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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2009;169(21):1944. doi:10.1001/archinternmed.2009.391.
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DIRECT-TO-CONSUMER OFFERS FOR FREE AND DISCOUNTED MEDICATIONS ON THE INTERNET

The United States has witnessed dramatic changes in the marketing of prescription drugs. Weppner et al analyze a new type of marketing that capitalizes on the role of the Internet. This marketing strategy, termed e-sampling, marries traditional drug sampling with direct-to-consumer marketing by offering online vouchers for free or discounted drugs directly to patients. Examining Web sites of the 50 most commonly prescribed brand- name drugs in 2007, the authors found that e-sampling is common among these top-selling medications. They also found that offers for free or discounted medication are presented in a manner that may distract from risk information.

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IMPACT OF A PHARMACIST-FACILITATED HOSPITAL DISCHARGE PROGRAM

Patients transitioning from the hospital setting to home are particularly vulnerable to medication discrepancies that can result in postdischarge adverse events, hospital readmissions, and emergency department visits. Although pharmacists are well suited to identify and resolve medication-related problems that occur at discharge, questions remain regarding the benefit of pharmacist involvement in the discharge process. Walker et al used a quasi-experimental design to prospectively evaluate utilization of health care resources between 358 patients who received a pharmacist intervention at discharge and 366 patients who did not. While the intervention improved the quality of patient discharge by identifying and reconciling medication discrepancies at discharge, no effect on readmission rates at 14 days (12.6% vs 11.5%; P = .65) and 30 days (22.1% vs 18%; P = .17) or emergency department visits (2.8% vs 2.2%; P = .60) was demonstrated. These findings suggest that this intervention may not be cost-effective.

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SUBCLINICAL HYPOTHYROIDISM AND FUNCTIONAL MOBILITY IN OLDER ADULTS

This study compares the functional mobility of 2290 community residents (aged 70-79 years and participating in the Health, Aging, and Body Composition study) by thyroid function categorized by thyrotropin level as euthyroid or mild or moderate subclinical hypothyroid (SCH). In age- and sex-adjusted analyses, the mild SCH group, compared with the euthyroid group, demonstrated better mobility (faster usual and rapid gait speed [1.20 vs 1.15 m/s and 1.65 vs 1.56 m/s, respectively; P < .001]) and a higher percentage had good cardiorespiratory fitness and reported walking ease (39.2% vs 28.0% and 44.7% vs 36.5%, respectively; P < .001). After 2 years, the mild SCH group experienced a similar decline as the euthyroid group but maintained their mobility advantage. The moderate SCH group had similar mobility and decline as the euthyroid group. Findings indicate that generally well-functioning 70- to 79-year-old SCH individuals do not demonstrate increased risk of mobility problems and those with mild elevations in thyrotropin level show a slight functional and possible health advantage.

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PHYSICIAN AND PHARMACIST COLLABORATION TO IMPROVE BLOOD PRESSURE CONTROL

This study evaluates the effectiveness of a physician and pharmacist collaborative intervention to improve blood pressure (BP) control. This prospective, cluster-randomized controlled clinical trial randomized clinics to control (n = 3) or intervention (n = 3) groups and enrolled 402 patients with uncontrolled hypertension (mean age, 58.3 years). Clinical pharmacists made drug therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. Mean BP (systolic/diastolic) decreased 6.8/4.5 and 20.7/9.7 mm Hg in the control and intervention groups, respectively (P < .05 for between-group systolic BP comparison). The adjusted difference in systolic BP was −12.0 (95% confidence interval [CI], −24.0 to 0.0) mm Hg, while the difference in diastolic BP was −1.8 (95% CI, −11.9 to 8.3). The 24-hour BP levels showed similar effect sizes. Blood pressure was controlled in 29.9% of patients in the control group and 63.9% in the intervention group (adjusted odds ratio, 3.2; 95% CI, 2.0 to 5.1 [P < .001]). A physician and pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates compared with a control group.

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CASE MANAGEMENT TO REDUCE RISK OF CARDIOVASCULAR DISEASE IN A COUNTY HEALTH CARE SYSTEM

The Stanford–San Mateo County Heart to Heart program evaluated a nurse and dietitian case management program in a largely Latino population with elevated risk of cardiovascular disease receiving services in a county health care system. The intervention significantly lowered global cardiovascular risk scores compared with usual care. The main driver of reduced cardiovascular risk was lowered blood pressure in the care-managed group, although favorable changes were noted in other risk factors. This study demonstrates that nurse and dietitian case management targeting multifactor risk reduction can lead to improvements in high-risk patients in low-income, minority populations receiving care in county health clinics.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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