Journal of the American Pharmacists Association最新文献

{"title":"Effectiveness, challenges, and improvement strategies for active tuberculosis case-finding practices by community pharmacy personnel: A scoping review","authors":"Carla Florencia,&nbsp;Kevin Aprilio,&nbsp;Dian Ayu Eka Pitaloka,&nbsp;Rob E. Aarnoutse,&nbsp;Ivan Surya Pradipta","doi":"10.1016/j.japh.2025.102966","DOIUrl":"10.1016/j.japh.2025.102966","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a major health challenge, with delayed detection accelerating its spread. Pharmacies are often the first contact for individuals with TB symptoms, yet their role in active case finding is underutilized.</div></div><div><h3>Objective</h3><div>This scoping review aims to comprehensively map the current studies, challenges, and potential strategies for effective and sustainable implementation.</div></div><div><h3>Methods</h3><div>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, we searched PubMed and Scopus for relevant studies up to October 26, 2023. We included studies on community pharmacy personnel (PP) engaged in active TB case-finding. Outcomes covered effectiveness, challenges, and potential strategies for active TB case finding involving PP. Two reviewers independently screened and extracted data, which were synthesized using the Consolidated Framework for Implementation Research.</div></div><div><h3>Results</h3><div>Twelve of 2003 articles met the inclusion criteria. All studies showed a contribution to TB case finding. However, key challenges identified include the complexity of integrating TB case-detection into routine workflows, patients' access barriers to clinics, and lack of resources. PP also faced issues such as their lack of confidence in TB screening and inadequate knowledge regarding TB referral. Improvement strategies are electronic referral, capacity building for PP, free diagnostic services, incentives for PP, and improved coordination between PP and TB program staff.</div></div><div><h3>Conclusion</h3><div>Enhancing active TB case detection by PP requires addressing challenges in workflow integration, patient access, and resource limitations. Capacity building, electronic referrals, free diagnostics, and incentives are key strategies to support PP involvement. Strengthening collaboration between the PP and TB program staff is essential for effective and sustainable referral processes.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102966"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433632","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}

{"title":"Multilevel factors associated with timeliness of care along the lung cancer care continuum: A systematic review","authors":"Sabina Nduaguba,&nbsp;Safalta Khadka,&nbsp;Nicole Stout,&nbsp;Mohammad Almubarak,&nbsp;Kimberly Kelly","doi":"10.1016/j.japh.2025.102965","DOIUrl":"10.1016/j.japh.2025.102965","url":null,"abstract":"<div><h3>Background</h3><div>Factors affecting time to lung cancer care may occur at multiple levels of influence.</div></div><div><h3>Objective</h3><div>The study aimed to identify multilevel factors associated with delays in lung cancer care.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines, Medline (PubMed), CINAHL, and SCOPUS were searched using validated search terms for lung cancer and factors, health disparities and time/delay. Eligible studies included original articles with quantitative, qualitative, or mixed-methods designs that investigated health disparities in, risk factors for, or barriers to timely screening, confirmatory diagnosis, or treatment among patients with lung cancer or those at risk for lung cancer. Title/abstract (TIAB), and full-text screening, study quality assessment (QA), and data extraction were conducted by 2 reviewers.</div></div><div><h3>Results</h3><div>13,068, 2608, and 424 TIAB were identified from PubMed, CINAHL, and SCOPUS, respectively. After deduplication, 14,405 articles were screened and 74 full-texts were assessed. Fifteen studies (all quantitative) were selected for QA and data extracted. Based on the National Institutes of Health QA tool, 5, 6, and 4 studies were rated good, fair, and poor, respectively. Multilevel factors associated with diagnosis to treatment interval were: Patient (demographic – age, sex, race/ethnicity, marital status, region, health insurance; disease – comorbidity, lung cancer type, stage, tumor size, brain metastasis, and treatment), clinic setting (facility type), environmental (income, poverty, hospital supply, and subspecialist supply). Other intervals assessed include: screening to diagnosis, symptom to initial primary care provider visit, suspicious image to diagnostics, suspicious image to diagnosis, suspicious image to surgical referral, and surgical referral to surgery.