American Journal of Health-System Pharmacy最新文献

Purpose: Rifampin is commonly used to treat device-related infections (DRIs) due to its activity against biofilms, despite a history of limited clinical evidence to support its use. Evidence published since 2011 regarding rifampin use for DRIs is reviewed to describe the contemporary findings and ongoing considerations for rifampin use in these infections.

Summary: A literature review was performed by searching PubMed and Google Scholar to identify relevant studies evaluating systemic rifampin use for the treatment of DRIs published from 2011 to 2023. References of identified studies were also screened for additional pertinent studies. Sixty-eight studies were identified, and 48 met the inclusion criteria. Rifampin efficacy was evaluated as both a primary outcome for cardiac device infections (n = 3) and prosthetic joint infections (n = 21) and as a nonprimary outcome (n = 24). Overall, the studies were primarily retrospective (n = 36) and small, with sample sizes ranging from 14 to 842 patients, and varied greatly with respect to prosthesis site, surgical intervention, pathogen, infection time frame, and antibiotic combination and duration. Efficacy outcome results varied greatly, with statistically significant evidence for the efficacy of rifampin combination in DRIs limited to a single study of prosthetic vascular graft infections and 13 studies of prosthetic joint infections.

Conclusion: The modern literature provides conflicting results regarding the benefit and lack of benefit with rifampin combination therapy in DRIs. Additional, robust research is imperative to solidify the ongoing role of rifampin in DRIs.

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.

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 purpose of this study was to assess the incidence of sodium-glucose cotransporter 2 (SGLT2) inhibitor initiation in hospitalized patients with heart failure and determine what potential factors may influence use.

Methods: A single-center, retrospective cohort analysis was conducted of hospitalized patients with heart failure. The primary outcome was the incidence of SGLT2 inhibitor initiation. Secondary outcomes included the rates of use of other guideline-directed medical therapy, identification of factors associated with initiation of SGLT2 inhibitors, and reasons why SGLT2 inhibitors were not initiated.

Results: A total of 503 patients were included. The overall incidence of SGLT2 inhibitor initiation was 18% across all heart failure types, with 30% incidence in heart failure with reduced ejection fraction, 2.2% incidence in heart failure with mildly reduced ejection fraction (HFmrEF), and 5.7% incidence in heart failure with preserved ejection fraction (HFpEF). Logistic regression analysis showed that older age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99; P = 0.009) and the presence of HFpEF (OR, 0.37; 95% CI, 0.17-0.77; P = 0.007) or HFmrEF (OR, 0.22; 95% CI, 0.05-0.69; P = 0.02) were negatively associated with SGLT2 inhibitor initiation. Presence of an angiotensin-converting enzyme inhibitor, angiotensin 2 receptor blocker, or angiotensin receptor/neprilysin inhibitor (OR, 2.14; 95% CI, 1.16-4.05; P = 0.017) or a β-blocker (OR, 3.78; 95% CI, 1.62-10.37; P = 0.004) was positively associated with the addition of an SGLT2 inhibitor, as was a cardiology consult (OR, 8.29; 95% CI, 2.36-52.83; P = 0.005). Providers rarely documented the reason for not prescribing an SGLT2 inhibitor, but the most commonly cited reasons were deferral to the outpatient setting (5.6%) and concern for renal function (4.6%).

Conclusion: Use of SGLT2 inhibitors remains low despite recommendations advocating for their use in heart failure, with these agents specifically underutilized in HFpEF and HFmrEF at this institution.

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 publication outlines development of the infrastructure and standard operating procedures (SOPs) for handling of gene therapy drugs within an integrated health-system setting. These guidelines aim to fill the gap in occupational safety standardization, as current materials focus on precautions in a research laboratory setting and do not fully take into account occupational hazards for pharmacists, technicians, and other medical staff.

Summary: Pharmacists in a large integrated healthcare system recognized the gap in knowledge as well as lack of standard procedures in handling gene therapy drugs in the pharmacy setting and sought to establish updated best practices. The objectives were to implement the necessary infrastructure and SOPs for the handling, compounding, and cleanup of gene therapy drugs and to update existing resources such as spill kits to reflect the new SOPs. Critical milestones included establishing a new biohazardous drug risk classification and standardizing medication labeling. These steps were necessary to ensure consistent and safe handling across the enterprise.

Conclusion: With the increasing prevalence of gene therapy drugs, it is of paramount importance to establish best practices to ensure occupational safety. While existing regulations and literature outline basic handling guidelines for laboratory use, there is a limited amount of information in relation to pharmacy departments within healthcare groups. In establishing robust SOPs surrounding the handling, compounding, and management of gene therapy drugs, pharmacy groups can better ensure both patient and staff safety.

