 pandemic has shown us how quickly science can move when we collectively dedicate time and resources towards addressing an issue, it reminds me as an OBGYN with a true focus on women’s health that there is a lot of opportunity for us to adapt to the evolving healthcare needs of women today, especially in a post-pandemic environment.

On the subject of unplanned pregnancy, as healthcare professionals, as partners, as potential future moms or dads, we have to come together as a worldwide community to help reduce the rates. This begins with a conversation.

But let’s first start with the facts. Unplanned pregnancy remains a significant public health issue, with nearly half of pregnancies being unplanned in the U.S. alone, according to data from 

. Globally, more than 1 billion women have a need for family planning, but for 270 million of them, that need for modern methods is 

. In my view, we have to do something to ensure she has the resources she needs to help make informed decisions with her HCP.

The average U.S. woman spends about 30 years avoiding pregnancy, which is three-fourths of her 

 An unplanned pregnancy can translate into a multitude of health factors and risks for both the mother and the baby, regardless of her socioeconomic background. For example, prenatal care may be delayed, and one study estimated that direct medical cost of unplanned pregnancy in the U.S. was more than 

. This does not account for the personal financial costs associated with 

, which may be even more challenging during the current pandemic, when many women may have lost jobs or faced new financial pressures.

Help Fuel the Conversation and Meet Her Where She Is

While these numbers surprise me even as an OBGYN, we are in a unique position to help change those numbers. This starts by having an open, honest conversation with our patients. We can be that objective source; we can ask the questions: “what are your family planning goals?,” “what is your plan?” We can listen to her needs and customize a plan that’s right for her. It’s important that healthcare providers and women work together to discuss what options are best for her.

I’ve appreciated my time at Organon, as we hope to provide education and access to information for patients, all while helping to listen to the needs of women. By increasing these pivotal conversations, increasing access to family planning options, and educating women about their choices, we can help them make informed choices about their sexual and reproductive health to help reduce the rates of unplanned pregnancy. Educating male partners about pregnancy planning can also help limit unplanned pregnancies, reduce the stigma associated with it, and encourage more open conversations.

As physicians on the front lines of women’s health, and as an industry committed to doing better for every woman everywhere, let's come together to spark a dialogue that fuels much-needed attention to this global public health issue. Let’s talk about unplanned pregnancy and change the conversation from one of stigma to one of impact. I invite you to join healthcare providers and women from across the globe to share your perspective on how to help reduce unplanned pregnancies at 

Dr. Edio Zampaglione is the Head of Global Medical Affairs and Outcomes Research at Organon, a global healthcare company formed in 2021 through a spinoff from Merck, known as MSD outside of the United States and Canada, to focus on improving the health of women throughout their lives. He served as a pharmacist and a practicing OBGYN before starting a career in the pharmaceutical industry in 2001. Throughout his career in the pharmaceutical industry, Dr. Zampaglione has always focused on helping improve access and a broader understanding of women’s health.

An unplanned pregnancy can translate into a multitude of health factors and risks for both the mother and the baby.

Reducing the Stigma of Unplanned Pregnancy Starts with a Conversation

Edio Zampaglione, MD

A panel of ophthalmologists discuss strategies for improving patient outcomes in retinal vein occlusion with anti-VEGF and other therapies.

Optimizing Treatment Outcomes in Retinal Vein Occlusion

Optimizing Treatment Outcomes in Retinal Vein Occlusion (RVO)

Hong-Uyen Hua, MD

Jeff McIntyre is the vice president of Liver Health Programs at the Global Liver Institute.

Reflecting on Resmetirom’s Historic FDA Approval for MASH

On March 14, 2024, the US Food and Drug Administration (FDA) made history when it granted accelerated approval to Madrigal Pharmaceuticals’ resmetirom (Rezdiffra), making it the first and only treatment for noncirrhotic nonalcoholic steatohepatitis (NASH), now known as 

metabolic dysfunction-associated steatohepatitis (MASH)

One year later, resmetirom’s impact on clinical practice and patient care continues to evolve. In recognition of the anniversary of the landmark decision, the latest 

 spotlights a conversation between a trio of subject matter experts reflecting on the past year of having resmetirom as a treatment option for patients, remaining unmet needs in MASH management, and the evolving therapeutic pipeline poised to further transform care.