</div></div><div><h3>Conclusion</h3><div>We did not identify any qualitative or mixed-methods study. The quality of the included quantitative were fair-good. Qualitative and mixed-methods studies on the timeliness of lung cancer care are recommended to provide context on multilevel factors. The identified multilevel factors will help in intervention planning to select intervention components that address gaps in the timeliness of lung cancer care.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102965"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440539","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}

{"title":"Implementation strategies for the provision of fentanyl test strips in community pharmacies: Perspectives from pharmacy teams and harm reduction experts","authors":"Thai Q. Nguyen,&nbsp;Brianna E. Smith,&nbsp;Ian Foo,&nbsp;Mayka Chaves,&nbsp;Joni C. Carroll","doi":"10.1016/j.japh.2025.102981","DOIUrl":"10.1016/j.japh.2025.102981","url":null,"abstract":"<div><h3>Background</h3><div>Fentanyl test strips (FTS) are harm reduction (HR) tools that allow people who use drugs (PWUD) to check drug supplies for fentanyl. Pharmacies can be locations to access FTS services given their accessibility in communities; however, many pharmacy teams may not know how to provide this service. There is a need to better understand best practices for the implementation of FTS within pharmacies.</div></div><div><h3>Objectives</h3><div>This research aimed to identify strategies for implementing the provision of FTS in Pennsylvania community pharmacies.</div></div><div><h3>Methods</h3><div>This was a preimplementation qualitative study. We conducted focus groups with pharmacy teams and HR experts. Participants were selected using a purposeful, mixed heterogeneity and snowball sampling strategy. The discussion guide was informed by (1) the National Harm Reduction Coalition’s Principles of Harm Reduction, (2) previous published barriers to HR in the pharmacies, and (3) the Consolidation Framework for Implementation Research 2.0. Data were analyzed using an inductive thematic analysis, and findings were returned to participants for member checking purposes.</div></div><div><h3>Results</h3><div>Seven pharmacy team members and 7 HR experts participated in 4 focus group discussions. Seven strategies were identified: (1) adopt HR principles in your pharmacy practice before FTS implementation; (2) educate yourself, your pharmacy team, your patients, health care providers, and your community about FTS and HR; (3) partner with organizations and providers to implement FTS and other HR services; (4) normalize providing drug checking tools, like FTS, and other HR products and services in the pharmacy; (5) build relationships with PWUD and their communities; (6) offer other health and patient care services alongside providing FTS; and (7) plan for FTS/HR service implementation and sustainability.</div></div><div><h3>Conclusion</h3><div>Both pharmacists and HR experts supported FTS distribution through community pharmacies. Seven strategies emerged from focus group discussions that guide FTS service implementation within pharmacies.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102981"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472650","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}

{"title":"Disparity implications of machine-learning-based MTM eligibility criteria","authors":"Chi Chun Steve Tsang,&nbsp;Yan Cui,&nbsp;William C. Cushman,&nbsp;Catherine M. Crill,&nbsp;Katherine Stracner,&nbsp;Junling Wang","doi":"10.1016/j.japh.2025.103015","DOIUrl":"10.1016/j.japh.2025.103015","url":null,"abstract":"<div><h3>Background</h3><div>Although Medicare Medication Therapy Management (MTM) programs have demonstrated clinical and economic benefits, racial/ethnic minority groups face challenges meeting eligibility criteria for enrollment. In 2017, the Centers for Medicare and Medicaid Services launched the 5-year Enhanced MTM demonstration, granting Part D plans flexibility in identifying eligible beneficiaries. However, because participating plans adopted predictive modeling to determine eligibility, concerns persist that this approach may perpetuate existing racial/ethnic disparities.