American Journal of Health-System Pharmacy最新文献

Purpose: The design, implementation, and impact of a pharmacist-led employee wellness hypertension program that utilizes remote blood pressure monitoring are described.

Summary: Employees of a private university and health insurance beneficiaries with a diagnosis of hypertension or a documented high blood pressure reading at a previous screening encounter were eligible to participate in the program. Participants received a remote blood pressure monitoring device and followed up with a pharmacist in person or via telehealth throughout the program. The pharmacist provided education on lifestyle modifications to improve blood pressure control, and recommendations regarding changes to the participant's medication therapy were made to the participant's primary care provider. Participants completed an in-person appointment at month 3 of the program for blood pressure reassessment. Twenty-four participants were enrolled in the program. The mean baseline systolic and diastolic blood pressures were 134 mm Hg and 85 mm Hg, respectively. Of the total of 24 participants, 18 participants (75%) had a blood pressure above their goal at baseline. At month 3 of the program, 7 of these 18 participants (39%) had achieved their blood pressure goal, with average systolic and diastolic blood pressure decreases of 8.9 mm Hg and 7.8 mm Hg, respectively. Pharmacist recommendations to primary care providers regarding medication changes had an acceptance rate of 70%.

Conclusion: A pharmacist-led employee wellness hypertension monitoring program that utilized remote monitoring devices improved employee blood pressure control through education on lifestyle modifications and medication recommendations to the participants' primary care providers.

Purpose: To evaluate the use of terms denoting race/ethnicity in product labeling for 100 of the medications most commonly used in critically ill patients and to assess this information for overall frequency, frequency by drug class, and frequency within package insert sections to highlight the need for standardized and consistent use of Food and Drug Administration-approved terminology in drug packaging and other informational materials.

Methods: Data were collected by reviewing individual drug manufacturer package inserts. Each package insert was assessed for terminology that explicitly referenced race or ethnicity, and these terms were coded and quantified. After evaluating each of the 100 package inserts, a spreadsheet detailing the usage and presence of race and ethnicity terminology, including its location within the insert and frequency was created. This composite list was then analyzed to identify patterns in using such terminology.

Results: A cumulative analysis of all race/ethnicity-based terminology found in the package inserts for the top 100 intensive care unit drugs demonstrated that race/ethnicity-related terminology occurred 94 times in 21 package inserts. Summarizing these categories by number of occurrences showed that the race/ethnicity-based term "Black" occurred most frequently (in 29.8% [28/94] of package inserts]). Concerning the frequency of race/ethnicity-related terminology by agent class, the most frequent use of these terms was (in descending order): diabetes medications, anticoagulation, antimicrobials, antihypertensives, and medications used for cholesterol/lipid lowering. Regarding the frequency of the terms in the main sections of a package insert, most of these terms (a third of the total occurrences) were in the "Adverse Reactions" section (in 31.9% [30/94] of package inserts]).

Conclusion: Some of the terminology found in the package inserts in our study was either not listed or specifically not recommended for use in federal government reporting. These findings elucidate the prevalence and contexts in which race/ethnicity-related terminology is employed, highlighting its potential impact on clinical decision-making and drug use evaluation.

Purpose: This study aimed to evaluate the impact of integrating smart glasses with a pharmacy compliance mobile application on the efficiency of completing medication unit inspections. The goal was to compare traditional inspection methods using a mobile application alone with a method using smart glasses integrated with a mobile application, focusing on time to complete documentation and user satisfaction.

Methods: The study employed a quasi-experimental design with pre- and postimplementation phases, each lasting 90 days. Ten pharmacy technicians participated, utilizing a mobile application alone during the preimplementation phase and integrating smart glasses during the postimplementation phase. The primary outcome was time to completion of unit inspection documentation. Secondary outcomes included user satisfaction as assessed through a 5-point Likert scale survey.

Results: The average time to completion of a unit inspection using a mobile application alone was 1 minute, compared to 4 minutes with use of smart glasses (P < 0.01). Survey responses indicated significantly lower user satisfaction scores for inspection efficiency, quality, and communication after integration of smart glasses. User scores in the comfort and interface categories did not differ significantly in the pre- and postimplementation surveys.

