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

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.

Background

One of the most potent barriers to treatment for substance use disorder (SUD) is stigma. Stigmatizing beliefs and attitudes by health care practitioners can negatively impact diagnosis, referral, and treatment. We implemented an interprofessional workshop using best practice principles of instructional design intended to reduce stigmatizing beliefs, attitudes, and behaviors among health professionals.

Methods

Stigma Unraveled/Addiction Unmasked was a 5.5-h interprofessional workshop conducted six times between May 2024 and January 2025. The workshops included instruction about the sources and consequences of stigma, personal reflection, participant-to-participant interaction, case studies, and direct contact with individuals with lived experience. Participants were asked to complete a 91-item pre-workshop (before) and 54-item post-workshop (3 months after) questionnaire containing items from the Shatterproof Addiction Stigma Index measuring desire for social distance, attitudes, and beliefs toward persons with a SUD (stimulants, alcohol, or opioids). The questionnaire also included items related to knowledge and public policy.

Results

A total of 214 individuals from 8 health professions participated in the workshops with 66 participants completing both the pre and post-workshop questionnaires (matched cohort). Comparing the pre and post-workshop responses from the matched cohort, there were significant reductions in the desire for social distance (27.0 ± 5.7 to 23.2 ± 6.5; p < 0.01; d = 0.62), stigmatizing beliefs (14.8 ± 4.7 to 12.1 ± 4.2; p < 0.01; d = 0.61), stigmatizing attitudes (13.8 ± 3.0 to 11.8 ± 3.4; p = 0.01; d = 0.62), and stigmatizing behavior (14.8 ± 4.1 to 12.8 ± 3.6; p = 0.04; d = 0.52) composite scores, as well as improvements in knowledge related to screening for SUD, stigmatizing language, and medication therapy. There was a high level of agreement for public policies to support individuals with SUD at baseline, with no change following the workshop.

Conclusions

The Stigma Unraveled/Addiction Unmasked interprofessional workshop prompted meaningful and statistically significant changes in participant beliefs, attitudes, behaviors, and knowledge.

Introduction

Addressing substance use disorders (SUD) stigma via interprofessional collaboration prior to patient exposure may empower more students to provide care to people with SUD (PwSUD) across settings.

Objective

To assess the impact of a SUD interprofessional educational program (SUD-IPEP) on medical (MS) and pharmacy students' (PS) attitudes about SUD treatment efficacy and personal characteristics of PwSUD.

Methods

Between February and March 2022, 288 students completed two self-study components and an active learning component. A 13-item perception survey was administered pre-IPEP and immediately post-IPEP. The survey consisted of five positive statements about treatment efficacy (e.g., treatment is effective and worth the effort) and the desired response was an increase in agreement with these statements. The remaining items were negative statements about the personal characteristics of PwSUD (e.g., these patients overuse health care resources and provide nothing in return) and the desired response was an increase in disagreement. Differences between subgroups (sex and race/ethnicity) were investigated. A third survey about the program's usefulness was administered 30 days post-IPEP.

Results

The response rate to the pre- and post-intervention surveys was 63.5%. At pre-intervention, there was agreement with positive statements, with no differences among subgroups. At post-intervention, PS showed a significant increase in agreement with statements about treatment efficacy. At pre-intervention, there was disagreement with negative statements about PwSUD, especially by females, MS, and Whites. No changes in perceptions were observed post-intervention for any group. Thirty-eight students completed the 30-day survey and 92% believed the SUD-IPEP benefited their professional development and/or practice, while 97% expected to continue using the information in the future.

Conclusions

Participation in the SUD-IPEP resulted in a general improvement in students' perceptions towards this patient population. Future studies should include whether additional educational components can help shift perceptions to reduce stigma towards PwSUD.

Background

The growth in ambulatory care positions for pharmacists demonstrates a need to recruit and train highly qualified pharmacists into the specialty. This paper describes how student skills related to patient care and practice advancement in ambulatory care pharmacy were enhanced through a partnership between one school of pharmacy (SOP) and a regional health system.

Methods

A concentration with didactic and experiential components created foundational learning opportunities for students interested in ambulatory care earlier in their curriculum, including a new course focused on ambulatory care pharmacy service development using real-world cases. Student perceptions were assessed using survey data and post-graduate outcomes are described.

Results

One hundred students from the classes of 2020 through 2025 have completed the concentration. Most students (95%) perceived better preparedness for ambulatory care rotations and agreed that the Ambulatory Care concentration made them more interested in pursuing a career in the field (88.2%) or a residency (82.4%). The health system perspective was assessed based on informal feedback from leadership and review of student projects. The health system described benefits in validating and informing service development. Longer term benefits are also discussed.

Conclusion

This unique partnership between an SOP and a regional health system creates opportunities that offer mutual benefits to the school, students, and the health system. The results of this evaluation indicate that students and health systems find immediate value from the collaboration and suggest possible longer-term benefits regarding practice advancement and the development of future practice specialists.