Journal of the American Pharmacists Association最新文献_第6页

Knowledge and perceptions of health literacy among pharmacists in Ohio in 2013 and 2021 2013 年和 2021 年俄亥俄州药剂师对健康知识的了解和看法。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-10-02 DOI: 10.1016/j.japh.2024.102260

Karissa Kim, Anne M. Metzger, Megan Than Win, Madison Luck, Marwan Alrasheed

Background

There is limited existing literature on pharmacists' knowledge of health literacy and the interventions pharmacists use to address limited health literacy.

Objectives

The primary objectives of this study were to evaluate pharmacists' knowledge and perceptions of the impact of limited health literacy on patients and their practice, and to review the techniques used to care for patients.

Methods

We conducted a cross-sectional, web-based survey of registered Ohio pharmacists in 2013 and repeated the survey in 2021. The Nursing Professional Health Literacy Survey was adapted and employed to assess 1) general knowledge; 2) health literacy in the workplace; and 3) demographics. Changes in pharmacists' knowledge and perceptions of health literacy, self-reported use of communication techniques, and methods for assessing a patient’s health literacy were evaluated.

Results

Response rates were 12.4% (N = 62) in 2013 and 3.5% (N = 174) in 2021. Awareness of the term health literacy increased, rising from 82.3% to 89.7% (P = 0.127). Less than 41% of pharmacists in both cohorts had received formal health literacy training; a regression model indicated that pharmacists with more years of practice were less likely to have had such training (P < 0.05). Most pharmacists admitted they never formally assess health literacy (79.0% in 2013 and 81.6% in 2021; P = 0.875) but reported often relying on their gut feeling to gauge a patient's health literacy (37.1% in 2013 and 41.4% in 2021; P = 0.658). The percentage of pharmacists who orally reviewed written instructions with patients, used layman’s terms, and had patients demonstrate instructions significantly increased (P < 0.05) between 2013 and 2021.

Conclusion

Gaps remain in pharmacists' knowledge and practices related to health literacy. From 2013 to 2021, there were improvements in how pharmacists communicate with patients who have limited health literacy, but no significant change in the methods used to assess health literacy.

背景：关于药剂师的健康素养知识以及药剂师针对有限的健康素养所采取的干预措施的现有文献有限：关于药剂师的健康素养知识以及药剂师为解决健康素养有限问题而采取的干预措施的现有文献十分有限：本研究的主要目的是评估药剂师对有限健康素养对患者及其实践的影响的了解和看法，并审查用于护理患者的技术：我们于 2013 年对俄亥俄州的注册药剂师进行了一次横断面网络调查，并于 2021 年再次进行了调查。我们对护理专业人员健康素养调查进行了改编，并采用该调查来评估 1) 一般知识；2) 工作场所的健康素养；3) 人口统计学。此外，还评估了药剂师对健康素养知识和看法的变化、自我报告的沟通技巧使用情况以及评估患者健康素养的方法：2013 年的回复率为 12.4%（62 人），2021 年为 3.5%（174 人）。对健康素养一词的认识有所提高，从 82.3% 上升至 89.7%（P=0.127）。两个组群中只有不到 41% 的药剂师接受过正规的健康素养培训；回归模型显示，从业年限越长的药剂师接受过此类培训的可能性越小（P 结论：药剂师在健康素养方面的知识仍然存在差距：药剂师在健康素养相关知识和实践方面仍存在差距。从 2013 年到 2021 年，药剂师与健康素养有限的患者沟通的方式有所改善，但用于评估健康素养的方法没有显著变化。

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引用次数: 0

Differences in prescribing patterns of opioid dependence drugs among patients with primary alcohol use problems and opioid use disorders within New York State by social determinant factors, 2005-2018 2005-2018年纽约州按社会决定因素分列的原发性酒精使用问题和阿片类药物使用障碍患者的阿片类依赖药物处方模式差异。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-27 DOI: 10.1016/j.japh.2024.102258

Chi-Hua Lu, Hsuan-Yun Su, Zackary Falls, David M. Jacobs, Qiuyi Zhang, Walter Gibson, Gail Jette, Debanjan Paul, Peter L. Elkin, Kenneth E. Leonard, Edward M. Bednarczyk

Background

The increase in alcohol use problems and opioid use disorder (OUD) highlights the need for research on effective medication treatments for patients with dual diagnoses.