Estimated to affect more than 30% of the global population, MASLD is the most common chronic liver disease around the world. MASH represents an advanced stage of MASLD and has historically lacked treatment options beyond lifestyle changes with diet and exercise. In the absence of pharmacologic therapies, weight loss served as the cornerstone of disease management.

This changed in March 2024, when resmetirom became the first and only FDA-approved MASH therapeutic, earning accelerated approval for the treatment of noncirrhotic MASH with moderate to advanced fibrosis. Although lifestyle interventions continue to play a pivotal role in MASH care, as the thyroid hormone receptor-beta selective agonist is indicated in conjunction with diet and exercise, they are no longer the only tools available for disease management.

 on the 1-year anniversary of resmetirom’s FDA approval and the evolving landscape of MASH management, moderator Jeff McIntyre asks Mazen Noureddin, MD, MHSc, and Juan Pablo Arab, MD, about the clinical impact resmetirom has had since being approved and whether it lived up to the expectations set for it as the first-ever MASH therapeutic.

Noureddin begins by highlighting resmetirom’s “game-changing” impact, citing strong clinical results, guideline updates, and the shift toward noninvasive testing. He notes that patients are seeing benefits and that long-term data continues to support the drug’s efficacy.

Arab expresses agreement, emphasizing that resmetirom has not only improved patient outcomes but also changed how clinicians approach MASH. Previously, primary care providers and endocrinologists were reluctant to screen for at-risk MASH due to a lack of treatment options. Now, with an FDA-approved therapy, he says there is greater urgency in identifying and managing these patients.

Discussing challenges, Arab points to the need for broader screening, improved access to noninvasive tests, and overcoming reimbursement hurdles, additionally stressing that implementing a new treatment requires systemic change across healthcare.

Noureddin adds that while hepatology clinics were well-prepared for resmetirom’s arrival, uptake in gastroenterology practices has been mixed. He sees a need for more education on noninvasive tests and fibrosis staging but says that overall, awareness and access are improving. He remains optimistic about the drug’s future and the potential for combination therapies to further transform MASH treatment.



Mazen Noureddin, MD, MHSc, is a professor of medicine and a transplant hepatologist at Houston Methodist and director of the Houston Research Institute.

Juan Pablo Arab, MD, is an associate professor of medicine in the division of gastroenterology, hepatology, and nutrition at Virginia Commonwealth University School of Medicine.

Noureddin has relevant disclosures with Altimmune, Madrigal Pharmaceuticals, Merck, Takeda, Terns, and others. Arab and McIntyre have no relevant disclosures.

US Food and Drug Administration. FDA Approves First Treatment for Patients with Liver Scarring Due to Fatty Liver Disease. March 14, 2024. Accessed March 13, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-patients-liver-scarring-due-fatty-liver-disease

Brooks, A. Stephen Harrison, MD: Promising Phase 3 Data for Resmetirom in NASH, Fibrosis. HCPLive. February 7, 2024. Accessed March 13, 2025. 

https://www.hcplive.com/view/stephen-harrison-md-promising-phase-3-data-resmetirom-nash-fibrosis

In the opening segment of this 6-part HCPLive RX Review, experts reflect on resmetirom’s FDA approval for MASH and clinical challenges to implementing it.

Jeff McIntyre

University of Rhode Island College of Pharmacy

 In the little time that we have left, I want to go around and get some final thoughts from each one of you. I would like you to address the whole issue of using naloxone. How do you address this with patients? How do you address this with clinicians, and what is your view about going forward? How is this going to change the landscape of opioid use in the United States? Why don’t we start with Jeremy, and we will keep going from there? Take 30 seconds, and we will just keep going.

 I think we have covered a lot of ground today. We know, and have known for a long time, that opioids have certain risks. They pose risks to patients, and they pose risks in the community when they are taken unsupervised or misused. From a safety measure perspective, there are things we can do. We can do a better job identifying the patients at risk or when identifying those patients who should or should not receive opioids. At the same time, I think we need more community awareness, and we can do this by using the naloxone program or some of the other programs discussed today. Rhode Island sounds amazing, and I am interested to learn more about what is happening out there. The tools we have today can enhance the safety of what we are doing on the medical side and help out there in the community with the substance misuse and illicit side. That is outside of the reach for some of us who do not work in settings where one can reach out to the community, but I think that these types of tools are underutilized. If these tools are utilized on a more frequent basis, and in a more normalized way, we have the potential to reverse what we have seen here with opioids and the subsequent harm caused by them.

