Fall: Not Just a Season on Your Calendar

What OhioHealth is Doing to Prevent Falls and Educate Our Patients on Home Safety

 12-13-16_ohiohealthby Jean Howard P.T., M.S., WCC, Manager of Clinical Services, OhioHealth Home Health

Leading experts from around the country are calling falls in the home an epidemic, and for good reason. We know the goal in home care is to provide a way to give the patient the best care possible at home and to keep them out of the hospital. In the comfort and sanctity of their own home they feel better about everyday life; a familiar place, with familiar people, and familiar surroundings. But after an injury or illness, sometimes having the old familiar items they have had around them for years, even decades, now presents a big challenge for safety. Some of the biggest challenges for a home health worker is trying to make sure that the patient has what they want, and need, while making sure that those things don’t present a safety issue that could land them back in the hospital.

12-13-16_accidents-imageThere is some good news: Falls are not just a way of life, they aren’t happening just because someone is getting older, and we can help!

OhioHealth Home Care is a large multi-hospital based service line with home health locations in central Ohio, which includes Marion, Mansfield and Athens. We have over 300 field clinicians serving nineteen counties working hard every single day to improve the safety of our often frail or vulnerable citizens in their homes. Being such a big organization presents distinct advantages and challenges when it comes to fall education and prevention.

First, let’s discuss the challenges. How can we get our message across to so many of our associates and ensure we have a universal message and education plan? This year we worked hard to make sure every person that spends time inside of a patient’s home had what they needed.

We distributed approximately 2,500 discipline specific patient education/teaching sheets on preventing falls and community falls resources. The teaching sheets were all customized and discipline specific for Nursing, Speech Therapy, Occupational Therapy, Physical Therapy, Social Workers and our Home Health Aides to use and distribute to their patients.


In addition, and thanks to the generous support of donations through the OhioHealth Foundation, we will be distributing 1,000 nightlights to our homebound patients that may be at risk for falling due to night time visual impairments and no lighting.

Our goal is simple, keep people in their homes safely for as long as possible. The goal might be simple but the execution on a daily basis is anything but simple. There are big challenges when you go into someone’s home. First, every set up is different. We are a guest in people’s homes so finding a way to change someone’s home for their own good is not easy. You don’t want to come off as the safety police. What we try to do at OhioHealth Home Care is to earn that trust and help them understand and believe in what we are saying. We know when it comes to safety and fall prevention that we are the experts, with teams and individuals who have been doing this for years. And the great thing about our industry is that it has become much more sophisticated, with monitoring and tools available. But nothing gets around that personal connection. It is built with an understanding that we are part of their team now. This allows our great men and women to really shine, and show why they are so special.

caneOne of the many things we have really focused on this year is the education component. We know that for a patient at home that balance is key. We started asking ourselves within OhioHealth Home Care, “What are we doing for intervention?” We know that we are the efficiency experts inside the home and can teach family members how to be there and help, but what about screening our patients for mobility so they know expectations and limitations. Because of that, OhioHealth Home Care started agency-wide screening for PTs and OTs to get an overall look at evidence based standardized plans for intervention.

We believe that home care works best when each discipline is working with the same play book. At OhioHealth, we sent out talking and teaching sheets for social workers, speech therapists, with their own focus and talking points to prevent falls. These color-coded sheets show everyone has a role, and some roles are similar, some are different. It is a concept, a plan that we will carry throughout the year.

I believe that gaining buy-in is key to making changes and implementing things we know will work. No matter if you are a smaller operation or a group as big as OhioHealth, you can never communicate enough. With your staff, your patient, or their family, sometimes it is that communication that will avoid a fall which could ultimately save a life. Falling into a false sense of security, taking something for granted, and/or not taking that extra step can be all the difference. OhioHealth Home Care is always trying to get better with the patient as our focus. Do we have it all figured out? No, and we never will. But nothing will stop our leaders and front line workers from trying to get better and be safer in the homes of our patients.