Conclusion: Integrating smart glasses with mobile application did not enhance the efficiency of pharmacy unit inspections. Further refinement of smart glasses technology is needed to fully realize its potential benefits.

Purpose: Estimated glomerular filtration rate (eGFR) is the standard for categorizing renal function. Current creatinine-based estimates have been demonstrated to have limited accuracy, with national organizations encouraging use of cystatin C to calculate eGFR. This study aimed to describe the relationship between eGFR calculated using serum cystatin C (eGFRcysC) vs serum creatinine (eGFRcreat) using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.

Methods: A retrospective review was performed for the period from July 2018 through June 2022 that included inpatient adults with a measured serum cystatin C level and a paired serum creatinine level obtained within 24 hours of each other. eGFRcreat and eGFRcysC were calculated using the CKD-EPI equations. The primary objective was to identify factors that were significantly associated with discordance between eGFRcysC vs eGFRcreat, which was expressed as the percentage difference in eGFR (eGFRpct_diff). Differences in eGFRpct_diff by patient subgroup were assessed using a paired t test or ANOVA as appropriate. Univariate and multivariate regression analyses were performed to further identify variables associated with eGFRpct_diff.

Results: The study population included 226 patients. The mean (95% confidence interval) eGFRpct_diff by patient subgroup was as follows: CKD stage 4, 45.0% (25.6% to 64.4%); weight loss of greater than 10% in 1 year, -33.9% (-45.6% to -22.2%); cancer, -36.1% (-48.2% to -24.1%); and hemiplegia, -32.7% (-46.2% to -19.2%). Thirty-seven patients had at least one 24-hour urine collection for determination of creatinine clearance. Measured 24-hour creatinine clearance was better correlated with eGFRcysC (R2 = 0.754) than it was with eGFRcreat (R2 = 0.557) or creatinine clearance calculated using the Cockcroft-Gault creatinine equation (R2 = 0.288).

Conclusion: Cautious interpretation is recommended when estimating renal function from serum creatinine alone in patients with conditions associated with loss of muscle mass, including weight loss, cancer, hemiplegia, and immobility.

Purpose: Antimicrobial resistance has become an increasing concern worldwide. Antimicrobial stewardship (AMS) is a critical approach to protect against the danger of untreatable microbes. AMS programs frequently rely on the expertise of infectious diseases-trained physicians and pharmacists, yet access to such expertise is frequently limited in rural or smaller facilities like critical access hospitals (CAHs) and skilled nursing facilities (SNFs). However, nearly all these facilities have a staff or contract pharmacist available, even in more rural parts of the United States. These pharmacists may be important potential resources to promote stewardship in these low-resource settings.

Summary: The North Dakota Department of Health and Human Services and North Dakota State University collaborated to provide free AMS certification to predominantly rural pharmacists through a program offered by the Society of Infectious Diseases Pharmacists (SIDP) between 2018 and 2022, except in 2020 (due to the COVID-19 pandemic). Eighty-five pharmacists out of 113 applications were selected to complete the program. The preferential selection was based on whether pharmacists worked in a CAH or SNF or were willing to assist the above healthcare facilities in AMS activities. Fifty-four percent of the participants completed the program and developed an AMS intervention at their facilities, with 32% having interventions in progress at the time of assessment and 9% lost to follow-up over 4 years.

Conclusion: Pharmacists were incentivized to gain expertise in AMS in low-resource settings by providing free SIDP certification through the state health department. This may be a cost-effective use of state dollars to promote AMS in low-resource settings.

Purpose: To evaluate the recommendations given by 4 publicly available artificial intelligence (AI) programs in comparison to recommendations in current clinical practice guidelines (CPGs) focused on critically ill adults.

