American Journal of Health-System Pharmacy最新文献

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: This article identifies, prioritizes, and summarizes published literature on the ambulatory care medication-use process (ACMUP) from calendar year 2021 that can impact ambulatory pharmacy practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing and collaborative practice, accessing care, adherence, and monitoring and quality. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement.

Summary: A PubMed search was conducted in January 2022 for the year 2021 using targeted Medical Subject Headings keywords and the tables of contents of selected pharmacy journals were also searched, providing a total of 6,026 articles. A thorough review identified 86 potentially practice-enhancing articles: 10 for transitions of care, 9 for prescribing and collaborative practice, 20 for adherence, 17 for accessing care, 18 for monitoring and quality, and 12 for monitoring and medication therapy management. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest ranked articles are briefly summarized, with a mention of why each article is important. The other articles are listed for further review and evaluation.

Conclusion: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Purpose: Secondary to the risk of antipsychotic-induced acute dystonia, prophylactic use of benztropine is occasionally warranted but is recommended for no longer than 7 days after initiating an antipsychotic, correlating to the period of highest dystonia risk. Despite the associated increased anticholinergic burden, many clinicians continue to order benztropine for periods exceeding the recommended prophylactic duration. We investigated the reduction of benztropine use duration subsequent to implementation of truncated electronic entry orders to improve benztropine prescribing within an acute psychiatric facility.

Methods: Data were collected for psychiatric inpatients admitted between January and June 2020 who were prescribed scheduled benztropine. In a quality improvement initiative implemented in April 2022, electronic orders for benztropine were modified from a 180-day to a 7-day duration, with subsequent postintervention data collection. The primary outcomes included a change in the duration of benztropine use for any indication in the hospital, and a change in the percentage of patients meeting predetermined "unnecessary use" criteria. Secondary analyses included the percentage of patients with discharge prescriptions for scheduled benztropine (either for prophylaxis or for other indications) in the pre- and postintervention periods.

Results: 73 pre- and 77 postintervention individual patients/encounters were included. Following the intervention, in-hospital duration of benztropine use for any indication decreased from a median of 14 days to a median of 7.5 days (P < 0.05), and appropriate use increased by 92.9%. The percentage of patients with prescriptions for scheduled benztropine decreased from 67.1% in the preintervention group to 29.9% in the postintervention group.

Conclusion: Decreased benztropine use duration, by means of truncated order entry sentences, during inpatient psychiatric admissions, appears feasible regardless of dual antipsychotic or first-generation antipsychotic use, and may reduce the rates of benztropine prescriptions written for discharge.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: A previous study at Ascension Seton Hospital Network (ASHN) found a 1:1 dose conversion to insulin detemir 100 units/mL (iDet100) from insulin glargine 300 units/mL (iGlar300) increased the incidence of hypoglycemia as compared to a 1:1 conversion from insulin glargine 100 units/mL. No studies have evaluated an automatic 20% dose reduction for this specific therapeutic interchange. The purpose of this study was to compare hypoglycemia rates following implementation of a protocol specifying a minimum 20% dose reduction when converting from iGlar300 to inpatient iDet100.

Methods: This multicenter, retrospective chart review-based study was a before/after study evaluating the impact of an ASHN protocol implemented in April 2021 requiring a minimum 20% reduction when converting from home iGlar300 to inpatient iDet100. Previously, a 1:1 interchange was standard. Patients admitted between May 2019 and December 2022 were included if at least 1 dose of iDet100 was received following interchange from iGlar300. The primary endpoint was hypoglycemia incidence before and after protocol implementation. Secondary endpoints included time to first hypoglycemia and number of doses given before hypoglycemia. Logistic regression was performed to analyze the relationship between percent interchange from home dose and hypoglycemia rate.

Results: A total of 284 patients were included: 128 in the preprotocol arm and 156 in the postprotocol arm. The incidence of hypoglycemia was significantly lower in the postprotocol arm than in the preprotocol arm (11.9% vs 24.7%; P = 0.018). The median time to first hypoglycemia was longer in the postprotocol versus the preprotocol arm, though the difference was not statistically significant (13 vs 18.5 hours, P = 0.082). For each percent reduction from iGlar300 to iDet100, the likelihood of hypoglycemia was reduced by 5.3%.

Conclusion: A protocol requiring a minimum 20% dose reduction from iGlar300 to inpatient iDet100 reduced the incidence of hypoglycemia. Health systems should consider adopting a similar approach to reduce the occurrence of hypoglycemia upon interchange.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: A population health pharmacy team was developed to improve health and increase reimbursement for patients with value-based care plans. The purpose of this study was to evaluate the impact of pharmacy involvement on care gap closure in Managed Medicaid patients.

