Please select the eligibility criteria that correspond to the clinical trial below.
Title: Pharmacist-initiated Intervention Trial in OsteoArthritis (PhIT-OA)
Brief Summary: Osteoarthritis (OA) is a major public health concern. Currently, there are at least 3 million Canadians afflicted with this condition with a 50% increase predicted by 2020. It is estimated that 85% of Canadians are afflicted with OA by age 70. As such, using the current health care structure, it is doubtful that the health system can keep pace with this increasing demand. Alternative health care delivery strategies must be investigated.

The purpose of this study is to assess if a pharmacist-initiated intervention for individuals with knee pain with a high likelihood of knee OA will lead to an improvement in the quality of care for these individuals.

We are hopeful that results of this study will show better management of knee osteoarthritis by a pharmacist-initiated intervention (which means that it is the pharmacist who will start the process for an intervention that includes exercise and an educational program when compared to no intervention. If this is the case, by implementing the proposed intervention program, subjects could be diagnosed earlier, the burden of illness on individuals could be diminished through an appropriate intervention program, and economic savings could be embraced.

Hypothesis: Community pharmacists can identify patients with likely knee OA and initiate a multidisciplinary intervention that will improve quality of care and outcomes.


Options:
A: Inclusion Criteria:

* Patients who have given their informed consent and expressed interest in participating in the study
* Asthmatic Patients

Exclusion Criteria:

* Patients with communication difficulties.
* Persons who obtain symbicort but not for their own use.
* Patients with other major diseases: Heart problems, COPD, EMPHYSEMA, lung cancer, AIDS.
* Patients with a respiratory infection.
* Patients with seasonal asthma.
* Pregnant women
* Patients who have previously participated in a health education study in asthma.
B: Inclusion Criteria:

1. Age \>50 years
2. ≥ 4 weeks of pain, aching or discomfort in or around the knee
3. Overweight or obese defined as BMI defined as ≥ 27 kg/m2
4. Not actively participating in a formal exercise program within the past 6 months
5. Self-reported difficulty in at least one of the following activities attributed to knee pain: lifting and carrying groceries, walking one quarter of a mile, getting in and out of a chair, or going up and down stairs.
6. Meet eligibility using the criteria on the pharmacist screening form (see attachment) - This form was adapted from the PhIND-OA study and amended to include points #3 to 6 above.

Exclusion Criteria:

1. Significant co-morbid disease that would pose a safety threat or impair ability to participate in an exercise program
2. Inability or unwillingness to modify dietary or exercise behaviours.
3. Knee X-Ray within the last 2 years
4. Inability to speak and write English
5. Knee pain due only to referred pain from osteoarthritis of the hip
C: Inclusion Criteria:

1. English or Spanish speaking males or females, over 18 years of age with a diagnosis of hypertension,
2. have uncontrolled BP defined as \> 140 mm Hg SBP or \> 90 mm Hg DBP for patients with uncomplicated hypertension; or \> 130 mm Hg SBP or \> 80 mm Hg DBP for patients with diabetes or chronic kidney disease, and
3. receive care from one of the participating clinics.

Exclusion Criteria:

1. current signs of hypertensive emergency (acute angina, stroke, or renal failure;
2. severe HTN (systolic BP \>200 or diastolic BP \> 114 mm Hg);
3. history of MI, stroke, or unstable angina in the prior 6 months;
4. systolic dysfunction with a LV ejection fraction \< 35% documented by echocardiography, nuclear medicine study, or ventriculography;
5. renal insufficiency, defined by a glomerular filtration rate less than 20 ml/min or previously documented proteinuria \> 1 gram per day;
6. significant hepatic disease, including prior diagnoses of cirrhosis, Hepatitis B or C infection, or laboratory abnormalities (serum ALT or AST \> 2 times control or total bilirubin \> 1.5 mg/dl) in the prior 6 months;
7. pregnancy;
8. diagnoses of pulmonary hypertension or sleep apnea (unless treated by continuous positive pressure ventilation);
9. poor prognosis with a life expectancy estimated less than 2 years;
10. residence in a nursing home or diagnosis of dementia; and
11. inability to give informed consent or impaired cognitive function (defined as \> 3 errors on the 10-item Pfeiffer Portable Mental Status Questionnaire, administered during study intake).
D: INCLUSION CRITERIA

Section A: Demographic Criteria

1. Patient was seen in your clinic or practice at least once in the past 24 months
2. English-speaking male or female
3. Age is 50 or older at medical record screening

   Section B: Risk Factors - Must have at least one of the following conditions
4. Uncontrolled diabetes (Hemoglobin A1c \> or + 7.5)
5. Elevated LDL cholesterol \> 110 for patients with PAD, CAD, stroke or diabetes or \> 140 otherwise
6. Elevated blood pressure with:

   * Systolic BP \>= 140 or Diastolic BP \>=90 in persons with diabetes or chronic kidney disease OR
   * Systolic BP \>= 150 in persons with uncomplicated hypertension

   Section C: Cardiovascular Conditions - total number of risk factors in Section B (above) plus number of conditions Section C (below) must be THREE OR MORE
7. History of coronary artery disease
8. Previous Heart Attack
9. History of Stroke
10. History of Transient Ischemic Attack
11. History of Atrial fibrillation
12. History of Peripheral Vascular Disease / claudication
13. History of carotid artery disease
14. Current smoker
15. Obesity with BMI \> 30

    EXCLUSION CRITERIA

    Section D: Exclusion Criteria - has NONE of the following:
16. Inability to give informed consent
17. Pregnant
18. Diagnosis of pulmonary hypertension (Note: secondary pulmonary hypertension is OK)
19. Cancer diagnosis with a life expectancy estimated less than 2 years
20. Residence in a nursing home or diagnosis of dementia
21. No telephone or a hearing impairment not allowing them to use a phone
22. Refusal to consider attempting to use the internet at home, community center, library, medical office or other source to access the PHRM
23. Patient has plans to move from the area or transfer care to a different clinic in the next 12 months
24. Omron blood pressure cuff cannot be used on patient's arm for any reason

Answer: B