 While acknowledging that opioids are still commonly used as part of a multidisciplinary approach to pain management and that opiates are still being misused illicitly, we need to have strategies that emphasize the availability of naloxone so that people can be as safe as possible. As Dr Adler said, this must be normalized, and we need to realize, when we think about this, it is going to take more years than we would like before it will become normalized, but we need to step it up and work toward that.

 I cannot agree more with my colleagues. I think that, when it comes to normalizing naloxone, we need to take the lessons we have learned from what successfully normalizes this method of treatment. Whether it is enacting policy interventions, having naloxone everywhere, putting up billboards, or getting that access. What we are doing is studying people, saying what makes you dispense naloxone, to pharmacists? Saying what makes you dispense it, to primary care physicians? What makes you want to give it, to a caregiver? What are those barriers? How do we break them down? I look forward to the day of over-the-counter naloxone that is still covered by insurance so we do not have financial barriers. There is a lot that we know, areas where we have been successful, and I think that yes, it is going to be around a long time. We have seen how COVID-19 has created these divisions. I think, by solving those divisions during COVID-19, we will solve some of the divisions in access to care for people with opioid use disorder or people who use opioids.

I see naloxone as one part of the puzzle here, one part of the comprehensive approach that we try to take in the emergency department [ED], and that is decreasing the barriers that patients need to overcome to get naloxone. This is improving their access to naloxone not only in the ED but also in other areas of life where they have access to health care, and in their daily lives. Having it available works, whether it is having a naloxone box sitting next to an AED [automated external defibrillator] box somewhere or offering it to patients proactively and not requiring them to have to ask for it.

Additionally, I think that, as science for medication-assisted treatment continues to be redefined every day—how effective that is for treatment—it is our responsibility to not only make sure that our patients are safe as they go out and use this, or that their community is safer because naloxone is out there. But we also need to provide multiple opportunities for patients to get linked to treatment, to be linked to peers, and to have access to medication-assisted treatment. I think this is equally important and should be offered as routinely as possible.

Theresa, some people hate to be the last one to speak when all the good stuff is taken.

Theresa Mallick-Searle, MS, RN-BC, ANP-BC:

heresa Mallick-Searle, MS, RN-BC, ANP-BC: 

As the token nurse on the platform here, I am really big into listening to my patients. It is not that my colleagues are not, but I want to hear what is important to the patient. I want to be able to have them partner with me in their health care. I want to be able to encourage my peers to look at the bigger community and be in it for the long term, to decrease the amount of fear out there. As a health care provider, for anything that we do, we are trying to do the best we can to take care of our patients.

Thank you all very much. I want to thank you at home as well for watching this HCPLive® Peer Exchange. If you enjoyed this content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox.

I am Dr Peter Salgo, and I will see you again next time.

The multidisciplinary panel of experts share final thoughts on strategies to normalize naloxone and decrease barriers to its obtainment and utilization. 

Final Thoughts on the Opioid Crisis and Normalizing Naloxone

Jeffrey Bratberg, PharmD, FAPhA, University of Rhode Island College of Pharmacy 

Ken reports on medical innovations and advances in practice and edits presentations for news and professional education publications. He previously taught and mentored pharmacy and medical students, and provided and managed pharmacy care and drug information services. He regularly contributes to Contagion Live, HCP Live, and Neurology Live.

Kenneth Bender, PharmD

Maddy Pontius is a Master’s Student in Forensic Psychology at the University of Denver with interests in rehabilitation psychology, health psychology, and neuropsychology. She is hoping to work within the overlap of offender rehabilitation and healthcare in the future.

Maddy Pontius, BA

Discussions about migraine treatment often revolve around a single topic: triggers. Patients with migraine are always eager to learn about factors that activate migraine in order to avoid them. Tracking and avoiding triggers is often one of the few means of control migraine patients feel they have over an otherwise unpredictable disease. However, this is an oversimplification. In practice, trigger avoidance is usually ineffective, and sometimes even detrimental to patients. That’s because:

Many supposed “triggers” are not triggers at all, but rather are premonitory symptoms signaling an attack is already underway.

Rarely does a single trigger produce a migraine attack.

Avoiding triggers can erode patients’ quality of life, since it can lead to avoidance of enjoyable activities

 as well as feelings of helplessness and self-blame.

Migraine Triggers Versus Prodromal Symptoms

Research has confirmed several triggers of migraine attacks:

 are perhaps the most common migraine trigger among women. The drop in estrogen levels just prior to menses is likely the cause.

