Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102159
Background
Literature on pregabalin use in patients with heart failure is largely limited to patient case reports and cohort studies.
Objective
This study aimed to evaluate the effect of pregabalin initiation on diuretic requirements in patients with heart failure.
Methods
A retrospective analysis of patients with heart failure who were started on pregabalin between January 1, 2014, and September 1, 2021, at the Veterans Affairs North Texas Health Care System was used. The primary objective was to determine the median change in loop diuretic dose, in furosemide dose equivalents, 6 months after pregabalin initiation.
Results
Of 58 patients analyzed, there was no statistically significant difference in the primary outcome (P = 0.162). The secondary outcomes were found to be nonstatistically significant, and there was no correlation between pregabalin dose and outcomes.
Conclusion
This represents the largest analysis of diuretic dose requirements in patients with heart failure after initiation of pregabalin. Although there was no difference in the median change of diuretic dose prescribed, pregabalin should still be used with caution.
{"title":"Reprint of: Effect of pregabalin initiation on diuretic requirements in patients with chronic heart failure","authors":"","doi":"10.1016/j.japh.2024.102159","DOIUrl":"10.1016/j.japh.2024.102159","url":null,"abstract":"<div><h3>Background</h3><div>Literature on pregabalin use in patients with heart failure is largely limited to patient case reports and cohort studies.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the effect of pregabalin initiation on diuretic requirements in patients with heart failure.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients with heart failure who were started on pregabalin between January 1, 2014, and September 1, 2021, at the Veterans Affairs North Texas Health Care System was used. The primary objective was to determine the median change in loop diuretic dose, in furosemide dose equivalents, 6 months after pregabalin initiation.</div></div><div><h3>Results</h3><div>Of 58 patients analyzed, there was no statistically significant difference in the primary outcome (<em>P</em> = 0.162). The secondary outcomes were found to be nonstatistically significant, and there was no correlation between pregabalin dose and outcomes.</div></div><div><h3>Conclusion</h3><div>This represents the largest analysis of diuretic dose requirements in patients with heart failure after initiation of pregabalin. Although there was no difference in the median change of diuretic dose prescribed, pregabalin should still be used with caution.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102128
Objectives
Atrial fibrillation (AF) is associated with increased risk of stroke that can be attenuated with newer anticoagulants, called direct oral anticoagulants (DOACs). Before the emergence of DOACs, warfarin or aspirin (ASA) was used for stroke prevention. Owing to the increased risk of bleed with concomitant anticoagulation therapy, populations that may benefit from ASA therapy are becoming limited. The primary objective of this study was to evaluate ASA utilization in an outpatient setting for patients with AF at high risk of stroke receiving a DOAC. The secondary objective was to evaluate what characteristics influence ASA use using a multivariate logistical regression model.
Design
This was a retrospective study conducted through electronic health record extraction between June 1, 2021, and May 31, 2022.
Setting and participants
Study sites included 219 outpatient Banner Health Facilities. A total of 5716 patients were included in the study.
Outcome measures
Patient characteristics and demographics, including CHA2DS2-VASc and HAS-BLED scores, were evaluated in adults 18 years and older with AF and an active DOAC prescription.
Results
There were 955 patients (16.7%) on ASA and 4761 patients (83.3%) not on ASA. Of the 955 patients on ASA, 33% (n = 315) did not have vascular disease. A total of 2289 patients had at least one vascular disease diagnosis. Of these patients, 28% (n = 640) were on ASA and 72% (n = 1649) were not on ASA. There were 142 patients with vascular disease who experienced a bleeding event with 36% of patients (n = 51) on ASA. Patients on ASA had a higher average CHA2DS2-VASc score (4.02 vs. 3.74) and HAS-BLED score (3.10 vs. 2.35) than patients not on ASA, respectively.
Conclusion
This study found approximately one-third of patients with documented ASA use had no documentation of vascular disease and an unclear pattern of use in patients with documented vascular disease, suggesting opportunities to de-escalate ASA in patients with AF on a DOAC.
