Bulletin Today
The Community Preventive Services Task Force (CPSTF) released a recommendation that the health care system incorporate tailored pharmacy-based interventions for cardiovascular disease (CVD) prevention into overall prevention efforts. Interventions delivered by community and health-system pharmacists are cost-effective and keep patients adherent to their medication regimen, CPSTF found.
CPSTF was established in 1996 by the U.S. Department of Health and Human Services to find population health interventions to save lives and improve longevity and quality of life.
The group conducted a systematic review of 48 studies and concluded that pharmacist-delivered interventions increase the proportion of patients who take their medications as prescribed.
The tailored pharmacy-based interventions were aimed to help patients who are at risk for CVD take their medications as prescribed.
Interventions included the use of interviews or assessment tools to identify adherence barriers. To overcome these barriers, pharmacists then developed and delivered tailored guidance based on the assessment results.
Guidance included the use of focused medication counseling or motivational interview sessions, and associated services included patient tools such as pillboxes, medication cards and calendars, medication refill synchronization, enhanced follow-up, communication between the pharmacist and the patient’s primary care provider, and patient education materials. The interventions were effective in both community and health-system settings and could be used alone or as part of a broader effort to reduce CVD risk.
In its analysis of the studies, CPSTF found the proportion of patients exposed to pharmacist-delivered interventions who were considered adherent increased by a median of 6.9 percentage points—an increase of 15.8%. Based on a subset of 13 studies, there was a median increase of 13.9 percentage points in the proportion of patients who received pharmacist-delivered interventions who achieved blood pressure control.
CPSTF also found these interventions are cost-effective for CVD prevention. Patients taking their blood pressure medication as prescribed is associated with 45% greater odds of controlling their blood pressure compared with not taking the medications properly. Improvements in blood pressure control may decrease the burden of heart disease and stroke. Patients with high cholesterol who do not adhere to their medications have a 26% greater likelihood of a cardiovascular-related hospitalization compared with patients who adhere to their prescriptions.
According to CDC, approximately 630,000 Americans die from cardiovascular disease annually.
FDA says sunscreen chemicals accumulate in body at high levels
A recent FDA study found that six active ingredients in sunscreens (avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octinoxate) led to maximum plasma concentration rates ranging from 3.3 ng/mL to 258.1 ng/mL, depending on the chemical and whether it was applied to the skin in the form of a lotion or spray.
The study included a total of 48 healthy participants who were randomly assigned to use one of four sunscreen products comprising lotions and sprays. Participants applied sunscreens to 75% of their bodies once on the first day and four times on days 2 through 4. Researchers collected 34 blood samples over 21 days from each participant, finding that concentrations of the chemicals increased after each day of application. The research suggests they accumulated within the bloodstream.
All of the ingredients continued to exceed the FDA safety threshold of 0.5 ng/mL on day 7, and two of the ingredients, homosalate and oxybenzone, remained above the threshold on day 21.
FDA says under the CARES Act, the agency is required to propose a revised sunscreen order by September 27, 2021.
Groups urge Congress to pay pharmacists for COVID-19 services
Twenty-four national organizations representing patients, consumers, the medically underserved, public health advocates, physicians, and diverse health care providers sent a letter to U.S. House and Senate leaders urging the inclusion of payment for pharmacists who provide COVID-19 and flu testing and immunization in the next package of coronavirus legislation. In the letter, the groups assert that pharmacist-provided patient care services improve patient outcomes, something that is particularly important during the pandemic.
The letter was spearheaded by the National Forum for Heart Disease and Stroke Prevention (National Forum) and signed by 23 other organizations. To address the urgent need to expand Americans’ access to COVID-19 and influenza testing and immunization, the groups wrote in the letter, Congress should designate pharmacists as providers under Medicare Part B in the upcoming COVID-19 legislative package. “Congress must recognize pharmacists as providers of billable services to reinforce the meaningful expansion of patient care, especially in underserved or otherwise vulnerable populations.”
The groups urged Congress and the president to “enact emergency policies that will multiply the sites where people can get COVID-19 and influenza testing and vaccination, and bring these services closer to where people live and work,” John M. Clymer, National Forum executive director, wrote in a blog post.
“The experts predict that the coming double-whammy of COVID-19 and flu is going to be tough on people, families, communities, employers, the health care system, and the country,” said Clymer. “Congress and President Trump can get ahead of the curve by enabling people to get COVID-19 and flu testing and vaccinations at pharmacies.”
“As the number of COVID-19 cases spike in certain communities across the country and the flu season approaches, the opportunity cannot be missed to ramp up patient access to testing and immunizations,” the letter reads. The signers wrote that it “is critical to enable all frontline health care professionals to provide care in alignment with their training and expertise to improve health outcomes in response to the public health emergency.”
The letter also emphasizes that evidence shows that team-based care that includes primary care providers, pharmacists, and nurses improves patients’ health. “Yet in many parts of the U.S., policy barriers preclude pharmacists from providing or being reimbursed for such care,” the groups wrote. A lack of fair and reasonable reimbursement for their services prevents pharmacists’ from delivering the full range of services for which they are trained to provide, they warned.
“It is critical that Congress act now to improve patient access to care nationwide in response to the pandemic. This letter reinforces the importance of team-based care that puts patients first and recognizes that one way to strengthen this aim is by removing barriers to pharmacists’ services,” said Meg Freiter, PharmD, APhA senior manager of pharmacy practice.
“The leading patient, consumer, seniors, and public health groups are absolutely important, but the support from doctors and nurses is especially significant because they recognize the need to expand access to health care,” Freiter continued. “They know that inadequate access is making the COVID-19 burden and disparities even worse, and that enabling people to get care from pharmacists will help solve these problems.”