Effect Of Clinical Pharmacist Intervention Research Articles

The Effect of Clinical Pharmacist Intervention on Renal Function Impairment in Patients with Antimicrobial-Induced Acute Kidney Injury in ICU.

The purpose of this study was to analyze the improvement effect of clinical pharmacist intervention on renal function impairment in patients with antimicrobial-induced acute kidney injury (AKI). A total of 145 patients with AKI caused by antibiotics admitted to the ICU department were selected as the research subjects. The patients were divided into the control group (n=57) and the intervention group (n=88) according to whether there were ICU specialist clinical pharmacists involved in clinical treatment. The renal function outcome and infection control were evaluated in the two groups. The proportion of renal function outcome in the intervention group was 88.6%, which was significantly higher than that in the control group. However, there was no statistically significant difference in infection control between the two groups. For the intervention group, the clinical pharmacists adopted three intervention methods: dose adjustment, drug replacement and CRRT treatment, respectively, according to the disease conditions of AKI patients. Among them, dose adjustment and drug replacement were the most frequently used intervention methods. In addition, the proportion of renal function outcome was higher in the group of patients who changed antibiotics and underwent CRRT, which were 93.1% and 100%, respectively. The adjusted-dose group had the highest infection control rate at 82.1%. However, there were no statistically significant differences in renal function outcomes and infection control among the three interventions. Clinical pharmacists participating in the clinical treatment of patients with antimicrobial-induced AKI in ICU can effectively improve the renal function of patients.

INTERVENTION OF CLINICAL PHARMACIST IN THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN OUTPATIENTS

Objective: The purpose of the study was to analyze the effect of clinical pharmacist intervention on glycemic control based on fasting blood glucose and glycosylated blood glucose level.  Methods: A randomized prospective interventional study was conducted in the outpatient department of a tertiary care hospital. Patients suffering from diabetes for a least 2 y were selected for the study based on the inclusion and exclusion criteria. The control group was not given any special pharmacist care, while the interventional group had a face-to-face interview, counseling, and telephonic follow-up during the study period. Based on the baseline values and endpoint parametric values, the result of the study was analyzed.  Results: The study was analyzed based on the difference in the glycemic index, using HbA1c and FBS values. The basal values of HbA1c were similar for both groups (8.5%), but a marked reduction to 7.2% was observed in the interventional group. FBS values reduced from 208 mg/dl to 186 mg/dl in the intervention group, while in the usual care group, the reduction was from 211 mg/dl to 198 mg/dl. Conclusion: The inclusion of clinical pharmacists in the healthcare team can offer a remarkable improvement in patient's condition by providing more support in the therapy.

Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy.

BACKGROUND: Patients who are prescribed specialty medications require close monitoring, including assessment of laboratory parameters, toxicities, and adherence. Specialty pharmacies integrated within a health system are able to access records, assess therapy, and efficiently communicate with prescribers. OBJECTIVE: To analyze interventions made by clinical pharmacists within the Cleveland Clinic Specialty Pharmacy (CCSP) regarding cost avoidance for the health care system and improvements in patient safety. METHODS: This was a retrospective, observational study that analyzed pharmacist interventions regarding specialty hematology/oncology medications. Interventions were measured with pharmacist documentation within the electronic health record (EHR). The primary endpoint was the cost-avoidance effect of clinical pharmacist interventions resulting from pharmacist access to the EHR. Secondary endpoints included pharmacist interventions that led to additional ancillary or supportive care, time taken to perform interventions, total interventions according to new or refill status, and total interventions performed according to insurance subtype. RESULTS: 547 interventions were identified during the study period, with a total cost avoidance of $1,508,131. The intervention with the highest overall cost savings was discontinuation of therapy ($290,091). The highest cost savings, based on intervention type, was lack of follow-up ($30,892). The medication with the highest overall cost savings was abiraterone ($273,160). Gilteritinib was associated with the highest cost saving per intervention ($28,350). The indication with the highest overall cost savings was prostate cancer ($402,601), while cutaneous T-cell lymphoma had the highest cost savings per intervention ($25,424). CONCLUSIONS: CCSP pharmacist interventions led to significant overall cost savings to the health care system. Although not measured in this study, it is reasonable to expect that decreased medication use may also translate into less financial burden for patients, as well as for pharmacy benefit managers. Access to the EHR and integration within the health care system may have facilitated the cost savings. DISCLOSURES: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to disclose.