{"title":"Opportunities for de-escalation of aspirin therapy in patients with atrial fibrillation at high stroke risk receiving direct oral anticoagulants","authors":"","doi":"10.1016/j.japh.2024.102128","DOIUrl":"10.1016/j.japh.2024.102128","url":null,"abstract":"<div><h3>Objectives</h3><div>Atrial fibrillation (AF) is associated with increased risk of stroke that can be attenuated with newer anticoagulants, called direct oral anticoagulants (DOACs). Before the emergence of DOACs, warfarin or aspirin (ASA) was used for stroke prevention. Owing to the increased risk of bleed with concomitant anticoagulation therapy, populations that may benefit from ASA therapy are becoming limited. The primary objective of this study was to evaluate ASA utilization in an outpatient setting for patients with AF at high risk of stroke receiving a DOAC. The secondary objective was to evaluate what characteristics influence ASA use using a multivariate logistical regression model.</div></div><div><h3>Design</h3><div>This was a retrospective study conducted through electronic health record extraction between June 1, 2021, and May 31, 2022.</div></div><div><h3>Setting and participants</h3><div>Study sites included 219 outpatient Banner Health Facilities. A total of 5716 patients were included in the study.</div></div><div><h3>Outcome measures</h3><div>Patient characteristics and demographics, including CHA<sub>2</sub>DS<sub>2</sub>-VASc and HAS-BLED scores, were evaluated in adults 18 years and older with AF and an active DOAC prescription.</div></div><div><h3>Results</h3><div>There were 955 patients (16.7%) on ASA and 4761 patients (83.3%) not on ASA. Of the 955 patients on ASA, 33% (n = 315) did not have vascular disease. A total of 2289 patients had at least one vascular disease diagnosis. Of these patients, 28% (n = 640) were on ASA and 72% (n = 1649) were not on ASA. There were 142 patients with vascular disease who experienced a bleeding event with 36% of patients (n = 51) on ASA. Patients on ASA had a higher average CHA<sub>2</sub>DS<sub>2</sub>-VASc score (4.02 vs. 3.74) and HAS-BLED score (3.10 vs. 2.35) than patients not on ASA, respectively.</div></div><div><h3>Conclusion</h3><div>This study found approximately one-third of patients with documented ASA use had no documentation of vascular disease and an unclear pattern of use in patients with documented vascular disease, suggesting opportunities to de-escalate ASA in patients with AF on a DOAC.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141143909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102126
{"title":"APhA 2024 Annual Meeting & Exposition Contributed Papers Program Abstracts","authors":"","doi":"10.1016/j.japh.2024.102126","DOIUrl":"10.1016/j.japh.2024.102126","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102157
Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management require frequent dose titration, patient education, and insurance coverage navigation, which pharmacists are well equipped to manage. Data are lacking regarding the benefit of a pharmacist-managed service using GLP-1 RAs for weight loss in a high-risk cardiac population.
Objective
This study aimed to evaluate the impact of a pharmacist-led weight loss service within a cardiology clinic using GLP-1 RAs and lifestyle counseling in patients with overweight and obesity.
Practice description
An outpatient cardiology clinic employs clinical pharmacists who use collaborative practice agreements to provide cardiovascular risk reduction services that did not include weight management at baseline.
Practice innovation
This is the first description of a pharmacist-led weight management clinic using solely GLP-1 RAs in a cardiology practice. Patients were referred to the clinical pharmacist, who initiated and titrated GLP-1 RA and provided lifestyle counseling.
Evaluation methods
This was a single-center, prospective, pre-post analysis of adults with a body mass index of at least 30 kg/m2 or 27 kg/m2 with a weight-related comorbidity, with a preceding failed dietary effort and insurance coverage for semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk) and managed by a pharmacist. The primary outcome was patients achieving ≥ 5% weight loss at 6 months, assessed via descriptive statistics.
Results
Between March 2022 and March 2023, 204 patients were referred by their cardiologist, and 59 patients started treatment with semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk). A total of 31 patients completed 6 months of treatment at time of study completion, and all achieved ≥ 5% weight loss at 6 months, with a mean weight loss of 12.6%. Glycated hemoglobin improved by 0.6%, low-density lipoprotein by 18 mg/dL, triglycerides by 29 mg/dL, systolic blood pressure by 9 mm Hg, and diastolic blood pressure by 2 mm Hg.
