Collaborative Drug Therapy Management Research Articles

Survey of Georgia community pharmacists’ needs to engage in advanced community pharmacy services

BackgroundCommunity pharmacists improve health, reduce fragmentation in care, lower health costs, and improve health outcomes. In Georgia, pharmacists are able to enter collaborative drug therapy management protocols, such as hypertension management, with a collaborating physician, which may allow pharmacists to provide advanced community pharmacy services (ACPS), however few Georgia pharmacists have this licensure. No program(s) exist that empower pharmacists to successfully engage in ACPS across the state of Georgia nor trains pharmacists to successfully engage in collaborative practice. ObjectiveThe goal of this project was to explore community pharmacists’ perception, confidence, and engagement in ACPS and how this can improve access to care in Georgia. MethodsSix hundred one independent community pharmacists were sent an electronic survey May 13, 2022, with weekly email reminders through June 17, 2022. Results were analyzed with the independent sample t test. Thematic analysis was completed on open response survey questions. ResultsNinety responses were received (15% response rate). In the majority of survey outcomes, no differences were found in needs for success between rural versus urban pharmacists. Pharmacies with a smaller technician-to-pharmacists ≤2 (staffing) ratios identified billing for services as a higher priority need for success for them to confidently engage in ACPS (P = 0.012) while pharmacies with a higher technician-to-pharmacists >2 (staffing) ratio agreed a larger need was in optimization of current workflow to allow for advanced community pharmacy service incorporation (P = 0.034). All community pharmacists agreed they would require expansion in staffing and the qualities desired for additional hires to support ACPS include ambition, proficiency, and communication skills. ConclusionNumerous needs for success exist for community pharmacists to feel comfortable and confident to engage in ACPS. Addressing these needs may increase community pharmacist impact through increasing utilization of these services.

Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. To test the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. This randomized clinical trial allocated patients 76 years or older who used 10 or more prescription medications to a deprescribing intervention or to usual care (1:1 ratio) at an integrated health system with multiple preexisting deprescribing workflows. Data were collected from October 15, 2020, to July 29, 2022. Physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. Primary end points were change in the number of medications and in the prevalence of geriatric syndrome (falls, cognition, urinary incontinence, and pain) from 181 to 365 days after allocation compared with before randomization. Secondary outcomes were use of medical services and adverse drug withdrawal effects. Of a random sample of 2860 patients selected for potential enrollment, 2470 (86.4%) remained eligible after physician authorization, with 1237 randomized to the intervention and 1233 to usual care. A total of 1062 intervention patients (85.9%) were reached and agreed to enroll. Demographic variables were balanced. The median age of the 2470 patients was 80 (range, 76-104) years, and 1273 (51.5%) were women. In terms of race and ethnicity, 185 patients (7.5%) were African American, 234 (9.5%) were Asian or Pacific Islander, 220 (8.9%) were Hispanic, 1574 (63.7%) were White (63.7%), and 257 (10.4%) were of other (including American Indian or Alaska Native, Native Hawaiian, or >1 race or ethnicity) or unknown race or ethnicity. During follow-up, both the intervention and usual care groups had slight reductions in the number of medications dispensed (mean changes, -0.4 [95% CI, -0.6 to -0.2] and -0.4 [95% CI, -0.6 to -0.3], respectively), with no difference between the groups (P = .71). There were no significant changes in the prevalence of a geriatric condition in the usual care and intervention groups at the end of follow-up and no difference between the groups (baseline prevalence: 47.7% [95% CI, 44.9%-50.5%] vs 42.9% [95% CI, 40.1%-45.7%], respectively; difference-in-differences, 1.0 [95% CI, -3.5 to 5.6]; P = .65). No differences in use of medical services or adverse drug withdrawal effects were observed. In this randomized clinical trial from an integrated care setting with various preexisting deprescribing workflows, a bundled hyperpolypharmacy deprescribing intervention was not associated with reduction in medication dispensing, prevalence of geriatric syndrome, utilization of medical services, or adverse drug withdrawal effects. Additional research is needed in less integrated settings and in more targeted populations. ClinicalTrials.gov Identifier: NCT05616689.

