American Journal of Health-System Pharmacy最新文献

Purpose: The purpose of this study was to evaluate pharmacist prescribing of nirmatrelvir/ritonavir to ensure this method of increasing access to treatment is safe and effective.

Methods: This multicenter, retrospective observational study included patients receiving a prescription for nirmatrelvir/ritonavir by a physician, nurse practitioner (NP), physician assistant (PA), or pharmacist at an Indiana University (IU) Health West Central Region site over a 3-month period. Patients were divided into two groups: those who received nirmatrelvir/ritonavir prescribed by a pharmacist (the pharmacist prescribed group) and those who received nirmatrelvir/ritonavir prescribed by other providers (the physician/NP/PA prescribed group). Electronic health record (EHR) reviews were performed to assess the appropriateness of prescriptions based on the presence of risk factors and symptoms, day of symptom onset, and dosing. The primary endpoint was the overall appropriateness of nirmatrelvir/ritonavir prescriptions in the two study groups based on emergency use authorization inclusion and exclusion requirements. Secondary endpoints included appropriateness of nirmatrelvir/ritonavir dosing and medically attended visits or mortality within 30 days. Statistical analysis of the endpoints occurred post hoc utilizing the Fisher's exact test.

Results: A total of 259 patients were included in the pharmacist prescribed group and 265 patients in the physician/NP/PA prescribed group. Overall appropriate nirmatrelvir/ritonavir prescribing occurred in 258 patients (99.6%) and 232 patients (87.5%) in the pharmacist and physician/NP/PA prescribed groups, respectively (P < 0.0001). Nirmatrelvir/ritonavir dosing was appropriate in 256 patients (98.8%) and 240 patients (90.6%) in the pharmacist and physician/NP/PA prescribed groups, respectively (P < 0.0001). The 30-day rates of medically attended visits were similar between groups. No patients died within 30 days of treatment in either group.

Conclusion: Pharmacist prescribing of nirmatrelvir/ritonavir may result in a higher likelihood of prescriptions meeting overall appropriateness criteria. Pharmacists represent an important healthcare professional resource to improve nirmatrelvir/ritonavir prescribing and utilization.

Purpose: The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations.

Summary: Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs.

Conclusion: This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

Purpose: This review summarizes the comprehensive management of obesity with a focus on the pharmacology, efficacy, and safety of anti-obesity medications.

Summary: Obesity is a highly prevalent chronic disease with significant health risks, requiring a multifaceted approach to treatment. While most approved weight loss medications have modest effects, newer medications such as semaglutide and tirzepatide have shown greater than 15% reduction in baseline weight. Optimal selection of therapy requires taking into consideration patient factors, such as comorbidities and goals, and medication-related factors, including weight loss efficacy, contraindications, and improvements in cardiovascular risk. As the availability of anti-obesity medications increases, multidisciplinary care teams will play an important role in selecting optimal strategies for long-term health benefits in individuals with obesity.

Conclusion: The expanding array of anti-obesity medications provides valuable treatment options alongside lifestyle interventions and surgical approaches for managing obesity and reducing weight-related health risks. As this therapeutic area continues to grow, selecting optimal agents and educating patients on administration, monitoring, and potential adverse effects will be critical for improving overall outcomes.

Purpose: To demonstrate the challenges with current diagnosis and treatment strategies for precipitated opioid withdrawal secondary to naloxone the emergency department (ED) setting and describe the role of the emergency medicine (EM) pharmacist in its management.

Summary: There are no standardized criteria to define precipitated opioid withdrawal syndrome, so the diagnosis is typically based on sentinel signs and symptoms and time course. Complicating factors include a positive urine toxicology screen for nonopioid substances, comorbidities and associated medications prior to admission, medications given in the ED, and a fluctuating patient course during the ED stay that likely involves all these issues. Although buprenorphine is frequently recommended as the primary treatment for precipitated withdrawal, its use can be complicated if patients are on methadone maintenance or other long-acting opioids. The EM pharmacist plays a key role in managing patients with precipitated withdrawal.

Conclusion: Practice changes related to the diagnosis and treatment of opioid use disorder (OUD) with precipitated withdrawal in the ED are needed. EM pharmacists as part of the interprofessional care team have an important role in the management of patients with OUD, including those patients undergoing possible precipitated withdrawal.

Purpose: Utilization of clinical pharmacists providing comprehensive medication management (CMM) has been shown to improve the quadruple aim of healthcare. Lack of fidelity surrounding CMM practice standardization components has led to heterogeneity in interpretation of clinical pharmacist outcomes. We compared 2 Veterans Health Administration (VHA) facilities with the patient-aligned care team (PACT) Platinum Practice designation in terms of clinical pharmacist practitioner (CPP) access and care quality relative to national CPP averages.

Methods: All data was extracted from the VHA Corporate Data Warehouse (CDW) and reports derived from data within the CDW. Within the fiscal year 2019-2020 timeframe, the PACT Platinum Practice facilities were assessed against a national average comparator on quality and access metrics using electronic VHA databases that capture data on patient visits with a CPP. For the evaluation of care quality, an electronic composite score of diabetes and hypertension metrics was used. Third next available appointment for the primary care provider (PCP) and CPP utilization were used as measures of access.

Results: Compared to national averages, the PACT Platinum Practice facilities had a higher proportion of patients meeting the evaluated quality metric across all months of the study period. For access, the mean time to the third next available primary care appointment was lower for the PACT Platinum Practice facilities compared to the national average. PACT Platinum sites had CPP utilization rates higher than national averages across the study period, and these rates remained stable.

Conclusion: This study demonstrated improved quality and access outcomes for 2 VA medical centers designated as PACT Platinum Practice sites relative to national averages. This is important because these practices have been evaluated and shown to have fidelity with the CMM practice management component. Evaluation of outcomes removing the element of practice heterogeneity allows for a more standardized comparison of outcome measures.