Objectives

This study analyzed trends and social disparities in prescribing OUD medications for patients who initially had alcohol use problems and later received their first OUD diagnosis.

Methods

This study used merged data from the New York State Office of Addiction Services and Supports and the Medicaid to analyze individuals aged 18 years and older who initially had primary alcohol use problems and later had OUD for the first time between 2005 and 2018. It examined the rates of new buprenorphine and naltrexone prescriptions across various demographic and socioeconomic groups.

Results

Among 27,029 clients, the average rate of new buprenorphine was 64.23 per 1000 clients (95% CI 61.30–67.15), with upward trends. The 18-35 age group had the highest buprenorphine utilization (111.48 per 1000 clients) and highest increase rates compared with other age groups. The white non-Hispanic group had the highest rates of buprenorphine (119.23 per 1000 clients) and showed larger increase over time compared with other race or ethnicity groups. Disabled patients showed slower increasing rates of buprenorphine than other groups. Upward trends were observed in naltrexone. All observed differences were statistically significant (P < 0.05).

Conclusions

Trends showed increased use of OUD medications, with varying rates of buprenorphine utilization across different ages, races, and employment statuses. Despite this, the rates of receiving new buprenorphine remained low, suggesting a need for innovative methods to expand access to treatments.

背景：酒精使用问题和阿片类药物使用障碍（OUD）的增加凸显了研究双重诊断患者有效药物治疗的必要性：酒精使用问题和阿片类药物使用障碍（OUD）的增加凸显了对双重诊断患者进行有效药物治疗研究的必要性：本研究分析了为最初有酗酒问题、后来首次被诊断为阿片类药物使用障碍的患者开具阿片类药物处方的趋势和社会差异：本研究利用纽约州成瘾服务与支持办公室和医疗补助计划的合并数据，分析了 2005 年至 2018 年间年龄在 18 岁及以上、最初有主要酒精使用问题、后来首次出现 OUD 的个人。该研究考察了不同人口和社会经济群体中新开丁丙诺啡和纳曲酮处方的比例：在 27,029 名客户中，丁丙诺啡的平均新处方率为每千名客户 64.23（95% CI [61.30, 67.15]），且呈上升趋势。与其他年龄组相比，18-35 岁年龄组的丁丙诺啡使用率最高（每 1000 名客户 111.48 次），增长率也最高。非西班牙裔白人群体的丁丙诺啡使用率最高（每 1000 名客户 119.23 次），与其他种族/族裔群体相比，随着时间的推移，其使用率增幅更大。与其他群体相比，残疾患者使用丁丙诺啡的比例增长较慢。纳曲酮呈上升趋势。所有观察到的差异均具有统计学意义（PConclusions：趋势表明，OUD 药物的使用有所增加，不同年龄、种族和就业状况的丁丙诺啡使用率各不相同。尽管如此，接受新丁丙诺啡的比例仍然很低，这表明需要采用创新方法来扩大治疗范围。

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引用次数: 0

Act for the future of community pharmacy 为社区药房的未来采取行动。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-25 DOI: 10.1016/j.japh.2024.102256

Jennifer L. Bacci, Joni C. Carroll, Kim C. Coley, Christopher Daly, William R. Doucette, Stefanie P. Ferreri, Sophia M.C. Herbert, Shelby A. Jensen, Melissa Somma McGivney, Megan Smith, Troy Trygstad, Randy McDonough