Optimizing Hypertension Treatment in Older Patients Through Home Blood Pressure Monitoring by Pharmacists in Primary Care: The MINOR Clinical Trial

Incorporating technology such as home blood pressure monitoring (HBPM) into the clinical routine generates opportunities to improve BP monitoring and control in primary health care. It is also important to prevent overtreatment. However, the combination of HBPM with collaborative drug therapy management (CDTM) has not yet been studied. This study aimed to assess the efficacy of combining HBPM with CDTM to optimize hypertension treatment for older patients. This open-label, parallel-group, randomized clinical trial was conducted between June 2021 and August 2022 in a Brazilian community pharmacy and included older patients (aged ≥60 years) with hypertension. Those who were classified as poorly adherent or nonadherent to the prescribed drug treatment or who were unable to perform HBPM were excluded. In the control group, participants received a BP monitor and instructions on how to perform HBPM. A general practitioner, who was provided a report with the obtained BP values, determined any changes to the treatment protocol. In the intervention group, a pharmacist enrolled participants in a drug therapy management protocol and provided the general practitioner with suggestions to optimize the antihypertensive drug therapy, in addition to the report with the BP values. The following outcomes were considered: the proportion of participants receiving deprescriptions of antihypertensive drugs, other treatment adjustments, and the difference in mean BP between the groups 45 days after performing HBPM. The study used a t test combined with Levene's test to calculate mean intergroup differences in BP, the paired t test to calculate mean intragroup differences in BP, and Pearson's χ2 test to determine intergroup differences in changes in drug therapy. In each group, 161 participants completed the trial. Antihypertensive agents were deprescribed for 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (P=0.01). In addition, 14 (8.7%) participants were prescribed antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (P=0.52). The mean office systolic BP and HBPM values were lower in the intervention group (P=0.22 and P=0.29, respectively). Combining HBPM with a CDTM protocol effectively optimized antihypertensive treatment for older patients in a primary health care setting. gov identifier: NCT04861727.

Evaluation of the Role of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic via a Collaborative Drug Therapy Management Protocol.

Historically, pharmacists have not been formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The objective of this study was to evaluate the number and type of medication-related interventions made by a clinical pharmacist, in an adult burn clinic, via a CDTM protocol. The protocol allows pharmacists to independently manage the following disease states: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All pharmacist visits between 1/1/22 and 9/22/22 were included. A total of 16 patients were seen at 28 visits with a clinical pharmacist for a total of 148 interventions. Patients were mostly males (81%) with a mean ± SD age of 41 ± 15 years. The majority of patients were in-state (94%), with 9 (56%) being from an outlying county. Patients were seen for a median (IQR) of 2 (1,2) visits. Interventions were made at all visits (100%) with a median of 5 (4,6) per visit. Interventions (per visit) included medication reconciliation [28 (100%)], a median of 1 (0,2) medication ordered or adjusted, labs ordered at 7 (25%) visits, with adherence and patient education both reviewed at over 90% of visits. To the best of our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, with a pharmacist directly impacting transitions of care. This may serve as a framework for other sites. Future directions include continuing to track data for medication adherence and access, billing/reimbursement, and clinical outcomes.