Methods: This study evaluated 4 publicly available large language models (LLMs): ChatGPT 4.0, Microsoft Copilot, Google Gemini Version 1.5, and Meta AI. Each AI chatbot was prompted with medication-related questions related to 6 CPGs published by the Society of Critical Care Medicine (SCCM) and also asked to provide references to support its recommendations. Responses were categorized as correct, partially correct, not correct, or "other" (eg, the LLM answered a question not asked).

Results: In total, 43 responses were recorded for each AI program, with a significant difference (P = 0.007) in response types by AI program. Microsoft Copilot had the highest proportion of correct recommendations, followed by Meta AI, ChatGPT 4.0, and Google Gemini. All 4 LLMs gave some incorrect recommendations, with Gemini having the most incorrect responses, followed closely by ChatGPT. Copilot had the most responses in the "other" category (n = 5, 11.63%). On average, ChatGPT provided the greatest number of references per question (n = 4.54), followed by Google Gemini (n = 3.43), Meta AI (n = 3.06), and Microsoft Copilot (n = 2.04).

Conclusion: Although they showed potential for future utility to pharmacists with further development and refinement, the evaluated AI programs did not consistently give accurate medication-related recommendations for the purpose of answering clinical questions such as those pertaining to critical care CPGs.

Purpose: Individuals may abstain from blood products due to religious or cultural beliefs. For trauma victims, blood loss is associated with anemia, decreasing oxygen delivery, and alternative treatment methods to blood transfusion are warranted in this population. Literature has investigated the use of epoetin alfa, an albumin-containing erythropoiesis-stimulating agent (ESA), to treat anemia for this indication; however, this may be problematic as albumin is a blood-derived product. Darbepoetin alfa is an albumin-free ESA alternative. This case series describes the use of darbepoetin alfa on anemia and outcomes in patients who abstain from blood products.

Summary: Trauma and acute care surgery patients are at risk for development of anemia related to traumatic injury as well as acute blood loss. Blood product transfusion is a common therapeutic intervention; however, patients may abstain from blood product administration. The 9 patients described herein with anemia (hemoglobin concentration of <7 g/dL or hematocrit level of <21%) during a hospital stay abstained from blood products and received darbepoetin alfa. Initial hemoglobin levels ranged from 4.1 to 10.1 g/dL, and patients received darbepoetin from 1 day to up to 17 consecutive days during their hospital stay. One patient experienced a type II non-ST elevation myocardial infarction.

Conclusion: The use of darbepoetin alfa appeared to be a therapeutic option to treat anemia in trauma and acute care surgery patients who abstain from blood products. Future studies are needed to compare epoetin alfa and darbepoetin alfa.

Purpose: To evaluate the implementation of an electronic early treatment assessment and monitoring (eTEAM) questionnaire within the electronic health record (EHR) patient portal designed to identify early adverse effects to oral anticancer therapy requiring pharmacist intervention.

Methods: This quality improvement analysis used the 5 dimensions of the RE-AIM implementation science framework to assess use of an innovative eTEAM questionnaire sent to patients 7 to 14 days after initial counseling on oral anticancer therapy. RE-AIM outcomes included the following: reach and adoption: the number of eTEAM questionnaires sent and the number of eTEAM responses received; effectiveness: the number of pharmacist interventions resulting from the eTEAM questionnaire; implementation: pharmacist responses to a postimplementation survey and semistructured individual interviews; maintenance: responses from postimplementation semistructured individual interviews with pharmacists. Results are reported descriptively.

Results: Of the 182 patients sent an eTEAM questionnaire, 47% (n = 85) responded. Pharmacists performed 29 interventions in 25 responding patients, most often due to adverse effects (n = 25) or adherence (n = 4). Most pharmacists agreed that the eTEAM questionnaire was appealing and feasible to use and that its use positively impacted their practice and patient care. Pharmacists recommended that the eTEAM questionnaire be improved by standardizing documentation of patients' actual oral anticancer medication start date in a discrete field.

Conclusion: The eTEAM questionnaire was positively received by patients, and pharmacists were supportive of its continued use based on feasibility and impact on practice. The eTEAM questionnaire effectively identified opportunities for pharmacist interventions in patients starting oral anticancer medications.