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Search Results: 1 - 10 of 236476 matches for " Thomas L. Lenz "
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Implementation of a Tool to Modify Behavior in a Chronic Disease Management Program
Nicole D. Gillespie,Thomas L. Lenz
Advances in Preventive Medicine , 2011, DOI: 10.4061/2011/215842
Abstract: Chronic diseases like diabetes, hypertension, and dyslipidemia continue to be a significant burden on the US health care system. As a result, many healthcare providers are implementing strategies to prevent the incidence of heart disease and other chronic conditions. Among these strategies are proper drug therapy and lifestyle modifications. Behavior change is often the rate-limiting step in the prevention and maintenance of lifestyle modifications. The purpose of this paper is to describe a tool used to guide the progression and assess the effectiveness of a cardiovascular risk reduction program. The tool uses the Transtheoretical Model of Behavior Change to determine the readiness and confidence to change specific lifestyle behaviors pertinent to cardiovascular health. The tool aids the practitioner in developing a patient-centered plan to implement and maintain lifestyle changes and can be tailored to use in any situation requiring a behavior change on the part of the patient. 1. Introduction Health behavior change is a key component in the prevention of disease. Studies have shown that 90% of type 2 diabetes, 80% of coronary artery disease, and 70% of all strokes are potentially preventable by a combination of nonsmoking, maintenance of a healthy bodyweight, regular physical activity, healthy eating habits, and moderate alcohol consumption [1]. Unfortunately, behavior change is often the rate-limiting step in the implementation and maintenance of these preventive lifestyle behaviors. The Transtheoretical Model of Behavior Change was developed to understand how individuals progress towards establishing and maintaining health behavior change for optimal health [2]. The model consists of six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. The key to using this theory in practice is to assess the patient’s stage and then educate and persuade the patient to move toward the action, maintenance, and termination stages [2]. The model is widely used by practitioners in the realm of substance abuse [3], as well as independently increasing physical activity [4] and proper nutrition [5]. However, there is little literature describing its practical use in a behavior change program that implements more than one behavior change. In 2008, a comprehensive cardiovascular risk reduction program (CVRRP) was developed at a private Midwestern university to curb the progression of cardiovascular disease in its employees [6]. The program offers the participants an individualized lifestyle medication program that targets
Use of a multidisciplinary tool to achieve target outcomes in Native American patients with diabetes: Treat-to-target
Emily L Sexson, Michael S Monaghan, Thomas L Lenz, Ann Ryan Haddad, Gail Jensen, Gary Elsasser
Journal of Multidisciplinary Healthcare , 2008, DOI: http://dx.doi.org/10.2147/JMDH.S4005
Abstract: e of a multidisciplinary tool to achieve target outcomes in Native American patients with diabetes: Treat-to-target Original Research (4506) Total Article Views Authors: Emily L Sexson, Michael S Monaghan, Thomas L Lenz, Ann Ryan Haddad, Gail Jensen, Gary Elsasser Published Date September 2008 Volume 2008:1 Pages 73 - 77 DOI: http://dx.doi.org/10.2147/JMDH.S4005 Emily L Sexson, Michael S Monaghan, Thomas L Lenz, Ann Ryan Haddad, Gail Jensen, Gary Elsasser Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA Purpose: Our purpose was to test a communication tool used in a multidisciplinary setting to more effectively achieve the recommended goals for glucose, blood pressure, lipids, and prophylactic aspirin use in a Native American population with type 2 diabetes. Methods: One hundred randomly selected patients were included in this observational, preintervention, post-intervention study design. The team began with a chart audit documenting hemoglobin A1c (Hgb A1c), blood pressure, cholesterol levels, and aspirin use. The intervention included the development of a one page form used to prompt providers to intensify therapy when the patient was not meeting evidence-based goals. The audit was repeated one year later. Results: Analysis of 74 patients completing the study showed a decrease in Hgb A1C from 8.812% pre-intervention to a mean 8.214% post-intervention (p < 0.007). At the time of pre-intervention audit, patients were already at target for blood pressure and no significant further decrease was found. Measures of total cholesterol, triglycerides, and aspirin use showed improvement, but statistical significance was not met. Conclusion: The one-page multidisciplinary tool used to intensify therapy significantly improved glucose control. More consistent interaction of the multidisciplinary team is necessary to reach other desired goals.