532 The Impact of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic

Abstract Introduction Pharmacists in our burn center have historically assisted with discharges and transitions of care for patients sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The goal of implementing this model in our clinic was to improve access to care and streamline management of pharmacologic issues. The objective of our study was to assess the impact of a clinical pharmacist on medication management in an adult burn clinic via a CDTM protocol. Methods The CDTM protocol allows pharmacists to independently manage the following disease states via in-person or telephone visits: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All treatment decisions, interventions, and education are documented in the electronic record. “Incident-to” billing is completed at Level 99211. All pharmacist visits between 1/1/22-9/21/22 were included for review in the study. Demographics were reported for unique patients, and interventions were included from each visit for patients with multiple pharmacist visits. Results A total of 19 patients were seen at 39 visits with a clinical pharmacist during the study. Patients were mostly males (84%) with a mean (SD) age of 45 (18) years. Majority of patients were in-state (95%), with 11 (58%) being from an outside county. Patients were seen for a median (IQR) of 2 (1,2) visits each. Additional interventions were made in 12 patients (63%) at 19 visits (49%), including medication reconciliation [16 (41%)], medications ordered [14 (36%)], labs ordered [2 (5%)], referrals placed [1 (3%)], and allergies addressed [1 (3%)]. At applicable visits, patients had a median (IQR) of 2 (1,2) interventions made or 2 (1, 3) medications ordered. Conclusions Historically, pharmacists were only involved with clinic patients when issues arose, serving in an “as-needed” capacity. Pharmacists are now able to proactively help with medication reconciliation, medication prescribing, ordering labs, and placing referrals. Implementing a CDTM protocol has allowed our pharmacists to become more formally involved in post-discharge follow-up and managing ambulatory burn patients. Applicability of Research to Practice To our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, which may serve as a framework for others. Future directions include continuing to track data for adherence, medication access, billing/reimbursement, and clinical outcomes.

Pharmacist-led hormonal contraceptive prescribing service in a Federally Qualified Health Center: Initial implementation outcomes

BackgroundThe United States has a higher rate of unintended pregnancy than many other developed countries, and Indiana’s unintended pregnancy rate is above the national average. Unintended pregnancy rates are highest among low-income women. Federally Qualified Health Centers (FQHC) provide care for the underserved and uninsured patient population. ObjectiveTo determine the acceptability, adoption, appropriateness, and feasibility of a pharmacist-led hormonal contraception prescribing service within a FQHC through a collaborative drug therapy management protocol. MethodsAn explanatory mixed methods analysis included surveys followed by semistructured interviews. A survey was created and distributed to all patients who received the service and all providers (physicians and nurse practitioners) employed at the FQHC during service implementation. Semistructured interviews were conducted with a subset of patients and providers. ResultsA total of 11 patients and 8 providers completed the survey between January 1, 2022 and June 10, 2022. Of these participants, 4 patients and 4 providers completed an interview between May 1, 2022 and June 30, 2022. Both patients and providers perceived the service as acceptable and appropriate, and providers perceived implementation of the service within clinic as feasible. Ten patients received a prescription from the pharmacist; 1 patient was referred to a provider as the pharmacist was unable to prescribe the medication requested. ConclusionImplementation of pharmacist prescribed hormonal contraception was perceived as acceptable, appropriate, and feasible by patients and providers. Pharmacists are perceived by patients and providers as an additional resource for hormonal contraception prescribing within a FQHC due to their clinical knowledge, efficiency, and attention paid to patients’ concerns.

Physician-Pharmacist Collaborative Drug Therapy Management in Pediatric Hypertension.

Pediatric hypertension affects 2% to 5% of children and adolescents in the United States and is frequently undertreated. The increasing prevalence of pediatric hypertension and worsening physician shortage create difficulties in closing this treatment gap. Physician-pharmacist collaborations have been shown to improve patient outcomes in adult patients. Our aim was to demonstrate a similar benefit for pediatric hypertension. Pediatric patients whose hypertension was managed at a single pediatric cardiology clinic from January 2020 to December 2021 were enrolled in collaborative drug therapy management (CDTM). Patients whose hypertension was managed in the same clinic from January 2018 to December 2019 were used as a comparison group. The primary outcomes were achievement of at-goal blood pressure at 3, 6, and 12 months and time to control of hypertension. Secondary outcomes were appointment adherence and serious adverse events. A total of 151 patients were included in the CDTM group, and 115 patients were included in the traditional care group. Of those, 100 CDTM patients and 78 traditional care patients were assessed for the primary outcome. Fifty-four (54%) CDTM patients and 28 (36%) traditional care patients achieved at-goal blood pressure at 12 months (OR, 2.09; 95% CI, 1.14-3.85). Appointment non-adherence was 9.4% for CDTM and 16% for traditional care (OR, 0.54; 95% CI, 0.35-0.82). Adverse events were similar between groups. CDTM increased rates of at-goal blood pressure without increased adverse events. Physician-pharmacist collaboration may improve treatment of hypertension in pediatric patients.