, including for religious reasons such as Ramadan

 Links between chronic stress, pain, migraine, and catastrophic thinking have been demonstrated by many studies.

 However, removing a stressful situation alone is unlikely to improve migraine. In fact, the abrupt cessation of stress is often itself a migraine trigger.

Many environmental factors may affect migraine (such as altitude, lightning, and barometric pressure changes) but the effects are relatively mild and in some cases nonsignificant.

It’s important to emphasize that rarely does any single trigger invariably produce a migraine attack. Much depends upon the patient’s own migraine threshold, which fluctuates over time. For example, sudden changes in daily activity or environment increase migraine susceptibility,

 making triggers more potent than usual. This can be disorienting for patients, who may find that activities that were tolerable one day become triggering the next.

Further confusing for patients is the difficulty figuring out which of the events or symptoms that preceded a migraine attack was the trigger. This has led to a plethora of reported triggers, most of which have not been borne out by research. Rather, data supports the idea that many of these symptoms are actually premonitory, or prodromal symptoms,

 which occur 2 to 48 hours prior to the headache phase of a migraine attack.

 Seen in this light, such symptoms are not triggers that can be avoided; rather, they signal to the patient that an attack is already underway.

Common premonitory symptoms often confused for triggers include:

Chocolate is probably the best example of a food craving misunderstood as a trigger. Although patients rank chocolate number one of all food-based triggers, placebo-controlled studies have failed to show that chocolate triggers migraine.

 The same can be said of caffeine, an oft-cited food “trigger” that 

Prodromal symptoms are individual to each patient. Identifying their prodromal symptoms can help a patient with migraine recognize that the headache phase is imminent, lessening the element of surprise and allowing them to take mitigation steps such as leaving work early, seeking out a dark room, notifying caregivers, or obtaining childcare for during the attack.

Reframing Triggers for Effective Migraine Treatment

Asking patients to avoid triggers does not appear to be effective, based on studies comparing the practice to a control group that didn’t change their behaviors. Trigger avoidance was also found less effective than cognitive therapy or an approach of learning to cope with triggers.

 Avoiding stress, for example, has been found less effective for chronic pain than coping or adaptive strategies and may lead to anxiety, increased disability, and catastrophic thinking.

Focusing extensively on migraine triggers during an office visit is not only an ineffective use of provider-patient time, but it may also have a host of negative consequences on the person with migraine’s quality of life:

Patients can feel blamed or self-blame for a migraine attack (e.g., “This is my fault because I drank wine”).

A patient may find it impossible to identify their triggers, especially in those with very frequent attacks (where everything can appear to be a trigger) or infrequent attacks (where it’s difficult to find consistent patterns).

The triggers identified may not be avoidable, such as stress or weather.

Focusing on triggers can increase anxiety or lead to anticipation of attacks. It may even pave the way to more migraine attacks. Nocebo is a major problem in headache, both in clinical trials and practice.

 Studies of other pain disorders have shown that increased pain expectations cause an increase in symptoms

; the suggestion that a specific trigger will cause a migraine attack may create similar expectancy mechanisms.

It does not address the underlying cause of the disorder.

With all this in mind, here are a few strategies when advising patients on triggers.

 Maintaining a regular diary or calendar eliminates recall bias and focuses on overall migraine control. It may also allow the discovery of unrecognized triggers amenable to treatment, such as caffeine withdrawal on weekends or menstrual migraine. In addition to tracking attacks, ask patients to write down strategies that worked, both preventively and abortively (medical and non-medical), to reduce their migraine symptoms.

Focus on healthy lifestyle choices that raise migraine threshold. 

Rather than trigger avoidance, focus on engaging in proactive behaviors that, done consistently, raise patients’ threshold for migraine triggers. Those include good sleep, regular nutrition patterns, regular exercise, and stress management techniques.

For further practical details on healthy lifestyle changes that improve migraine, see my colleagues’ Stephen Silberstein, MD and William Young, MD’s article “Lifestyle Changes for Migraine: Practical Tips for the Neurologist & PCP.”

To help patients understand the concept of threshold and their ability to raise their own migraine resistance level, try this patient-centric article from Ctrl M Health.

Recognize and treat “cephalgiaphobia.” 

Ask patients if they worry about migraine when they are headache-free or restrict activities due to fear of migraine. Fear of migraine between attacks is an important predictor of chronification and medication overuse.

