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Archive - 12 - 2009
December 30, 2009 (Newswise) - Need a little extra incentive to kick the habit? Just in time for New Years resolutions, a UCLA study finds that even after age 80, smoking continues to increase ones risk for age-related macular degeneration (AMD), the leading cause of blindness in Americans over 65.The American Journal of Ophthalmology publishes the findings in its January edition.The take-home message is that its never too late to quit smoking, said lead author Dr. Anne Coleman, professor of ophthalmology at the Jules Stein Eye Institute at UCLA. We found that even older peoples eyes will benefit from kicking the habit.AMD causes progressive damage to the macula, the center of the retina that allows us to see fine details. When the macula degenerates, people experience darkness or blurring in their central vision, preventing them from being able to read, drive and recognize faces.After age, smoking is the second most common risk factor for AMD. This study sought to determine whether age influences the effects of smoking on AMD risk.Coleman and her colleagues followed a group of 1,958 women who underwent retinal photographs at five-year intervals, starting with a baseline exam at age 78. Four percent, or 75 of the women, smoked.
The researchers compared the retinal images at ages 78 and 83 to check for the appearance of AMD, and evaluate whether smoking affected the womens likelihood of developing the disease.Age is the strongest predictor for AMD, yet most of the research in this field has been conducted in people younger than 75, explained Coleman. Our population was considerably older than those previously studied. This research provides the first accurate snapshot of how smoking affects AMD risk later in life.Overall, women who smoked had 11 percent higher rates of AMD than other women their same age. In women over 80, however, those who smoked were 5.5 times more likely to develop AMD than women their age who did not smoke.We saw a slightly higher rate of AMD in women after age 80, but the rate was dramatically higher in older women who smoked, said Coleman. The bottom line is that AMD risk increases with age. And if you smoke, your risk of developing the disease rises even more.Cigarette smoking has been hypothesized to increase AMD risk by reducing serum antioxidant levels, altering blood flow to the eyes and decreasing retinal pigments.This study provides yet another compelling reason to stop smoking and suggests that it is never too late to quit, said Dr. Paul Sieving, director of the National Eye Institute.The National Eye Institute and National Institute on Aging funded the research. About 1.75 million U.S. residents suffer from advanced AMD with vision loss; the number is expected to grow to almost 3 million by 2020.Colemans coauthors included Carol Mangione, Robin Seitzman and Fei Yu of UCLA; Steven Cummings and Katie Stone of the California Pacific Medical Center Research Institute; Jane Cauley from the University of Pittsburgh; Kristine Ensrud from the University of Minnesota; Marc Hochberg from the University of Maryland; Kathryn Pedula from the Kaiser Permanente Center for Health Research; and Edgar Thomas from the Retina Vitreous Associates Medical Group.
December 29, 2009 (UB) - The role of pharmacists hasn't received much attention in the debate on the cost of health care. But national and regional studies show that when pharmacists directly participate in patient care, they significantly reduce treatment costs and improve outcomes.
A study on diabetic patients by the University at Buffalo School of Pharmacy and Pharmaceutical Sciences identified cost savings with improvements in a key indicator of glucose control in diabetes patients, the hemoglobin A1C measurement. The A1C provides a three-month average of the amount of excess glucose in the blood. Higher A1Cs indicate that a patient is at higher risk for developing long-term complications associated with diabetes, such as kidney disease or vision problems.
Published last spring in the Journal of the American Pharmacists Association, the UB study of 50 patients with Type 2 diabetes demonstrated that in just six months clinical pharmacists, in collaboration with primary care providers, were able to significantly reduce patients' A1C levels.
In the UB study, patients' A1C levels were reduced by an average of 1.1 percent, from an average of 8.5 percent to 7.4 percent, one year after being enrolled in the program, while also improving the overall metabolic profile.
"Our results show that enhancing the patient's access to care through collaborative physician-pharmacist relationships can yield lower blood glucose levels, improve the overall metabolic profile and reduce costs to the payer," says Erin Slazak, PharmD, UB clinical assistant professor of pharmacy practice and board certified pharmacotherapy specialist.
These clinical improvements occurred while monthly costs per patient went down by approximately $212, around $2,500 per year, even though there were nominal increases in the cost of medications prescribed.
The key to success?
"Patients had unlimited access to pharmacists throughout the year," says Slazak.
Patients referred to the UB program had been identified by their primary care providers as having difficulty controlling their blood sugar. Slazak notes that it was not uncommon to see patients with glucose levels as high as 400 mg/dl (normal levels are below 100 mg/dl).
The UB pharmacists spent an initial one-hour appointment with each patient, where they worked up detailed health records covering dietary information and all medications and disease conditions, and then reviewed them with each patient.
After that, patients could call or make appointments with pharmacists at will.
"We did extensive education with patients about how to manage their conditions," says Slazak. "In many cases, we were instrumental in getting them to start insulin. There is a lot of resistance to that, and not just because it's an injection."
For patients in the initial stages of administering insulin, she says it was common to be contacted once every few days. The pharmacists then made suggestions to physicians about changes in medications, dosages or lifestyle that might be beneficial to their patients.
That kind of individualized attention is far from the norm for diabetic patients.
"Nationwide, the standard of care is that the primary care provider manages diabetes alone," says Slazak. "Pharmacists typically do not have direct involvement."
That is partly because some states, including New York, have not yet approved collaborative practice agreements between physicians and pharmacists. In the Buffalo study, for example, physicians were required to review pharmacists' recommendations and approve all interventions first. Completion of the review process and approval occurred in only half of the cases, potentially limiting the overall benefit to the patient.
"We know there's a long-term clinical and economic benefit to pharmacists working directly with patients and we think that can continue to grow," says Scott V. Monte, PharmD, UB clinical assistant professor of pharmacy practice and director of Diabetes and Cardiovascular Research, CPL Associates, LLC, in Buffalo. "Pharmacists can help achieve better outcomes if given the chance."
The study was conducted through MedSense, part of the Pharmacotherapy Research Initiative, a collaborative effort between Lifetime Health Medical Group and UB, to study how pharmacists impact patient care. MedSense is one of many program sites that are part of the UB Pharmacotherapy Research Initiative in the School of Pharmacy and Pharmaceutical Sciences, which was established to study how pharmacy medication management can improve the health of patients while cutting costs through patient-centered pharmacotherapy.
In addition to Slazak and Monte, other co-authors on the paper include Nicole Paolini Albanese, PharmD, UB clinical assistant professor; Martin Adelman, PhD, chief information officer at CPL Associates, LLC; Gauri Rao, a student in the UB School of Pharmacy and Pharmaceutical Sciences, and Joseph A. Paladino, PharmD, UB professor of pharmacy and director of outcomes research at CPL Associates, LLC.
The program is jointly funded by Lifetime Health Medical Group and the UB School of Pharmacy and Pharmaceutical Sciences.
The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.