Impact of a pharmacist collaborative drug therapy management protocol on utilization of a discharge prescription program and hospital readmissions.

To evaluate the impact of a collaborative drug therapy management (CDTM) agreement allowing a pharmacist to automatically prescribe refills of discharge medications to patients' preferred outpatient pharmacy on utilization of a hospital discharge prescription program and hospital readmission rates. This was a single-center, quasi-experimental pre-post intervention study. Patients aged 18 years or older discharged from the cardiology services to home were eligible for inclusion in the study. The CDTM agreement was initiated on July 1, 2019. Patients discharged to home from July 1, 2018, to June 30, 2019, were assigned to the historical control group. The primary outcome was the difference in the proportion of 
patients who used the bedside medication delivery service at hospital discharge between the groups. Secondary outcomes included 30-day hospital readmissions and a descriptive analysis of medications prescribed by a pharmacist through the program. A χ2 test was used to assess the primary outcome, and multivariable logistic regression was used to assess hospital readmissions. In total, 1,704 and 2,200 patients were discharged in the control and CDTM groups, respectively. The CDTM group had a greater proportion of patients who participated in the discharge prescription program compared to the historical control group (77.8% vs 68.7%; P < 0.0001). There was no difference in 30-day hospital readmission rate between the groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.83-1.23; 
P = 0.94). A CDTM protocol to improve the availability of medication refills at a patient's regular outpatient pharmacy improved utilization of a bedside medication delivery service but did not change 30-day readmission rates.

Expansion of a Pharmacist-Led Culture Follow-Up Program to Real-Time Notification of Multidrug-Resistant Microbiology Results in the Emergency Department.

Introduction: There are currently limited published data for a pharmacist-led multidrug-resistant (MDR) culture follow-up program through a collaborative drug therapy management (CDTM) agreement in the emergency department (ED). Objective: The objective of this study was to assess the impact of a pharmacist-led culture follow-up program for MDR microbiology results on ED revisit rate. Methods: A single-center quasi-experimental retrospective study was conducted comparing the outcomes before (December 2017 to March 2019) and after (April 2019 to July 2020) implementation of the ED MDR Culture program. Patients 18 years of age or older; with confirmed positive microbiology culture of extended-spectrum beta-lactamases (ESBL), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) at any site; and discharged from the ED were included. The primary outcome was to evaluate ED revisit within 30 days due to antimicrobial treatment failure, defined as lack of resolution or worsening of infection. A statistical analysis was performed for categorical data using Fisher's exact test, and for continuous data using unpaired t test or Mann-Whitney U Test, when applicable. Results: A total of 130 patients were included in the analysis. Patients in the post-implementation group (n = 70) had a significant reduction in ED revisits compared to the pre-implementation group (n = 60); 9 [12.9%] versus 17 [28.3%], respectively; P = .046. Conclusion: Implementation of an ED MDR culture program was associated with significantly less ED revisits within 30 days due to antimicrobial treatment failure, thus demonstrating the expanded role of ED pharmacists in antimicrobial stewardship in the outpatient setting.

Exploration of collaborative drug therapy management mode for elderly patients with chronic diseases

Exploration of collaborative drug therapy management mode for elderly patients with chronic diseases

A remote hypertension management program clinical algorithm.

