Journal of the American Pharmacists Association最新文献

Background: Use of sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors) falls short of their cardiorenal protective benefits. Patient and provider-level barriers hinder the adoption of these life-saving medications. Innovative practices to provide primary care providers (PCPs) with added clinical-decision support via a dedicated remote interdisciplinary diabetes rounds (IDRs) team could promote SGLT-2 inhibitor selection.

Objective: To evaluate the impact of the IDR's proactive provider outreach on the prescribing rate of SGLT-2 inhibitors and assess the application of an SGLT-2 inhibitor case-finding algorithm to allow targeted intervention in a population-health-based setting.

Methods: This is a quality improvement prospective cohort observational study from October 2021 to May 2022. Patients who met the prespecified criteria for SGLT-2 eligibility were reviewed via IDR with recommendations sent to the PCP via the electronic health record. The primary analysis employed a multivariate logistic regression to assess the difference in SGLT-2 inhibitor prescription rates between reviewed and not reviewed patients, adjusting for variables affecting SGLT-2 inhibitor prescribing. The secondary analysis measured the algorithm's accuracy in identifying patients with compelling indications.

Results: The IDR team reviewed a total of 206 patients (mean age, 63 years; 53.9% women; 42.7% Black; mean A1c 8.3%) with a successful PCP appointment. Patients reviewed by the IDR team had an increased prescribing rate within 90 days of the visit (adjusted odds ratio 5.1, 95% CI 3.06-8.47). The algorithm identified 1084 SGLT-2 inhibitor-eligible patients with a sensitivity of 90.4% (95% CI, 86.4%, 94.4%) and specificity of 85.1% (95% CI, 79.9%, 90.4%).

Conclusion: IDR team's review of eligible patients with recommendations to PCPs was associated with significantly increased SGLT-2 inhibitor prescription rates. Development of an algorithm with high sensitivity and specificity for targeted intervention may provide a pathway for channeling therapy and decreasing clinical inertia in population health management efforts.

Background: Many US hospitals and health systems have implemented well-being programs to address the clinician well-being and burnout crisis. Most community pharmacists experience at least one symptom of burnout, yet they have been overlooked for inclusion in well-being initiatives.

Objective: To explore community pharmacists' perceptions of how motivation and burnout impact patient care and how fulfillment of basic psychological needs (autonomy, competence, and relatedness) impacts motivation and well-being.

Methods: Focus groups were conducted with 20 community pharmacists. A semistructured focus group guide was developed using Self-Determination Theory (SDT). Transcriptions from the focus groups were analyzed using deductive qualitative analysis with SDT as a framework and inductive analysis to code subthemes.

Results: Our findings revealed that pharmacists who feel burnout experience depersonalization toward patients which lowers the quality of patient-pharmacist interactions. Pharmacists who did not feel burnout expressed a sense of professional fulfillment, which motivated them to provide patient-centered care. Pharmacists indicated that unrealistic expectations from patients and corporate management, such as pressure from patients to fill prescriptions quickly and management expectations to meet prescription fill quotas, negatively impacted autonomy. Conversely, having access to clinical information, workflow optimization, and realistic job expectations supported autonomy. Poor relationships with patients and coworkers negatively impacted relatedness and contributed to communication barriers, workplace negativity, and emotional detachment from work. Relatedness was facilitated by building relationships and mutual respect with patients and coworkers and cultivating a positive work culture. Expectations for perfection and the need for multitasking when understaffed diminished competency. Adequate staffing and allocation of time to complete job duties served to support competency.

Conclusion: Community pharmacists are faced with situations that undermine autonomy, relatedness, and competency, which according to SDT need to be fulfilled to facilitate well-being.

Background: Policy changes during the COVID-19 pandemic allowed buprenorphine to be prescribed for opioid use disorder via telemedicine without an in-person visit. A recently proposed change will limit buprenorphine access to 30 days without an in-person visit. Given that people living in rural areas may be disproportionally impacted by this change, we sought to better understand how buprenorphine adherence may be impacted by requiring in-person visits.

Objective: Compare buprenorphine adherence after telemedicine to adherence after in-person visits for patients who live in rural and urban areas.

Methods: In this retrospective cohort study, we used electronic health record data from a large medical center. The cohort included all adult patients prescribed buprenorphine for opioid use disorder during 2017-2022. The primary outcome was adherence, characterized by the Medication Possession Ratio (MPR) and gaps in buprenorphine treatment at 30 and 180 days. We conducted a longitudinal analysis at visit level, stratified by patient urbanicity, and controlled for patient, prescriber, prescription, and setting characteristics.

Results: From 511 patients, we followed 3302 in-person and 519 telemedicine visits. Compared to in-person visits we observed no difference in the adherence following telemedicine visits overall. However, telemedicine was associated with higher MPR for rural patients (30 days: adjusted marginal effects [AME], 3.7%; 95% CI, 2.0-5.5; P < 0.001 and 180 days: AME, 8.5%; 95% CI 5.7-11.3; P < 0.001) and fewer gaps (30 days: AME, -6.7%; 95% CI, -9.9 to -0.1; P < 0.001 and 180 days: AME, -9.4%; -14.0 to -4.5; P < 0.001) compared to in-person visits.

Conclusion: These findings suggest that telemedicine is a viable alternative to in-person visits, especially for patients living in rural areas, which should help guide future policies that preserve or increase access to buprenorphine in a manner that can reduce barriers for patients.