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Last Updated
July 28, 2016
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July 28, 2016
SafeMed -- From hospital to home: A Collaborative Model for Safer Transitions
Patients with multiple chronic conditions, polypharmacy and unmet social needs are often at risk for serious drug 
therapy problems during the transition from hospital to home. A new model has made these transitions safer and 
decreased hospital admissions and emergency department visits for patients.  Developed by the University of 
Tennessee in partnership with Methodist Le Bonheur Healthcare in Memphis, the SafeMed model uses a primary 
care-based team, which includes physicians, pharmacists, nurses and community health workers, to form a support 
network for high-risk and high-needs patients as they transition from the hospital to the outpatient setting.  A new 
module from the AMA’s STEPS Forward™ collection of practice improvement initiatives can help practice teams 
implement the SafeMed model, which enables them to work closely with patients to build strong relationships that 
make it easier to coordinate and manage their care.
 
The University of Tennessee Health Sciences Center saw 30 percent fewer hospitalizations, 44 percent fewer 30-day 
readmissions and 52 percent fewer ED visits for patients with multiple chronic conditions and frequent ED visits in 
just six months.
 
The SafeMed program starts with a report every morning that tells the clinic which of its assigned patients have 
been hospitalized in the last 24-72 hours. The nurse leader uses the report to determine which patients might 
benefit from SafeMed care transitions support so that home visits by a community health worker can be scheduled.
Community health workers meet with the SafeMed team physician, pharmacist and nurse leader to address specific 
medication problems or care management issues identified during home visits. They also meet with the SafeMed 
team leaders on a weekly or monthly basis to conduct case reviews and refine care plans.  Participating patients are 
invited to regular clinic-based SafeMed peer group support and education sessions, where they suggest topics for 
discussion and ask questions to help them better navigate the health system. Each patient is asked to remain in the 
program for at least three months to receive the full benefit of the approach.
 
The SafeMed approach used in Memphis can be adapted by individual practices to reduce drug therapy problems, 
patient morbidity and mortality resulting from preventable drug therapy problems, and avoidable hospital 
readmissions. It can also lower costs and improve medication adherence, disease management and overall patient 
health.

July 27, 2016
FDA Strengthens Warnings About Class of Antibiotics
The U.S. Food and Drug Administration it I strengthening label warnings on a class of antibiotics called 
fluoroquinolones because the drugs can lead to disabling side effects, including long-term nerve damage and 
ruptured tendons.  The Agency also cautioned that these bacteria-fighting drugs -- including levofloxacin (Levaquin) 
and ciprofloxacin (Cipro) -- shouldn't be prescribed for sinusitis, chronic bronchitis or simple urinary tract infections 
unless no other treatments options exist.  Besides Cipro and Levaquin, other fluoroquinolones include moxifloxacin 
(Avelox), ofloxacin (Floxin) and gemifloxacin (Factive).
 
A safety review revealed that potentially permanent side effects involving tendons, muscles, joints, nerves and the 
central nervous system can occur hours or weeks after exposure to fluoroquinolone pills or injections.  Also, two or 
more serious side effects can occur together, the FDA said.  Because of this, the FDA recommends reserving these 
antibiotics for serious bacterial infections, such as anthrax, plague and bacterial pneumonia.   The new labeling 
action will include an updated boxed warning and revisions to the Warnings and Precautions section of the label.  
Also, a medication guide that patients receive describes the safety issues tied to these drugs, the agency said.

July 26, 2016
Prescription Drug Spending Drops in Medical Marijuana States
A new study shows that medical marijuana is bringing down Medicare spending in Washington, DC, and the 17 
states that also have legalized it, to the tune of $165.2 million in 2013. University of Georgia researchers estimate 
the government program could have saved as much as $468 million if all states offered the drug as an alternative to 
prescription medications. Their review of Part D prescriptions from 2010–13, with a focus on medicines that could 
also be treated with medical marijuana, indicated that enrollees filled fewer orders during those years to relieve 
pain, anxiety, depression, nausea, psychosis, seizures, sleep disorders, and spasticity. Prescriptions for glaucoma 
medicine rose, however, which researchers attribute to the fact that marijuana is an unrealistic option for these 
patients because it only offers relief for about 1 hour. That finding, they stress, signals that users of medical 
marijuana are motivated by medical urgency and not by the euphoric effects of the drug. The study is published in 
Health Affairs.

July 25, 2016
Increasing Medication Adherence with Multi-Channel Communications
An OptumRx study involving subjects who received several different kinds of medication alerts, refills, and dosage 
reminders via mobile phone culminated in an overall medication adherence rate of 85% on the intervention side and 
only 77% adherence on the control side. Adherence rates are higher when using the most complex form of mobile 
technology that includes artificial intelligence-adapted text messages with reinforcement learning.
 
Live patient counseling with pharmacists is the most effective channel for medication adherence. The maxim of "2 
minutes to trust building" is based on patients having a long-term healthier outcome when they are allowed to 
speak openly for a minimum of 2 minutes with free-flowing conversation. At the pharmacy, patients may discuss 
sickness more willingly and ask more questions. A Walgreens study about a cholesterol level-lowering regimen 
showed that patient face-to-face consultations with pharmacists result in high medication adherence. At the end of 
1 year, more than 40% of the intervention group reached a target adherence rate of 80% or more, while only a 
little more than 30% of the control group reached the same rate.

July 20, 2016
SELF-PRESCRIBING ANTIBIOTICS IS A BIG PROBLEM
Five percent of adults from a cohort of 400 people reported using antibiotics without a prescription during the 
previous 12 months. Twenty-five percent said they would use antibiotics without contacting a medical professional. 
These findings demonstrate yet another factor abetting the spread of antibiotic resistance. The research is published 
ahead of print July 11 in Antimicrobial Agents and Chemotherapy, a journal of the American Society for 
Microbiology.  In the study, the investigators surveyed a random sample of socioeconomically and ethnically diverse 
adult patients of family practice clinics, from around Houston, Texas.

Fourteen percent of the patients reported keeping a stash of antibiotics at home, said corresponding author Larisa 
Grigoryan, MD, Ph.D., instructor in the Department of Family and Community Medicine, Baylor College of Medicine, 
Houston, TX. Forty percent of antibiotics used without a prescription were purchased in stores and pharmacies in 
the U.S. Another 24 percent were obtained outside of the U.S. Friends or relatives supplied 20 percent of 
antibiotics, and leftover medicines from previous prescriptions accounted for 12 percent. Four percent of the total 
were veterinary antibiotics. The vast majority of antibiotics that patients were storing—74 percent—were saved 
from previous prescriptions. The most common conditions patients reported self-treating with antibiotics were sore 
throat, runny nose, or cough—conditions that typically would get better without any antibiotic treatment, according 
to Grigoryan.

Antibiotics can cause serious side effects, said Grigoryan. More importantly, overuse, and inappropriate use of 
antibiotics can cause resistance to develop and spread, which is hazardous for the individual, as well as for public 
health. Every year, at least 2 million Americans become infected with antibiotic resistant pathogens, and these 
infections kill 23,000, according to the US Centers for Disease Control and Prevention. Antimicrobial resistance can 
spread among different species of bacteria.

“When people self-diagnose and self-prescribe antibiotics it is likely that the therapy is unnecessary because most 
often these are upper respiratory infections that are mostly caused by viruses,” said Grigorian. Antibiotics do not kill 
viruses. In the case of bacterial infections, “even if the cause is bacterial, lay people don’t know which antibiotics 
cover which pathogens and for how long should they use them.” Misusing antibiotics so that some of the pathogenic 
bacteria survive often fosters resistance.