playing a role in the transition from hospital to home, OTC products, including home healthcare products, can help patients maintain their independence at home. “People are staying at home longer because it is so cost-prohibitive to be in a nursing home, to be in a managed care facility, to be in a hospital,” said Jeff Swain, VP marketing and product development at Carex Health Brands. “There’s a real opportunity both in that area, as well as people who are transitioning from a hospital stay to home.”

Retail pharmacy is often the first stop for patients on their way home from the hospital, suggesting pharmacists can play a critical role in helping transition those patients from one care setting to the other. “We believe the role of the pharmacist is extremely important for products like this,” said Kristin Harper, VP brand management and marketing at Cardinal Health. “They definitely provide a critical role in helping with that continuum of care.”

One-in-five patients are readmitted to the hospital within the first 30 days of discharge, according to a report to Congress from the Medicare Payment Advisory Commission. “What they found was that they were readmitted not for their initial diagnoses, but for problems that occurred in that acute care period — the first 10 to 15 days that they were discharged,” noted Kerri Miller, founder of Make People Better, which supplies a line of pre- and probiotic immune support products.

And many of those patients — both those being discharged by hospitals and those staying at home longer — are being cared for by another. Today, nearly 43.5 million Americans provide care to an adult, according to a recent report from the National Alliance for Caregiving and AARP.

In fact, many of the OTC products that will serve this need are purchased by caregivers. “Two-thirds of our products are purchased by caregivers,” Swain said. These caregivers are providing that care on top of working full-time jobs in many cases, he said, so they don’t have a lot of time to spend on product research. That makes shelf education and pharmacist intervention critical.

“By targeting not only the patient, but also the caregiver, we want to make life easier for them,” Harper said. “By providing hospital-quality products, it helps to remove that worry that they have: ‘Is this going to be the best care for my loved one?’”

There may even be an opportunity in creating a destination center for caregivers of patients either preparing for surgery or coming home from surgery, positioned adjacent to either first aid or durable medical equipment that contains advanced wound care, gloves for caregivers, incontinence products, as well as products designed to prevent infection or improve recovery.

Cardinal Health recently released a line of more than 165 home health products called Hospital Quality at Home — products designed to help caregivers make that transition from the hospital to home.

And Hibiclens, an antimicrobial cleanser recommended for use before surgery to prevent/reduce surgical site infections, MRSA or a Staphylococcus infection, may be another good fit. “Doctors often direct patients to shower [with an antimicrobial cleanser] prior to surgery and after surgery,” said Steve Sorci, key market manager, at U.S. Surgical Molnlycke Health Care. “A lot of times they don’t know where to look, so they go to the pharmacist.”

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Study: Aiming for new lower systolic blood pressure target can improve outcomes

BY Michael Johnsen

CLEVELAND — Jackson Wright, Jr. and researchers from University Hospitals Case Medical Center on Monday presented new results from the Systolic Blood Pressure Intervention Trial showing that in patients at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of fatal and non-fatal major events or death compared to targeting systolic blood pressure to the usually recommended target of less than 140 mm Hg.
 
The findings were presented at the American Heart Association Scientific Sessions in Orlando and published in the New England Journal of Medicine and add to the preliminary results from SPRINT announced two months ago. These findings demonstrated that intensive management of high blood pressure below a commonly recommended blood pressure target significantly reduces rates of cardiovascular disease, and lowers risk of death in a group of adults 50 years and older with high blood pressure.
 
The SPRINT study, sponsored by the National Institutes of Health, has evaluated the benefits of maintaining a new target for systolic blood pressure, the top number in a blood pressure reading, among a group of patients 50 years and older at increased risk for heart disease or who have kidney disease. University Hospitals Case Medical Center/Case Western Reserve University School of Medicine coordinated one of the five Clinical Center Networks across the country selected to conduct the trial that has recruited more than 9,300 participants.
 
This blood pressure intervention portion of the trial was stopped 3.26 years into a planned 5-year term as a result of the finding of a 25% reduction in the primary cardiovascular outcome and 27% reduction of all-cause mortality in those randomized to the lower 120 mm blood pressure target. Specifically, a 38% reduction in heart failure and 43% reduction in death from heart-related events was found and reported in NEJM.
 
“What is so groundbreaking about the findings from SPRINT is that we are beginning to determine the most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and death, especially in a diverse population of older patients without diabetes,” said Wright, lead author and co-principal investigator on the SPRINT trial. Wright is director of the Clinical Hypertension Program at UH Case Medical Center and Professor of Medicine at Case Western Reserve School of Medicine and first author on the article.
 
The study reported about 1%-2% higher rates of adverse events such as hypotension, syncope, electrolyte abnormalities and acute kidney injury/failures in the group of patients treated to the lower systolic blood pressure target. As a continuation of these findings, SPRINT researchers are proceeding to examine how the lower systolic blood pressure target may impact the incidence of dementia and long-term kidney disease.
 
In order to achieve the 120 mm Hg target, the findings also noted that an average of one additional medication was required for the lower target with no difference in tolerability even in patients over age 75.
 
“I cannot predict whether the information presented today will alter the guidelines,” Wright said. “I can however assure that it will certainly create a discussion on the merits of treating hypertensive patients to much lower blood pressure targets than previously recommended.”
 
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Study finds link between vitamin D deficiency and increased heart disease risk

BY Michael Johnsen

SALT LAKE CITY – Recent studies have found that vitamin D deficiency is linked to more serious health risks such as coronary artery disease, heart attacks and strokes, in addition to weakened bones.
 
Researchers at the Intermountain Medical Center Heart Institute here have found that patients are fine from a heart standpoint, and may need no further treatment, if their vitamin D level is anywhere above 15 nanograms per milliliter.
 
“Although vitamin D levels above 30 were traditionally considered to be normal, more recently, some researchers have proposed that anything above 15 was a safe level. But the numbers hadn’t been backed up with research until now,” said Brent Muhlestein, co-director of cardiovascular research at the Intermountain Medical Center Heart Institute, and lead researcher of the study.
 
“Even if any level above 15 is safe, one out of 10 people still have vitamin D levels lower than that. This equates to a very large percentage of our population,” he said.
 
Muhlestein and his team have studied the effects of vitamin D on the heart for several years, looking at smaller numbers of patients. In this study, thanks to Intermountain Healthcare’s vast clinical database, they were able to evaluate the impact of vitamin D levels on more than 230,000 patients.
 
The 230,000 patients were split up into four groups (those with vitamin D levels of less than  15 ng/ml, levels of between 15-29, levels of between 30-44 and levels greater than or equal to 45) and were followed for the next three years by researchers who looked for major adverse cardiac events, including death, coronary artery disease, heart attacks, stroke and incidents of heart or kidney failure.
 
Muhlestein found that for the 9% of patients in the less than 15 group, their risk of cardiovascular events increased by 35% compared to the other three groups, and the risks faced by the other three groups weren’t very different from each other.
 
“This study sheds new light and direction on which patients might best benefit from taking vitamin D supplements,” Muhlestein said. “Even though there’s a possibility that patients may benefit in some way from achieving higher blood levels of vitamin D, this new information tells us the greatest benefit to the heart will likely occur among patients whose vitamin D level is below 15 ng/ml.”
 
Going forward, Muhlestein hopes to take these findings and perform a randomized trial with patients whose levels are below 15. The idea is to randomly separate them into groups and provide supplements for one but not the other to see what the long-term benefits for combatting heart problems really are.
 
“As we continue to study vitamin D and the heart, we hope to ultimately gain enough information so we can inform all patients specifically what they should do to reduce their cardiac risk as much as possible,” he said. 
 
 
 
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