Community pharmacies serve as a vital gateway to primary care and public health, offering face-to-face pharmacist expert care to assure safe and effective medication use. However, they are disappearing at an alarming rate, with 20%-30% of all community pharmacy locations projected to close within the next year. The objective of this commentary is to highlight the critical need for systemic reforms and collective action within our profession to address the unique challenges faced by community pharmacies, ensuring their sustainability and continued role in providing essential health care services for patients. Key issues and evidence are provided to help pharmacy professionals better articulate why pharmacy closures are happening now and how we can work toward a transformed future. Pharmacy closures stem from an unsustainable business model characterized by declining reimbursement for prescription medications, opaque and anticompetitive pricing practices of pharmacy benefit managers, and limited reimbursement for clinical services. Among these challenges, our profession has the opportunity to create a future for community pharmacy where every person has local access to pharmacist expert care and medications through sustainable, integrated community pharmacy practice. Our profession must embrace community pharmacy teams’ role in patient care, champion opportunities to integrate community pharmacists and their support staff as members of the health care team, and advocate for payment transparency and transformation. Creating this future will take all pharmacists and all pharmacy professionals.

社区药房是初级保健和公共卫生的重要门户，提供面对面的药剂师专家护理，确保安全有效地用药。然而，社区药房正在以惊人的速度消失，预计 20-30% 的社区药房将在明年内关闭。这篇评论的目的是强调我们的行业亟需进行系统性改革并采取集体行动，以应对社区药房所面临的独特挑战，确保其可持续发展并继续在为患者提供基本医疗保健服务方面发挥作用。本文提供了关键问题和证据，以帮助药学专业人士更好地阐明药房关闭的原因，以及我们如何努力实现转型的未来。药房倒闭源于不可持续的商业模式，其特点是处方药报销额度下降、药房福利管理公司（PBM）的定价行为不透明且反竞争，以及临床服务报销额度有限。在这些挑战中，我们的专业有机会为社区药房创造一个未来，通过可持续的综合社区药房实践，让每个人都能在当地获得药剂师的专业护理和药物。我们的行业必须接受社区药学团队在患者护理中的角色，支持将社区药剂师及其支持人员整合为医疗团队成员的机会，并倡导支付透明化和转型。创造这样的未来需要所有药剂师和所有药学专业人士的共同努力。

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引用次数: 0

Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes 药剂师领导的药物治疗管理诊所管理 2 型糖尿病的成本效益。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-24 DOI: 10.1016/j.japh.2024.102253

Mrinmayee Joshi, Christine Pham, Huiwen Deng, Sheryl Mathew, Rachel M. Norton, Kibum Kim, Daniel R. Touchette, Jessica J. Tilton

Background

Diabetes imposes a substantial public health burden. Involvement of clinical pharmacists in diabetes disease management can improve health outcomes while managing expenditure.

Objective

This study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus, from a U.S. payer perspective.

Methods

A cohort simulation Markov model was developed to simulate the occurrence of major complications of diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities were based on data from electronic health records and published literature. Outcomes evaluated were lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effective ratio (ICER). Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes, and of reduced MTMC visit frequency.

Results

Over a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The ICER for MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure.

Conclusion

The study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term health care costs.

研究目的本研究旨在从美国支付方的角度评估药剂师主导的药物治疗管理诊所（MTMC）与常规护理相比，对 2 型糖尿病（T2DM）患者的终生成本效益：方法：建立了一个队列模拟马尔可夫模型，其中包括糖尿病和糖尿病主要并发症的影响。过渡概率、MTMC 治疗效果、健康状态成本和效用均基于电子健康记录数据和已发表的文献。评估结果包括终生增量成本、质量调整生命年（QALYs）和比率。对所有模型输入进行了敏感性分析；情景分析评估了预防更多糖尿病并发症对经济结果的影响以及减少 MTMC 就诊频率的影响：在一生中，MTMC 的总成本为 160,145 美元，QALY 为 6.73；常规护理的总成本为 152,806 美元，QALY 为 6.65。与常规治疗相比，MTMC 的增量成本效益比 (ICER) 为每 QALY 收益 93,375 美元，表明在每 QALY 收益 100,000 美元的支付意愿阈值下具有成本效益。情景分析表明，模拟额外并发症或减少就诊频率可降低 ICER。研究结果对 MTMC 成本以及中风、心肌梗死和肾衰竭发生的危险比最为敏感，同时糖化血红蛋白和收缩压也有所改善：这项研究表明，将临床药学服务纳入综合护理策略具有潜在的成本效益。研究结果支持扩大此类服务的覆盖范围和报销范围，以优化临床疗效并降低长期医疗成本。