Hypertension is the leading risk factor for death, affecting over onebillion people worldwide, yet control rates are poor and stagnant. We developed a remote hypertension management program that leverages digitally transmitted home blood pressure (BP) measurements, algorithmic care pathways, and patient-navigator communications to aid patients in achieving guideline-directed BP goals. Patients with uncontrolled hypertension are identified through provider referrals and electronic health record screening aided by population health managers within the Mass General Brigham (MGB) health system. Non-licensed patient navigators supervised by pharmacists, nurse practitioners, and physicians engage and educate patients. Patients receive cellular or Bluetooth-enabled BP devices with which they monitor and transmit scheduled home BP readings. Evidence-based medication changes are made according to a custom hypertension algorithm approved within a collaborative drug therapy management (CDTM) agreement with MGBand implemented by pharmacists. Using patient-specific characteristics, we developed different pathways to optimize medication regimens. The renin-angiotensin-aldosterone system-blocker pathway prescribed ARBs/ACE inhibitors first for patients with diabetes, impaired renal function, and microalbuminuria; the standard pathway started patients on calcium channel blockers. Regimens were escalated frequently, adding thiazide-type diuretics, and including beta blockers and mineralocorticoid receptor antagonists if needed. We have developed an algorithmic approach for the remote management of hypertension with demonstrated success. A focus on algorithmic decision-making streamlines tasks and responsibilities, easing the potential for scalability of this model. As the backbone of our remote management program, this clinical algorithm can improve BP control and innovate the management of hypertension in large populations.

Development of PharmPAL: A Collaborative Practice Pharmacy Clinic in Ambulatory Palliative Care.

Increased access to interprofessional palliative care is needed in ambulatory oncology settings. To achieve this, Dana-Farber Cancer Institute launched a collaborative drug therapy management clinic, PharmPAL, where credentialed advanced practice pharmacists lead independent patient visits. As part of a pilot project focused on clinical innovation, we analyzed PharmPAL referrals and pharmacist interventions between July 2020 and June 2021. We extracted referral patterns, patient hospitalizations, and deaths from the electronic medical record. Outpatient palliative care clinicians completed a survey to determine pharmacist needs and overall satisfaction with PharmPAL. From July 2020 to June 2021, PharmPAL constituted 4.7% (299/6305) of all outpatient palliative care encounters. Most palliative care clinicians (86% [6/7]) reported a desire to increase PharmPAL availability. No patient hospitalizations or deaths were attributed to PharmPAL visits. PharmPAL increased access to palliative care services. All clinicians reported satisfaction with PharmPAL. We continue to assess the impact PharmPAL has on clinic operations and provider satisfaction.

Implementation of a pharmacist-led diabetes management service in an endocrinology clinic

BackgroundDiabetes is a complicated health condition that can lead to significant health complications. Pharmacists are in an ideal position to make therapeutic interventions, provide clinical education, and can provide necessary follow-up to evaluate response to therapy for patients with diabetes. ObjectivesThe primary objective of this study is to evaluate the mean change in hemoglobin A1c (HbA1c) in patients receiving short-term diabetes management services from a clinical pharmacist through collaborative drug therapy management. MethodsThis study is a single-center retrospective chart review of patients with diabetes who have been referred by their endocrinologist to the clinical pharmacist for short-term intensification of pharmacologic management of hyperglycemia. Patients included in the study completed at least 2 visits with the pharmacist during the study period. The primary outcome was to evaluate the mean absolute change in HbA1c at 3-6 months from baseline. ResultsData were collected from 117 patients. The average age was 55 years (19-91 years, SD ± 14.5), 65 patients (55.6%) were female, average duration of diabetes was 14.9 years (0.5-49 years, SD ± 9.9), 21 patients (17.9%) had type 1 diabetes, 96 patients (82.1%) had type 2 diabetes, and 88 patients (75.2%) had a baseline HbA1c of at least 8.5%. On average, patients reduced their HbA1c by 2.0% (P < 0.001) at 3-6 months. For patients with a baseline HbA1c of at least 8.5%, they experienced a 2.5% (P < 0.001) reduction in HbA1c at 3-6 months. ConclusionThe addition of a clinical pharmacist within the endocrinology practice was associated with significant improvements in glycemic control for those referred. This short-term, intensive service model demonstrates that patients can achieve significant reductions in HbA1c with temporary support from a clinical pharmacist.

