Study to Identify Traumatic Brain Injury Therapies
Rush University Medical Center (RUMC) in Illinois and 10 other health care facilities in the United States and Canada have been awarded a $4.3 million grant from the National Institutes of Health to identify which rehabilitation therapies, or combination of therapies, can best help victims of traumatic brain injuries.
“Our aim in this study is to isolate individual components of the range of therapies we use to treat our patients and determine how, and to what degree, each is associated with improved function,” James Young, MD, chairman of the department of physical medicine and rehabilitation at RUMC, said in a news release.
The 5-year study will collect the records of more than 2,300 patients who have suffered moderate to severe traumatic brain injuries, including detailed demographic, diagnostic and clinical profiles of each patient. Daily logs will be kept of the individually tailored treatment programs the patients undergo in physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry and social support. Outcomes will be catalogued and correlated with both the patients’ characteristics and therapeutic interventions.
The researchers will then analyze the data to determine which therapies were the most successful in improving outcomes for patients with different types and severities of traumatic brain injuries.
Patients will also be followed for a full year after being discharged to assess their quality of life, including whether they were able to live independently, drive a vehicle and participate in daily activities.
The analysis will involve an unusual research methodology called practice-based evidence for clinical practice improvement, which relies on data from routine clinical practice to determine what works for whom, when and at what cost.
Symptoms of a traumatic brain injury can be mild, moderate or severe, and vary depending on the extent and location of the brain damage. For patients with moderate or severe injuries, symptoms range from headaches and lethargy to convulsions, loss of coordination, confusion, cognitive deficits and behavior and mood changes.
Research to date has done little to help identify the best treatments for the range of symptoms. Randomized clinical trials of rehabilitation therapies, for example, typically evaluate only specific treatments for a select group of patients. Results are not general enough to apply to the whole population of traumatic brain injury patients.
By isolating individual components of therapy as applied to patients with different degrees of traumatic brain injuries, the researchers expect to be able to prescribe best practices for rehabilitation, raising the standard of treatment in facilities all across the country.
Clinical Pharmacists Can Reduce Drug Costs
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Clinical pharmacy services can significantly reduce the cost of prescription drugs and save money elsewhere in the health care system, according to a new study by researchers at the University of Illinois at Chicago.
For every dollar spent by hospitals or health systems to provide clinical pharmacy services, $4.81 was saved through lower drug costs, reductions in adverse drug events and medication errors and other savings, Glen Schumock, senior researcher on the study and associate professor and director of UIC’s Center for Pharmacoeconomic Research said.
Schumock and his colleagues evaluated 93 studies published between 2001 and 2005 to uncover the impact of clinical pharmacy services, defined as services that involve direct patient care by a clinical pharmacist. Unlike traditional pharmacy services, in which a pharmacist dispenses medications, clinical pharmacists make recommendations to physicians regarding drug therapy or sometimes even help write the prescription.
Clinical pharmacy services in the studies examined were provided in hospitals, community pharmacies, nursing homes and other facilities. Such services have been available since the late 1970s but have only recently become common, Schumock said.
“The expansion of clinical pharmacy services is one potential mechanism that could be more greatly employed to curb the problem of prescription drug spending,” he said.
Prescriptions in the United States cost $287 billion in 2007 and the rising cost of drugs is often cited as a problem in the country’s health care system. Health care accounted for 16% of the U.S. gross domestic product in 2006, costing $2.1 trillion, according to the Centers for Medicare and Medicaid Services.