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引用次数: 0

Delivery of enhanced asthma care in pharmacies: Perceptions and experiences of Australian service providers 在药房提供哮喘强化护理：澳大利亚服务提供商的看法和经验。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-24 DOI: 10.1016/j.japh.2024.102252

Sarah Serhal, Ines Krass, Bandana Saini, Sinthia Bosnic-Anticevich, Lynne Emmerton, Bonnie Bereznicki, Luke Bereznicki, Bronwen Wright, Kiara Wilson, Bernadette Mitchell, Carol Armour

Background

Evidence-based asthma management services have been tested in Australian community pharmacies for over 2 decades and have been well received by patients but are not retained in practice. The positive clinical outcomes of these tested services suggest the potential for wider implementation, for which the providers’ perspective is critical.

Objective

This investigation evaluates the implementability of the Pharmacy Asthma Service (PAS) through the experiences and perceptions of the community pharmacists delivering the service.

Methods

Forty-eight pharmacists took part in a posttrial semi-structured qualitative telephone interview, representing 42 of 51 (82%) eligible PAS intervention arm pharmacies. Qualitative data were deductively analyzed in accordance with the Implementation Outcomes Framework.

Results

Pharmacists recognized the positive impact of the service on patients’ health outcomes, the pharmacist’s practice, and in fostering stronger and more beneficial pharmacist-patient relationships. However, whilst acknowledging the importance of such a service, the pharmacists faced challenges in recruitment and patient follow-up. Pharmacists stated that further work is required to address pharmacist and patient time constraints, patient health beliefs and to increase the acceptance of pharmaceutical care provision in community pharmacy practice by patients and other health care professionals.

Conclusion

Pharmacists can deliver enhanced clinical care for asthma patients with positive perceived professional and patient outcomes. However, it remains evident that time, remuneration, and recognition of the pharmacist’s role in chronic care management form barriers to the implementation of asthma services in community pharmacies. Broader policy and systemic changes are required to successfully balance medication supply and quality patient management roles at the same time as a required shift in research processes.

背景：以证据为基础的哮喘管理服务已在澳大利亚社区药房测试了二十多年，深受患者欢迎，但并未在实践中得到保留。这些经过测试的服务取得了积极的临床效果，这表明有可能在更大范围内实施，而服务提供者的观点对实施至关重要：本调查通过提供服务的社区药剂师的经验和看法来评估药房哮喘服务（PAS）的可实施性：48 名药剂师参加了试验后的半结构式定性电话访谈，他们代表了 51 家符合条件的 PAS 干预药房中的 42 家（82%）。根据 "实施结果框架 "对定性数据进行了演绎分析：结果：药剂师认识到该服务对患者的健康结果、药剂师的实践以及促进药剂师与患者之间更稳固、更有益的关系产生了积极影响。然而，药剂师在承认这项服务的重要性的同时，也面临着招募和患者随访方面的挑战。药剂师表示，还需要进一步努力解决药剂师和患者的时间限制、患者的健康观念等问题，并提高患者和其他医护人员对社区药房提供药物治疗的认可度。然而，时间、报酬以及对药剂师在慢性病管理中作用的认可，显然仍是社区药房开展哮喘服务的障碍。需要进行更广泛的政策和系统变革，以成功平衡药物供应和优质患者管理角色，同时在研究过程中进行必要的转变。

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引用次数: 0

Pharmacy barriers for transgender and gender diverse young adults 变性和性别多元化年轻人的药房障碍。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-23 DOI: 10.1016/j.japh.2024.102251

Hannah E. Johnson, TK Logan, Kelly K. Hill

Background

Transgender and gender diverse (TGD) individuals face substantial physical and mental health care barriers. Community pharmacies are one of the most accessible health care settings; however, concern for discrimination at the pharmacy has been reported. It is important to gain a better understanding of TGD individual’s perspectives and experiences at the pharmacy to ensure optimal and inclusive care.

