HEALTH

NACDS to FDA advisory committee: Curb DXM abuse without impeding appropriate use

BY Allison Cerra

ALEXANDRIA, Va. As the Food and Drug Administration’s Drug Safety and Risk Management Committee debated Tuesday on ways to curb abuse of cough suppressants containing dextromethorphan, the National Association of Chain Drug Stores testified that the scheduling of dextromethorphan under the federal Controlled Substances Act is not the right solution.

“Dextromethorphan is consumers’ No.1 choice to treat cough. Depriving consumers of the option to self-medicate with dextromethorphan would have substantial public health consequences because cough and cold are extremely prevalent in the U.S. population, affecting the average adult two to four times per year,” NACDS VP regulatory affairs Kevin Nicholson said to the FDA Drug Safety and Risk Management Committee.

NACDS also urged the committee to consider the approach set forth by Sen. Dick Durbin, D-Ill., in the Dextromethorphan Abuse Reduction Act of 2009, which would prohibit the sale of dextromethorphan to minors.

“Dextromethorphan is the most common ingredient in over-the-counter cough medicines in the United States,” Nicholson stated. “[The] abuse of dextromethorphan is concentrated primarily among teenagers, and this concentration makes possible a targeted and strategic approach to preventing abuse.”

In addition to working on legislative remedies, the association also has worked with the White House Office of National Drug Control Policy and the Drug Enforcement Administration to help raise awareness of the scourge of medication abuse, particularly among young people.

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Your very own pharmacist just a click (and consult) away

BY DSN STAFF

Consumers are working more, playing more, shopping more and learning more online than ever before. So the click-and-consult services that Rite Aid has made available to its wellness+ members not only represent today’s cutting edge, but also offer a peek into how consumers may interact with their healthcare teams tomorrow.

“Patients take a great deal of interest in being able to have a conversation with their pharmacist,” said Robert Thompson, Rite Aid EVP pharmacy. “The online chat is just another vehicle by which a patient might be able to have a discussion with a Rite Aid pharmacist,” he said. And that’s important, Thompson added, because each means of communication holds relevance for different groups of the population. And whether a patient prefers one-on-one consultations, round-the-clock telephone access—an 800 number for wellness+ members to consult a Rite Aid pharmacist has been up and running since that program’s inception in April—or this new online portal, Rite Aid has made itself available to its patients no matter a patient’s personal consultation preference. “For us, it’s all about providing a service that will enhance the ability of patients to communicate with a pharmacist,” Thompson added.

As for the service, wellness+ members can avail themselves of a pharmacist consultation at any time, day or night, either online or in select stores. “The pharmacists that staff our clinical call center are all PharmDs,” Thompson noted. “And many of them have received additional forms of clinical training. Our clinical call center does a variety of clinical programs—including supporting chat—that are really focused on compliance initiatives. They also provide clinical support for our own pharmacists internally.”

Rite Aid’s team of clinical pharmacists will be available to counsel patients on such issues as potential drug-drug interactions between their prescription therapies and their nonprescription remedies, or what foods and drinks may interfere with the effectiveness of their therapies. The clinical pharmacists also will be prepared to counsel on general health questions, such as how to control high blood pressure or lower cholesterol; how to tell the difference between a cold and the flu; ways to help manage diabetes; how to deal with insomnia; and questions about vaccinations.

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Type 2 diagnoses propel diabetes epidemic

BY Alaric DeArment

WASHINGTON —Diabetes quickly has grown into one of the top disease epidemics in the United States, with the American Diabetes Association estimating it to affect close to 24 million Americans. Growth mostly has occurred among those with Type 2 diabetes.

A report by the Agency for Healthcare Research and Quality helped show what the epidemic looks like on the ground. According to the report, released last month, there were more than 7.7 million hospital stays for patients with diabetes in 2008, resulting in $83 billion in hospital costs, or 23% of total hospital costs.

Class and geography had a lot to do with hospitalization rates, according to the report. When broken down by ZIP code, rates were higher in low-income areas than in high-income areas, with 3,232 hospitalizations per 100,000 people in the lowest-income areas, compared with 1,762 per 100,000 people in those areas with the highest incomes.

Among U.S. regions, the South had the highest rates, with 2,829 per 100,000 people hospitalized, while the West had the lowest, with 1,866 per 100,000 hospitalized. Not surprisingly, according to the Centers for Disease Control and Prevention, the South and West also have the highest and lowest rates of obesity, respectively, a major factor in the rise of Type 2 diabetes. Eight-of-the-9 states with obesity rates more than 30% as of 2009 are in the South, while 9-of-the-17 states with rates less than 25% are in the West, including Colorado, the only state in which fewer than 20% of residents are obese.

Top 10 most common principal reasons for hospitalization among patients with diabetes in 2008

*Based on all-listed diagnoses; includes % of total hospitalizations for patients with diabetes†Based on records with diabetes as a secondary diagnosis (e.g., for hospitalizations with a principal diagnosis of congestive heart failure, 41.6% have diabetes as a coexisting condition) Source: AHRQ, Center for Delivery, Organization and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2008
RANK PRINCIPAL DIAGNOSIS #OF HOSPITAL STAYS AMONG PATIENTS WITH DIABETES* %OF HOSPITAL STAYS WITH DIABETES AS A COEXISTING CONDITION†
1 Diabetes 519,522 (6.7%) NA
2 Congestive heart failure (nonhypertensive) 424,147 (5.5%) 41.6%
3 Coronary atherosclerosis (hardening of the arteries) 346,054 (4.5%) 37.7
4 Pneumonia 290,709 (3.8%) 25.1
5 Septicemia 224,842 (2.9%) 28.4
6 Acute myocardial infarction (heart attack) 220,760 (2.9%) 34.2
7 Chronic obstructive pulmonary disease and bronchiectasis 219,743 (2.8%) 30.7
8 Nonspecific chest pain 212,706 (2.8%) 29.3
9 Cardiac dysrhythmias 196,293 (2.5%) 24.6
10 Complication of device, implant or graft 194,516 (2.5%) 28.4

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