Importance of Pharmacists as a Front Line Warrior in Improving Medication Compliance in Covid 19 Patients

To explore the effect of clinical pharmacist intervention on the treatment of viral pneumonia with intravenous methyl prednisolone and others. The clinical data of 112 patients from July 2020 to September 2020 were categorized into observational group (n=56) and random group (n=56) according to the randomized double blind method. The control group with routine nursing intervention and the observational group was treated with comprehensive clinical pharmacist and nursing intervention. Quality of life, recovery time and saturation levels were assessed frequently and on a weekly basis. The observational group was found to have improved oxygen saturation levels during frequent evaluation with the saturation probes when compared with control group, as well the recovery time was also improved. The quality of life in the observation group was significantly better than that in the control group. Incorporating a clinical pharmacist as an integral member of the health care team, brings numerous benefits, one among them is significant improvement in the delay drug administration to the patient. It is undeniable that a clinical pharmacist is a drug information resource for all the health professionals working in a hospital setting.

Importance of Pharmacists as a Front Line Warrior inImproving Medication Compliance in Covid 19 Patients

To explore the effect of clinical pharmacist intervention on the treatment of viral pneumonia with intravenous methyl prednisolone and others. The clinical data of 112 patients from July 2020 to September 2020 were categorized into observational group (n=56) and random group (n=56) according to the randomized double blind method. The control group with routine nursing intervention and the observational group was treated with comprehensive clinical pharmacist and nursing intervention. Quality of life, recovery time and saturation levels were assessed frequently and on a weekly basis. The observational group was found to have improved oxygen saturation levels during frequent evaluation with the saturation probes when compared with control group, as well the recovery time was also improved. The quality of life in the observation group was significantly better than that in the control group. Incorporating a clinical pharmacist as an integral member of the health care team, brings numerous benefits, one among them is significant improvement in the delay drug administration to the patient. It is undeniable that a clinical pharmacist is a drug information resource for all the health professionals working in a hospital setting.

Investigating the effect of clinical pharmacist intervention in transitions of care on drug-related hospital readmissions among the elderly: study protocol for a randomised controlled trial

IntroductionDrug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety. We...

Effect of clinical pharmacist intervention on the treatment of acute pancreatitis.

Background The participation of clinical pharmacists in the treatment of acute pancreatitis has rarely been reported. Objective The aim of this study was to retrospectively evaluate the impact of intervention of clinical pharmacists on the treatment of acute pancreatitis. Setting An academic teaching hospital in Taizhou, Jiangsu, China. Method Two hundred and twenty-eight patients with acute pancreatitis were retrospectively enrolled from July 2017 to July 2018 and divided into an intervention group (n = 119) and a control group (n = 109) according to whether a clinical pharmacist was involved. No significant differences in the baseline clinical characteristics were found between the groups. Clinical pharmacists participated in drug formulation and adjustment, pharmaceutical care, and follow-up. Main outcome measure Clinical outcomes, average hospital stays, costs, incidence of adverse drug reactions, 1-month subsequent visit rate, and patient satisfaction between the two groups were measured. Results The clinical symptoms of patients in both groups were relieved after treatment. There were no significant differences between the groups in computed tomography grades after treatment, incidence of adverse drug reactions, or average hospital stays. However, the intervention group had lower total costs of hospitalization, drugs and antibiotics but higher rates of 1-month subsequent visits and satisfaction compared with the control group. Conclusion The intervention of clinical pharmacists in the treatment of acute pancreatitis can effectively reduce costs of hospitalization, drug and antibiotics and improve follow-up compliance and patient satisfaction.