Objective

To identify TGD individual experiences and barriers at the pharmacy.

Methods

This institutional review board−approved qualitative study recruited TGD young adults in the United States between ages 18 and 29 years for semi-structured focus group discussions. Questions focused on barriers to obtaining medications at the pharmacy and negative or positive experiences with pharmacists. Interviews were recorded, transcribed, and transcripts were analyzed for common themes amongst participants.

Results

Nine 1.5- to 2-hour focus groups were conducted and included 30 participants (2–6 participants in each group). All participants reported having been prescribed medications by a physician or mental health provider. Participants self-reported issues at pharmacies and with pharmacy personnel. Major themes included issues accessing medications and supplies (needles, syringes), questioning of prescription validity and patient identity, and lack of education or understanding of TGD individuals by pharmacy staff.

Conclusion

TGD individuals experience barriers at the pharmacy and concerning issues with pharmacy staff. Education, structural competency, and improvements in gender-related data management are necessary for pharmacists and pharmacy staff to provide equitable and inclusive care for TGD individuals.

背景：变性人和性别多元化（TGD）人士面临着巨大的身体和心理保健障碍。社区药房是最容易获得医疗保健服务的场所之一，但也有报道称药房存在歧视问题。更好地了解 TGD 在药房的观点和经历对确保提供最佳的包容性医疗服务非常重要：目的：确定 TGD 在药房的个人经历和障碍：这项经 IRB 批准的定性研究在美国招募了 18-29 岁的半结构化焦点小组讨论。问题主要集中在在药房取药的障碍以及与药剂师相处的负面或正面经历。我们对访谈进行了记录和转录，并对转录内容进行了分析，以寻找参与者之间的共同主题：共进行了九次 1.5-2 小时的焦点小组讨论，共有 30 人参加（每组 2-6 人）。所有参与者都表示曾接受过医生或心理健康提供者开具的处方药。参与者自行报告了在药店以及与药店工作人员之间遇到的问题。主要主题包括：获取药物和用品（针头、注射器）的问题、对处方有效性和患者身份的质疑，以及药房工作人员缺乏对 TGD 患者的教育或了解：结论：TGD 患者在药房会遇到障碍，他们与药房工作人员之间也存在一些相关问题。药剂师和药房工作人员必须接受教育、具备结构性能力并改进与性别相关的数据管理，才能为 TGD 患者提供公平、包容的护理。

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引用次数: 0

Empowering pharmacy technicians as vaccine champions: A pilot study in independent community pharmacies 让药剂师成为疫苗卫士：独立社区药房试点研究。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-23 DOI: 10.1016/j.japh.2024.102257

Allison Hursman, Hailey Wanner, Ellen Rubinstein

Background

Increasing vaccine uptake in communities has been essential, even before coronavirus disease 2019. The use of "vaccine champions" or "VaxChamps" has shown promise. VaxChamps, who are often community members with specialized training but no special credentials, advocate for vaccination by sharing their experiences and knowledge. Pharmacy technicians’ scope of practice, coupled with their frequent interactions with pharmacy patients, make them ideal vaccine champions and a natural fit for the VaxChamp program. This study assessed the implementation and impact of the VaxChamp program in North Dakota community pharmacies.

Objectives

To describe the development and implementation of the VaxChamp program in community pharmacies and evaluate its effect on vaccination rates and vaccine-related tasks within each pharmacy’s organizational context.

Methods

The VaxChamp program involved training one technician per participating pharmacy to spend 5 hours per week on vaccine-related tasks. Data collection included pre-post surveys, monthly reports, and semi-structured interviews with VaxChamps and pharmacists-in-charge from 6 pharmacies. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using inductive methods to identify key themes.

Results

The 6 participating pharmacies varied in location and staffing. Most had prior vaccine administration experience. VaxChamps’ roles ranged from administrative tasks to direct vaccine administration, depending on the pharmacy’s staffing and workflow. Vaccination rates for pneumococcal and hepatitis B vaccines increased in several pharmacies, while shingles vaccination rates declined. The presence of advanced pharmacy practice experience students often influenced VaxChamps’ responsibilities, underscoring the need for clear role delineation.