Conclusion
Pharmacist-led management of GLP-1 RA in patients with obesity or overweight led to clinically meaningful weight loss and improvements in weight-related comorbidities.
{"title":"Reprint of: Impact of a pharmacist-led weight management service in a cardiology clinic","authors":"","doi":"10.1016/j.japh.2024.102157","DOIUrl":"10.1016/j.japh.2024.102157","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management require frequent dose titration, patient education, and insurance coverage navigation, which pharmacists are well equipped to manage. Data are lacking regarding the benefit of a pharmacist-managed service using GLP-1 RAs for weight loss in a high-risk cardiac population.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of a pharmacist-led weight loss service within a cardiology clinic using GLP-1 RAs and lifestyle counseling in patients with overweight and obesity.</div></div><div><h3>Practice description</h3><div>An outpatient cardiology clinic employs clinical pharmacists who use collaborative practice agreements to provide cardiovascular risk reduction services that did not include weight management at baseline.</div></div><div><h3>Practice innovation</h3><div>This is the first description of a pharmacist-led weight management clinic using solely GLP-1 RAs in a cardiology practice. Patients were referred to the clinical pharmacist, who initiated and titrated GLP-1 RA and provided lifestyle counseling.</div></div><div><h3>Evaluation methods</h3><div>This was a single-center, prospective, pre-post analysis of adults with a body mass index of at least 30 kg/m<sup>2</sup> or 27 kg/m<sup>2</sup> with a weight-related comorbidity, with a preceding failed dietary effort and insurance coverage for semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk) and managed by a pharmacist. The primary outcome was patients achieving ≥ 5% weight loss at 6 months, assessed via descriptive statistics.</div></div><div><h3>Results</h3><div>Between March 2022 and March 2023, 204 patients were referred by their cardiologist, and 59 patients started treatment with semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk). A total of 31 patients completed 6 months of treatment at time of study completion, and all achieved ≥ 5% weight loss at 6 months, with a mean weight loss of 12.6%. Glycated hemoglobin improved by 0.6%, low-density lipoprotein by 18 mg/dL, triglycerides by 29 mg/dL, systolic blood pressure by 9 mm Hg, and diastolic blood pressure by 2 mm Hg.</div></div><div><h3>Conclusion</h3><div>Pharmacist-led management of GLP-1 RA in patients with obesity or overweight led to clinically meaningful weight loss and improvements in weight-related comorbidities.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102163
Objective(s)
Heart failure (HF) is chronic and progressive. Individuals with a left ventricular ejection fraction (LVEF or EF) < 40% are classified as having heart failure with reduced ejection fraction (HFrEF). Black patients have the highest incidence of HF and are more likely to suffer serious consequences from the disease. Identifying and addressing racial disparities in care is vital to ensuring health equity. The primary objective was to determine the association of race with 1-year heart HF admission rates for white and black patients, when adjusted for EF and age. The secondary objective was to determine the proportion of patients not on guideline-directed medication therapy (GDMT).
Design
This study was a retrospective chart review conducted between 10/22/2021 and 11/22/2022 of Veteran patients with HFrEF who were identified via the VA Heart Failure Dashboard. Only White and Black patients were included. A multivariable logistic regression was used to determine odds of admission due to HF. Pharmacotherapy was analyzed to identify gaps in GDMT and if racial disparities existed.
Setting and participants
Veterans within the Veterans Affairs Western New York Healthcare System.
Outcome measures
One-year HF admission rates for white and black patients, when adjusted for EF and age. Proportion of patients not on GDMT.
Results
Of the 345 patients with HF originally identified, 172 were included; 22% were admitted within one year. Black patients were 2.9 times more likely to be admitted. (P = 0.031). A median of two drugs (interquartile range [IQR] 1-3) could be added and one dose could be optimized (IQR 1-4) to reach GDMT goals. No differences were found in the prescribing of GDMT or in proportion of patients not on GDMT at recommended doses between white and black patients.