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Immunization and Heart Disease

National Influenza Vaccination Week is December 4-10, 2016

by Lilliam R. Gomez, RN-BC, BSN, CPHQ, and Laurel E. Martin, RN, BSHCA, COS-C, First Choice Home Health, Inc., Boynton Beach, FL


The leadership and quality teams at First Choice Home Health, Inc. utilize evidence-based practices to improve disease management and ultimately our quality indicators including immunization rates. We are always updating our disease management programs to continue to improve the health and welfare of the patient populations. The Centers for Disease Control and Prevention (CDC) indicates that patients with heart disease are at a higher risk for serious complications from influenza (CDC, 2016) and/or pneumonia (CDC, 2016). Therefore we have integrated immunization into our pneumonia and heart failure disease management programs.

Data drives quality improvement! The immunization data reports from the Home Health Quality Improvement National Campaign (HHQI), CASPER and Home Health Compare are reviewed regularly for trending and progress towards improvement. We review our organization’s CASPER data reports, including tally reports, and utilize spreadsheets and graphs to disseminate the findings to all personnel at monthly staff meetings. In addition, all data is posted in key areas of the organization. The quality team reviews the ongoing CDC listserv for updates, current state influenza status, and the Morbidity and Mortality Weekly Report (MMWR).

Our quality team utilizes national resources from the CDC, HHQI, Joint Commission, CHAP and ACHC. Clinicians screen and educate all patients with heart failure about influenza and pneumoccocal immunizations. Specific patient education materials are available with the pneumonia and heart failure disease management programs. We provide regular clinician education and offer patient immunization and infection control pamphlets and resources at our monthly staff meetings. The Nursing Track from the HHQI Immunization & Infection Prevention Best Practice Intervention Package (BPIP) is provided to all nurses as part of their clinical education materials.

First Choice Home Health also works on improving staff influenza vaccination rates. The monthly staff meeting’s attendance form includes a checkbox to indicate if any staff member has had their influenza vaccination. There is a follow-up process to validate immunization or a declination of vaccination form. This process is also included in the orientation of all new staff.

Our agency is also participating in HHQI’s Home Health Cardiovascular Data Registry (HHCDR) which aligns with reducing risk of cardiovascular events. We are collecting data on:

  • Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic
  • Hypertension: Controlling High Blood Pressure
  • Tobacco Use: Screening and Cessation

We are very proud to have achieved HHQI’s Cardio Milestone 4 and are currently working toward Milestone 5. Currently, only one other home health agency in the country has completed the fifth milestone.

Our efforts to improve immunizations for patients and staff have affected our publicly reported rates on Home Health Compare. First Choice Home Health, Inc. currently has a 4-star Quality of Patient Care Star Rating which includes influenza immunization rates and a 5-star Patient Surveys Star Rating. We are also in one of the nine states implementing the Home Health Value-Based Purchasing (HHVBP) model which includes both influenza rates for patients and for home health care personnel. We feel the leadership’s support for quality improvement including immunizations and the quality foundation we have created aligns us well for the first year of HHVBP.

Consistency is another key to our success. We stay focused on our quality work, integrate it into daily practice, and monitor our performance by conducting chart audits monthly and reviewing our data and progress at monthly staff meetings. We also see the value of keeping our cardiovascular patients current with their immunizations to improve their lives.

Leadership commitment and teamwork is a must, and First Choice has both!


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What Being a Home Health Aide Means to Me

By Mary Leitner, Home Health Aide, T.O.N.E. Home Health Services, Inc., Detroit, MI

11-13-16_tone-logoA home health aide is someone with a clear understanding of the plan of care for the patient, as well as sympathy and empathy. This consists of communicating with each team member, such as the RN, PT, OT and LMSW, to insure the plan of care comes together for the good of the patient.
Patients often have a tendency to be a little closer to their aides then the rest of the team. They tend to communicate some key issues without knowing it. For example, I had a diabetic patient whose glucose levels would spike, and no one on the team could figure out why. The patient would take his insulin on time every day and the caregiver cooked well balanced meals. But through normal conversation with the patient, I found out that his son worked at a bakery and would bring goodies home every other night – which would cause the spike in glucose levels. I spoke to the nurse, who then spoke with the caregiver and doctor. The insulin was adjusted for evening dose and all was well.

