Impact Of Pharmacist Interventions Research Articles

Impact of Pharmacist Intervention on Inappropriate Continuations of Antipsychotics upon ICU Discharge.

Background: Transitions of care (TOC) are important to best practices as they are at times prone to medication errors. The intensive care unit (ICU) is an essential location needing effective TOC due to many reasons, but an important one being that certain medications are only indicated there. One example is antipsychotics used for agitation, delirium, and sedation. Objective: To design, implement, and analyze the benefit of a pharmacist intervention on inappropriate antipsychotic continuation from the ICU to another point in care at a small community hospital. Secondary outcomes include patients discharged from the hospital on antipsychotics inappropriately and accepted pharmacist interventions. Methods: This standard of care, prospective with historical control study included adult patients who were ordered a formulary antipsychotic for delirium, agitation, or sedation during their ICU-level of care admission at SSM Health: St. Clare Hospital- Fenton. Results: There were 33 patients in the historical period and 24 in the intervention period. Those in the intervention period were less likely to have a continuation of antipsychotics beyond 72 hours compared to patients in the historical period (16.7% vs 57.6%, P = 0.002). In addition, patients in the intervention period were less likely to have continuation of antipsychotics when discharged to home (12.5% vs 36.4%, P = 0.04). Conclusions: A pharmacist-driven intervention led to a significant decrease in patients continuing antipsychotics upon ICU discharge. This decrease was seen at both 72hours from patients leaving the ICU and at hospital discharge.

Potentially inappropriate medication prescribing based on 2019 Beers criteria and the impact of pharmacist intervention in elderly patients with kidney diseases: A report from Iran.

A potentially inappropriate medication (PIM) is a pharmaceutical agent that poses a greater risk of harm than potential benefit to elderly patients. This study aimed to detect PIMs and their risk factors in hospitalized elderly patients with kidney disease. This cross-sectional study assessed medication orders of elderly patients (≥65 years old) with kidney diseases admitted to the hospital. In the first 6 months, we retrospectively evaluated all medications to identify PIMs according to the 2019 Beers criteria. In the second phase, a clinical pharmacist prospectively evaluated all medications and suggested modifications as needed. Data were analyzed to determine risk factors for prescribing PIMs. Based on our evaluation of 258 patients, we observed that the utilization of PIMswas prevalent among the study population. Of the total patients evaluated, 273 instances of PIM use were identified, with only 23.3% of patients not having any PIMs. Notably, proton pump inhibitors and benzodiazepines were the most frequently prescribed PIMs. The risk of experiencing a PIM was significantly amplified by a higher degree of polypharmacy, with odds approximately 2.68 times higher (p < 0.01). Several factors were found to be associated with an increased likelihood of having a PIM, including being male, undergoing hemodialysis, having chronic kidney disease or other comorbidities, and having an extended hospital stay. The second phase of study, in terms of addressing these issues, physicians adhered to 67.5% of the 120 recommendations made by pharmacists regarding the discontinuation of PIM usage. High prevalence of PIMs was detected in our study population. Preventing medication-associated harms in the elderly can reduce the financial burden imposed on healthcare systems. Therefore, routine evaluation of medications with clinical pharmacists and/or implementation of computerized medication decision support systems is recommended to prevent PIMs use.

Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis.