Key state‐level policy elements governing pharmacist collaborative practice

AbstractThe American College of Clinical Pharmacy previously published a white paper in 2015, “Collaborative Drug Therapy Management and Comprehensive Medication Management,” as well as position statements on collaborative drug therapy management (CDTM) in 1997 and 2003. Although significant federal and state legislation addressing collaborative practice has evolved and expanded throughout the United States since then, variability in state‐level policy remains a barrier for effective collaborative practice. Collaborative practice facilitates the delivery of comprehensive medication management by clinical pharmacists and enhances team‐based care. State governments are the primary entities that determine the scope of practice for health professionals. As such, state‐level policy plays a crucial role in enabling or impeding the implementation of advanced pharmacist services and effective CDTM. Almost all states currently enable pharmacist prescriptive authority in some form. In 2017, the National Alliance of State Pharmacy Associations and the National Association of Boards of Pharmacy issued joint recommendations outlining model elements of state policies for statewide protocol authority and pharmacist prescribing.

Implementation of a pharmacist-led hormonal contraceptive prescribing service in a campus community pharmacy in Indiana, United States

Objective(s)College-age people have the highest numbers of unintended pregnancies and pharmacies within college campuses are in a unique position to meet student needs. Our objective was to implement a pharmacist contraceptive prescribing service in a campus pharmacy and examine the service utilization. Study designThe Purdue University Pharmacy (Indiana, United States) implemented a pharmacist hormonal contraception prescribing service via a collaborative drug therapy management agreement with the campus student health center. The collaborative drug therapy management agreement enables pharmacists to independently prescribe pills, patches, rings, injections, and emergency contraception to students meeting eligibility criteria. After completing a patient health screening and blood pressure check, the pharmacist discusses the eligible method(s) and prescribes up to a 12-month supply. A referral to another provider for long-acting reversible contraception or further evaluation may also be provided. We collected basic information about each encounter (e.g., age, blood pressure, method of contraception prescribed, and time). ResultsDuring the 2020–2021 academic year, 125 prescribing consultations took place with an average appointment length of 20 minutes (range, 12–65 minutes). The median patient age was 21 years (range, 18–30 years). Eligible patients (n = 123, 98%) received a prescription and 119 (95%) prescriptions were written: combined oral pill (n = 91, 77%), injection (n = 12, 10%), patch (n = 6, 5%), vaginal ring (n = 5, 4%), and progestin only pill (n = 5, 4%). Conclusion(s)The pharmacist contraception prescribing service developed by the Purdue University Pharmacy and Student Health Center is a unique approach to meeting the needs of students. Few external resources are required for implementation, and most patients were medically eligible to receive hormonal contraception. ImplicationsCollaboration between on-campus student health centers and pharmacies can be explored as 1 approach to increase access to hormonal contraception for students.

Implementation Of A Pharmacist-Driven Medication Optimization Service Improves Heart Failure Medication Doses And Diabetes Metrics

<h3>Background</h3> Although titration of guideline-directed heart failure medications (GDMT) to maximum doses improves morbidity and mortality in patients with heart failure with reduction ejection fraction (HFrEF), analysis of real world clinical data indicates that the majority of patients remain on suboptimal regimens. <h3>Hypothesis</h3> : We hypothesize that an outpatient pharmacist driven service utilizing collaborative drug therapy management (CDTM) increases compliance with GDMT and optimization of cardio-protective diabetes medications <h3>Methods</h3> A retrospective chart review was performed on eligible patients seen by the heart failure pharmacist from January 2020 through December 2020 at the Rochester Regional Health Heart Failure Clinic. Data was gathered for patients through March 2021 to allow for at least 3 months of follow up. A total of 117 eligible patients identified for being referred to heart failure pharmacist for HFrEF GDMT titration and/or diabetes management (N=100 in HFrEF analysis; N=64 in diabetes analysis) during the study period. <h3>Results</h3> At 3 months from initial pharmacist visit, mean doses of HFrEF GDMT, expressed as a percentage of target dose, were all increased from baseline. β-blocker doses increased from 41.8% to 54.3% (P<0.001), while RAAS inhibitor doses increased from 40.1% to 55.3% (P<0.001)). Fully optimized GMDT regimens improved from 9 patients (9%) at baseline to 37 patients (37%) (P<0.001), and the percent of HFrEF patients on SGLT2 inhibitors increased from 35% to 54% (P=0.008). Diabetes endpoints also significantly improved, with mean A1c reduction of 0.9% from baseline (8.4% vs 7.5%, P<0.001). The percent of patients with controlled A1c (≤7.0%) on both SGLT2 inhibitor and GLP1 agonist improved from 1.6% to 17.8% of patients (P=0.0044). <h3>Conclusion</h3> This study demonstrates that a physician-pharmacist collaborative drug therapy management (CDTM) model is effective at increasing doses of HFrEF GDMT. Furthermore, pharmacist co-management of GDMT optimization and diabetes optimization is an effective model for improving compliance with guidelines, control of diabetes, and, ultimately, cardiovascular risk through the utilization of appropriate cardio-protective medications.