</div></div><div><h3>Objectives</h3><div>To assess whether health cost-based MTM eligibility differs across race/ethnicity and whether machine learning models reproduce observed disparities in predicted eligibility.</div></div><div><h3>Methods</h3><div>This study analyzed 2019 Medicare administrative data linked to the Area Health Resource File for a 10% random sample of fee-for-service beneficiaries. Outcomes were binary indicators of top-quartile medication and health care costs, each measured from the Medicare and health care system perspectives. Multivariable logistic regression was employed to assess racial/ethnic disparities in top-quartile costs, using 6 algorithms – regularized logistic regression, random forest, gradient boosted trees, support vector machine, multilayer perceptron, and a consensus model. Predicted probabilities were computed to assess disparities in model outputs using multivariable fractional logistic regression.</div></div><div><h3>Results</h3><div>Among 1,848,654 Medicare beneficiaries, Black and Hispanic individuals had significantly lower adjusted odds of top-quartile costs across all cost outcomes compared to their non-Hispanic White counterparts. For instance, the odds of being in the top quartile for total medication costs were 28% lower for Black beneficiaries (odds ratio [OR] = 0.72, 95% confidence interval [CI] = 0.70–0.75) and 21% lower for Hispanic beneficiaries (OR = 0.79, 95% CI = 0.74–0.84). Machine learning models reproduced these disparities in predicted probabilities, mirroring patterns in the empirical data.</div></div><div><h3>Conclusion</h3><div>Implementing cost-based MTM eligibility through predictive algorithms may perpetuate racial/ethnic disparities in MTM program access. Future research should explore strategies to mitigate such a potential when using such modeling to determine MTM eligibility.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103015"},"PeriodicalIF":2.5,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890920","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}

{"title":"How individuals choose medications: Tool development for a discrete choice experiment on eye allergy treatment decisions","authors":"Laura Formosa,&nbsp;Ruben Vargas,&nbsp;Leslie Wilson","doi":"10.1016/j.japh.2025.103010","DOIUrl":"10.1016/j.japh.2025.103010","url":null,"abstract":"<div><h3>Background</h3><div>Allergic conjunctivitis affects nearly 40% of the U.S. population, triggered by allergens like pollen or pet dander. Since only 10% of individuals seek medical attention, most rely on over-the-counter (OTC) treatments. The condition can be managed with OTC and prescription (Rx) medications, depending on symptom severity. However, little is known about how individuals decide between treatment approaches.</div></div><div><h3>Objectives</h3><div>This study aimed to develop and pilot-test a choice-based conjoint (CBC) tool to measure preferences for 3 treatment approaches: 1) self-selected OTC treatment, 2) pharmacist-advised OTC treatment, and 3) physician-prescribed Rx treatment.</div></div><div><h3>Methods</h3><div>We developed a CBC tool following ISPOR guidelines for conjoint analysis and discrete choice experiments. Key steps included identifying relevant attributes through literature review, validating them through interviews (n = 9), and designing the CBC in Sawtooth Software (Sawtooth Software, Inc) with 10 random and 3 fixed scenarios. Validity testing was conducted with 22 participants to evaluate the tool's ability to capture variability across preference responses.</div></div><div><h3>Results</h3><div>The CBC tool included 7 attributes: speed of access to treatment, first treatment decision, accuracy of treatment, ease and comfort of administration, cost, time and duration of relief, and side effects, each with 2–3 levels. Validity results showed capture of variability in responses and ability to respond to fixed questions.</div></div><div><h3>Conclusion</h3><div>This research developed a CBC tool using discrete choice methods to measure how individuals make trade-offs among access, symptom relief, and other factors when selecting treatment approaches for allergic conjunctivitis. The tool offers a replicable framework for measuring individual's treatment management decisions in health care across the health care continuum. This tool will allow measurement of individual preferences for medication choices across the spectrum from self- or pharmacy-assisted OTC, to physician prescribed treatments.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103010"},"PeriodicalIF":2.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844661","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}

