Journal of the American College of Clinical Pharmacy : JACCP最新文献

Background

Intracranial and extracranial hemorrhages are significant causes of morbidity and mortality. Emergency medicine pharmacists (EMPs) can play a crucial role in anticoagulation reversal by identifying patients on anticoagulation, selecting the optimal anticoagulation reversal agent, and ensuring adequate dosing and prompt administration. The goal of this systematic review and meta-analysis was to determine the impact EMPs have on time to anticoagulation reversal and patient outcomes in anticoagulation-associated hemorrhages.

Methods

A medical librarian performed a literature search in EBSCO CINAHL, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection from inception to January 2025 for all types of oral anticoagulants and for life-threatening bleeding that required emergent reversal. Newcastle-Ottawa was used to assess the risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the level of certainty of the evidence. Random effects models estimating mean differences and 95% confidence intervals are reported.

Results

There were 2445 titles and abstracts screened, with 44 undergoing full-text evaluation. Six observational studies including 219 patients who received an anticoagulation reversal agent with the presence of an EMP and 198 patients who received a reversal agent without an EMP were included. Time from emergency department (ED) presentation to anticoagulation reversal agent administration (75.60 min, 95% confidence interval [CI]: −101.7 to −49.5) and time from medication order to administration were faster with an EMP (−18.7 min, 95% CI: −23.5 to −14.0). There was no difference in short-term mortality. The included studies had a high risk of bias and were deemed very low quality of evidence.

Conclusion

EMP involvement in patient care during anticoagulation reversal of acute hemorrhages improved time to anticoagulation reversal agent administration. Larger scale, higher-quality studies are necessary to assess the value of EMPs in improving patient-centered outcomes.

Background

The opioid crisis remains a significant public health concern in the United States, with escalating rates of overdose and poisoning. However, health care professional schools have limited curricular time to address this issue. In response, faculty at Roseman University and Touro University have developed an Interprofessional Education (IPE) annual event to improve student understanding and comfort levels in addressing substance use disorder (SUD) and reduce stigma toward SUD among health care professional students. The objective of this study is to evaluate the effect of a SUD-focused IPE education among health care professional students on stigma levels and comfort levels in addressing SUD with persons with SUD.

Methods

An anonymous cross-sectional study was conducted using pre- and post-IPE surveys in Qualtrics. In 2023 and 2025, IPE students from four health care programs (Pharm.D., BSN, PA, and DO) were invited to complete surveys rating their comfort level with speaking about naloxone and familiarity with community resources. Students also answered the Medical Condition Regard Scale (MCRS) survey to determine their level of stigma related to SUD. Pre- and post-IPE results were compared from year to year and by program.

Results

Over 430 health care professional students participated in the SUD-focused IPE events. All survey response rates were over 50%. Over 60% of respondents were female, and PA and Pharm.D. were the most represented programs. In both years, all programs reported increased comfort in counseling and initiating conversations about naloxone and familiarity with community resources for SUD. There was an increase in MCRS scores for all programs, indicating reduced stigma (p < 0.001).

Conclusion

IPE continues to be a great opportunity to impact future health professionals' comfort levels in initiating critical conversations surrounding substance use, providing overdose prevention counseling, and increasing awareness of community resources, all while significantly reducing stigma.

Background

Pharmacist training on naloxone is often assessed within a few months following initial instruction; however, the retention of the skills necessary in a naloxone rescue beyond short-term follow-up and in the same cohort is not well documented.

The aim of this study was to determine how students of the same class would perform on a simulated opioid-induced breathing emergency (OIBE) response with naloxone during their third professional (P3) year versus their first professional (P1) year.

Methods

Pharmacy students in their P1 year were provided asynchronous training on naloxone information and use 2 days prior to a required skills lab. During class, students were provided hands-on experience with various naloxone devices, and then completed a simulation related to an encountered OIBE with naloxone response. These students completed the same simulation 2 years later during their P3 year having not received any additional training. A checklist from previously published work was used to evaluate student performance during each simulation. Results of the P1 and P3 simulations were compared.

Results

Eighty-three percent (n = 55) of students had P1 and P3 data and were included in the analysis. The mean scores for students with matching data were 77% (standard deviation [SD] = 10.42) during the P1 year and 86% (SD = 11.47) during the P3 year (p < 0.001). Two checklist items showed significant improvement from the P1 to P3 years: determine if the patient is breathing (P1 = 20%, P3 = 76%; p < 0.001), and slightly tilt the patient's head (P1 = 20%, P3 = 41%; p = 0.01). One item showed a significant decrease from the P1 to P3 years: determine if the patient has a pulse (P1 = 96%, P3 = 70%; p < 0.001).

Conclusion

Students of the same class performed better during their P3 year than their P1 year on a simulated OIBE with naloxone.

Background

Therapeutic inertia (TI) in type 2 diabetes mellitus (T2DM) is defined as the lack of timely adjustment to therapy when a patient's treatment goals are not met. Failure to initiate or intensify evidence-based therapies for T2DM increases the risk of micro and macrovascular disease complications. There are limited data regarding clinicians' (nurse practitioners and pharmacists) perceptions of TI and patient-perceived barriers to therapeutic progress in T2DM. A better understanding of perceptions of TI might assist in identifying targeted interventions to limit its occurrence. The objective of this study was to determine perceived factors that contribute to TI in patients with T2DM from a primary care clinician perspective.

Methods

This was a multi-centered prospective qualitative study. Purposive sampling was used. Primary care clinicians, licensed in the state of Michigan and treating patients with T2DM, were assessed on their attitudes and beliefs toward TI in the treatment of T2DM. Participant interviews were conducted by one investigator, and responses were independently reviewed by two separate investigators. Data were coded, organized, and analyzed using Dedoose software.