While caring for the patient is my most important role, there are times when just listening to other family members can be helpful. Sometimes the family member or caregiver may be the only person taking care of the patient. As a home health aide, you may be the only outside person the caregiver sees all week. In this case, being a listener can go a long way.

taking-bp-homeI had a patient with a daughter and a son who were her caregivers. Sometimes a family member is so close to the patient that they overlook what they are saying. For example, the son did all the leg work (taking the patient to appointments, grocery shopping, and running errands). The daughter made the appointments, cleaned the house, and cooked the meals. The patient felt she was being heard. When the daughter would make a doctor’s appointment the mother (patient) would say, “I’m tired of getting stuck in my arm. Look at it, my arm is black and blue.” The daughter heard, “I’m tired of going to the doctor because they are not helping me.” I suggested to the daughter and son to check with the doctor to see if the injections could be given in another area besides the arm for now. I also encouraged them to maybe take her to her favorite restaurant, just to give her something positive to look forward to. Going on a car ride around the area before her appointment might also brighten her day.

Being a home health aide, you always have to remember to work efficiently to get everything done that you need to get done, in addition to getting everything done that the patient wants and needs. Three ways to work efficiently is to distribute, prioritize, and simplify tasks. Also, be realistic. You may not be able to get everything done, even if you plan carefully. Reassess your schedule during the day. Don’t be afraid to change your plan. It is better to accomplish the highest priority tasks and let others go unfinished than to do everything half way. The key to success is to be flexible.


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Be a Quitter! Take Part in the 2016 Great American Smokeout

by Nervana Elkhadragy, PharmD, and Karen S. Hudmon, DrPH, MS, RPh, Professor of Public Health Pharmacy, Purdue University College of Pharmacy

smoking_stopWith the 2016 Great American Smokeout just around the corner (November 17), there is no better time to start planning an attempt to quit smoking! The Smokeout challenges smokers to quit for a full 24 hours, with the hope that this day will be the first of many, many more without tobacco.

Individuals who are interested in quitting often ask, “What’s the best way to quit?” Fortunately, there are countless research studies that collectively inform our knowledge base and provide effective strategies for quitting. However, there is one big problem: Most individuals attempt to quit on their own…without help…and this is the LEAST effective approach to quitting.

Here we describe how to treat tobacco dependence as two parts – specifically, we discuss the importance of: (1) treating the nicotine dependence and (b) receiving professional counseling to address the behavior of smoking. We also suggest different resources for quitters as well as for health care professionals who want to help their patients.

PART 1: Nicotine Dependence

First a few words on nicotine, which is the addictive component in tobacco. Nicotine is not the harmful part of tobacco, but it’s the reason why quitters feel anxious and irritable when they’ve gone too long without a cigarette. Fortunately, there are seven different medications that can make individuals more comfortable by helping to alleviate withdrawal. Three of these are sold without a prescription (nicotine patch, gum, and lozenge), and four require a prescription (nicotine inhaler, nicotine nasal spray, bupropion SR, and varenicline). With so many options, which is best? It depends. All of these options are effective, and several can be used in combination. Below, we list some factors to be considered – with a key factor being the individual’s ability to adhere to the recommended dosing regimen. Cessation medications must be taken according to a fixed schedule to “prevent” withdrawal symptoms, rather than to “treat” them after they occur.

Nonprescription Medications

  • Nicotine gum and lozenge: The nicotine gum and lozenges are available in 2 mg (if you smoke your first cigarette > 30 minutes after waking) and 4 mg (if you smoke < 30 minutes after waking). These products can serve as an oral substitute for tobacco, and they can be titrated to adjust for withdrawal symptoms throughout the day. The challenge, however, is that gum and the lozenge are short-acting formulations and must be dosed every 1-2 hours while awake, with a minimum of nine 9 doses a day initially for the first 4 to 6 weeks. If an individual is not able to adhere to this rigorous dosing schedule, then the gum and lozenge should be ruled out as an option (unless combined with the nicotine patch – more on this later). The gum is more viscous than normal chewing gum and therefore is not recommended for persons with significant dental work or with jaw disorders. Proper chewing technique, as described on the box, is necessary to ensure appropriate release of the nicotine from the gum.
  • Nicotine transdermal patch: The nicotine patch is available in 7 mg, 14 mg, and 21 mg, and the initial strength is based on the number of cigarettes smoked per day. The most important benefit of the patch is its ease of use – it’s a long-acting formulation that is applied only once daily and therefore is ideal for individuals who are unable or unlikely to be able to take the minimum of 9 doses a day initially that is required for the short-acting NRT formulations. The patch can be combined with a short-acting NRT product, such as the gum, lozenge, inhaler, or nasal spray. The patch delivers consistent nicotine levels over 24 hours and the short-acting products are then used as a supplement for situational cravings. The patch is not recommended for persons with dermatologic conditions because nicotine and the patch adhesives can be irritating to the skin.