An Evidence-Based Review of Fat Modifying Supplemental Weight Loss Products
Amy M. Egras,William R. Hamilton,Thomas L. Lenz,Michael S. Monaghan
Journal of Obesity , 2011, DOI: 10.1155/2011/297315
Abstract: Objective. To review the literature on fat modifying dietary supplements commonly used for weight loss. Methods. Recently published randomized, placebo-controlled trials were identified in PubMed, MEDLINE, International Pharmaceutical Abstracts, Cochrane Database, and Google Scholar using the search terms dietary supplement, herbal, weight loss, obesity, and individual supplement names. Discussion. Data for conjugated linoleic acid (CLA), Garcinia cambogia, chitosan, pyruvate, Irvingia gabonensis, and chia seed for weight loss were identified. CLA, chitosan, pyruvate, and Irvingia gabonensis appeared to be effective in weight loss via fat modifying mechanisms. However, the data on the use of these products is limited. Conclusion. Many obese people use dietary supplements for weight loss. To date, there is little clinical evidence to support their use. More data is necessary to determine the efficacy and safety of these supplements. Healthcare providers should assist patients in weighing the risks and benefits of dietary supplement use for weight loss.
Therapeutic Lifestyle Strategies Taught in U.S. Pharmacy Schools
Thomas L. Lenz, PharmD, MA,Michael S. Monaghan, PharmD,Elizabeth A. Hetterman
Preventing Chronic Disease , 2007,
Abstract: IntroductionSeveral organizations representing pharmacy and other health professions stress the importance of teaching public health topics as part of training future practitioners. The objective of our study was to assess the number of U.S. pharmacy schools that incorporate lifestyle modification topics into their curricula.MethodsWe developed an electronic survey on lifestyle modification topics and sent it to each of the 89 pharmacy schools in the United States. The survey defined lifestyle modification topics as topics that address nutrition, exercise, weight loss, smoking cessation, and alcohol use.ResultsOf 89 pharmacy schools contacted, 50 (56%) responded to the survey. Of the 50, four offer at least one required course in a lifestyle modification topic, seven offer at least one elective course, and one offers a required course that incorporates more than one lifestyle modification topic. Five required and nine elective courses were identified from the responses. Nutrition was the most commonly offered required course topic, followed by smoking cessation, exercise, weight loss, and alcohol use.ConclusionFew pharmacy schools are addressing recommendations to promote public health education through formalized didactic courses. More courses on lifestyle modification topics should be offered to pharmacy students, who will be highly accessible to the public as pharmacists and will be able to offer education to enhance public health focused on the prevention of chronic diseases.
Development and Implementation of a Novel Lifestyle Medicine Advanced Pharmacy Practice Experience Elective
Nicole D. Gillespie, PharmD,Thomas L. Lenz, PharmD, MS, PAPHS, FACLM
INNOVATIONS in Pharmacy , 2012,
Abstract: Objective: To develop and implement an Advanced Pharmacy Practice Experience (APPE) to increase student’s awareness and use of lifestyle modifications in chronic disease prevention and management. Design: A five-week APPE was developed that utilized a wide variety of activities, including direct patient care, patient education, case studies, journal clubs and reflective assessment and writing to explore various lifestyle modifications and their relation to chronic disease prevention and management. Conclusion: The novel lifestyle medicine APPE provides students a unique opportunity to advance their knowledge in therapeutic lifestyle changes and expand their understanding of the pharmacist’s role in chronic disease prevention and management.
Comparison of Traditional Versus Evidence-Based Journal Club Formats
Kathleen Packard, PharmD, MS, BCPS,Megan Herink, PharmD, BCPS,Thomas L. Lenz, PharmD, MA, PAPHS
INNOVATIONS in Pharmacy , 2011,
Abstract: Purpose: The objective of the study was to compare a traditionally structured journal club with an evidence based structured journal club during an advanced clinical pharmacy rotation and to determine the best utilization that aligns with recent changes to the pharmacy school accreditation standards.Methods: The study included 21 students who completed journal club utilizing the traditional journal club format and 24 students who utilized an evidence based journal club format. Background characteristics, student reported beliefs, and mean critical evaluation skills scores were evaluated and compared in each group.Results: There were no statistically significant differences between the two cohorts in mean overall percentage grade for the activity. Students in the traditional cohort received significantly higher grades for the Study Analysis and Critique section (90.97 + 12.18 versus 81.25 + 11.18, P=0.01) as well as for the Preparedness section (96.11 + 8.03 versus 85.0 + 17.13, P=0.002). Students in the evidence based cohort received statistically superior grades for the Presentation Skills section (96.43 + 6.39 versus 82.47 + 14.12, P=0.0004).Conclusion: An evidence based journal club is a reasonable and effective alternative to the traditionally structured journal club when the primary objective is to assist students in understanding evidence based concepts and to apply current literature to clinical practice.