 Finding effective acute medication may reduce the risk of chronification.

 Cognitive behavioral therapy can be particularly effective.

 Patients with very frequent migraine—for whom triggers appear to be everywhere—may benefit from effective preventive medication.

Expect that patients will be new to the idea of replacing trigger-avoidance strategies with proactive behaviors. They will need encouragement and guidance to follow through. Until recently, evidence-based, expert-reviewed programs to help patients with lifestyle change for migraine were rare. That is a guiding reason why we at the Jefferson Headache Center and Thomas Jefferson University Hospital have partnered with Ctrl M Health, whose app-delivered program makes this information widely accessible.

Providers have the ability to help patients redirect their efforts into the factors within their control that are shown to actually make a difference. I find patients also benefit from the empowerment this behavioral approach brings, making them more confident in their ability to manage migraine. Those gains, in turn, allow them to continue making progress in reducing migraine frequency and severity, improving their quality of life.

The Jefferson Headache Center and Thomas Jefferson University have partnered with Ctrl M Health to create comprehensive, evidence-based programming and support for people with migraine. For free provider resources, best practice tips, and patient handouts, visit their For Providers page.

1. Martin PR. Managing headache triggers: think ‘coping’ not ‘avoidance.’ Cephalalgia. 2010;30(5):634–7. DOI: 10.1111/j.1468-2982.2009.01989.x

2. Loder EW. Menstrual migraine: pathophysiology, diagnosis, and impact. Headache. 2006;46(Suppl 2):S55–60. DOI: 10.1111/j.1526-4610.2006.00555.x

3. Abu-Salameh I, Plakht Y, Ifergane G. Migraine exacerbation during Ramadan fasting. JHeadache Pain. 2010;11(6):513–7. DOI: 10.1007/s10194-010-0242-z

4. Drescher MJ, Elstein Y. Prophylactic COX 2 inhibitor: an end to the Yom Kippur headache. Headache. 2006;46(10):1487–91. DOI: 10.1111/j.1526-4610.2006.00609.x

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7. Lipton RB, Buse DC, Hall CB, Tennen H, Defreitas TA, Borkowski TM, et al. Reduction in perceived stress as a migraine trigger: Testing the “let-down headache” hypothesis. Neurology. 2014;82(16):1395–401. DOI: 10.1212/WNL.0000000000000332

8. Marmura MJ, Hernandez PB. High-altitude headache. Curr Pain Headache Rep. 2015;19(5):483. DOI: 10.1007/s11916-015-0483-2

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Forget what you think you know about red wine or chocolate ‘activating’ migraine. Many commonly accepted “triggers” aren’t triggers at all.

Helping Your Patients Avoid the Migraine Trigger Trap

Michael Marmura, MD

metabolic dysfunction-associated steatotic liver disease (MASLD)

 and bariatric surgery are becoming increasingly common in light of the rising obesity epidemic. Bariatric surgery offers well-established benefits on MASLD outcomes, including reduced adverse liver and cardiovascular events, improvement in steatohepatitis, and potential histologic regression of fibrosis.

Despite this, patients may still develop cirrhosis following bariatric surgery, either through progressive steatosis or other mechanisms. While many have sought to validate the efficacy and safety of performing bariatric surgery on patients with compensated cirrhosis, there is a paucity of literature describing the effect of bariatric surgery on outcomes of cirrhosis decompensation events.

We performed a retrospective, population-based analysis using the National Inpatient Sample database from October 2015 - December 2020 to identify all adults with obesity hospitalized with decompensated cirrhosis, including ascites, variceal hemorrhage, hepatic encephalopathy, or portal hypertension. These patients were then stratified into those with (n = 14,500) or without (n = 1,010,955) a history of bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy).

On outcomes analysis, inpatient mortality rates were lower in the bariatric surgery cohort (2.9% vs 4.1%; 

= .002), as were rates of acute kidney injury (24% vs 27%; 

<.001), respiratory failure requiring mechanical ventilation (0.7% vs 1.5%; 

<.001), and upper GI bleed (6.7% vs 9.6%; 

<.001). On univariate logistic regression analysis, bariatric surgery was protective against inpatient mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.58-0.89; 

= .002). However, after adjusting for age, race, Baveno stage, and Charlson Comorbidity Index, protective significance was lost (OR, 0.82; 95% CI, 0.66-1.03; 

Weight loss is the primary treatment for MASLD, and despite a growing armamentarium of non-surgical weight loss strategies, bariatric surgery remains the most effective and enduring treatment for obesity. A recent systematic review reported an overall lower risk of adverse liver outcomes among patients with obesity who underwent bariatric surgery compared to those who did not (Hazard ratio, 0.33; 95% CI, 0.31-0.34), including significantly reduced risk of developing cirrhosis.