Prescription Medications

  • Bupropion SR (Zyban) and Varenicline (Chantix): Bupropion SR and varenicline are both tablets that are taken by mouth twice a day (after an initial few days of titrating the dosage upward). Bupropion use requires a discussion with a healthcare provider about potential contraindications and warnings, and both medications require a discussion about monitoring for potential neuropsychiatric symptoms. Bupropion use can lead to increased seizure risk in certain individuals.
  • Nicotine inhaler and nasal spray: The nicotine inhaler is designed to release nicotine as a vapor into the mouth (not the lungs) where it is absorbed across the buccal mucosa, and the nasal spray is absorbed across the lining of the nasal passages. These are both are effective when used as prescribed but are short-acting and therefore require frequent dosing throughout the day. Individuals with chronic nasal disorders should avoid use of the nasal spray, and individuals with any type of bronchospastic disease or airways disorder should consider other options.

Combination Therapy: There is abundant evidence to suggest that combination therapy (using two or more cessation medications) outperforms monotherapy (use of one medication alone), and it should be recommended with confidence for most patients who are quitting smoking. This approach, which is likely new to many tobacco users, typically involves the nicotine patch plus one of the short-acting NRT medications. Another option is to combine the nicotine patch with bupropion SR. Combination therapy should be a regimen of choice for anyone who: (a) has a high level of dependence, e.g., smoking a pack or more of cigarettes a day, or (b) has tried to quit before using one medication but suffered significant withdrawal symptoms (despite appropriate dosing of their medication) that led to relapse.

In general, all of these medications work well – when taken as directed – but the tips provided above will help patients decide which approach is best for them. Whether you are a patient talking with a healthcare professional, or a clinician trying to help a patient, be sure to discuss how many cigarettes are smoked daily, how soon after waking the first cigarette of the day is smoked, and whether it will be possible to stick to a frequent dosing schedule (e.g., 9 or more times a day).

PART 2: Changing Behavior

smokingEqually important, if not more important than using cessation medication(s), is the need to focus on changing smoking-related behaviors. Several strategies have been shown to enhance the rate of quitting and prolong abstinence. A strategy that can help is to consider the “5 R’s”:

Relevance: Think about reasons why quitting is important for you or might be important for your family – it could be that you have children and do not want to expose them to second hand smoke, that you want to be a good role model, or that you want to live to see your grandchildren.

Risk: Identify the potential negative consequences of smoking on your health – these could include difficulty with breathing, increased risk of cancers, reduced ability to conceive, or reduced heart function.

Rewards: Identify the potential benefits of quitting – examples range from improved health, ability to exercise or be more active, or reduced skin wrinkles.

Roadblocks: Write down what’s keeping you from quitting and what coping strategies you can use to overcome those barriers. Be honest and explicit when thinking about those roadblocks, it could be fear of failure, or concern about weight gain.

Repetition: Continue to reassess and revisit your 5 R’s, determine new coping methods, and repeat interventions.

In addition to thinking about the 5 R’s, consider accessing one or more of the variety of available services, such as individualized tobacco cessation counseling sessions via the Tobacco Quitline (call 1-800-QUIT NOW), local group programs, or web-based programs such as www.quitnet.com. In general, the more help you get, the better the odds are of quitting for good. But that’s not enough – remember, when you sign up for those sessions, make sure you do the “homework” assigned to you during the program. Moreover, when enrolled in a program, be sure to learn effective coping strategies for withdrawal symptoms; those who have effective coping methods have better results.

