From the Editor
Filling the Knowledge Gaps
S
taying abreast of the latest evidence and consensus guidelines is critically important to manage the increasingly complex patients we see in our practices. Advances in practice are at an all-time high for some disciplines: Oncology, diabetes, and cardiology are included in this group. Technology has afforded health care professionals increased opportunities to access information quickly to fill gaps in knowledge or solve acute needs. However, there remains a strong need for compilation and evaluation of evidence by experts in the field, such as that published in a peer-reviewed, clinical review article in a biomedical journal. There is artistry in this process, as the collective efforts result in refinement of knowledge, with a sharpening of the content so that it is easier to read, understand, and help to educate ourselves and others. We have such an example in this issue of the journal. Kacey A. Carroll and colleagues tackle the topic of acute coronary syndromes (ACS) in the elderly. This subject area is of high interest, as is the available evidence to guide treatment decisions. The number of medications involved in treating the variants of ACS is expansive. With big potential benefits also comes higher risk, particularly with anticoagulant and antiplatelet agents. Since many of these medications are begun in acute care, information on follow-on care in the long-term care and post-acute care settings is essential. This article should get you upto-date on the latest findings in ACS and prepare you for problem-solving in the increasing number of patients with these conditions. In our In Business article this month, Joanne Kaldy provides an informative overview on the dynamic opportunities and challenges of providing intravenous medications in long-term care facilities and home settings. With increasing focus on reducing primary and rehospitalizations, there is a growing need in providing these services in alternative settings, which are less expensive than providing them in acute care facilities, and often better for patients. Leaders in this evolving and expanding
field of pharmacy practice share their experiences. They offer strategic guidance on the regulations in this practice area and suggest key resources for getting started in this care-delivery opportunity. Antipsychotic medications have been under intense scrutiny in long-term care and post-acute settings for decades. Quetiapine, considered to be a second-generation, or atypical antipsychotic, has been a popular choice among geriatricians because of its sedative properties and its use for insomnia. Amie Taggart Blaszczyk and colleagues review the current evidence regarding the value of this agent in the management of sleep and psychiatric conditions and provide alternatives to managing antipsychotics—excellent information to put into practice. Medication therapy management, often referred to as MTM, has been discussed among payers and providers for a decade or more because this service promises to reduce the risk of medication-related problems. Although the growth in this field has been hampered by limited reimbursement for MTM services and recognition of pharmacists as MTM providers, the future looks promising for these services and reimbursement opportunities. In this issue, Michael J. Schuh presents the fee-for-service model of MTM reimbursement as well as the cost-avoidance model, the two predominant models for providing these services. I think we all feel that MTM, if adequately compensated, will increase the value of medications in the management of disease and patient satisfaction with their care. Finally, memantine has been a staple for the management of mild-to-moderate dementia of the Alzheimer’s type for more than a decade. The original manufacturer is discontinuing production of the original formulation in favor of the extended-release formulation. This issue remains in flux at the time of this writing, with implications for patient care; stay tuned. H. Edward Davidson, PharmD, MPH Editor-in-Chief Doi:10.4140/TCP.n.2015.249
The Consultant Pharmacist may 2015 Vol. 30, No. 5
249
Filling the Knowledge Gaps
S
taying abreast of the latest evidence and consensus guidelines is critically important to manage the increasingly complex patients we see in our practices. Advances in practice are at an all-time high for some disciplines: Oncology, diabetes, and cardiology are included in this group. Technology has afforded health care professionals increased opportunities to access information quickly to fill gaps in knowledge or solve acute needs. However, there remains a strong need for compilation and evaluation of evidence by experts in the field, such as that published in a peer-reviewed, clinical review article in a biomedical journal. There is artistry in this process, as the collective efforts result in refinement of knowledge, with a sharpening of the content so that it is easier to read, understand, and help to educate ourselves and others. We have such an example in this issue of the journal. Kacey A. Carroll and colleagues tackle the topic of acute coronary syndromes (ACS) in the elderly. This subject area is of high interest, as is the available evidence to guide treatment decisions. The number of medications involved in treating the variants of ACS is expansive. With big potential benefits also comes higher risk, particularly with anticoagulant and antiplatelet agents. Since many of these medications are begun in acute care, information on follow-on care in the long-term care and post-acute care settings is essential. This article should get you upto-date on the latest findings in ACS and prepare you for problem-solving in the increasing number of patients with these conditions. In our In Business article this month, Joanne Kaldy provides an informative overview on the dynamic opportunities and challenges of providing intravenous medications in long-term care facilities and home settings. With increasing focus on reducing primary and rehospitalizations, there is a growing need in providing these services in alternative settings, which are less expensive than providing them in acute care facilities, and often better for patients. Leaders in this evolving and expanding
field of pharmacy practice share their experiences. They offer strategic guidance on the regulations in this practice area and suggest key resources for getting started in this care-delivery opportunity. Antipsychotic medications have been under intense scrutiny in long-term care and post-acute settings for decades. Quetiapine, considered to be a second-generation, or atypical antipsychotic, has been a popular choice among geriatricians because of its sedative properties and its use for insomnia. Amie Taggart Blaszczyk and colleagues review the current evidence regarding the value of this agent in the management of sleep and psychiatric conditions and provide alternatives to managing antipsychotics—excellent information to put into practice. Medication therapy management, often referred to as MTM, has been discussed among payers and providers for a decade or more because this service promises to reduce the risk of medication-related problems. Although the growth in this field has been hampered by limited reimbursement for MTM services and recognition of pharmacists as MTM providers, the future looks promising for these services and reimbursement opportunities. In this issue, Michael J. Schuh presents the fee-for-service model of MTM reimbursement as well as the cost-avoidance model, the two predominant models for providing these services. I think we all feel that MTM, if adequately compensated, will increase the value of medications in the management of disease and patient satisfaction with their care. Finally, memantine has been a staple for the management of mild-to-moderate dementia of the Alzheimer’s type for more than a decade. The original manufacturer is discontinuing production of the original formulation in favor of the extended-release formulation. This issue remains in flux at the time of this writing, with implications for patient care; stay tuned. H. Edward Davidson, PharmD, MPH Editor-in-Chief Doi:10.4140/TCP.n.2015.249
The Consultant Pharmacist may 2015 Vol. 30, No. 5
249