{"title":"Pharmacists' propensity to trust automated technologies: A demographic analysis","authors":"Megan Whitaker,&nbsp;Brigid Rowell,&nbsp;Jin Yong Kim,&nbsp;Raed Al Kontar,&nbsp;X. Jessie Yang,&nbsp;Corey A. Lester","doi":"10.1016/j.japh.2025.103011","DOIUrl":"10.1016/j.japh.2025.103011","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI), in conjunction with automated technologies, is being deployed in pharmacies. Little research has been published regarding pharmacists' general willingness to trust AI. Understanding pharmacists' propensity to trust (PTT) AI may help guide the successful implementation and adoption of AI tools.</div></div><div><h3>Objective</h3><div>The objective is to assess pharmacists' PTT AI with automated technology and identify factors that may influence this tendency.</div></div><div><h3>Methods</h3><div>As part of a larger study, licensed pharmacists completed a demographics survey and the PTT survey before testing AI advice on medication fills. The PTT survey consisted of 6 statements about AI and pharmacists indicated their level of agreement using a 5-point Likert scale, with higher numbers indicating more agreement. Summary statistics, Kruskal-Wallis tests, linear regressions, and confidence intervals were calculated.</div></div><div><h3>Results</h3><div>Ninety-nine pharmacists completed the surveys. The mean pharmacist age was 38.1 years and the median PTT score was 3.83 (<em>P</em> &lt; 0.001). Age was a statistically significant predictor of PTT (β = 0.02, <em>P</em> &lt; 0.001, and R² = 0.11). Linear regressions yielded statistically significant results for age and the work experience category of 21 or more years. No significant differences were found between the PTT scores and gender, ethnicity, race, or pharmacy setting.</div></div><div><h3>Conclusions</h3><div>Older and more experienced pharmacists had higher PTT scores. Exposure to AI tools during pharmacy education may help younger pharmacists optimize their PTT AI.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103011"},"PeriodicalIF":2.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835831","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}

{"title":"A unifying vision for pharmacy: Defining professional identity through stakeholder perspectives","authors":"Denise H. Rhoney,&nbsp;Kimberly K. Daugherty,&nbsp;Aleda M.H. Chen,&nbsp;Mariann Churchwell,&nbsp;Stephanie Sibicky,&nbsp;Krisy-Ann Thornby,&nbsp;Nicholas R. Nelson,&nbsp;Erika L. Kleppinger,&nbsp;Dennis Parker,&nbsp;Kelly R. Ragucci,&nbsp;Cindy D. Stowe PharmD,&nbsp;Tina P. Brock","doi":"10.1016/j.japh.2025.103013","DOIUrl":"10.1016/j.japh.2025.103013","url":null,"abstract":"<div><h3>Background</h3><div>Amid evolving health care demands, pharmacy faces a critical identity inflection point that requires a cohesive vision.</div></div><div><h3>Objective</h3><div>This study aimed to define a cohesive, stakeholder-informed vision for the U.S. pharmacist's societal role by analyzing perceptions from across education, practice, and policy.</div></div><div><h3>Methods</h3><div>The study applied a multimethod qualitative design guided by constructivist epistemology incorporating thematic analysis, metaphor discourse analysis, force field mapping, and analysis of alignment with national forecast reports. Data were collected from 27 focus groups and 8 individual interviews with 148 participants representing 8 stakeholder categories.</div></div><div><h3>Results</h3><div>From these themes, five metaphorical roles emerged, medication safety and optimization; access and equity in health care; chronic disease management; health promotion and preventative services; and patient education, counseling, and advocacy, highlighting broad agreement on pharmacists' contributions. Five metaphorical roles, safety net, steward, coach, navigator, and advocate, reflected a multidimensional professional identity. Force field analysis demonstrated a balance between driving forces, such as accessibility, medication safety, and public health leadership, and restraining forces, including lack of provider status, regulatory variation, and workforce instability. Comparative analysis showed strong alignment with national pharmacy forecasts, though gaps emerged in areas such as digital readiness, economic literacy, and global practice models.</div></div><div><h3>Conclusion</h3><div>This study provides an empirically grounded framework to inform a unifying vision for pharmacy's future. Stakeholder insights reinforce the need for education reform, policy realignment, and narrative clarity to reposition pharmacists as essential contributors to health-system transformation. By embracing a hybrid identity and dismantling structural barriers, the profession can fulfill its societal mandate in safety, accessibility, and care innovation.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103013"},"PeriodicalIF":2.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835819","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}

