The Vitals - June 2015

Examining the News Affecting Pharmacy & Clinics
June 2015, Vol 3, No 6 - The Vitals

In This Article

Statin Use Increases Risk for Diabetes Complications

Statins, which are used for the prevention of cardiovascular disease in healthy adults, may be linked to higher risks for diabetes, diabetes complications, and obesity, according to recent data. Although previous research has linked statin use to higher risks for diabetes, this is the first report to implicate its use with higher risk for diabetes complications.

Ishak Mansi, MD, Department of Medicine, Veterans Affairs North Texas Health Care System, Dallas, and colleagues conducted a retrospective cohort study to evaluate the relationship between statin use and new-onset diabetes, diabetic complications, and being overweight/obese among healthy adults. Study participants were TRICARE beneficiaries evaluated between October 1, 2003, and March 1, 2012. Patients with preexisting cardiovascular conditions, elements of the Charlson Comorbidity Index (eg, diabetes mellitus), or life-limiting diseases at baseline were excluded from the study.

Among 25,970 healthy adults identified, 3982 were statin users, and 21,988 were non­users. Patients taking statins had higher odds of new-onset diabetes (odds ratio [OR], 1.87), diabetes complications (OR, 2.50), and being overweight/obese (OR, 1.14). The study authors noted that these results suggest that short-term clinical trials may not fully describe the risk/benefit of primary interventions with long-term statin use.

Mansi I, Frei CR, Wang CP, Mortensen EM. Statins and new-onset diabetes mellitus and diabetic complications: a retrospective cohort study of US healthy adults. J Gen Intern Med. 2015 Apr 28. Epub ahead of print.

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Grip Strength Predictor of Mortality, Cardiovascular Disease

Evaluating grip strength could be a simple and inexpensive method to determine all-cause mortality, cardiovascular death, and cardiovascular disease. Data from a recent study even suggest that it is a stronger predictor than systolic blood pressure.

To evaluate the independent prognostic value of grip strength, Darryl P. Leong, PhD, from the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, and colleagues conducted a large, longitudinal population study including 17 countries with varying incomes and sociocultural settings: the Prospective Urban Rural Epidemiology (PURE) study. Patients were included in the study if ≥1 household members were aged 35 to 70 years, and if members of the household planned to stay at their address for another 4 years.

Grip strength was evaluated using a Jamar dynamometer. Data pertaining to all-cause mortality, cardiovascular mortality, noncardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, injury due to fall, and fracture were collected. Hospital admission for any respiratory disease (eg, asthma, chronic obstructive pulmonary disease [COPD], tuberculosis, pneumonia) was also evaluated.

Overall, 142,861 participants were enrolled in the study between January 2003 and December 2009; median follow-up was 4 years, and 2% of the patients died (3379 of 139,691). Grip strength was inversely associated with all-cause mortality, cardiovascular mortality, noncardiovascular mortality, myocardial infarction, and stroke.

No significant association was seen between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, or injury from fall or fracture. However, grip strength was positively associated with cancer risk in high-income countries.

Leong DP, Teo KK, Rangarajan S, et al; Prospective Urban Rural Epidemiology (PURE) study investigators. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015 May 12. Epub ahead of print.

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Smoking, Mental Health Linked To Frequent ED Visits

Smokers are 4 times more likely to frequently visit the emergency department (ED) than nonsmokers, according to researchers. In addition, psychiatric illness and substance abuse tripled the likelihood of patients visiting the ED 3 or more times annually.

“There are 12 million [ED] visits each year related to behavioral health diagnoses,” Jessica Castner, PhD, RN, Assistant Professor, University at Buffalo School of Nursing, NY, and colleagues explained. “Frequent ED utilization among subpopulations, such as those with behavioral health diagnoses, flags the need for more accessible and effective healthcare delivery systems.”

As part of this retrospective analysis, the investigators stratified patients by overall health complexity, and examined the relationship between behavioral health diagnoses (eg, psychiatric and substance abuse) and frequent treat-and-release ED use in a cohort of >50,000 Medicaid patients (age, 18-64 years). Data were collected from 2009 Medicaid claims from 2 western New York State counties and patients were stratified into 4 cohorts based on underlying disease complexity (healthy, at risk for chronic disease, diagnosed with chronic disease, and diagnosed with a system failure).

Overall, psychiatric diagnosis (odds ratio [OR], 1.4-2.3), substance abuse (OR, 2.4-3.8), and smoking (OR, 1.7-4.0) were significantly associated with increased odds of frequent treat-and-release ED use across all 4 cohorts. These data demonstrate that Americans with chronic diseases visit their primary care providers and go to the ED. In addition, the investigators report that medical care visits have increased in the past few years. Patients may visit the ED more frequently as they get greater access to health insurance, and could impact health insurers, patients, and the healthcare systems as a whole, according to the study authors.

Castner J, Wu YW, Mehrok N, et al. Frequent emergency department utilization and behavioral health diagnoses. Nurs Res. 2015;64:3-12.

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Telemedicine Cost-Effective In Pediatric Patients

Although telemedicine is costly to implement and maintain, recent research suggests that it provides significant cost-savings compared with telephone consultations to the healthcare providers of acutely ill children who visit rural emergency departments (EDs).

The costs of telemedicine have not been comprehensively evaluated in this patient population, according to Nikki H. Yang, DVM, MPVM, PhD, Department of Pediatrics, University of California, Davis (UC Davis) Children's Hospital, and colleagues. They reviewed data from the Pediatric Critical Care Telemedicine Program at UC Davis, including interactions with 8 rural EDs between 2003 and 2009, and evaluated cost, effectiveness, and return on investment. Asthma, bronchiolitis, dehydration, fever, and pneumonia were the 5 diseases evaluated.

Dr Yang and colleagues found that the average cost of a telemedicine consultation was $3641 per child, per ED, annually in 2013. Telemedicine resulted in 31% fewer patient transfers compared with telephone consultations; the cost reduction was $4662 per child/ED/year. In addition, cost-effectiveness analysis demonstrated that telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. Cost-savings in many cases were associated with savings accrued from reduced transfers between hospitals, including via air ambulance. Overall, telemedicine reduced the number of patient transfers by 31%. Further analysis indicated a $1.96 return for each dollar invested in telemedicine.

Yang NH, Dharmar M, Yoo BK, et al. Economic evaluation of pediatric telemedicine consultations to rural emergency departments. Med Decis Making. 2015 May 7. Epub ahead of print.

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Healthcare Policy

5 Facts About ESSB 5557

1. The legislation Engrossed Substitute Senate Bill (ESSB) 5557 recognizes pharmacists as providers, and was signed into law by Jay Inslee, governor of the state of Washington.
2. It requires that health insurance carriers include pharmacists as network providers.
3. The legislation was passed with overwhelming bipartisan support, and is the first of its kind in the country to mandate coverage of pharmacists’ patient care services.
4. Before this legislation, pharmacists were recognized for dispensing medication by most health insurance carriers, and patients were not covered for healthcare services they received from pharmacists.
5. At the federal level, the Pharmacy and Medically Underserved Areas Enhancement Act was introduced to the House (H.R. 592) and the Senate (S. 314) early this year.

  1. American Pharmacists Association. Washington state signs provider status legislation into law, recognizes pharmacists as providers. Published May 15, 2015. Accessed May 29, 2015.
  2. Washington State Legislature. SB 5557 – 2015-16. Updated May 29, 2015. Accessed May 29, 2015.

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Last modified: August 20, 2015
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