Whether you have no previous experience with quitting tobacco, or you’ve had numerous quit attempts, having the right tools, knowledge, and support is important for long-term success! There has never been a time when resources that provide individualized support and reliable information was so widespread and accessible. Why not make the most of it?


And for the history buffs, a little background on the Great American Smokeout… it was started by Fred Mayer, a pharmacist in Marin County California, back in 1977.Fred is widely regarded as the “Father of Public Health Pharmacy,” not only for his initiation of the Great American Smokeout, but also for his work in promoting safety caps on prescription vials, working with the Drug Enforcement Agency for Medication Take Back Day programs, and reducing unplanned pregnancies and sexually transmitted diseases and infections by promoting condom awareness campaigns, advocating for sex education in schools, and working in tandem with Planned Parenthood and PTAs in school districts.


For healthcare providers:

For individuals who want to quit:

  • 1-800-QUIT NOW – tobacco cessation quitline for individualized counseling
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Self-Management Plays a Key Role in Controlling Diabetes

by Misty Kevech, HHQI RN Project Coordinator

161843047November is American Diabetes Month and World Diabetes Day is November 14, 2016. The Centers for Disease Control and Prevention (CDC, 2016) reports there are over 29 million Americans living with diabetes and 86 million with prediabetes. Diabetes is the 7th leading cause of death which is under-reported (CDC, 2014). Complications from diabetes adds a great burden to patients, families, and our health systems. Diabetes is the leading cause of:

  • Kidney failure
  • Non-traumatic lower-limb amputations
  • New cases of blindness in adults

Socioeconomic status and other underserved population factors can greatly affect the management of diabetes and preventing complications. There can be many reasons that affect a patient’s ability to self-manage, including lack of fresh foods (food deserts) in both urban and rural areas, lack of or inadequate transportation assistance for medical appointments, and health literacy issues, just to name a few.

Home health agencies (HHA) are a great setting to teach patient diabetes self-management to prevent incidence, exacerbations, complications, and deaths. There are plenty of evidence-based tools and resources to assist HHAs and their clinicians to assist with develop culturally appropriate plans of actions with patients. HHQI’s Disease Management: Diabetes Best Practice Intervention Package (BPIP) provides evidence-based practices, tools, and resources for caring for your patients with diabetes.

Adult learners, including patients and clinicians, learn better if information is presented in various formats. HHQI offers free multimedia modules as a way to supplement education. Each module and can be downloaded from the HHQI website to your laptop or tablet and played in the patient’s home. The modules are also available on HHQI National Campaign’s YouTube channel.


11-8-16-foot-diabetesThere are two clinician multimedia modules to support clinical diabetes management (about 15 minutes each).


prediabetes-hhqi-resource-thumbnailThere are several patient multimedia modules and videos to support or reinforce diabetes management education (about 5 minutes each).

  • Prediabetes and Signs & Symptoms of Diabetes
    • Provides information on prediabetes – what it is and risk factors.
    • Discusses signs/symptoms of type 2 diabetes and the need for medical follow-up.
  • Healthy Eating
    • Learn simple healthy eating practices that can be included in every day meals.
    • Learn how to read and understand food labels to make good food choices.
  • Diabetes Self-Care
    • Discusses the importance of regular exams and tests including A1C levels, foot care, blood pressure measurement, eye exams, and lipid levels.
  • HHQI Cardiovascular Health Patient Video: Diabetes & Your Heart
    • Discusses the effects and complications of high blood glucose on the cardiovascular system.


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Face the Facts: Stroke is Treatable

By Julia Richards, Manager, Stroke Survival Programs, National Stroke Association

Lives can improve with better awareness, access and action.

Julia Richards

World Stroke Day is October 29, 2016. On this day the National Stroke Association, along with other agencies across the globe, will join together to raise awareness about stroke.

The theme for this year’s World Stroke Day campaign is, “Face the Facts: Stroke is Treatable.” Participating organizations around the world will focus on raising awareness about stroke and stroke treatments, improving public understanding of different types of treatments and post-stroke care, and steps that anyone can take to influence laws that affect healthcare for individuals, families and others affected by stroke.