{"title":"Expanding pharmacogenomics in the community pharmacy setting: A survey of Alabama community pharmacists' confidence, perceptions, interest, and preparedness","authors":"Courtney S. Watts Alexander,&nbsp;Lucia G. Tocco,&nbsp;Lena D. McDowell,&nbsp;Lindsey A. Hohmann,&nbsp;Kimberly Braxton Lloyd,&nbsp;Olivia G. Chafe,&nbsp;Courtney E. Gamston","doi":"10.1016/j.japh.2025.103012","DOIUrl":"10.1016/j.japh.2025.103012","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacogenomics (PGx) clinical decision support (CDS) is essential for effective PGx implementation, yet most tools remain confined to institutional settings. Community pharmacists, who make up nearly half of the U.S. pharmacy workforce, are among the most accessible health care providers, offering care without appointments and reaching patients across both urban and rural areas. This accessibility positions them as critical entry points for delivering PGx services and advancing equitable access. However, many lack the training and resources necessary to provide informed PGx care.</div></div><div><h3>Objective</h3><div>The purpose of this study was to survey Alabama community pharmacists to assess confidence in PGx knowledge and experiences, perceived benefits and barriers, and interest and preparedness for implementation, with attention to the role of CDS tools.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was distributed via email to Alabama pharmacists between September and October 2024. Items included Likert-type scales, multiple-choice, yes/no, and open responses. Descriptive statistics characterized responses, and Mann-Whitney <em>U</em> tests compared responses between subgroups.</div></div><div><h3>Results</h3><div>Of 1638 invited pharmacists, 233 responded (14.2%), with 135 included in the analysis. Participants were primarily female (70.9%), urban (81.5%), and averaged 45.4 years of age. Only 19% reported prior PGx training. Confidence in foundational knowledge was low (mean scale score = 2.74, standard deviation [SD] = 0.44). Perceived benefits were high (mean scale score = 4.06, SD = 0.17). Interest and preparedness varied (interest = 3.52 [SD = 0.15]; preparedness = 2.69 [SD = 0.32]). Fifty percent desired PGx-CDS tools, and 53% expressed interest in offering PGx services; however, few reported adequate site resources.</div></div><div><h3>Conclusion</h3><div>Alabama pharmacists expressed strong PGx interest and perceived benefits, but reported gaps in knowledge, confidence, and infrastructure. Given their accessibility, community pharmacists represent a critical bridge to equitable PGx adoption. Expanding PGx education, training, and CDS integration is essential to enable sustainable PGx delivery in community pharmacy.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103012"},"PeriodicalIF":2.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835824","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}

{"title":"Implementation and outcomes of a pharmacist-led social determinants of health screening and intervention program in an integrated health system specialty pharmacy model","authors":"Irfana Lakada,&nbsp;Martha Stutsky,&nbsp;Carolkim Huynh,&nbsp;Shreevidya Periyasamy,&nbsp;Andrea Idusuyi","doi":"10.1016/j.japh.2025.103008","DOIUrl":"10.1016/j.japh.2025.103008","url":null,"abstract":"<div><h3>Background</h3><div>Social determinants of health (SDOH) are nonmedical factors that impact health outcomes. Pharmacists within integrated health system specialty pharmacies (HSSPs) are positioned to identify and address SDOH barriers.</div></div><div><h3>Objective</h3><div>The objective was to implement and evaluate a pharmacist-led SDOH program for HSSP patients.</div></div><div><h3>Practice description</h3><div>The practice innovation was implemented within 4 health systems in Michigan and Massachusetts with associated HSSPs and a standard specialty pharmacy clinical management model incorporating initial patient counseling and periodic reassessments.