Conclusion
Black patients were more likely to be admitted for HF than white patients. Pharmacists can play an important role in identifying the need for optimizing GDMT. Future studies could focus on pharmacist-led prospective interventions with an aim to close the gap in racial disparities.
{"title":"Identifying racial disparities in the management of heart failure with reduced ejection fraction","authors":"","doi":"10.1016/j.japh.2024.102163","DOIUrl":"10.1016/j.japh.2024.102163","url":null,"abstract":"<div><h3>Objective(s)</h3><div>Heart failure (HF) is chronic and progressive. Individuals with a left ventricular ejection fraction (LVEF or EF) < 40% are classified as having heart failure with reduced ejection fraction (HFrEF). Black patients have the highest incidence of HF and are more likely to suffer serious consequences from the disease. Identifying and addressing racial disparities in care is vital to ensuring health equity. The primary objective was to determine the association of race with 1-year heart HF admission rates for white and black patients, when adjusted for EF and age. The secondary objective was to determine the proportion of patients not on guideline-directed medication therapy (GDMT).</div></div><div><h3>Design</h3><div>This study was a retrospective chart review conducted between 10/22/2021 and 11/22/2022 of Veteran patients with HFrEF who were identified via the VA Heart Failure Dashboard. Only White and Black patients were included. A multivariable logistic regression was used to determine odds of admission due to HF. Pharmacotherapy was analyzed to identify gaps in GDMT and if racial disparities existed.</div></div><div><h3>Setting and participants</h3><div>Veterans within the Veterans Affairs Western New York Healthcare System.</div></div><div><h3>Outcome measures</h3><div>One-year HF admission rates for white and black patients, when adjusted for EF and age. Proportion of patients not on GDMT.</div></div><div><h3>Results</h3><div>Of the 345 patients with HF originally identified, 172 were included; 22% were admitted within one year. Black patients were 2.9 times more likely to be admitted. (<em>P</em> = 0.031). A median of two drugs (interquartile range [IQR] 1-3) could be added and one dose could be optimized (IQR 1-4) to reach GDMT goals. No differences were found in the prescribing of GDMT or in proportion of patients not on GDMT at recommended doses between white and black patients.</div></div><div><h3>Conclusion</h3><div>Black patients were more likely to be admitted for HF than white patients. Pharmacists can play an important role in identifying the need for optimizing GDMT. Future studies could focus on pharmacist-led prospective interventions with an aim to close the gap in racial disparities.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102153
Background
Pre-exposure prophylaxis (PrEP) medication is the keystone of preventative measures to curtail the spread of human immunodeficiency virus (HIV). However, oral PrEP, the tablet intended to prevent HIV, has been slow to proliferate among men who have sex with men (MSM). This is of major concern given that MSM account for the largest number of new HIV diagnoses in the United States. More recently, the newest generation of PrEP in the form of a long-acting injectable (LAI) is to be administered every 2 months as an intramuscular injection and many MSM indicate preferring LAI-PrEP to the oral form of PrEP. However, uptake of PrEP, in all forms, remains low. Research is sparse that focuses on LAI-PrEP uptake among black and Latinx MSM (BLMSM).
Objective
This study aimed to address this concern; this study explored the willingness to uptake LAI-PrEP and recommendations for increasing awareness and encouraging uptake of LAI-PrEP among BLMSM.
Methods
Qualitative data were collected between February 2022 and December 2022 through focus groups via Zoom with BLMSM (N = 30, black = 14, Latinx = 16) aged 18 to 29 years (mean = 23, SD = 3) in Los Angeles County.
Results
Findings revealed that although 90% of BLMSM were aware of PrEP in oral form, only 10% were aware of LAI-PrEP. Findings from the qualitative analysis suggested to consider self-administration of LAI-PrEP, allow local community pharmacists to assess and administer it, and promote uptake of LAI-PrEP using high-profile male content creators and stars on OnlyFans social media platform.
Conclusion
Increasing PrEP uptake, in all forms available, such as promoting awareness through popular social media stars, and engaging community pharmacists in feasible ways, is critical for addressing the disproportionate impact of HIV among the BLMSM community.
