Students make strides in adherence among elderly
BALTIMORE — If the government paid for drug cost incentives for Medicare patients with congestive heart failure, the program could recoup those costs and more by spending less on expensive hospitalizations for patients.
That finding was one of several to emerge from research conducted by pharmacy students at the University of Maryland School of Pharmacy. The four students presented their findings on elderly drug adherence at the annual meeting of the Gerontology Society of America in New Orleans.
The researchers were tackling a subject with major implications for pharmacy and health: how elderly patients deal with multiple medical conditions, stay on their medications and avoid the need for emergency hospitalizations.
Doctoral student Jennifer Lloyd, of Maryland’s Doctoral Program in Gerontology, found a link between drug cost incentives and reduced hospitalizations for Medicare patients with congestive heart failure. “A significant proportion of these patients remain untreated,” said Lloyd, who found that higher adherence to most CHF medications was linked with lower Medicare spending over three years.
Sarah Dutcher, a graduate student at the university’s Department of Pharmaceutical Health Services Research, studied drug use patterns among Medicare beneficiaries with heart failure. She found that those with dementia got fewer medications for heart failure than those without it — but that those with both conditions who received and adhered to drugs for heart failure benefited as much as those with no dementia through fewer hospitalizations.
Fifth-year Ph.D. student Jingjing Qian studied drug adherence rates for patients who suffer from both depression and chronic obstructive pulmonary disease. Using Medicare patient records, Qian found that patients with COPD were less likely to use or continue to use antidepressant drugs. Physicians who collaborated with the study said they considered COPD to be more serious than the patients’ depression and tended to treat it first.
Pharmacist H. Keri Yang, a postdoctoral fellow at the school, found that 12.4% of Medicare beneficiaries with depression also had dementia. Those suffering from both conditions tended to be significantly older, had more co-morbidities and used more chronic disease medications than those without dementia, she found. However, beneficiaries with co-morbid depression and dementia had higher risks of hospitalization and were less likely to use any antidepressant.
ReportersNotebook — Chain Pharmacy, 1/10/11
Supplier News — The Food and Drug Administration has approved a generic drug for hypertension made by Mylan. Mylan announced the approval of nifedipine extended-release tablets in the 30-mg, 60-mg and 90-mg strengths. The drug is a generic version of Bayer’s Adalat CC. Nifedipine tablets had sales of around $82 million during the 12-month period ended June 2010, according to IMS Health.
U.S. generic drug maker Watson Pharmaceuticals and Indian drug maker Natco Pharma will work together to develop and commercialize a generic drug used for bone marrow disorders, the two companies said. The agreement concerns lenalidomide tablets in the 5-mg, 10-mg, 15-mg and 25-mg strengths. The drug is a generic version of Celgene’s Revlimid, used to treat the plasma cell cancer multiple myeloma and myelodysplastic syndrome.
T he FDA has approved Sagent Pharmaceuticals’ topotecan hydrochloride for injection, a generic version of GlaxoSmithKline’s chemotherapy drug Hycamtin, Sagent said. The U.S. market for injectable topotecan was around $158 million in 2010, according to IMS Health. Topotecan is used in patients who have recurrent small-cell lung cancer sensitive disease or cervical cancer.
An FDA advisory committee has recommended approval for an investigational diet pill. Orexigen Therapeutics and Takeda Pharmaceutical announced that the FDA Endocrinologic and Metabolic Drugs Advisory Committee voted 13-7 that clinical trial data demonstrated that the benefits of the drug Contrave (naltrexone and bupropion) outweighed its risk and supported approval. The committee also voted 11-8 to recommend a study to examine Contrave’s effect on risk for cardiac disease.
In the past, the agency declined to approve such diet pills as Vivus’ Qnexa (phentermine and topiramate) and Arena Pharmaceuticals’ Lorquess (lorcaserin), while requesting that Abbott’s Meridia (sibutramine) be removed from the market due to safety concerns.
Johnson & Johnson made its courtship with Dutch biotech company Crucell official by acquiring all of the company for $2.3 billion, the two companies said.
J&J said it would maintain Crucell’s headquarters in Leiden, Netherlands, and keep it as the center for vaccines within J&J’s pharmaceuticals division. It also would keep the company’s senior management and “generally” keep its current staff intact.
Navajo pharmacist fills patient education gap
TSAILE, Ariz. — Some people enter the twilight years of college without a clue of what they want to do, only to decide at the last minute. Others, like pharmacist Terry Teller, know early on.
For Teller, a member of the Navajo Native American tribe originally from Lukachukai, Ariz., helping to heal people is part of his heritage, with multiple generations of medicine men and women on both sides of his family.
Teller had several healthcare-related jobs, including research and working as a nurse’s aid. He considered medical school before working with a pharmacist at an Indian Health Service facility in Tsaile, Ariz., which inspired him to go to pharmacy school at the University of New Mexico, where he earned his doctor of pharmacy degree in 2007.
“From all of those, I found I really didn’t want to do the direct patient care a doctor would provide,” Teller told Drug Store News. He now divides his time between work as a staff pharmacist at Tsaile and as a weekend relief pharmacist at Walmart stores in Farmington and Gallup, N.M.
At Walmart, Teller often finds himself using a skill uncommon among pharmacists: his ability to speak the Navajo language, which his parents speak and he studied in high school and college. As the only pharmacist in his area who speaks the language, he’s often in high demand, particularly among elderly customers. “Once they know I speak Navajo, once they know I can explain things, I get held up on the floor for a while,” Teller said.
One issue that accompanies speaking in a different language is cultural attitudes. “One of the challenges is having [the customers] understand that these medications will work, because there is a struggle to tell them, especially if they’re very traditional in thought. A lot of them have the mindset that they need a ceremony, and their high blood pressure or blindness will disappear,” Teller said, noting that patients often will attend ceremonies and use traditional herbal remedies, creating a need to consult references to Navajo herbal medicines and online databases to prevent potential drug interactions.
Another issue is the way illness is discussed in Navajo culture. Teller can’t tell a patient directly that he or she has a disease and will encounter certain symptoms, but instead must frame it in indirect terms, such as saying that if “a person” had a disease, he or she might encounter this or that symptom. “If I tell them [directly], in the traditional Navajo mindset, it’s like cursing them,” Teller said.
According to the Centers for Disease Control and Prevention, Native Americans and Alaska Natives have the highest rates of diabetes in the 10- to 19-year-old age category. Apache County, where Lukachukai is located, and neighboring McKinley County, N.M., have diabetes prevalence rates greater than 10.6%, according to the CDC.
Most diabetes patients strive to keep their A1c levels below 7%, but Teller sometimes encounters patients with levels of 14%. Heart disease rates among Native Americans and Alaska Natives also are among the highest in the country, with the CDC reporting hypertension rates of 28% and high cholesterol rates of 30%.
Any program working to reduce those rates requires public awareness, but that’s part of what got Teller into pharmacy in the first place. “For me, why I wanted to get into pharmacy was that I didn’t like direct patient care, but where I get a lot of my enjoyment is with patient education,” he said.