</div></div><div><h3>Practice innovation</h3><div>A SDOH screening and intervention program was developed and piloted at 4 health systems with associated HSSPs. Patients with HIV, rheumatoid arthritis (RA), and hyperlipidemia meeting pre-defined inclusion criteria were enrolled in the program from September 2023 through September 2024. After screening patients for SDOH barriers, pharmacists offered targeted interventions and structured follow-ups to ensure resolution of challenges.</div></div><div><h3>Evaluation methods</h3><div>Patients enrolled in the program were analyzed using data extracted from the electronic medical record and patient management platform. The primary outcome was intervention acceptance rate; secondary outcomes included intervention categories, patient-perceived value of interventions, ongoing support needs, pharmacist time spent, and clinical outcomes.</div></div><div><h3>Results</h3><div>Of the 50 patients (HIV: n = 6; RA: n = 27; hyperlipidemia: n = 17) enrolled, 56% completed screening and 79% of those accepted interventions. Of the 19 patients who received follow-up, 63% found the interventions beneficial, and 4 required ongoing support. The most frequent interventions included food security/nutrition (46%) and physical activity (25%). The average time per intervention was 60 min (range: 15-180 min). Patients with interventions demonstrated clinical outcomes improvements, including a mean Routine Assessment of Patient Index Data 3 score reduction of 3 points (range: 1.3-27.3) and mean low-density lipoprotein reduction of 29.8 mg/dL (range: 44-137) for RA and hyperlipidemia, respectively.</div></div><div><h3>Conclusions</h3><div>These pilot results suggest that a pharmacist-led SDOH program may be effective in addressing patient barriers, demonstrated by high acceptance rate and perceived benefit of interventions and improved clinical outcomes.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103008"},"PeriodicalIF":2.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800950","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}

{"title":"Methemoglobinemia induced by dapsone, hydroxychloroquine, and rifampin combination for post-treatment Lyme disease syndrome: A case report","authors":"Jarett Worden,&nbsp;Tyler Baumeister,&nbsp;Sarah Stogner,&nbsp;Nancy Henin,&nbsp;Rebecca A. Stern","doi":"10.1016/j.japh.2025.103009","DOIUrl":"10.1016/j.japh.2025.103009","url":null,"abstract":"<div><h3>Background</h3><div>A patient presented to the emergency department with drug-induced methemoglobinemia due to a combination of medications prescribed for post-treatment Lyme disease syndrome (PTLDS). This case highlights the potential risks of dapsone, hydroxychloroquine (HCQ), and rifampin for the management of PTLDS.</div></div><div><h3>Case summary</h3><div>A 62-year-old female presented to the hospital with shortness of breath and low oxygen saturation. Past medical history included a diagnosis of PTLDS, for which she was prescribed a combination of dapsone, HCQ, doxycycline, rifampin, and ivermectin at home. The patient had an oxygen saturation of 88% on room air but was otherwise clinically stable. Arterial blood gas was obtained and demonstrated an elevated methemoglobin level (11.2%). Analysis of peripheral blood smear revealed oxidative hemolysis, indicating medication-induced methemoglobinemia. Glucose-6-phosphate-dehydrogenase (G6PD) testing was ordered to assess for G6PD deficiency, as this is a known risk factor for methemoglobinemia and had not previously been evaluated for this patient. Testing did not demonstrate a G6PD deficiency for this patient. A negative Lyme total antibody test confirmed no active infection. Both dapsone and HCQ are known to induce methemoglobinemia and the addition of rifampin may enhance this effect. Patient improved on supplemental oxygen, ascorbic acid, and discontinuation of dapsone, HCQ, ivermectin, doxycycline, and rifampin therapy.</div></div><div><h3>Practice implications</h3><div>There is no strong evidence for any anti-infectives used for the treatment of PTLDS, with either short- or long-term use. Dapsone and HCQ can each cause methemoglobinemia. That effect may be increased when used together, especially in combination with rifampin. Appropriate risk assessment and monitoring should be considered when utilizing this combination.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 2","pages":"Article 103009"},"PeriodicalIF":2.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800975","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}