 However, despite surgery, fibrosis may still progress and patients remain susceptible to other causes of cirrhosis, such as viral hepatitis or alcohol-associated liver disease. In fact, bariatric surgery is known to increase the risk of alcohol use disorder post-operatively, facilitating more rapid and higher peak alcohol delivery to the systemic circulation.

Regardless of etiology, our study illustrates improved outcomes among patients with obesity and a history of bariatric surgery hospitalized with decompensated cirrhosis compared to nonsurgical patients. This likely relates to overall improved metabolic and comorbid health conferred by bariatric surgery. Though an important finding, future analyses are needed to further understand this relationship, including identifying temporal relationships between surgery and the onset of cirrhosis and decompensation, as well as subanalysis based on cirrhosis etiology and ongoing risk factors.

Aminian A, Al-Kurd A, Wilson R, et al. Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis. 

. Nov 23 2021;326(20):2031-2042. doi:10.1001/jama.2021.19569

Lassailly G, Caiazzo R, Ntandja-Wandji LC, et al. Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis. 

. Oct 2020;159(4):1290-1301.e5. doi:10.1053/j.gastro.2020.06.006

Verrastro O, Panunzi S, Castagneto-Gissey L, et al. Bariatric-metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial. 

. May 27 2023;401(10390):1786-1797. doi:10.1016/S0140-6736(23)00634-7

Are VS, Knapp SM, Banerjee A, et al. Improving Outcomes of Bariatric Surgery in Patients With Cirrhosis in the United States: A Nationwide Assessment. 

. Nov 2020;115(11):1849-1856. doi:10.14309/ajg.0000000000000911

Bai J, Jia Z, Chen Y, Li Y, Zheng S, Duan Z. Bariatric Surgery is Effective and Safe for Obese Patients with Compensated Cirrhosis: A Systematic Review and Meta-Analysis. 

. May 2022;46(5):1122-1133. doi:10.1007/s00268-021-06382-z

Wang G, Huang Y, Yang H, Lin H, Zhou S, Qian J. Impacts of bariatric surgery on adverse liver outcomes: a systematic review and meta-analysis. 

. Jul 2023;19(7):717-726. doi:10.1016/j.soard.2022.12.025

Pepino MY, Okunade AL, Eagon JC, Bartholow BD, Bucholz K, Klein S. Effect of Roux-en-Y Gastric Bypass Surgery: Converting 2 Alcoholic Drinks to 4. 

. Nov 2015;150(11):1096-8. doi:10.1001/jamasurg.2015.1884

King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. 

. Jun 20 2012;307(23):2516-25. doi:10.1001/jama.2012.6147

The retrospective analysis highlights improved outcomes among patients with obesity and a history of bariatric surgery hospitalized with decompensated cirrhosis.

Bariatric Surgery in Patients Hospitalized with Decompensated Cirrhosis: A Nationwide Analysis

Stephen Firkins, MD

Chief Pharmacist, Express Scripts® Pharmacy

Caregivers continue to face increased responsibilities and stress due to the 

 pandemic and knowing where to turn for help is not easy. A recent study shows that pharmacists will have an expanded role in patient care, and caregivers will want to take note of how they can tap into pharmacists’ expertise, which is often an underutilized resource.

Together, our organizations, Express Scripts® Pharmacy and Columbia University Mailman School of Public Health, partnered on new research to more deeply understand the expanding role of pharmacists in transforming patient care in the decade ahead. Between November and December 2021, we surveyed more than 3,000 patients, 1,000 pharmacists, and 500 providers (including physicians and nurse practitioners). The resulting Prescription of Trust report is the largest and most comprehensive research study ever conducted on this topic.

Our survey found that pharmacists currently spend about 50% of their time dispensing and filling medications, but that percentage is expected to decrease over the next decade. More than 80% of pharmacists agree they will see increased patient counseling responsibilities, take on an increased role in preventive care measures, and be more integrated in care management teams. We recognize this expansion of duties cannot happen fast enough, as the COVID-19 pandemic has accelerated the shortage of physicians and nurses available to serve patients.