278 Developing AMILDA: An Intervention to Improve Symptoms and Medication Adherence among Latinx Adults with Depression and Anxiety

OBJECTIVES/GOALS: To develop the Adherence to Medications In Latinx adults with Depression and Anxiety (AMILDA) intervention using community engaged research principles, AMILDA will integrate culturally tailored messaging to improve depression and anxiety symptoms and adherence to antidepressant medications. METHODS/STUDY POPULATION: Bilingual steering committee members representing primary care and behavioral health professionals from 2 primary care clinics, and 1 lay community member met monthly for 1 year to develop the intervention. One clinic is an academic health center and the other is a federally qualified health center. Members identified, developed, and voted on the interventions components, therapeutic goals, and the mechanisms underlying its effectiveness that needed to be studied. To evaluate AMILDAs components, we conducted an observational study of health care providers (N=13) and Latinx adults with depression and/or anxiety (patients; N=26) from both clinics, and community pharmacists (N=9) from surrounding pharmacies to gather feedback. Based on their input, we revised the intervention. RESULTS/ANTICIPATED RESULTS: AMILDA consists of culturally tailored collaborative drug therapy management with a collaborative practice agreement between the physician and pharmacist. Patients recently started on an antidepressant receive language and culturally concordant motivational interviewing, teach back, and infographics; AMILDA is designed to improve symptoms, adherence, and health determinants. Most provider, pharmacist, and patient participants reported that AMILDA could be beneficial. Several participants indicated a lack of understanding about a US pharmacists scope of practice. Recommendations included ensuing language concordance, incorporating more statistics and scientific data, using images that are relatable, avoiding idioms and stereotypes, taking the time to build rapport, and being friendly. DISCUSSION/SIGNIFICANCE: AMILDA will be tested in a pilot effectiveness randomized controlled study to determine if it improves depression and anxiety symptoms and adherence to antidepressants among Latinx adults compared with enhanced usual care. The mechanisms to be assessed include self-efficacy, antidepressant knowledge, and personal health literacy.

624 Implementation of a Collaborative Drug Therapy Management Protocol in an Adult Burn Clinic

IntroductionCollaborative Drug Therapy Management (CDTM) protocols allow qualified clinical pharmacists working within a defined context to independently assume responsibility for a variety of direct patient care activities. The goal of this model is to improve access to care, often in a more affordable and timely manner. Pharmacists in our burn center have historically assisted with discharge planning and transitions of care for patients being sent home or to a facility. Despite these efforts, pharmacists were not formally involved in managing Burn Clinic patients. The objective of implementing a CDTM Protocol in Burn Clinic was to streamline management of burn-related pharmacologic issues.MethodsThe CDTM protocol allows the pharmacist to assess patients’ therapeutic needs related to thermal injury, inhalation injury, or dermatologic disorder. Disease states managed include: pain, agitation, delirium, insomnia, venous thromboembolism, skin and soft tissue infections, and complications of hypermetabolic burn response.ResultsIn Burn Clinic, via in-person or telephone visits, pharmacists can independently evaluate and modify pharmacologic treatment regimens in accordance with state legislation, including initiation, renewal, and adjustment of drugs and vitamins. The pharmacist can also review, order, interpret, and conduct pertinent laboratory studies and wound culture results. In addition, the pharmacist completes medication reconciliation, performs patient education, and consults other healthcare providers, as needed. All visits, patient care, education, and treatment decisions are documented in the electronic record. “Incident-to” billing is completed at Level 99211, as this is a hospital-based clinic.ConclusionsHistorically, pharmacists were peripherally involved with Burn Clinic patients when issues arose, serving in an “as-needed” capacity. With more proactive involvement, pharmacists are uniquely positioned to help with de-prescribing, drug interactions, insurance issues, access to medications, adherence, and dose optimization. Implementing a CDTM protocol allows pharmacists to become more formally involved in post-discharge follow-up and to help manage ambulatory burn patients.

