***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Cardiovascular disease ( CVD ) is a major cause of mortality in the United States , representing the highest total expenditures among major diseases . To improve CVD-associated outcomes , medication therapy management ( MTM ) services have been included in essential health benefit packages offered by various health plans . Nevertheless , the impact of such MTM services on outcomes is still unclear , especially from the perspective of the self-insured employer . OBJECTIVES To ( a ) compare economic outcomes between patients who received and those who did not receive MTM services from the self-insured employer 's perspective and ( b ) compare clinical outcomes before and after receiving MTM services . METHODS This study consisted of 2 pre- and post-retrospective design s : ( 1 ) a cohort study with comparison groups and ( 2 ) a cohort study within group comparison . Patients were beneficiaries aged 19 years or older who were diagnosed with CVD conditions according to ICD-9-CM codes and continuously enrolled in a public university-sponsored insurance plan between 2008 - 2010 . Patients were divided into MTM and non-MTM groups . The first MTM encounter was assigned as the index date for the MTM group . Match-paired patients who did not receive MTM services were r and omly assigned the index date based on age category , gender , and comorbidity . Measures for pharmacy , medical , and total expenditures were obtained from medical and pharmacy cl aims . Paired t-tests and independent t-tests using data generated from 1000 bootstraps compared mean cost difference within and between groups . The return on investment ( ROI ) was calculated by dividing the average net benefit from MTM services by the average cost of MTM services . Clinical parameters , including blood pressure ( BP ) and body mass index ( BMI ) , were retrieved from electronic medical records from a pharmacist-provided clinic where MTM services took place . Paired-t tests were used to compare the mean difference between baseline and endpoint values . Further , this study examined changes in the proportion of patients who achieved an individualized treatment goal for BP and BMI . The study also quantified the improvement in disease stages after the index date using the McNemar 's test . Statistical analyses were performed by using SAS software version 9.2 with statistical significance level of 0.05 . RESULTS A total of 63 patients and 62 match-paired patients were included in the MTM group and the non-MTM group , respectively . The mean cost ( SD ) per patient in the MTM group during the 6 months post-index period for CVD-related pharmacy , all-cause medical , and total expenditures was lower than the 6 months pre-index period by $ 22.0 ( 19.1 ) , $ 79.2 ( 99.6 ) , and $ 75.1 ( 136.2 ) , respectively . In contrast , the mean cost ( SD ) for the non-MTM group increased during the 6 months post-index date by $ 10.7 ( 24.2 ) , $ 246.4 ( 248.4 ) , and $ 289.0 ( 269.5 ) for pharmacy , medical , and total expenditure , respectively . When comparing the 2 groups , the MTM group had statistically significantly lower costs per patient for pharmacy expenditures ( difference of -31.9 ± 25.1 , P less than 0.0001 ) , medical expenditures ( difference of -$325.6 ± 271.2 , P less than 0.0001 ) , and total direct expenditures ( difference of -$359.3 ± 219.2 , P less than 0.0001 ) . Given the net benefit of MTM services ( $ 359.3 ) and the average cost of MTM service ( $ 134.6 ) , the ROI was $ 1.67 per $ 1 in MTM cost . Regarding clinical outcomes , while no statistically significant differences were observed in clinical outcomes , MTM services demonstrated clinical benefits . At the post-index period , the percentage of patients who had achieved their goals increased from 55 % to 70 % for BP and from 13.0 % to 21.7 % for normal BMI compared with the pre-index period . In terms of the extent of improvement in disease stages , clinical improvements in the stages of hypertension ( χ2 = 12.77 , P less than 0.05 ) as well as BMI ( χ2 = 6.39 , P less than 0.05 ) at the endpoint were observed . CONCLUSIONS Cardiovascular-related pharmacy , all-cause medical , and total expenditures were statistically lower among beneficiaries who received MTM services compared with those who did not . In addition , MTM services had a positive ROI and demonstrated clinical significance s by the increasing number of patients who achieved treatment goals and improved disease stages for hypertension and BMI The effect of pharmaceutical care on the prevention , detection , and resolution of medication-related problems in high-risk patients in a rural community was studied . Adult patients who received care at clinics in a medically underserved area of Alabama and who were identified as being at high risk of medication-related adverse events were r and omly assigned to a control group or an intervention group . The control group received st and ard medical care , and the intervention group received pharmaceutical care , including a medical record review , a medication history review , pharmacotherapeutic evaluation , and patient medication education and monitoring over a one-year period .  A total of 69 patients completed the study ( 33 in the intervention group and 36 in the control group ) . The percentage of patients responding to hypertension , diabetes , dyslipidemia , and anticoagulation therapy increased significantly in the intervention group and declined in the control group . Ratings for inappropriate prescribing improved in all 10 domains evaluated in the intervention group but worsened in 5 domains in the control group . There were no significant differences between the groups at 12 months in health-related quality of life or medication misadventures . Medication compliance scores improved in the intervention group but not in the control group . Medication knowledge increased in the intervention group and decreased in the control group . Pharmaceutical care in a rural , community-based setting appeared to reduce inappropriate prescribing , enhance disease management , and improve medication compliance and knowledge without adversely affecting health-related quality of life OBJECTIVE To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis .  METHODS Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies . Patients in the control group received usual and customary care . Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis . In addition , the treatment group pharmacists monitored the patients ' drug therapy , to identify and address drug-related problems . Data including the glucocorticoid taken by the patient , medications , and osteoporosis risk factors were collected at baseline and after 9 months of monitoring , via Web-based survey completed in the pharmacy . Using an intent to treat approach , the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy , presence of estrogen therapy , presence of calcium supplement , discussion of glucocorticoid-induced osteoporosis risk , discussion of bone density test , presence of bone mineral density test , reported inactivity , and reported low calcium diet . RESULTS The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement ( Control [ -6.9 % ] vs. Treatment [ 17.1 % ] , P < 0.05 ) . No other contrast was significant . CONCLUSIONS Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis . Pharmacists who educate at-risk patients can impact the self-care of these patients Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design OBJECTIVES To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning . DESIGN A r and omized-controlled trial . SETTING Health center ambulatory clinic . PARTICIPANTS Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks . A  medication-change intervention group of 57 elders was compared with a control group of 76 elder adults . INTERVENTION The primary intervention was a comprehensive review and recommended modification of a patient 's medication regimen . Changes were endorsed by each patient 's primary physician and discussed with each patient . MEASUREMENTS Measures were the Timed Manual Performance Test , Physical Performance Test , Functional Reach Assessment , subtests from the Wechsler Adult Intelligence Scale , a modified R and t Memory Test , the Center for Epidemiological Studies -Depression Scale , the Self-Rating Anxiety Scale , and the R and 36-item Health Survey 1.0 . Comorbidity was determined using the International Classification of Diseases , Ninth Revision , Clinical Modification . Medication usage was determined using brown bag review . RESULTS Intervention subjects decreased their medications by an average of 1.5 drugs . No differences in functioning were observed between groups . Intervention subjects saved an average $ 26.92 per month in wholesale medication costs ; control subjects saved $ 6.75 per month ( P<.006 ) . CONCLUSION Although the intervention significantly reduced the medications taken and monthly cost , most patients were resistant to reducing medications to the recommended level . Further study is needed to underst and patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health . Greater focus on prescriber behavior is recommended OBJECTIVE To compare patients ' adherence to therapy , expectations , satisfaction with pharmacy services , and health-related quality of life ( HRQOL ) after the provision of pharmaceutical care with those of patients who received traditional pharmacy care .  DESIGN R and omized controlled cluster design . SETTING Sixteen community pharmacies in Alberta , Canada . PATIENTS AND OTHER PARTICIPANTS Ambulatory elderly ( > or = 65 years of age ) patients covered under Alberta Health & Wellness 's senior drug benefit plan and who were concurrently using three or more medications according to pharmacy profiles . INTERVENTION Pharmacies were r and omly assigned to either treatment ( intervention ) or control ( traditional pharmacy care ) groups . Patients at treatment pharmacies were recruited into the study , and pharmacists provided comprehensive pharmaceutical care services . Pharmacists at control pharmacies continued to provide traditional pharmacy care . MAIN OUTCOME MEASURES Study participants ' opinions , adherence to therapy , and scores on the Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 ) . RESULTS Compared with those of patients receiving traditional care , treatment patients ' expectations that their pharmacist would perform activities congruent with pharmaceutical care changed over the study period . Treatment patients ' satisfaction with the constructs " trust , " " evaluation and goal setting , " and " communicates with doctor " were also positively affected . HRQOL and patient adherence were not significantly affected by pharmaceutical care interventions . CONCLUSION Successful implementation of a pharmaceutical care practice model has the potential to increase patients ' satisfaction with their pharmacists ' activities and may increase patients ' expectations that pharmacists will work on their behalf to assist them with their health care needs . If pharmaceutical care affects patients ' HRQOL , instruments more specific than the SF-36 may be needed to detect the differences Background —R and omized controlled trials have demonstrated that collaborative medication review s can improve outcomes for patients with heart failure . We aim ed to determine whether these results translated into Australian practice , where collaborative review s are nationally funded . Methods and Results —This retrospective cohort study using administrative cl aims data included veterans 65 years and older receiving bisoprolol , carvedilol , or metoprolol succinate for which prescribing physicians indicated treatment was for heart failure . We compared those exposed to a general practitioner – pharmacist collaborative home medication review with those who did not receive the service . The service includes physician referral , a home visit by an accredited pharmacist to identify medication-related problems , and a pharmacist report with follow-up undertaken by the physician . Kaplan-Meier analyses and Cox proportional hazards models were used to compare time until next hospitalization for heart failure between the exposed and unexposed groups . There were 273 veterans exposed to a home medicines review and 5444 unexposed patients . Average age in both groups was 81.6 years ( no significant difference ) .  The median number of comorbidities was 8 in the exposed group and 7 in the unexposed ( P<0.0001 ) . Unadjusted results showed a 37 % reduction in rate of hospitalization for heart failure at any time ( hazard ratio , 0.63 ; 95 % CI , 0.44 to 0.89 ) . Adjusted results showed a 45 % reduction ( hazard ratio , 0.55 ; 95 % CI , 0.39 to 0.77 ) among those who had received a 
    Output:
    
The evidence was insufficient to determine the effect of MTM interventions on most evaluated outcomes ( eg , drug therapy problems , adverse drug events , disease-specific morbidity , disease-specific or all-cause mortality , and harms ) .
The interventions improved a few measures of medication-related problems and health care use and costs ( low strength of evidence ) when compared with usual care .
Medication therapy management interventions reduced health plan expenditures on medication costs , although the studies reported wide CIs .
Medication therapy management interventions may reduce the frequency of some medication-related problems , including nonadherence , and lower some health care use and costs , but the evidence is insufficient with respect to improvement in health outcomes