The best part about the findings from our research is that patients and health care providers truly trust pharmacists to play a greater role in providing care. In fact, our research found that 72% of doctors and nurse practitioners already consider pharmacists to be part of the patient care team.In addition, nearly 80% of patients said they see pharmacists as an integral part of their health care team.

So, what should caregivers know about pharmacists, and how should they engage with them to make the most of their expertise?Caregivers should keep in mind that pharmacists do much more than dispense medications. Our research found pharmacists in ambulatory clinics, health systems (hospitals), and home delivery pharmacies often serve as specialists, advising patients with specific diseases or interacting with a larger health team to help manage complex patient care.

Pharmacists can help ease a caregiver’s stress by addressing medication issues including polypharmacy and adherence, as well as condition issues. Additional Express Scripts Pharmacy 

 shows there’s a link to better health outcomes when pharmacists get involved with patient counseling and chronic disease management

For example, patients with diabetes often need continuing care to help manage their condition. Caregivers can reach out to their pharmacist for medication consults but also for information about disease management and preventive care.

Similarly, pharmacists can assist with many other conditions, including high blood pressure and high cholesterol. As part of their expanding role, pharmacists can perform blood pressure and cholesterol screenings that allow them to make recommendations for potential future treatment. The more caregivers can partner with pharmacists to prevent emergency room trips, hospitalizations, or the advancement of a chronic disease by supporting adherence, the better we can affect a patient’s health outcomes.

Caregivers may also want to consider the benefits of telepharmacy services (via phone or video.) With the COVID-19 pandemic, the use of telehealth skyrocketed, but the use of telepharmacy has not been as quickly adopted. However, our study showed that nearly half (49.7%) of patients would find it extremely or very helpful to have routine testing and medical visits done from home. Telepharmacy is an underutilized resource for people to connect with a pharmacist anytime, anywhere. At many home delivery pharmacies, such as Express Scripts Pharmacy, their members can access pharmacists by phone 24/7.

Lastly, caregivers should keep in mind that most pharmacists chose their profession because of their desire to take care of patients, and the Prescription of Trust shows they are embracing their growing responsibilities with 70.1% saying they are excited about the evolving role of the pharmacist.

To learn more about The Prescription of Trust report, as well as how caregivers can make the most of patient care provided by pharmacists, please follow this link: 

Susan Peppers, RPh, Chief Pharmacist, Express Scripts® Pharmacy, is dedicated to quality and patient safety with responsibility for Pharmacy Practice, Patient Consultation, and Clinical Programs.

John McHugh, MBA, PhD is an Assistant Professor in the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health. His research focuses on health care organizations and how they operate and respond to changing incentives.

The views expressed in this piece are those of the author, not necessarily those of the publication.

Clinicians and health care experts interested in contributing to HCPLive can 

Caregivers Can Lean on Pharmacists Who Are Taking on Expanding Role in Patient Care

Susan Peppers, RPh

In approximately 1 in 1000 women worldwide over the age of 40 and in the US, as many as 65 out of every 100,000 women are diagnosed with a rare, autoimmune disease that can cause significant liver damage and potentially lead to liver failure if left untreated.

 This disease is known as primary biliary cholangitis (PBC).

 Although PBC is more common in women, we now know that more men than previously thought also have this disease.

Many people may not experience symptoms in the early stages of the disease.

 If this chronic liver disease is left untreated, it can progress to cirrhosis.

The journey to a PBC diagnosis can be long and challenging, especially when there may not be any signs of the disease that others can see.

 For many patients, the path to a PBC diagnosis can involve numerous testing and procedures.

First-line and second-line treatment options are available to patients. After 1 year on first-line therapy, one’s health care provider will assess treatment goals by looking at biochemical response.

 Some patients don’t meet treatment goals—this is known as an inadequate response to therapy. In such cases, several second-line treatments are available for appropriate patients who qualify.

Routine liver blood tests can reveal abnormalities.

 If PBC is suspected by one’s doctor, an antimitochondrial antibody (AMA) test is generally used to confirm a PBC diagnosis.

 For people living with PBC, some treatment goals include normalizing or improving a protein called alkaline phosphatase (ALP) and managing symptoms of the disease, such as pruritus.

 A treatment plan that helps sustain ALP levels and more effectively manages symptoms may help improve disease outcomes.

Authors