Health-Related Quality of Life Impact in Employees Participating in a Pharmacist-Run Risk Reduction Program
Thomas L. Lenz, PharmD,Nicole D. Gillespie, PharmD,Maryann Z. Skrabal, PharmD,Michele A. Faulkner, PharmD
INNOVATIONS in Pharmacy , 2012,
Abstract: Health related quality of life (HRQOL) and self-perceived well-being have been shown to be associated with lower healthcare utilization and costs in people with chronic diseases. A pharmacist-run employee health program started in 2008 sought to improve HRQOL through the use of individualized lifestyle behavior programming, medication therapy management, and care coordination activities. Following one year of participation in the program, employee participant’s self-reported general health rating significantly improved compared with their baseline rating (p < 0.001). Participants also reported a significantly lower number of days within a month when they did not feel physically and/or mentally well at baseline vs. one-year, respectively (10.3 days vs. 6.0 days, p < 0.01). Pharmacists can positively impact self-reported HRQOL when working in an employee health setting.
Lifestyle Medicine-Related Cardiovascular Risk Factor Changes in Employees Participating in a Pharmacist-Run Risk Reduction Program
Thomas L. Lenz, PharmD,Nicole D. Gillespie, PharmD,Michele A. Faulkner, PharmD,Maryann Z. Skrabal, PharmD
INNOVATIONS in Pharmacy , 2012,
Abstract: Cardiovascular disease (CVD) remains the leading cause of death among American adults accounting for approximately one-third of all deaths. It has been shown, however, that the actual causes of death are related to lifestyle behaviors such as tobacco use, poor diet and physical activity and alcohol consumption. A pharmacist-run employee health program, started in 2008, sought to lower CVD risk through the use of individualized lifestyle behavior programming, medication therapy management, and care coordination activities. Following one year of participation in the program, employee participants were shown to significantly increase exercise quantity (p < 0.001), fruit and vegetable consumption (p < 0.001), and decrease self-reported stress level (p = 0.006). The percentage of program participants simultaneously adherent to the recommended levels of exercise, combined fruit and vegetable intake and tobacco abstinence at one-year was 34.5% vs. 5.5% at baseline. This compares with only 5.1% of the U.S. population adherent to the same three behaviors. Pharmacists can positively impact healthy lifestyle behaviors when working in an employee health setting.
Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program
Mallory C. McKenzie, PharmD,Thomas L. Lenz, PharmD,Nicole D. Gillespie, PharmD,Jessica J. Skradski, PharmD
INNOVATIONS in Pharmacy , 2012,
Abstract: Objective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program. Design: Retrospective analysis of medication adherence using pharmacy refill data. Setting: A medium sized university located in the Midwest United States and the organization’s outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof. Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM), lifestyle medicine and care coordination. Main Outcome Measures: The Proportion of Days Covered (PDC) and the Medication Possession Ratio (MPR). Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01). The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence) for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01). The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence) pre enrollment versus post enrollment (+10%, P=0.086). The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively. Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for at least one year and was shown to be better when compared to a matched cohort of similar age, condition and region.
A Lifestyle Medicine Clinic in a Community Pharmacy Setting
Thomas L. Lenz, PharmD, MA, PAPHS,Jessica Skradski, PharmD,Maryann Z. Skrabal, PharmD, CDE,Liz Ferguson, MA
INNOVATIONS in Pharmacy , 2010,
Abstract: Chronic diseases continue to be a significant burden to the health care system. Pharmacists have been able to show that drugtherapy for patients with chronic diseases can be improved through medication therapy management (MTM) services but have yet to become significantly involved in implementing lifestyle modification programs to further control and prevent chronic conditions. A novel and innovative lifestyle medicine program was started by pharmacists in a community pharmacy in 2008 to more comprehensively prevent and manage chronic conditions. The lifestyle medicine program consists of designing seven personalized programs for patients to address physical activity, nutrition, alcohol consumption, weight control, stress management, sleep success, and tobacco cessation (if needed). The lifestyle medicine program complements existing MTM services for patients with hypertension, dyslipidemia, and/or diabetes. This program is innovative because pharmacists have developed and implemented amethod to combine lifestyle medicine with MTM services to not only manage chronic conditions, but prevent the progression of those conditions and others. Several innovative tools have also been developed to enhance the effectiveness of a lifestyle medicine program. This manuscript describes the program’s pharmacy setting, pharmacy personnel, participants and program details as well as the tools used to integrate a lifestyle medicine program with MTM services.
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