{"title":"Recommendations from black and Latinx sexual minority males to include pharmacists to increase greater accessibility and OnlyFans stars to promote uptake of injectable PrEP","authors":"","doi":"10.1016/j.japh.2024.102153","DOIUrl":"10.1016/j.japh.2024.102153","url":null,"abstract":"<div><h3>Background</h3><p>Pre-exposure prophylaxis (PrEP) medication is the keystone of preventative measures to curtail the spread of human immunodeficiency virus (HIV). However, oral PrEP, the tablet intended to prevent HIV, has been slow to proliferate among men who have sex with men (MSM). This is of major concern given that MSM account for the largest number of new HIV diagnoses in the United States. More recently, the newest generation of PrEP in the form of a long-acting injectable (LAI) is to be administered every 2 months as an intramuscular injection and many MSM indicate preferring LAI-PrEP to the oral form of PrEP. However, uptake of PrEP, in all forms, remains low. Research is sparse that focuses on LAI-PrEP uptake among black and Latinx MSM (BLMSM).</p></div><div><h3>Objective</h3><p>This study aimed to address this concern; this study explored the willingness to uptake LAI-PrEP and recommendations for increasing awareness and encouraging uptake of LAI-PrEP among BLMSM.</p></div><div><h3>Methods</h3><p>Qualitative data were collected between February 2022 and December 2022 through focus groups via Zoom with BLMSM (N = 30, black = 14, Latinx = 16) aged 18 to 29 years (mean = 23, SD = 3) in Los Angeles County.</p></div><div><h3>Results</h3><p>Findings revealed that although 90% of BLMSM were aware of PrEP in oral form, only 10% were aware of LAI-PrEP. Findings from the qualitative analysis suggested to consider self-administration of LAI-PrEP, allow local community pharmacists to assess and administer it, and promote uptake of LAI-PrEP using high-profile male content creators and stars on OnlyFans social media platform.</p></div><div><h3>Conclusion</h3><p>Increasing PrEP uptake, in all forms available, such as promoting awareness through popular social media stars, and engaging community pharmacists in feasible ways, is critical for addressing the disproportionate impact of HIV among the BLMSM community.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102069
Background
Community pharmacy practice has incurred significant changes in scope of responsibility and workplace environment, particularly during the COVID-19 pandemic. The trends may impact how student pharmacists perceive community pharmacy practice and their future career opportunities.
Objective
To determine current perceptions that student pharmacists have toward community pharmacy practice.
Methods
A 15-item electronic, cross-sectional questionnaire was distributed to approximately 2200 student pharmacists from March to April 2023. To be included, respondents needed to be a current adult pharmacy student. The questionnaire included items about career interests, perceptions towards 12 different aspects of community pharmacy practice, and demographics. Data were analyzed primarily using descriptive statistics. A priori stratifications included interest to pursue community pharmacy according to class year and according to level of work experience.
Results
A total of 146 responses were included (response rate 6.6%). A total of 101 (69.2%) respondents were women, 108 (74.0%) were white, and the mean age was 24 years. Respondents represented all 4 pharmacy professional years, and 113 (77.4%) respondents reported current or previous work experience in community pharmacy. Most respondents were not interested in pursuing community pharmacy directly after graduation 77 (52.7%), nor as a long-term career 87 (59.6%). Student pharmacists found the most appealing aspects of community pharmacy practice to be salary/benefits, job availability and security, interactions with coworkers in the pharmacy, interactions with other medical professionals, relationships and interactions with patients, and teaching responsibilities. Student pharmacists found the work hours and schedule, business management responsibilities, navigating insurance-related tasks, and the pace of the work environment to be unappealing.
Conclusions
Student pharmacists report a low interest in pursuing community pharmacy practice. Minimizing deterrents and enhancing the appealing aspects of community pharmacy as perceived by student pharmacists may help improve recruitment and retainment, as well as improve perceptions of the practice.