Conclusion

Integrating pharmacy technicians as VaxChamps in community pharmacies is a promising strategy to increase vaccination rates and enhance public health. Future research should explore ways to better integrate technicians into comprehensive immunization strategies and address the contextual factors that influence program implementation.

背景：即使在 COVID-19 之前，提高社区的疫苗接种率也是至关重要的。使用 "疫苗卫士 "或 "VaxChamps "已初见成效。疫苗接种倡导者通常是受过专业培训但没有特殊证书的社区成员，他们通过分享自己的经验和知识来倡导疫苗接种。药房技术人员的执业范围加上他们与药房患者的频繁互动，使他们成为理想的疫苗接种倡导者，也是 VaxChamp 计划的理想人选。本研究评估了 VaxChamp 计划在北达科他州（ND）社区药房的实施情况和影响：描述 VaxChamp 计划在社区药房的发展和实施情况，并评估其对疫苗接种率和各药房组织环境中与疫苗相关任务的影响：VaxChamp 计划包括为每个参与计划的药房培训一名技术人员，使其每周花费五小时从事与疫苗相关的工作。数据收集包括事后调查、月度报告，以及对 VaxChamps 和六家药房的药剂师主管 (PIC) 进行的半结构化访谈。定量数据采用描述性统计进行分析，定性数据则采用归纳法进行分析，以确定关键主题：结果：参与研究的六家药房在地点和人员配备上各不相同。大多数药房都有过疫苗管理经验。根据药房的人员配备和工作流程，VaxChamps 的职责从行政工作到直接接种疫苗不等。几家药房的肺炎球菌和乙型肝炎疫苗接种率有所上升，而带状疱疹疫苗接种率则有所下降。高级药学实践经验 (APPE) 学生的存在往往会影响 VaxChamps 的职责，这强调了明确角色分工的必要性：结论：将药学技术人员作为 VaxChamps 纳入社区药房是提高疫苗接种率和改善公共卫生的一项有前途的策略。未来的研究应探索如何更好地将技术人员纳入综合免疫战略，并解决影响计划实施的环境因素。

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引用次数: 0

Impact of a diabetic retinal exam screening program on quality measure gaps at a family medicine practice 糖尿病视网膜检查筛查计划对家庭医疗诊所质量标准差距的影响。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-21 DOI: 10.1016/j.japh.2024.102254

Michael Hair, Alexandra Tardugno, Alyssa Greenaway, Chelse Wisenor, Autumn Stewart-Lynch

Background

Diabetic retinopathy is a common complication in people with diabetes, and annual screening is recommended by the American Diabetes Association. This annual exam is also a Health Effectiveness Data and Information Set quality measure. Barriers such as lack of access to healthcare or cost of specialist visits may impact the number of patients who receive these exams.

Objective

The objective of this study is to describe the impact of a diabetic retinal exam screening program at a rural family medicine center on the number of quality measure gaps resolved.

Practice description

This study occurred at a rural family medicine center in southwestern Pennsylvania with a medically underserved patient population. A pharmacist at the site holds board certifications in Advanced Diabetes Management and as a Diabetes Care and Education Specialist. This pharmacist manages diabetes through a collaborative practice agreement.

Practice innovation

A regional Medical Assistance plan provided a list of patients with a quality measure gap for an annual diabetic retinal exam and loaned a RetinaVue 700 Imager to take retinal photos. After screening eligible patients via phone, retinal exams were administered by student pharmacists and medical assistants to consenting patients over the course of 9 days. Images were then sent to an ophthalmologist to be interpreted.

Evaluation methods

The rate of quality measure gaps closed and satisfaction survey results are reported using descriptive statistics.

Results

A total of 61 patients were included in the analysis. This program closed quality measure gaps for 11 (18.0%) patients who were able to receive an in-office eye exam.

Conclusion

This pilot project shows that offering in-office diabetic retinal exams may be an effective strategy to close quality measure gaps and provide access to screening among a medically underserved population.

