Please select the eligibility criteria that correspond to the clinical trial below.
Title: Adherence and Intensification of Medications: A Population-Based Clinical Pharmacists Implementation Study Among Hypertensive Diabetes Patients
Brief Summary: Background: Good blood pressure (BP) control among patients with diabetes is essential in preventing diabetes complications and has been found to be not only cost-effective but cost-saving. Nonetheless, over 25% of VA patients with diabetes do not have adequate BP control. Among these poorly controlled patients, over 65% have problems with medication adherence or inadequate intensification of medications. We therefore propose a partnership with the VA Pharmacy Benefits Management (PBM) Office and VISN 11 to evaluate a tailored clinical pharmacist-based intervention to improve medication management, adherence and BP control.

Objectives: The specific objectives of this implementation study are: 1) To evaluate the effects of the intervention on blood pressure (primary outcome) and glycemic and lipid control (secondary outcomes); 2) To assess the impact of the intervention on patients' adherence to blood pressure, anti-hyperglycemic, and lipid-lowering regimens, and intensity of these regimens; 3) To evaluate the cost-effectiveness of the intervention compared to usual care; 4) To evaluate the level of attainment of intervention implementation, examine the process of intervention implementation, and determine the potential for sustainability.


Options:
A: Inclusion Criteria:

* Age: 60 years and older
* Chronic heart failure (CHF)
* Stable CHF medication including a diuretic
* Hospitalization for decompensated heart failure within past 12 months OR a value of ≥ 350 pg/mL for BNP or ≥ 1,400 pg/mL for NT-proBNP
* Written informed consent

Exclusion Criteria:

* Use of a weekly dosing aid
* Unwillingness or inability to visit a participating pharmacy once a week
* Planned cardiac surgery
* Life-expectancy \< 6 months
* Unwillingness or inability to comply with the study protocol (including drug abuse or alcohol dependency)
* Participation in other studies (currently or in the last 4 weeks)
B: Inclusion Criteria:

* Patients aged≥70 years with a long-term illness scheme or hospital admission the past 3 months
* Visiting their preferred general practioner (GP) or another GP in the same practice
* patient oral non opposition

Exclusion Criteria:

* Patient who does not speak French
* Severe disease with a life expectancy \<12 months
* Institutionalized patients
* Patient insured under the French national health insurance system
C: Inclusion Criteria:

VA inclusion criteria

1. Must be a veteran at a study site;
2. Have a diagnosis of diabetes;
3. Meet blood pressure, medication adherence and intensification requirements (as determined by the study team)

Exclusion Criteria:

VA Exclusion

1. Dementia
2. Traumatic brain injury
3. Pregnancy
4. Age \<18 or \>100
D: Inclusion Criteria:

* Primary care provider is participating in trial
* Are an adult (≥ 18 years) with type 2 diabetes
* English speaking
* Recognize their primary care provider as their main diabetes care provider
* Declare being available for follow-up for six months after treatment decision

Exclusion Criteria:

- Have major barriers to provide written informed consent and to participate in shared decision making (i.e., severe vision or hearing impairment, cognitive impairment, non-English speaking)

Additional Inclusion Criteria for Diabetes Medication:

* Have a clinical diagnosis of type 2 diabetes for one year or more (c-peptide test is not required)
* Use 0, 1, or 2 oral hypoglycemic agents at maximum doses
* Have stable but inadequate glycemic control or worsening glycemic control as identified by their most recent HbA1c measure (within 12 months of the time of eligibility over 7.3%
* Be identified by provider as a medically-appropriate candidate for diabetes medications, (i.e., have not contraindications to taking the medications, e.g., allergy).

Additional Exclusion Criteria for Diabetes Medication:

- Use insulin therapy.

Additional Inclusion Criteria for Cardiovascular Medication:

* Have a clinical diagnosis of type 2 diabetes for any duration (c-peptide test is not required).
* Be identified by provider as a medically-appropriate candidate for statins, (i.e., have not contraindications to taking the medications, e.g., allergy).

Additional Exclusion Criteria for Cardiovascular Medication:

- Use a statin currently.

Answer: C