1.
Impact of a physician-led point of care medication delivery system on medication adherence.
Palacio, A, Chen, J, Tamariz, L, Garay, SD, Li, H, Carrasquillo, O
The American journal of managed care. 2016;(7):e264-9
Abstract
OBJECTIVES To evaluate the impact of a physician-led point of care medication delivery system (POCMDS) on adherence to glucose, blood pressure, and cholesterol-lowering medications. STUDY DESIGN Prepost intervention observational study. METHODS From December 15, 2010, to December 14, 2012, we conducted a prepost analyses of 800 Medicare Advantage members receiving care in a network of capitated clinics in south Florida serving a predominantly minority population. Eligibility criteria included a diagnosis of diabetes for at least 1 year, taking at least 1 of the 3 classes of medications, and having received care in the clinic network for at least for 12 months before and after the POCMDS implementation. Our primary outcome is the medication possession ratio (proportion of days covered [PDC]) for each class of medication. RESULTS We found an absolute increase of 17 percentage points (95% CI, 13-20) in the PDC for oral antidiabetic agents, 29 (95% CI, 26-32) for cholesterol medications, and 21 (95% CI, 19-23) for blood pressure medications. Most of the subjects (80%) reported POCMDS was more convenient than using retail pharmacies. By having the POCMDS prioritize generic medications, the increases in adherence were not associated with increased pharmacy costs. At baseline, over half the patients were at goal for low-density lipoprotein cholesterol, glycated hemoglobin, and systolic blood pressure; thus, we did not detect any additional improvements in these intermediate clinical outcomes. CONCLUSIONS Among elderly minority patients with diabetes, a POCMDS improved adherence to various medications classes without increasing pharmacy costs. Thus, POCMDS may be of interest to policy makers, particularly in our current era of healthcare reform.
2.
Beta-glucans in the treatment of diabetes and associated cardiovascular risks.
Chen, J, Raymond, K
Vascular health and risk management. 2008;(6):1265-72
Abstract
Diabetes mellitus is characterized by high blood glucose level with typical manifestations of thirst, polyuria, polydipsia, and weight loss. It is caused by defects in insulin-mediated signal pathways, resulting in decreased glucose transportation from blood into muscle and fat cells. The major risk is vascular injury leading to heart disease, which is accelerated by increased lipid levels and hypertension. Management of diabetes includes: control of blood glucose level and lipids; and reduction of hypertension. Dietary intake of beta-glucans has been shown to reduce all these risk factors to benefit the treatment of diabetes and associated complications. In addition, beta-glucans also promote wound healing and alleviate ischemic heart injury. However, the mechanisms behind the effect of beta-glucans on diabetes and associated complications need to be further studied using pure beta-glucan.