{"title":"Student pharmacist perceptions toward community pharmacy practice","authors":"","doi":"10.1016/j.japh.2024.102069","DOIUrl":"10.1016/j.japh.2024.102069","url":null,"abstract":"<div><h3>Background</h3><div>Community pharmacy practice has incurred significant changes in scope of responsibility and workplace environment, particularly during the COVID-19 pandemic. The trends may impact how student pharmacists perceive community pharmacy practice and their future career opportunities.</div></div><div><h3>Objective</h3><div>To determine current perceptions that student pharmacists have toward community pharmacy practice.</div></div><div><h3>Methods</h3><div>A 15-item electronic, cross-sectional questionnaire was distributed to approximately 2200 student pharmacists from March to April 2023. To be included, respondents needed to be a current adult pharmacy student. The questionnaire included items about career interests, perceptions towards 12 different aspects of community pharmacy practice, and demographics. Data were analyzed primarily using descriptive statistics. A priori stratifications included interest to pursue community pharmacy according to class year and according to level of work experience.</div></div><div><h3>Results</h3><div>A total of 146 responses were included (response rate 6.6%). A total of 101 (69.2%) respondents were women, 108 (74.0%) were white, and the mean age was 24 years. Respondents represented all 4 pharmacy professional years, and 113 (77.4%) respondents reported current or previous work experience in community pharmacy. Most respondents were not interested in pursuing community pharmacy directly after graduation 77 (52.7%), nor as a long-term career 87 (59.6%). Student pharmacists found the most appealing aspects of community pharmacy practice to be salary/benefits, job availability and security, interactions with coworkers in the pharmacy, interactions with other medical professionals, relationships and interactions with patients, and teaching responsibilities. Student pharmacists found the work hours and schedule, business management responsibilities, navigating insurance-related tasks, and the pace of the work environment to be unappealing.</div></div><div><h3>Conclusions</h3><div>Student pharmacists report a low interest in pursuing community pharmacy practice. Minimizing deterrents and enhancing the appealing aspects of community pharmacy as perceived by student pharmacists may help improve recruitment and retainment, as well as improve perceptions of the practice.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102174
Background
Pre-exposure prophylaxis (PrEP) is highly effective at reducing the risk of human immunodeficiency virus (HIV) acquisition in at-risk individuals; however, it is largely underutilized. The Veterans Health Administration has created an HIV PrEP dashboard to identify at-risk veterans in attempt to increase PrEP enrollment.
Objective
This study aimed to determine whether the use of an HIV PrEP dashboard would prove effective at increasing PrEP enrollment at a single facility.
Methods
This was a single-center quality improvement project. Three pharmacists used the HIV PrEP dashboard and retrospective chart review to identify eligible patients for PrEP. A multimodal process of contacting patients was conducted. The primary objective was to evaluate the number of patients who enrolled in PrEP during the study period. Secondary objectives included evaluating the ability of the HIV PrEP dashboard to identify eligible patients, identify effective strategies to target PrEP enrollment, and compare those patients who accepted with those who declined PrEP to evaluate barriers to enrollment.
Results
Of the 94 patients reviewed, 26 patients (27.7%) were found eligible for PrEP. Of the eligible patients, 3 patients (11.5%) were enrolled, and 7 patients (26.9%) declined PrEP. The others were lost to follow-up (9 of 26, 34.6%), had no action taken on a chart note to provider (6 of 26, 23.1%), or did not have a primary care provider assigned at the local facility (1 of 26, 3.9%). The 3 patients who were successfully enrolled in PrEP were all contacted and prescribed PrEP through the infectious diseases (ID) clinic. There were no statistically significant differences between the cohorts of patients who accepted and declined PrEP.
Conclusions
The use of an HIV PrEP dashboard aided in identifying eligible patients for PrEP. Enrollment through the ID clinic was the most successful modality. Further research is needed to characterize barriers to PrEP uptake and to develop strategies to increase prescribing from non-ID providers.