Effect of pharmaceutical intervention on rational use of alanyl-glutamine

Objective To explore the effect of clinical pharmacist intervention on the rational use of alanyl-glutamine injection. Methods Refer to the second quarter of 2015 and the second quarter of 2016 in the General Hospital of Shanxi Datong Coal Group using alanyl-glutamine injection discharge instructions for special comment, compared and analyzed the changes in the use of the drug before and after the intervention. Results Before intervention, the usage rate and the irrational rate of alanyl-glutamine injection were 4.6% and 52.9%, those were 2.9% and 10.9% after intervention.The differences were statistically significant(χ2=49.209, 169.200, all P<0.05). There were significant differences before and after intervention compared in the choice of drug suitability, the high concentration of the medicine liquid, the excessive supply of amino acid and the incompatibility of the compatibility (χ2=38.882, 31.348, 26.242, 4.286, all P<0.05). Conclusion The pharmacy intervention is feasible and effective for the rational use of alanyl-glutamine injection, and it can reduce irrational using rate. Key words: Pharmaceutical intervention; Alanyl-glutamine; Analysis

Effect of clinical pharmacist intervention on clinical rational use of antineoplastic drugs

Objective To explore the effect of clinical pharmacist on clinical rational use of antineoplastic drugs after participating in treatment group. Methods Retrospective research was used.According to whether there was a clinical pharmacist directly or indirectly involved in, all medical teams of the oncology department were divided into intervention group, advisory group and control group in our hospital.Intervention group was the medical team that had a specialist clinical pharmacist who could intervene irrational use of antineoplastic drug in the treatment on the spot.Advisory group was in the same area with the intervention group, and didn't have a specialist clinical pharmacist, but used to communicate with clinical pharmacist and take his medication advice, where clinical pharmacist indirectly involved in treatment.The control group was the medical group in the other area without clinical pharmacists of oncology department.The control group one and two were with the most beds among the control group.Randomly selected lung cancer, breast cancer, esophageal cancer, gastric cancer, colorectal cancer, gynecological cancer, liver/gallbladder/pancreatic cancer and other tumors patients from intervention group, advisory group, control group one and control group two, from January 2015 to December 2015, 10 copies of each case, 80 copies of each group.And antineoplastic drugs were commented specially.The information such as sex, age, clinical diagnosis, irrational antineoplastic drug use, adverse reaction and unexpected events and hospitalization time were recorded. Results The rate of irrational antineoplastic drug use of the intervention group (41.25%) was lower than the advisory group(80%), and was significantly lower than two control groups(147.50%, 161.25%), advisory group was also lower than two control groups, but no significant differences between the two control groups(χ2=0.193, P>0.05). Irrational chemotherapy, inappropriate usage and dosage and inappropriate indications were prominent problems in intervention group and advisory group.In addition, there were more improper solvent and contraindicated or adverse interaction problems in two control groups.Adverse events and incidence of unexpected events in intervention group (46.25%, 12.50%) were significantly lower than those in two control groups[(73.75%, 22.50%), (23.75%, 18.75%)]. Furthermore, the length of stay of intervention group patients was shortest in four groups (F=8.766, P<0.05). Conclusion By participating in the treatment group, clinical pharmacists can discover the irrational drug use and security risks in treatment, can provide medication guidance, consultation, publicity and other pharmaceutical service for specialist medical staff and patients.They will be more and more prominent in the treatment of cancer. Key words: Clinical pharmacist; Intervention; Antineoplastic drugs; Rational drug use

Effect of Clinical Pharmacist Intervention on Hemoglobin A1C Reduction in Veteran Patients With Type 2 Diabetes in a Rural Setting.

Type 2 diabetes mellitus (T2DM), if left uncontrolled, is associated with significant morbidity and mortality. Patients in rural areas may not have access to adequate resources to successfully treat diabetes. Clinical pharmacists may be utilized to bridge this gap. To evaluate the impact of a clinical pharmacist on glycemic control in veterans with T2DM enrolled in a rural, outpatient clinic. Retrospective chart review was performed on veterans with T2DM referred to the pharmacist-managed therapeutic monitoring clinic at a community-based outpatient clinic located in rural Jackson, TN. Patients served as their own controls. Patients with hemoglobin A1C (A1C) ≥8% were included. The primary outcome was A1C change from baseline in patients managed by the clinical pharmacist. Secondary end points included blood pressure, cholesterol, and weight. Of 111 veterans identified as having a A1C ≥8% in the pharmacist-managed clinic, 86 met inclusion criteria. At baseline, mean ± SD A1C was 10.5% ± 2.0% (range = 8.7%-16.2%). By the end of the intervention period, mean A1C had decreased by 2.8 percentage points to 7.7% ± 1.4% (P < 0.001). At the end of the intervention, 34% (n = 29) had a A1C of <7%, 40% (n = 34) between 7% and 7.9%, and only 6% (n = 5) >10% (P < 0.001). Improvements in diastolic blood pressure (P = 0.001), total cholesterol (P = 0.001), and triglyceride levels (P = 0.036) were also statistically significant when baseline and intervention period values were compared. Pharmacist interventions at a rural, outpatient clinic had a statistically significant impact on A1C reduction in veterans with T2DM.

