Innovations in pharmacy最新文献

Background: Recent legislatures have granted expanded prescriptive authority to pharmacists with a collaborative practice agreement with a physician. This authority could include prescribing tobacco cessation products, birth controls, and antivirals for COVID-19. Although closely associated with providing preventative measures for COVID-19 in the forms of testing and vaccinations, the relationship between pharmacist prescriptive power and rate of COVID-19 vaccination remains unexplored. The objective of the study is to determine the association between pharmacist prescriptive authority and the rate of COVID-19 vaccinations between neighboring counties along state lines of states with differing laws on this prescriptive power. Methods: States with expanded pharmacist prescriptive authority include: New Mexico, Oregon, Idaho, Florida, California, North Carolina, Montana, New York, Iowa, Massachusetts, and Ohio. Counties are selected if the center of the county is within 30 miles from a state border that divides a state with expanded pharmacist prescriptive authority from a state without. Monthly vaccination data from January 2021 to December 2021 was acquired from the Centers for Disease Control and Prevention and linear regression was performed and state-border-pair fixed effects was used as a control. Results: The estimated effect of expanded prescriptive authority is an increase of five percentage points in the share of the adult population that completed the initial COVID-19 vaccine series. Conclusion: The relationship between pharmacist prescriptive authority and increased COVID-19 vaccination rates is statistically significant. The results showed that allowing pharmacist to have prescriptive powers could potentially aid in reducing vaccine hesitancy for future pandemics.

BACKGROUND: Vaccination misinformation can contribute to vaccine hesitancy and decreased vaccination. Previous influenza immunization events at various K-12 schools carried out by Idaho State University L.S. Skaggs College of Pharmacy have noticed a small turn out of teachers and staff getting immunized during these events. Given the prominent role that teachers/staff serve in communities, we surveyed K-12 teachers and staff to determine their perceptions, knowledge, and reasons surrounding vaccine hesitancy. Our survey focused on the influenza vaccine, but also inquired about vaccine knowledge in general. METHODS: A Qualtrics survey was distributed online throughout the West Ada School District, located in southwestern Idaho. Demographics, receipt of influenza vaccine, vaccination motivation, knowledge and reasons for hesitancy were collected. Surveys were distributed July 2020 and analyzed using descriptive statistics. Response differences between those who most recently received their influenza vaccine and those who did not were also compared using chi-square or Mann-Whitney U tests when appropriate. RESULTS: A total of 503 surveys were completed, with all respondents teaching throughout the K-12 curriculum. A majority of respondents (n=409;81%) received a yearly influenza vaccination. Reasons for vaccination included: avoidance of flu, reduction of spread, and prevention of complications. Reasons against vaccination included: lack of efficacy, side effects, and numerous "other" responses. When comparing general influenza vaccine knowledge between those who received their influenza vaccine vs. those that did not, those who had been vaccinated displayed responses that more closely coincided with scientific data. CONCLUSIONS: The majority of surveyed K-12 teachers/staff received their influenza vaccine during the 2019-2020 season. However, ~20% of teachers/staff are still hesitant due to misinformation regarding vaccinations. Resources and partnerships between health organizations and school districts may increase vaccine acceptance.

Purpose: There are few studies that have assessed the utility of metformin and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in type 1 diabetes (T1D), specifically looking at glucose control indices. These studies have largely evaluated the impact of agents within the class that are not routinely used. Limited data exist on the use of the dual glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonist (GLP-1/GIP RA) in T1D. The objective of this study was to evaluate the effect of this growing practice in utilizing these common non-insulin therapies in T1D. Methods: This single-center, retrospective cohort study evaluated adult patients with T1D who received standard insulin therapy plus the following non-insulin therapies for at least 3 months: metformin; GLP-1 RA or GLP-1/GIP RA; or metformin and a GLP-1 RA or GLP-1/GIP RA (combination group). Data points were collected on starting dates of the first and second (if applicable) non-insulin agents, and the first office visit of at least 3 months on maximum tolerated doses. The primary endpoint was change in total daily insulin dose (TDD). Secondary and safety endpoints were evaluated in A1c, weight, and hypoglycemia. Results: A total of 110 of 366 patients met inclusion criteria. Changes in average insulin TDD were +4.06, -5.9 and -6.9 units for the metformin, GLP-1RA or GLP-1/GIP RA, and combination groups respectively (P =0.013). TDD after non-insulin therapy addition decreased in all patients on average 3.54 units (P =0.02). Non-insulin therapies showed a significant decrease in A1c by 0.62%, weight by 3.8kg, and hypoglycemia was seen in 76% of patients. Conclusions: Non-insulin therapies added to standard insulin therapy in T1D resulted in decreased insulin requirement, increased glycemic control, and decreased body weight. While statistically significant, it remains unclear if the decreased insulin requirement is clinically significant. Further prospective studies are warranted to validate these findings.