背景：暴露前预防疗法（PrEP）在降低高危人群感染人类免疫缺陷病毒（HIV）的风险方面非常有效；然而，该疗法在很大程度上未得到充分利用。退伍军人健康管理局已建立了一个 HIV PrEP 面板，用于识别高危退伍军人，以提高 PrEP 的注册率：本研究旨在确定使用 HIV PrEP 面板是否能有效提高单个机构的 PrEP 注册率：这是一个单中心质量改进项目。三名药剂师使用 HIV PrEP 面板和回顾性病历审查来确定符合 PrEP 条件的患者。采用多种方式与患者取得联系。首要目标是评估研究期间加入 PrEP 的患者人数。次要目标包括评估 HIV PrEP 面板识别符合条件的患者的能力，确定针对 PrEP 注册的有效策略，并对接受和拒绝 PrEP 的患者进行比较，以评估注册的障碍：在接受审查的 94 名患者中，有 26 名患者（27.7%）符合 PrEP 条件。在符合条件的患者中，3 名患者（11.5%）加入了 PrEP，7 名患者（26.9%）拒绝接受 PrEP。其他患者则失去了随访机会（26 人中有 9 人，占 34.6%），没有对医疗服务提供者的病历记录采取任何行动（26 人中有 6 人，占 23.1%），或者没有在当地医疗机构指定初级医疗服务提供者（26 人中有 1 人，占 3.9%）。成功注册 PrEP 的 3 名患者都是通过传染病 (ID) 诊所联系并开具 PrEP 处方的。接受和拒绝接受 PrEP 的患者群之间没有统计学上的显著差异：结论：使用 HIV PrEP dashboard 有助于识别符合 PrEP 条件的患者。通过 ID 诊所进行登记是最成功的方式。需要开展进一步的研究，以确定接受 PrEP 的障碍，并制定策略以增加非 ID 医疗服务提供者的处方量。
{"title":"Reprint of: Impact of an HIV pre-exposure prophylaxis dashboard on veteran PrEP enrollment","authors":"","doi":"10.1016/j.japh.2024.102174","DOIUrl":"10.1016/j.japh.2024.102174","url":null,"abstract":"<div><h3>Background</h3><div>Pre-exposure prophylaxis (PrEP) is highly effective at reducing the risk of human immunodeficiency virus (HIV) acquisition in at-risk individuals; however, it is largely underutilized. The Veterans Health Administration has created an HIV PrEP dashboard to identify at-risk veterans in attempt to increase PrEP enrollment.</div></div><div><h3>Objective</h3><div>This study aimed to determine whether the use of an HIV PrEP dashboard would prove effective at increasing PrEP enrollment at a single facility.</div></div><div><h3>Methods</h3><div>This was a single-center quality improvement project. Three pharmacists used the HIV PrEP dashboard and retrospective chart review to identify eligible patients for PrEP. A multimodal process of contacting patients was conducted. The primary objective was to evaluate the number of patients who enrolled in PrEP during the study period. Secondary objectives included evaluating the ability of the HIV PrEP dashboard to identify eligible patients, identify effective strategies to target PrEP enrollment, and compare those patients who accepted with those who declined PrEP to evaluate barriers to enrollment.</div></div><div><h3>Results</h3><div>Of the 94 patients reviewed, 26 patients (27.7%) were found eligible for PrEP. Of the eligible patients, 3 patients (11.5%) were enrolled, and 7 patients (26.9%) declined PrEP. The others were lost to follow-up (9 of 26, 34.6%), had no action taken on a chart note to provider (6 of 26, 23.1%), or did not have a primary care provider assigned at the local facility (1 of 26, 3.9%). The 3 patients who were successfully enrolled in PrEP were all contacted and prescribed PrEP through the infectious diseases (ID) clinic. There were no statistically significant differences between the cohorts of patients who accepted and declined PrEP.</div></div><div><h3>Conclusions</h3><div>The use of an HIV PrEP dashboard aided in identifying eligible patients for PrEP. Enrollment through the ID clinic was the most successful modality. Further research is needed to characterize barriers to PrEP uptake and to develop strategies to increase prescribing from non-ID providers.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102162
Background
Polypharmacy, a broad term to describe the use of numerous and often unnecessary medications, has been connected to frailty, hospital admissions, falls, and even mortality. The Veterans Health Administration (VHA) developed the VIONE (vital, important, optional, not indicated, and every medication has an indication) dashboard to identify patients with polypharmacy and serve as a framework for deprescribing of medications across VHA facilities where it is used in a variety of practice settings by different disciplines.