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 intent of this study was to evaluate the predictive performance of two common methods for estimating kidney function in critically ill trauma patients with presumed normal kidney function.

Methods: A retrospective analysis of 2 common methods for estimating kidney function, the Cockcroft-Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (2021 CKD-EPI) equations, was undertaken for adult trauma patients. Patients with a 24-hour urine collection for determination of measured creatinine clearance (mCrCl) within 4 to 14 days after admission were included in the study. Patients with a serum creatinine concentration of >1.5 mg/dL or who required dialysis were excluded.

Results: The 200 patients included in the study had a median (IQR) mCrCl of 184 (141-233) mL/min; both the CG and CKD-EPI equations were biased towards underpredicting mCrCl, with median (IQR) values of 135 (100-177) mL/min and 135 (113-155) mL/min, respectively (P < 0.001). One hundred twenty-two patients had augmented renal clearance (ARC), defined as an mCrCl of >129 mL/min/1.73m2, and those patients had a median (IQR) mCrCl of 216 (188-265) mL/min; both the CG and CKD-EPI equations were biased towards underpredicting mCrCl in patients with ARC: the median (IQR) estimates were 160 (126-197) mL/min and 147 (129-164) mL/min, respectively (P < 0.001). For those without ARC (n = 78), the median (IQR) mCrCl was 125 (98-153) mL/min; both the CG and CKD-EPI equations underpredicted mCrCl, with median estimates of 98 (76-116) mL/min and 112 (92-132) mL/min, respectively (P < 0.001). The CKD-EPI equation outperformed the CG method for all markers of precision in patients without ARC (P < 0.003).

Conclusion: Common predictive equations for assessing kidney function in critically ill patients with traumatic injuries underpredicted mCrCl, especially in those with ARC.

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: In January 2021, Ohio pharmacists were recognized by Medicaid as providers, became eligible to obtain Medicaid provider identification numbers, and were able to begin billing for services using evaluation and management codes. The objectives of this study were to compare outcomes before (2020) and after (2021 and 2022) pharmacist provider status was implemented in a network of primary care clinics: (1) the percent change in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as "incident-to" versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services.

Methods: A retrospective review of all encounters and administrative claims (all payors) provided by pharmacists (7.9 full-time equivalents) within 7 primary care clinics affiliated with a large academic medical center was conducted. The data were compared year-to-year using descriptive statistics to determine the magnitude of change.

Results: A total of 14,416 encounters were included in the study (1,863 in 2020, 4,963 in 2021, and 7,590 in 2022). In 2020, 37.8% (705/1,863) of pharmacist encounters were billed for reimbursement. In 2021, this percentage increased to 39.1% (1,939/4,963) encounters, with a further increase in 2022 to 49.1% (3,725/7,590). Differences in the percentage of pharmacist encounters billed as incident-to versus pharmacist as provider were also evident, with 37.8% (705/1,863) of pharmacist encounters billed incident-to in 2020, as compared to 36.8% (2,796/7,590) in 2022. In this same time period, mean reimbursement for pharmacist-as-provider encounters increased by 189.5% (from $10.45 to $30.25) per encounter, and the number of pharmacist-as-provider encounters increased year over year (from 0% [0/1863] in 2020 to 1.1% [54/4,963] in 2021 and 12.3% [929/7,590] in 2022; P < 0.001).

Conclusion: This study found an increase in the billing and reimbursement attributable to clinical pharmacists in primary care settings in Ohio after their recognition as 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 purpose of this study was to characterize the current state of training in the care of critically ill obstetric patients for postgraduate year 2 (PGY2) critical care pharmacy residents across the US. Additionally, we sought to compare the level of comfort in caring for these patients between those who received training during their residency and those who did not.

Methods: This was a descriptive analysis of the training provided to PGY2 critical care pharmacy residents. Two surveys were sent to residency program directors (RPDs) and to current residents and recent graduates of PGY2 critical care pharmacy training programs.

Results: A total of 44 RPDs responded to the survey. Of the respondents, 9% indicated that their program has an obstetrics rotation while 66% of programs include case reviews or topic discussions. Forty-two current residents and recent graduates of PGY2 critical care pharmacy training programs responded to the survey. Of those who responded, 24% indicated that they had a formal rotation experience. The median comfort level in care of critically ill obstetric patients was significantly higher for pharmacists who had received training vs those who had not (P < 0.001).

Conclusion: These survey results highlight an opportunity for more thorough training in care of critically ill obstetric patients for PGY2 critical care pharmacy residents. This training is associated with increased comfort level in caring for these complex patients.