Methods: This was a single-center, retrospective cohort study of Managed Medicaid patients seen at outpatient facilities. Patients had a pharmacy risk score (PRS) of 6 or greater and had not achieved the Medicaid quality measures for both glycated hemoglobin (HbA1c) and blood pressure (BP). The intervention group included patients reviewed by pharmacy, compared to a control group of patients not reviewed by pharmacy. The primary outcome was closure of at least one care gap by the end of 2022. Secondary outcomes were the number of each type of gap closed, the frequency at which recommendations were made by pharmacists, and the frequency at which pharmacist recommendations were implemented by providers.

Results: Data were collected for 80 patients for the period from January through October 2022. The primary outcome occurred in 37 (74%) patients in the intervention group and 15 (50%) patients in the control group (odds ratio, 2.85; P = 0.032). The HbA1c gap was closed in 30 (60%) patients in the intervention group and 8 (27%) patients in the control group. The BP gap was closed in 24 (48%) patients in the intervention group and 11 (37%) patients in the control group. The frequency with which recommendations were made by a pharmacist was associated with gap closure (P = 0.012). No significant difference was found based on the frequency at which recommendations were implemented by providers (P = 0.4).

Conclusion: Pharmacy intervention was associated with an almost 3-fold-higher likelihood of closing at least one care gap in Medicaid patients. HbA1c gap closure was achieved more frequently than BP gap closure due to pharmacy involvement. The frequency with which recommendations were made by pharmacy was associated with increased gap closure regardless of the frequency with which these recommendations were implemented by providers.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: The healthcare sector contributes approximately 4% to 5% of global greenhouse gas (GHG) emissions, thereby impacting climate change. Various initiatives, including teleworking, have been considered to mitigate GHG emissions, but their environmental impact remains poorly defined in the healthcare sector. This study aims to evaluate the impact of teleworking by hospital pharmacists on GHG emissions reduction by comparing the actual situation at one Canadian hospital, which includes teleworking shifts from home, to a scenario where all working shifts necessitate travel to the hospital.

Methods: The study was conducted at the pharmacy department of an academic hospital with 86 pharmacists (75 pharmacist full-time equivalents), between June 1, 2020, and May 31, 2023. Two different online carbon footprint calculators, one developed by the Centres de Gestion des Déplacements (CGD) and one available at the website of Carbon Footprint Ltd., were employed to measure mean GHG emissions in kilograms of carbon dioxide equivalents (CO2eq) for individuals based on their modes of transport and distances traveled between home and work.

Results: During the study period, teleworking resulted in a significant reduction of mean GHG emissions per pharmacist relative to the scenario of all on-site shifts, with a reduction of 134 kg CO2eq (1,160 CO2eq vs 1,026 CO2eq; t = 3.32; P = 0.0007) estimated with the CGD calculator and a reduction of 135 kg CO2eq (1,117 CO2eq vs 982 CO2eq; t = 4.31; P < 0.0001) estimated with the Carbon Footprint calculator. Those figures correspond to a reduction of 11.5% (11,249 kg CO2eq) to 12.1% (11,315 kg CO2eq) of the total quantity of emissions associated with commuting for the 84 pharmacists over 3 years. The median distance from home to the hospital was 10.0 (8.1) km, with nearly three-quarters of pharmacists commuting by public or active transport.

Conclusion: Teleworking has a positive environmental impact and could be implemented in other pharmacy departments. The implemented teleworking approach represents an encouraging initial step toward reducing the GHG emissions associated with the travel of employees.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: Workplace and work-related violence are growing concerns in the healthcare community and among healthcare professionals. A gap exists in our understanding of the most extreme form of violence, homicide, against pharmacists and the contributing factors leading to their tragic deaths. The objective of this study was to identify homicides of pharmacists and characterize potential patterns, including, but not limited to, the connection to pharmacists' work.

Methods: Data from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) were analyzed to explore the number and characteristics of homicides of pharmacists that occurred between 2003 and 2020.

Results: Between 2003 and 2020, 33 homicides of pharmacists were reported to the NVDRS. A slight majority (n = 17, 52%) of victims were female. Six (18%) were determined to be workplace or work-related homicides; only 2 homicides were related to the work of a pharmacist. Nearly two-thirds (n = 21, 64%) were perpetrated with a firearm. The suspects for most of these homicides were male (n = 28, 85%), and many were either a current or former partner of the decedent (n = 14, 42%).

Conclusion: In the US, homicides of pharmacists occur infrequently relative to the general population. Homicides in pharmacists' workplaces are uncommon, and homicides of pharmacists appear to be tied most often to domestic violence and firearms.