Purpose. The best method to measure blood pressure (BP) in a clinic setting is debatable. This study was conducted to compare serial BPs to a single repeat BP after an initial elevated reading. Methods. For this quality improvement process, instead of obtaining a second BP measurement after an initially elevated BP, medical assistants (MA) obtained serial BP readings two minutes apart. Rooming BP was compared to the first serial BP reading (current process), and to the average of the last two BP readings. Results. Seventy-eight patients were included. The average rooming BP was 155.5 ± 15.3 mmHg systolic (mean ± standard deviation) and 88.7 ± 11.8 mmHg diastolic, which decreased to 146.05 ± 18.2 mmHg systolic and 85.7 ± 11.8 mmHg diastolic for the first BP and 147.5 ± 16.2 mmHg systolic and 86.9 ± 12.1 mmHg diastolic for the average BP. Compared to the rooming BP, both readings were significantly decreased (first BP: p<0.001 SBP, p=0.006 DBP; average BP: p<0.001 SBP, p=0.011 DBP), but results were not significant when first BP was compared to average BP (p=0.756 SBP, p=0.278 DBP). A total of 26.9% and 23.1% of patients reached a BP goal of <140/90 mmHg with the first BP (p<0.001), and average BP (p<0.001), respectively. Conclusion. In patients presenting to an outpatient clinic with an initial elevated BP reading, simply repeating a single BP measurement shortly after completing the rooming process resulted in significantly reduced BP readings, and was equal to obtaining serial readings. In a busy clinic or pharmacy setting, healthcare providers can be reasonably confident that a single repeat blood pressure is an accurate reflection of a patient's true BP.

Background: Although the FDA approved acetaminophen toxicity dosing regimen for intravenous n-acetylcysteine (NAC) is a three-bag regimen, alternate regimens have been published which are generally simpler, and decrease errors and adverse effects. It is not clear how pervasive alternative regimens are used in hospitals in the US and reasons for a change from the FDA regimen. Objective: Characterize practice patterns for treating acetaminophen toxicity. Methods: A pilot-tested, electronic survey containing demographic and practice pattern questions for acetaminophen toxicity management was sent to residency program directors. The survey was open for 4 weeks with several reminder e-mails sent to non-responders. Descriptive statistics were used to summarize the data. Results: There were 119 responses (9.2% response rate). Responses were representative of all geographic areas in the US and were most commonly from community hospitals (67.2%) and those with 300 or more beds (72.2%). Nearly two-thirds used the FDA approved NAC regimen, whereas others used an alternate regimen. Reasons for making the change were for simplicity, to decrease errors or adverse events, or based on local poison center recommendations. More than one-third of respondents reported not using a maximum dosing weight. Conclusions: N-acetylcysteine is usually administered intravenously using the FDA approved regimen for acetaminophen toxicity. The weight for dosing was commonly capped at 100 kg, but some institutions did not use a maximum. Alternative intravenous regimens have been implemented at some institutions with the impetus for change being safety and simplicity.

Background: Our student-run free clinic (SRFC) treats uninsured patients with type 2 diabetes (T2D) in a medically underserved region. Mississippi has the second highest diabetes prevalence in the nation. Increasing access for patients with diabetes to affordable medication is challenging. Some studies provide encouraging results for lowering hemoglobin A1C and increasing medication adherence through patient assistance programs (PAP). None have examined a student-run PAP committee's impact on diabetes outcomes. Objective: To compare A1C levels for patients with diabetes enrolled in PAPs by our committee with those not enrolled and to describe clinical outcomes. Methods: A retrospective review of patients with T2D at our SRFC between 2015 and 2023 was performed. The primary outcome was change in A1C within a 4-9 month follow-up window. Secondary outcomes were emergency department (ED) visits and hospital admissions. Results: Twenty-five patients with T2D were enrolled in PAPs, while 77 were not. The PAP group had a higher baseline A1C (10.9% vs. 8.7%). The difference in A1C between groups was not statistically significant (P=0.68), even with adjustment for covariates (P=0.59). ED visit and hospital admission frequency was similar between groups. Neuropathy was the most common diabetic complication. ED visits and hospital admissions for heart attacks occurred only in the non-PAP group. Conclusion: While patients enrolled in PAPs showed a greater average reduction in A1C, the difference was not statistically significant. The higher baseline A1C in the PAP group carries greater reduction potential. A prospective study is necessary to better evaluate PAP enrollment outcomes for uninsured patients with diabetes.