QP1: Development of PharmPAL: A Collaborative Practice Pharmacy Clinic in an Ambulatory Care Clinic

Background: As authoritative resources on the optimal use of medications in symptom management, palliative care pharmacists exemplify several clinical, administrative, and educational roles within the outpatient clinic setting. Knowledge of medication-use processes allows pharmacists the ability to improve patient safety and outcomes. In 2018 a quality improvement project to optimize the scheduling of pharmacist-provider joint visits in the Dana-Farber Cancer Institute Outpatient Palliative Care Clinic led to overwhelming Adult Palliative Care (APC) provider satisfaction. Given this success and continued desire for pharmacy collaboration, the “PharmPAL” Clinic was initiated in July of 2020. PharmPAL is a collaborative drug therapy management (CDTM) clinic where credentialed pharmacists lead intermediary and follow-up palliative care visits encompassing patient assessments, counseling, education, ordering of laboratory tests, and selecting, initiating, continuing, and modifying medication regimens. The goal of PharmPAL is to support the growth of the palliative care clinic by providing care to patients with intense symptom management needs through interval visits with a pharmacist within their credentialed scope of practice, increasing the availability of follow-up to patients. Methods: Through a survey disseminated to all outpatient palliative care providers, reasons for referral for both joint visits and PharmPAL visits were gathered. Based on an overwhelming percentage of providers in favor of increasing PharmPAL visits, the weekly availability increased from eight 30 minute appointments per week in the first seven months to twelve 30 minute appointments each week. Results: The top five reasons for PharmPAL referral include new consult requiring close follow-up, education and counseling, stable patient for refill review, schedule availability, and regimen or medication change in the previous visit or anticipated in visit. Barriers to utilizing PharmPAL include pharmacist availability, APC scheduling, and out-of-state patients. An increase in PharmPAL availability has led to an increased volume of patients and encounters for both PharmPAL and the outpatient clinic overall. Additional surveys will be employed to address feedback for ongoing areas for improvement in order to reach our goal of a 30% increase of PharmPAL referrals within the first three months and continued improvement in overall provider satisfaction with PharmPAL. Conclusion: As outpatient palliative care clinics are incorporating pharmacist-led visits into practice, identification of outcomes metrics is critical to the ongoing growth of these clinics. Over the next several months we plan to continue to assess the impact PharmPAL has on clinic operations and provider satisfaction in the Dana-Farber Cancer Institute outpatient palliative care clinic.

Washington pharmacist Timothy Fuller dies at 75 years.

Timothy Stephen Fuller, collaborative practice trailblazer and longtime pharmacist–consultant for the Washington State Board of Pharmacy, died January 17 at his home in Sequim. He was 75 years old. Fuller was widely known for his research and advocacy on collaborative practice for pharmacists, an issue he championed during more than 2 decades of service with the pharmacy board. He was instrumental in establishing the nation’s first collaborative model for pharmacists to administer vaccines, and he helped normalize the profession’s role in providing emergency contraceptives and other drug therapies. In 1996, Fuller and editor Christopher P. Barry published the Handbook of Collaborative Drug Therapy Management. The handbook became a national blueprint for pharmacists to expand the reach and practical autonomy of the profession through collaborative practice agreements. “Throughout his career—as a pharmacy leader in hospitals and with the Washington Board of Pharmacy—Tim Fuller was committed to implementing cutting-edge solutions to optimize...