Objective
This study aimed to describe the implementation of a pharmacist-led, system-wide, deprescribing initiative in the primary care setting.
Practice description
Interdisciplinary education was provided through academic detailing. Subsequently, patients were identified for inclusion in the project using the VIONE dashboard focusing on those at highest risk of polypharmacy and moving down to the lowest risk. Interested patients underwent a medication reconciliation. A clinical pharmacist practitioner (CPP) then contacted the patient to discuss potential deprescribing options. Recommendations were relayed to the primary care provider (PCP) for final approval and communicated to the patient by the pharmacy team.
Practice innovation
Primary care CPPs (n = 3) integrated deprescribing into their standard workload. This service was implemented in the primary care setting across an entire health care system consisting of 16 different primary care teams.
Evaluation methods
The initiative’s impact was measured by the number of discontinued medications, the acceptance rate of recommendations by the PCP, the potential annualized cost avoidance, and the number of patients referred to CPP medication management clinics.
Results
Among 63 patients, a total of 352 medications were deprescribed resulting in a potential annualized cost avoidance of $184,221. The acceptance rate of discontinuation recommendations was 96.7%. Subsequently, 25.4% of patients were referred to pharmacist-led clinics for disease state management.
Conclusion
Embedding deprescribing into standard CPP workflow within the primary care setting facilitated a way for polypharmacy reduction and allowed the expansion of pharmacy-led services at VA Butler Healthcare System.
{"title":"Reprint of: Pharmacist-driven deprescribing initiative in primary care","authors":"","doi":"10.1016/j.japh.2024.102162","DOIUrl":"10.1016/j.japh.2024.102162","url":null,"abstract":"<div><h3>Background</h3><div>Polypharmacy, a broad term to describe the use of numerous and often unnecessary medications, has been connected to frailty, hospital admissions, falls, and even mortality. The Veterans Health Administration (VHA) developed the VIONE (vital, important, optional, not indicated, and every medication has an indication) dashboard to identify patients with polypharmacy and serve as a framework for deprescribing of medications across VHA facilities where it is used in a variety of practice settings by different disciplines.</div></div><div><h3>Objective</h3><div>This study aimed to describe the implementation of a pharmacist-led, system-wide, deprescribing initiative in the primary care setting.</div></div><div><h3>Practice description</h3><div>Interdisciplinary education was provided through academic detailing. Subsequently, patients were identified for inclusion in the project using the VIONE dashboard focusing on those at highest risk of polypharmacy and moving down to the lowest risk. Interested patients underwent a medication reconciliation. A clinical pharmacist practitioner (CPP) then contacted the patient to discuss potential deprescribing options. Recommendations were relayed to the primary care provider (PCP) for final approval and communicated to the patient by the pharmacy team.</div></div><div><h3>Practice innovation</h3><div>Primary care CPPs (n = 3) integrated deprescribing into their standard workload. This service was implemented in the primary care setting across an entire health care system consisting of 16 different primary care teams.</div></div><div><h3>Evaluation methods</h3><div>The initiative’s impact was measured by the number of discontinued medications, the acceptance rate of recommendations by the PCP, the potential annualized cost avoidance, and the number of patients referred to CPP medication management clinics.</div></div><div><h3>Results</h3><div>Among 63 patients, a total of 352 medications were deprescribed resulting in a potential annualized cost avoidance of $184,221. The acceptance rate of discontinuation recommendations was 96.7%. Subsequently, 25.4% of patients were referred to pharmacist-led clinics for disease state management.</div></div><div><h3>Conclusion</h3><div>Embedding deprescribing into standard CPP workflow within the primary care setting facilitated a way for polypharmacy reduction and allowed the expansion of pharmacy-led services at VA Butler Healthcare System.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.japh.2024.102120
{"title":"APhA Awards & Fellow Recipients","authors":"","doi":"10.1016/j.japh.2024.102120","DOIUrl":"10.1016/j.japh.2024.102120","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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