背景：糖尿病视网膜病变是糖尿病患者常见的并发症，美国糖尿病协会建议每年进行一次筛查。这项年度检查也是 HEDIS 质量衡量标准之一。无法获得医疗保健服务或专科就诊费用等障碍可能会影响接受这些检查的患者人数：本研究的目的是描述农村家庭医疗中心的糖尿病视网膜检查筛查项目对解决质量测量差距数量的影响：这项研究发生在宾夕法尼亚州西南部的一个农村家庭医学中心，该中心的病人大多医疗服务不足。该中心的一名药剂师拥有高级糖尿病管理 (BC-ADM) 和糖尿病护理与教育专家 (CDCES) 证书，并通过合作实践协议管理糖尿病：实践创新：一家地区医疗补助计划提供了一份存在年度 DRE 质量差距的患者名单，并出借了一台 RetinaVue 700 成像仪用于拍摄视网膜照片。通过电话筛选出符合条件的患者后，由学生药剂师和医疗助理在九天内对同意的患者进行视网膜检查。然后将图像发送给眼科医生进行解读：评价方法：采用描述性统计方法报告质量测量差距弥补率和满意度调查结果：结果：共有 61 名患者参与了分析。该项目为 11 名（18.0%）能够接受诊室内眼科检查的患者消除了质量差距：该试点项目表明，提供诊室内糖尿病视网膜检查可能是缩小质量差距的有效策略，并能为医疗服务不足的人群提供筛查机会。

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引用次数: 0

Probable chlorthalidone-induced hypokalemic rhabdomyolysis 可能是氯塞酮诱发的低钾横纹肌溶解症。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-13 DOI: 10.1016/j.japh.2024.102249

Gagandeep Singh, Caitlin Canton, Diana R. Langworthy

Purpose

A case of hypokalemic rhabdomyolysis related to chlorthalidone use is reported

Case

A 52-year-old male was admitted to the hospital for acute onset generalized weakness and was found to have severe hypokalemia and rhabdomyolysis. The patient had been on chlorthalidone therapy with a dose increase from 25 mg daily to 50 mg daily 2 months prior to admission. Extensive workup ruled out neurologic, rheumatologic, and endocrinologic causes of hypokalemia. In the absence of other causes, it was determined that the patient was experiencing a severe presentation of chlorthalidone-induced hypokalemia resulting in rhabdomyolysis. The patient’s rhabdomyolysis and weakness improved with aggressive potassium correction, and potassium wasting eventually resolved with discontinuation of chlorthalidone.

Conclusion

Although mild hypokalemia is a known side effect of thiazide and thiazide-like diuretics, health care providers should be aware of the possibility of severe manifestations of this adverse reaction, even at relatively small dose increases.

目的：报告一例与使用氯沙坦有关的低钾横纹肌溶解症：摘要：一名 52 岁的男性因急性全身无力入院，被发现患有严重的低钾血症和横纹肌溶解症。入院前两个月，患者一直在使用氯沙坦酮治疗，剂量从每天 25 毫克增加到每天 50 毫克。广泛的检查排除了导致低钾血症的神经、风湿和内分泌原因。在没有其他病因的情况下，确定患者出现了严重的氯沙坦诱导的低钾血症，导致横纹肌溶解。积极补钾后，患者的横纹肌溶解症和虚弱症状有所改善，停用氯沙坦后，钾消耗最终得到缓解：结论：尽管轻度低钾血症是噻嗪类和噻嗪类利尿剂的一种已知副作用，但医护人员仍应注意这种不良反应的严重表现的可能性，即使剂量增加相对较小。

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引用次数: 0

Orlando Veterans Affairs stratification tool for opioid risk mitigation (STORM) very high risk interdisciplinary team review: A brief report 奥兰多退伍军人事务局阿片类药物风险缓解分层工具（STORM）极高风险跨学科小组审查：简要报告。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-09-12 DOI: 10.1016/j.japh.2024.102250