Effectiveness of the clinical pharmacist in reducing mortality in hospitalized cardiac patients: a propensity score-matched analysis.

BackgroundPharmacist-led medication review services have been assessed in the meta-analyses in hospital. Of the 135 relevant articles located, 21 studies met the inclusion criteria; however, there was no statistically significant difference found between pharmacists’ interventions and usual care for mortality (odds ratio 1.50, 95% confidence interval 0.65, 3.46, P=0.34). These analyses may not have found a statistically significant effect because they did not adequately control the wide variation in the delivery of care and patient selection parameters. Additionally, the investigators did not conduct research on the cases of death specifically and did not identify all possible drug-related problems (DRPs) that could cause or contribute to mortality and then convince physicians to correct. So there will be a condition to use a more precise approach to evaluate the effect of clinical pharmacist interventions on the mortality rates of hospitalized cardiac patients.ObjectiveTo evaluate the impact of the clinical pharmacist as a direct patient-care team member on the mortality of all patients admitted to the cardiology unit.MethodsA comparative study was conducted in a cardiology unit of a university-affiliated hospital. The clinical pharmacists did not perform any intervention associated with improper use of medications during Phase I (preintervention) and consulted with the physicians to address the DRPs during Phase II (postintervention). The two phases were compared to evaluate the outcome, and propensity score (PS) matching was applied to enhance the comparability. The primary endpoint of the study was the composite of all-cause mortality during Phase I and Phase II.ResultsPharmacists were consulted by the physicians to correct any drug-related issues that they suspected may cause or contribute to a fatal outcome in the cardiology ward. A total of 1,541 interventions were suggested by the clinical pharmacist in the study group; 1,416 (92.0%) of them were accepted by the cardiology team, and violation of incompatibilities had the highest percentage of acceptance by the cardiology team. All-cause mortality was 1.5% during Phase I (preintervention) and was reduced to 0.9% during Phase II (postintervention), and the difference was statistically significant (P=0.0005). After PS matching, all-cause mortality changed from 1.7% during Phase I down to 1.0% during Phase II, and the difference was also statistically significant (P=0.0074).ConclusionDRPs that were suspected to cause or contribute to a possibly fatal outcome were determined by clinical pharmacist service in patients hospitalized in a cardiology ward. Correction of these DRPs by physicians after pharmacist’s advice caused a significant decrease in mortality as analyzed by PS matching. The significant reduction in the mortality rate in this patient population observed in this study is “hypothesis generating” for future randomized studies.

Effect of clinical pharmacist interventions on the rational use of antibiotics

Objective To study the effect of clinical pharmacist interventions on the rational use of antibiotics. Methods 1 000 hospitalized patients before the implementation of intervention in April 2012 to April 2013(control group)and the other 1 000 cases of hospitalized patients in May 2013 to May 2014 after the implementation of the intervention(study group)were selected, the antibiotics use rate, hospitalization time and cost, cost of using antibacterial drugs were compared between the two groups. Results The antibiotics use rate of the study group was 56.0%(560/1 000), significantly lower than 78%(780/1 000)of the control group, with significant differences between the two groups(χ2=11.089,P=0.032), the hospitalization time, cost of using antibacterial drugs of the study group were(12.6±0.8)days,(912.2±13.2)yuan, significantly better than(16.9±0.7)days,(1 528.1±32.5)yuan of the control group, with significant differences between the two groups(t =9.892,10.142,P=0.028,0.014); The two groups of hospitalization expenses showed no statistical significance(t=4.984,P=0.072). Conclusion Clinical pharmacist intervention has a positive effect on the application of antibacterial drugs, which can significantly reduce the use of antimicrobial drugs and reduce the hospitalization days. Key words: Clinical pharmacist; Intervention; Antibacterial drugs