Introduction: The pace of change in healthcare and throughout the world will only continue to escalate. This evolution of continuously changing information requires us to be responsive and innovative. There are more ways than ever to share information, and more need than ever to share best practices for leadership related to pharmacy. In keeping with the mission of INNOVATIONS in pharmacy (Iip), we invite you to share creative and dynamic scholarly leadership work. Methods: The traditional written manuscript is an author-centric form of scholarly output; the format, process, expediency, and familiarity of written manuscripts benefit authors, but may not be as easily consumed as more user-centric forms of information. The Iip leadership section team investigated alternative ways to disseminate the results of research work that don't include a traditional written manuscript. Findings: We reached out to leaders across a variety of pharmacy work and practice settings to understand the importance of leadership today and the importance for leadership in pharmacy. Responses were common across pharmacy professionals in all settings; nearly every response mentioned that leadership is important to help motivate a team toward a shared goal or vision and to be a role model. Pharmacy leaders feel that leadership is needed to make decisions, take accountability and, especially in an area as highly regulated as healthcare, ensure regulations and procedures are followed and standards are upheld. At the same time, our current environment requires attention to new challenges such as a multigenerational workforce and artificial intelligence. Call to Action: Through our work as scholars, we can provide evidence-based, pertinent, timely solutions to address these issues, in ways that make it easily transferable to broad audiences. The future of pharmacy leadership is in our hands and awaits our unique insights. Traditional written manuscripts are valuable but may not fully connect with some people. The evolving landscape of healthcare leadership demands novel perspectives, creative applications, and open-minded evaluations. Join us on this transformative journey. Submit your Innovative scholarly works to Iip.

Purpose: In the treatment of type 2 diabetes mellitus (T2DM), select sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are recommended based on comorbidities such as chronic kidney disease (CKD), heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD). Because guidelines typically recommend insulin for inpatient treatment of T2DM, there is potential that these therapies may be negatively impacted by hospitalization. This study aimed to assess the effect of hospitalization on outpatient T2DM therapy. Methods: In this retrospective study, patients were included if they had a diagnosis of T2DM plus a comorbidity (CKD, HF, ASCVD) for which they were prescribed an SGLT2 inhibitor or GLP-1 receptor agonist and had a recent hospitalization and follow-up appointment at an outpatient clinic. Electronic medical records were reviewed to determine if these therapies were continued during transitions of care. Data was analyzed with basic descriptive statistics. Results: Thirty-six patients on SGLT2 inhibitor therapy met inclusion criteria. Four (11%) patients were never restarted on therapy outpatient following hospitalization, three of which did not have an appropriate reason for discontinuation. Twenty-two patients on GLP-1 receptor agonist therapy met inclusion criteria. Four (18%) were never restarted on therapy outpatient following hospitalization, two of which did not have an appropriate reason for discontinuation. Conclusion: Five out of 58 patients (8.6%) included in the study experienced an inappropriate discontinuation of therapy throughout the transitions of care process. While most patients had their T2DM medication restarted, this study shows hospitalization can impact guideline-directed outpatient therapy.

Description of the problem: While previous studies have described the impact of incorporating a postgraduate year two (PGY2) Ambulatory Care resident on clinical outcomes and revenue, the impact of an independent Patient Centered Medical Home (PCMH) experience from the resident perspective has not been reported. The purpose of this study was to determine the impact of an independent PCMH rotation on resident confidence. Description of the innovation: A longitudinal, independent PCMH rotation has been part of a PGY2 Ambulatory Care residency since program inception. To determine the impact of this experience on resident confidence, a 23-item survey was developed and distributed electronically to all previous PGY2 Ambulatory Care residents who completed this experience. Critical Analysis: All invited residents (n=15) responded. Following PGY2 completion, 46.7% of respondents worked as a clinical pharmacist specialist at an academic medical center. Most (86.7%) practiced in primary care and/or population health. The majority responded that the independent PCMH clinic rotation resulted in a positive impact on their confidence in ownership of practice (100%), providing clinical care (93.3%), and pharmacist-patient interactions (86.7%). Implications: An independent PCMH rotation during PGY2 Ambulatory Care training can have a positive impact on post-residency clinical confidence.