Lauren Hundley, Dalena Nguyen, Anna Alexander, Mariellen Moore, Christina Coakley, Tho Nguyen, Jenny Szabo, Kimberly Reno-Ly

Background

Compared to the general population, Veterans Health Administration (VHA) patients have higher rates of mental illness, chronic pain, and substance use disorders (SUD), conditions that increase risk for opioid-related adverse events. VHA developed the Stratification Tool for Opioid Risk Mitigation (STORM) and mandated case reviews by an interdisciplinary team (IDT) for patients identified as very high risk, a process implemented and led by clinical pharmacist practitioners at the Orlando Veterans Affairs Healthcare System (OVAHCS) in 2018.

Objective

To evaluate and describe the implementation and process for IDT reviews of patients identified as very high risk by the STORM clinical decision support tool at OVAHCS.

Methods

A single center, retrospective, observational chart review was conducted. Veterans reviewed by the STORM IDT between January and September 2018 were reviewed for change in Morphine Equivalent Daily Dose (MEDD), naloxone, nonopioid analgesics, medications for SUD, benzodiazepines, engagement with clinical services (e.g., mental health, SUD, and pain clinic), and overdose or suicide attempts in the year prior versus the year after IDT review. The frequency of follow-up IDT reviews was evaluated.

Results

Seventeen patients were identified. Four were excluded due to nonopioid related death within 12 months after review. The average baseline MEDD was 82.2 mg (range 10–496 mg) and average 12 months after review was 7.5 mg (range 0 – 67.5 mg), a decrease of 74.7 mg, or 90.9% reduction. An increase in medications for SUD (3 patients; 23%), SUD engagement (3 to 6 patients), and urine drug tests was observed (79% increase). Benzodiazepine use decreased by 50%.

Conclusion

This report provides insight on the IDT case review process at OVAHCS, a process that may vary widely across facilities. A reduction in MEDD, increase in SUD treatment, and improved risk mitigation was observed. The central role of clinical pharmacy and expanded process for continued follow-up warrants further study.

背景：与普通人群相比，退伍军人健康管理局（VHA）的患者患有精神疾病、慢性疼痛和药物使用障碍（SUD）的比例较高，这些疾病会增加阿片类药物相关不良事件的风险。退伍军人健康管理局开发了阿片类药物风险缓解分层工具（STORM），并规定由跨学科团队（IDT）对确定为极高风险的患者进行病例审查，该流程于 2018 年在奥兰多退伍军人事务医疗保健系统（OVAHCS）由临床药剂师实施和领导：评估并描述奥兰多退伍军人事务医疗保健系统（OVAHCS）通过 STORM 临床决策支持工具识别为极高风险患者的 IDT 审查的实施和流程：进行了单中心、回顾性、观察性病历审查。STORM IDT 在 2018 年 1 月至 9 月期间对退伍军人进行了审查，审查内容包括每日吗啡当量剂量 (MEDD)、纳洛酮、非阿片类镇痛药、治疗 SUD 的药物、苯二氮卓、参与临床服务（如心理健康、SUD、疼痛诊所）的情况，以及 IDT 审查前一年与 IDT 审查后一年的用药过量或自杀未遂情况。评估了 IDT 复查的频率：结果：确定了 17 名患者。结果：确定了 17 名患者，其中 4 名患者在复查后 12 个月内因与阿片类药物无关的死亡而被排除。基线 MEDD 平均为 82.2 毫克（范围为 10 - 496 毫克），复查后 12 个月的平均值为 7.5 毫克（范围为 0 - 67.5 毫克），减少了 74.7 毫克，即减少了 90.9%。据观察，治疗药物滥用（3 名患者；23%）、药物滥用参与（3 到 6 名患者）和尿液药物检测均有所增加（增加 79%）。苯二氮卓的使用减少了 50%：本报告深入介绍了 OVAHCS 的 IDT 病例审查过程，不同机构的审查过程可能大相径庭。据观察，MEDD 有所减少，SUD 治疗有所增加，风险缓解有所改善。临床药学的核心作用和持续跟踪的扩展流程值得进一步研究。

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引用次数: 0