Impact of Clinical Pharmacist Intervention on Medication Adherence and Disease related Knowledge among Patients with Low Health Literacy in Puerto Rico

Introduction: Patients living in central rural towns in Puerto Rico comprise one of the most critical at-risk populations of limited health literacy due to the higher incidence of poverty and lower educational levels within this sector. The objective of this study was to assess the effect of clinical pharmacist intervention on medication adherence and disease knowledge among patients with low health literacy from the municipalities of Adjuntas and Lares in Puerto Rico. Methods: This study used a prospective analysis of patients referred for a pharmacist educational intervention in two rural outpatient clinics of Puerto Rico. Thirteen patients with inadequate glycemic control (A1C ≥ 9%), uncontrolled hypertension (≥ 150/90) or medication non-adherence (PDC < 0.80) were referred to the study by a primary care physician. Initial health literacy was measured by the Spanish Short Test of Functional Health Literacy in Adults (S-TOFHLA). The primary outcome of the study was average change of medication adherence assessed by calculating the proportion days covered (PDC) at baseline and at the end of the study period. The secondary outcome of the study was average change in patient’s disease-related knowledge using the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument measured at baseline and at the end of the study period. The average change on hemoglobin A1C and blood pressure was also calculated between baseline and post-intervention evaluation. Results: The study showed a significant improvement in disease-related knowledge and modest improvements in disease clinical markers and medication adherence. Adherence improved from an average PDC of 0.59 to a PDC of 0.64. Disease related knowledge improved from an average 58% to an 83% in questionnaire scores. Conclusion: Due to small patient recruitment and the lack of statistically significant data in this study, further research with a larger patient population is required to accurately identify the potential benefits of these interventions.

Impact of Clinical Pharmacist Interventions on 30-Day Readmission Rate in Hospitalized Patients With Acute Myocardial Infarction.

Background: Limited literature exists on the positive impact of pharmacists specifically on hospital readmission of patients with acute myocardial infarction (AMI). Objective: To evaluate the overall effect of clinical pharmacist interventions on preventing hospital readmissions and improving the health of patients with AMI. Secondary objectives include identifying trends in the demographic characteristics of AMI patients, identifying potential barriers to adherence, and assessing the average time spent by a pharmacist counseling AMI patients. Methods: This prospective, nonrandomized, single-center study was approved by the institutional review board. The hospital's 30-day AMI readmission rate prior to study initiation was used as the control group. An AMI report was generated daily to identify patients admitted to the hospital diagnosed with either non-ST or ST segment elevation myocardial infarction. The clinical pharmacist then counseled the included patient prior to discharge and provided a follow-up phone call 48 hours after discharge. The primary outcome was the all-cause 30-day readmission rate for AMI patients. Results: Out of 71 patients screened, 50 patients were included in the study. Only 3 of the 50 patients included were readmitted (6.0%). The prestudy rate from October 2012 to October 2013 was 11.6%, or 58 readmissions out of 498 AMI admissions. Although the study group was much smaller in size, a 6% readmission rate is encouraging and offers potential for a future intervention. Conclusion: Clinical pharmacist services for AMI patients, including counseling, interventions, and a follow-up phone call after discharge, may benefit decreasing the 30-day AMI readmission rate; however, further studies are needed.

Effect of clinical pharmacist intervention on medication discrepancies following hospital discharge

Medication discrepancies may occur at transitions in care and negatively impact patient outcomes. To determine if involving clinical pharmacists in hospital care, medication reconciliation and discharge medication plan communication can reduce medication discrepancies with a prospective, randomized, blinded, controlled trial. A large, tertiary care, academic medical center. The intervention consisted of clinical pharmacist medication reconciliation, patient education and improved communication of the discharge medication plan, as devised by the hospital physician and care team, to primary care physicians and community pharmacists. Medication discrepancies were identified by blinded research pharmacists who reviewed primary care physician and pharmacy records at discharge through 90 days post-discharge to create 30- and 90-day medication lists. Rate of medication discrepancies compared across groups. A total of 592 subjects from internal medicine, family medicine, cardiology and orthopedic services were evaluated for this study. Clinically important medication discrepancies in the primary care physician record were different between groups 30 days after hospital discharge following a clinical pharmacist's intervention. The mean number of medication discrepancies per patient for the enhanced group being nearly half the number in the control group. However, this effect did not persist to 90 days post-discharge and did not extend to community pharmacy records. The present study demonstrates the involvement of pharmacists in hospital care, medication reconciliation and discharge medication plan communication may affect the quality of the outpatient medical record.