For this year’s campaign, the National Stroke Association launches an interactive infographic that is part of a digital day of engagement on the topic of strokes. The infographic features facts vs. fictions about stroke incidence, treatment and recovery.

There are many misconceptions about stroke and stroke recovery in the general public. Many people think that stroke only happens to older individuals, that stroke is a death sentence, or that recovery ends at three months. The National Stroke Association would like to use the opportunity of World Stroke Day 2016 to educate the public on the truths about stroke, and provide a way for people to take that message out into their communities.

The National Stroke Association will provide a sharing option as part of the social media campaign for World Stroke Day. People who view the interactive infographic will be 10-21-16_nsa_hope_blubluencouraged to share it via Facebook and Twitter, spreading the word about the treatable nature of stroke.

For World Stroke Day 2016, please join the National Stroke Association and others around the world in raising awareness about stroke.

HHQI REMIDNER: In observance of World Stoke Day, HHQI would like to remind you of our many resources including an 8-minute patient video on the risks for stroke that you can watch on YouTube or download the MP4 to save to your laptop, tablet or flash drive.  There are also many other patient resources on the risks and signs of heart attach & stoke on our HHQI webpage including My Healthy Heart Workbook available in many languages.

There are many other clinician and patient resources on our HHQI Website . Check out the Cardiovascular Health Part 1  and Cardiovascular Health Part II  Best Practice Intervention Packages (BPIP’s) as well as other patient videos on Cardiovascular Lifestyle Modifications, Cardiovascular Risk Factors, Cardiovascular Blood Pressure Medication Management, and Smoking & Your Heart.

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September is Cholesterol Education Month – Learn About Cholesterol: The Good, the Bad, and the Ugly

9-16-16_chelsea_francesby: Chelsea E. Leonard, PharmD, Clinical Pharmacist, and Frances V. Cohenour, PharmD, Clinical Pharmacist and Co-Owner, Chad’s Payless  Pharmacy, Florence, AL

According to Quaker Oats, “Cheerios can help lower cholesterol and reduce the risk of heart disease!” If there has been a commercial about something or it has been on the news, chances are your community pharmacist has already been asked about it.  Because we field questions about anything and everything dealing with health, we can be a tremendous resource for advice and guidance.  The term “cholesterol” is mentioned all the time, and most people probably know that high cholesterol is bad (especially since everyone wants to help us lower it), but what exactly does it mean to have high cholesterol?

Cholesterol is a fatty substance found in the cells and the blood.  It literally looks like blobs of grease floating in your blood. Bodies need cholesterol to make some hormones and Vitamin D, but we make all the cholesterol we need. Certain foods that we eat introduce extra cholesterol in our blood stream, and this is where the problems happen. People with high cholesterol have twice the risk of developing heart disease than people with normal cholesterol. Cholesterol levels should be checked at least every five years, although most providers choose to check it annually. When cholesterol is reported, a few different numbers are important:

  • HDL, or “good” cholesterol, absorbs bad cholesterol and takes it back to the liver to be flushed out of the body. If HDL is higher, it can reduce the risk of heart problems and strokes. We want this cholesterol to be high!
  • LDL, or “bad” cholesterol, makes up the majority of cholesterol in the body. These are the blobs of grease. When your LDL is too high, the arteries can become clogged and potentially cause heart problems and strokes. Most medications work on this type of cholesterol.
  • Triglycerides, the “ugly” cholesterol, are a type of fat found in the blood. When high triglycerides are combined with high LDL or low HDL the risk of a heart attack or stroke is increased. Triglycerides are affected by foods we eat. If I ate a giant greasy breakfast and had my cholesterol checked right after, my triglycerides would probably be sky high (and my doctor would probably freak out)! Cholesterol should always be checked when you haven’t eaten anything in the past eight hours to ensure that the results are the most accurate.