Results

Fourteen participants completed the study. Clinicians in the study were predominately pharmacists (57.1%) and female (92.9%) and the majority had more than 10 years of practice experience (57.1%). Major themes identified to help overcome TI were the importance of patient education, empathy toward the patient, and team collaboration. Therapeutic barriers identified by clinicians included cost, clinician/clinic time, and patient accountability.

Several perceived facilitators and barriers to TI in the management of T2DM were identified. Clinicians described a team-based approach with clearly delineated and complementary roles between clinicians to support patient care and minimize TI.

Conclusions

TI remains a persistent problem in clinical practice. Several opportunities exist to reduce TI in patients with T2DM, which include a multidisciplinary approach to care and improved access to medications and services (transportation, nutrition education, etc.).

Background

Pharmacist-led collaborative drug therapy management (CDTM) has been shown to improve chronic disease outcomes, enhance patient quality of life, and reduce health care costs. However, the perspectives of health care providers on these pharmacist-led services are not fully understood.

The primary objective of this study was to examine literature published on the perceptions of CDTM relationships between pharmacists, physicians, and advanced practitioners, such as nurse practitioners and physician assistants.

Methods

This scoping review sought to identify literature examining provider perceptions of pharmacist-led CDTM following the updated Arksey and O'Malley framework along with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR) for reporting guidelines. Studies were included if they were conducted in United States outpatient settings, written in English, and evaluated advanced pharmacy services such as CDTM, collaborative practice agreements, lab test ordering, or pharmacotherapy management. Studies were excluded if they focused on non-pharmacy professions, institutional settings, or lacked data on provider perceptions. Screening, selection, and data extraction were performed using Covidence, an online systematic review platform.

Results

This study maps the available literature surrounding physicians' and advanced practitioners' perceptions of and influences on CDTM relationships with pharmacists, drawing from 16 studies that met inclusion criteria. Most studies yielded qualitative results from a variety of survey instruments. Overall, the literature highlights a variety of providers' general perceptions of pharmacists involved in the CDTM relationship, with many perceptions being positive. Additionally, these studies reported both facilitators and barriers to a successful CDTM relationship.

Conclusion

This review identifies provider perceptions, facilitators, and barriers to successful CDTM relationships. Gaps in literature identified through this review included limited studies utilizing validated instruments and variability in the surveys used to collect data. Future studies should utilize standardized methods to assess provider perceptions and target the identified barriers to successful CDTM relationships.

Background

Pain management in patients with substance use disorder (SUD) is complex and often under-addressed in inpatient settings. Clinical pharmacy specialists (CPS) with expertise in pain management and addiction medicine can play a critical role in closing this care gap. To quantify and describe the clinical and financial impact of a Pain Management CPS focused on addiction medicine through characterization of intervention types and associated cost value.

Methods

This was a retrospective chart review of pharmacist interventions conducted over a four-week period in September 2024 at a large, academic, quaternary-referral center. The primary outcome was the identification of intervention type and quantity. Secondary outcomes included the cost value assigned to interventions, and the number of patients discharged with medications for opioid use disorder (MOUD).

Results

Over a one-month period, the Pain Management CPS documented 236 interventions across 72 patient encounters. The most common interventions were the addition of medication (30%) and therapeutic dose adjustments (29.9%). The four-week intervention value was $52711, with a projected annual value exceeding $600 000. MOUD were ordered in > 98% of encounters.

Conclusion

A dedicated Pain Management CPS with a focus on addiction medicine provides significant clinical and financial value in the inpatient setting. Their interventions support effective pain management, improve MOUD access, prevent adverse events, and enhance provider education, all of which contribute to improved patient outcomes and institutional value.

Background

In 2022, North Carolina (NC) passed a bill authorizing immunizing pharmacists to dispense HIV post-exposure prophylaxis (PEP) pursuant to a statewide protocol. This survey evaluated NC community pharmacists' knowledge, acceptability, appropriateness, and feasibility of pharmacist-initiated HIV PEP pursuant to the statewide protocol, and evaluated the barriers and facilitators to the implementation.

Methods

An online 15-min Qualtrics (Qualtrics, Provo, UT) survey was emailed to practicing NC community pharmacists registered with the NC Board of Pharmacy. Data was collected between March and April 2025. Descriptive statistics are reported.

Results

A total of 569 pharmacists responded (response rate = 9.3%), with 447 eligible pharmacist responses. Respondents were predominantly white (81%, n = 362), female (67.8%, n = 303), and practicing at a national chain pharmacy (38.4%, n = 174). Fifty percent (n = 280, 50%) of pharmacists noted that they were unaware of the NC standing protocol authorizing pharmacists to dispense HIV PEP. Most pharmacists felt slightly knowledgeable about current HIV PEP regimens (48.5%, n = 216), and most pharmacists (68.7%, n = 307) were slightly or very willing to initiate HIV PEP according to the statewide protocol. Respondents perceived the benefits of pharmacist-initiated HIV PEP to be increased access to preventative care in the community (69.9%, n = 391) and reduced transmission of HIV (64.6%, n = 361), and the most commonly perceived barriers include a lack of time (68%, n = 304) and staff to incorporate this into the workflow (65.8%, n = 294). Pharmacists also perceived a lack of training (52.3%, n = 234) and a lack of financial reimbursement for HIV PEP (50.3%, n = 225) as barriers to implementation.

Discussion

Despite limited awareness of the statewide protocol, most pharmacists are willing to dispense HIV PEP pursuant to the statewide protocol. Insurance coverage for pharmacist time to assess the patient and dispense HIV PEP along with training for community pharmacists on how to implement pharmacist-initiated HIV PEP into practice is needed.