Effect of Clinical Pharmacist Interventions on Prevention of Adverse Drug Events in Surgical Intensive Care Unit

Background: A pharmacist’s participation in medical rounds in intensive care unit (ICU) is becoming popular nowadays. In this study, we investigated the effect of pharmacologic intervention by a pharmacist’s participation in medical round in ICU on prevention of adverse drug events (ADEs). Methods: From March 2011 to July 2011, the intervention data were obtained by participating in medical round two or three times a week, and by reviewing electronic medical records of patients admitted to surgical ICU. The incidence, cause, and type of ADEs were noted, respectively. Expected cost avoidance was calculated from interventions, which were considered to be preventive of ADEs. The acceptance rate of pharmacologic interventions was noted. Results: Among 2781 patients, a total of 159 intervention data were collected in 90 patients. Recommendation for drug dosage adjustment or monitoring in patients with potential overdose and sub-therapeutic dose made up 82% of the total interventions. In 8% of interventions, initiation of drug therapy was recommended. 83% of the interventions were accepted and the acceptance rate of interventions within 24 hrs was 58%. The rate of the interventions, which were considered to be preventive of ADEs was 62%. Expected cost reduction obtained by preventing ADEs was 25,867,083₩ during a 5-month period. Conclusions: A pharmacist’s participation in physician rounds in ICU was associated with prevention of ADEs and subsequent reduction of the cost in drug therapy.

PCN134 Effects of Clinical Pharmacist Interventions on Clinical Outcomes in Oncology Patients

To assess the effect of clinical pharmacist interventions on the clinical outcomes in oncology patients. A total of 100 patients received their chemotherapy cycles with clinical pharmacy interventions were enrolled in the present study during January 2007 to January 2008. Clinical pharmacy interventions include: Detecting medication errors by using a modified form of the American Society of Hospital Pharmacists (ASHP) worksheet. Correcting those errors and sending recommendations to the medical staff. The clinical pharmacy interventions reduced the number of medication errors from 1548 to 444 which was statistically significant (p=0.004). A total of 1104 clinical pharmacy interventions were documented in this present study. Forty-five percent of clinical pharmacy interventions have led to increase in the efficacy of chemotherapy regimen and 54.7% have led to decrease in the chemotherapy toxicity. Seventy six percent of the errors recorded in the present study occurred in the prescribing stage, about 20 % in the administration stage and 3.8% in the dispensing stage. The clinical pharmacy interventions among oncology patients can reduce the number of medication errors; improve the clinical outcomes through increasing chemotherapy efficacy and reducing the toxicity.

Pharmacist interventions to improve prescribing of vancomycin and tobramycin

The effect of clinical pharmacist interventions that promoted the use of nafcillin rather than vancomycin and of gentamicin rather than tobramycin, when appropriate, was evaluated. Physician information sheets and criteria describing appropriate use of the target drugs vancomycin and tobramycin were developed by a clinical pharmacist and infectious disease physicians. When drugs were prescribed for indications that did not meet the established criteria, the clinical pharmacist either contacted the prescribing physician or left the sheet in the patient's chart if the physician was not available. The average use of the target drugs and their alternatives was evaluated monthly during two six-month study periods and compared with the average use of these drugs during a three-month period before the target-drug programs were initiated. Throughout the 12-month study, on a per-patient basis, nafcillin use increased 31% while vancomycin use decreased 27% compared with the reference period; gentamicin use increased 21% while tobramycin use decreased 12% during the same period. These changes in use resulted in a net decrease in drug expenditures of $161,396. Approximately 0.5 full-time equivalent was spent on the program, and the return on investment for the service was greater than 10 to 1. Clinical pharmacist interventions through target-drug programs were effective in improving the appropriateness of vancomycin and tobramycin prescribing based on literature-derived criteria. The effects achieved by these interventions may decrease with time, and ongoing drug-use monitoring and physician education are necessary.