Community pharmacists are accessible, knowledgeable and trusted and can help patients and other healthcare providers manage cholesterol. Although we do not usually have access to laboratory values, we are still able to provide education and recommendations. Some pharmacists even have the capability to test your cholesterol in the pharmacy and provide the results in about five minutes! Knowing the results, we can counsel patients on what their numbers mean and what they need to do to improve them. This is a great resource for patients who may not be able to make it to their doctor’s office or want to know how they’re doing in between doctor visits.

PillsInHandThe gold star medications for cholesterol management are known as statins. Common statins include simvaSTATIN (Zocor), atorvaSTATIN (Lipitor), and rosuvaSTATIN (Crestor). These medications are most beneficial for patients with high cholesterol and heart disease. They are the strongest drugs available for reducing LDL cholesterol. Most statin medications are given once daily, and simvastatin, lovastatin, and fluvastatin should be given at bedtime. Muscle symptoms (myopathy), including cramps and weakness, are the most common side effects that are reported from statin medications. Women have a higher risk for developing statin-induced myopathy. Patients with symptoms of myopathy should be monitored and potentially changed to a lower dose of their current medication or a different statin. If the patient still reports symptoms, a nonstatin medication may be necessary. Community pharmacists can make recommendations to patients and prescribers if there is a concern regarding side effects and medications.

Nonstatin medications include bile acid sequestrants (ex. cholestyramine), fibric acid derivatives (ex. fenofibrate), niacin, and cholesterol-absorption inhibitors (ex. Zetia).  Nonstatin medications are only recommended when a patient is unable to tolerate a statin; however, a nonstatin medication may need to be added based on the patient’s cholesterol panel. If a patient has high triglycerides, they might need to be on a statin and a fibric acid derivative. If a statin has not lowered LDL enough, Zetia might need to be added to their regimen. All cholesterol regimens should be tailored to the patient’s needs.

Like any other medication, cholesterol medications are not going to be effective if the patient is not taking them properly. Pharmacists have the ability to monitor a patient’s adherence to the medication and can discuss this with them if they notice a problem. From my personal experience as a community pharmacist, adherence issues are usually due to the medication’s cost. Community pharmacists can intervene to find a cheaper alternative for the patient. Another reason for adherence issues is forgetfulness. Patients often get caught up in the chaos of their day and simply forget to take their medicine. I even forget to take my own medication sometimes! If this happens, I usually recommend that they set a reminder on their phone (if they are tech savvy) or encourage them to keep their medications where they will see them each day, such as on the nightstand or by their toothbrush. The only way to receive the maximum benefit from medications is to take them!

101471962The cholesterol guidelines recommend that lifestyle changes are implemented for at least three months before starting a medication regimen. Pharmacists are also trained to teach patients about lifestyle modifications that can lower cholesterol. Dietary changes and physical activity are two key factor that help lower cholesterol. Thirty minutes of exercise five days per week is the recommendation for most people, and a diet low in fat and high in fiber can help with cholesterol levels. If red wine is more your speed, one glass per day might also be beneficial. Although easier said than done (believe me, I know!), these modifications are crucial for cholesterol management and heart health.

In addition to prescription medications and lifestyle modifications, there are some over-the-counter medications that can also be beneficial for patients with high cholesterol. As with all over-the-counter medications, a pharmacist or prescriber should be consulted before starting something new.

  • Coenzyme Q10 (CoQ10) supplementation has shown some benefit in reducing muscle symptoms from statins. This supplement is relatively inexpensive and low-risk for patients. CoQ10 should not be taken if the patient is taking a blood thinner like warfarin.
  • Omega-3 fish oil can decrease triglycerides and increase HDL. If patients taking fish oil complain of a fishy aftertaste, freezing the capsules before taking them could help. Fish oil should not be taken if the patient is taking a blood thinner like warfarin.
  • Niacin helps to increase HDL. Many patients experience flushing, where the skin becomes red, warm, and sometimes itchy, after taking niacin. Taking an extended-release formulation of niacin and eating beforehand can lessen this effect. Some patients have also seen a decrease in flushing if they take an aspirin 30 minutes before taking the niacin.

Community pharmacists are great resources for cholesterol management and medication management. We are filled with little nuggets of wisdom to help patients and providers achieve goals. I encourage you to contact a pharmacist if you ever have any questions about cholesterol or any other medical problem.

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