Under-utilisation of immunisation services remains a public health challenge. Pharmacists act as facilitators and increasingly as immunisers, yet relatively little robust evidence exists of the impact elicited on patient health outcome and vaccination uptake. To evaluate the influence of pharmacist interventions on public vaccination rate. SCOPUS, PubMed, and Web of Science were searched from inception to April 2023 to retrieve non- and randomised controlled clinical trials (RCTs). Studies were excluded if no comparator group to pharmacist involvement was reported. Data extraction, risk of bias assessments, and meta-analyses using random-effect models, were performed. Four RCTs and 15 non-RCTs, encompassing influenza, pneumococcal, herpes zoster, and tetanus-diphtheria and pertussis vaccine types, and administered in diverse settings including community pharmacies, were included. Pooled effect sizes revealed that, as compared to usual care, pharmacists, regardless of their intervention, improved the overall immunisation uptake by up to 51% [RR 1.51 (1.28, 1.77)] while immunisation frequency doubled when pharmacists acted specifically as advocators [RR 2.09 (1.42, 3.07)]. While the evidence for pharmacist immunisers was mixed, their contribution to immunisation programmes boosted public vaccination rate. Pharmacists demonstrated leadership and acquired indispensable advocator roles in the community and hospital settings. Future research could explore the depth of engagement and hence the extent of influence on immunisation uptake.

The impact of pharmacist interventions, follow-up frequency and default on glycemic control in Diabetes Medication Therapy Adherence Clinic program: a multicenter study in Malaysia

BackgroundPharmacist’s involvement in optimizing medication adherence among diabetic patients has been implemented for over a decade. Diabetes Medication Therapy Adherence Clinic (DMTAC) was set up to educate diabetic patients, monitor treatment outcomes, and manage drug-related problems. While evidence shows that pharmacist-led DMTAC was effective in reducing HbA1c, there was limited data regarding the impact of different intervention types and default to follow-up on glycemic control.AimTo assess the impact DMTAC on glycemic control and the difference in glycemic control between hospital and health clinic settings as well as defaulter and non-defaulter. In addition, the impact of pharmacist’s interventions, DMTAC follow-up frequencies, and duration of diabetes on glycemic control were also determined.MethodsA retrospective study was conducted among diabetes patients under DMTAC care between January 2019 and June 2020 in five hospitals and 23 primary health clinics. Patients’ demographics data, treatment regimens, frequencies of DMTAC visits, defaulter (absent from DMTAC visits) and types of pharmacists’ intervention were retrieved from patients’ medical records and electronic database. HbA1c was collected at baseline, 4–6 months (post-1), and 8–12 months (post-2).ResultsWe included 956 patients, of which 60% were females with a median age of 58.0 (IQR: 5.0) years. Overall, the HbA1c reduced significantly from baseline (median: 10.2, IQR: 3.0) to post-1 (median: 8.8, IQR: 2.7) and post-2 (median: 8.3, IQR: 2.6%) (p < 0.001). There were 4317 pharmacists’ interventions performed, with the majority being dosage adjustment (n = 2407, 55.8%), followed by lab investigations (849, 19.7%), drugs addition (653, 15.1%), drugs discontinuation (408, 9.5%). Patients treated in hospitals received significantly more interventions than those treated in primary health clinics (p < 0.001). We observed significantly less reduction in HbA1c in DMTAC follow-up defaulters than non-defaulters after 1 year (− 1.02% vs. − 2.14%, p = 0.001). Frequencies of DMTAC visits (b: 0.19, CI: 0.079–0.302, p = 0.001), number of dosage adjustments (b: 0.83, CI: 0.015–0.151, p = 0.018) and number of additional drugs recommended (b: 0.37, CI: 0.049–0.691, p = 0.024) had positive impact on glycemic control whereas duration of diabetes (b: − 0.0302, CI: − 0.0507, − 0.007, p = 0.011) had negative impact.Conclusion Glycemic control improved significantly and sustained up to one year among patients in pharmacists-led DMTAC. However, DMTAC defaulters experienced poorer glycemic control. Considering more frequent visits and targeted interventions by pharmacists at DMTAC resulted in improved HbA1c control, these strategies should be taken into account for future program planning.

The impact of pharmacist intervention on the intravenous-to-oral switch therapy of proton pump inhibitors in cardiovascular surgery

ABSTRACT Background The prescriptions of proton pump inhibitors (PPIs) have been widely concerned due to both huge increase in medical costs and possible long-term adverse events (AEs) caused by the improper route of drug administration. The aim of this study was to assess the effectiveness of pharmacist interventions on the clinical outcome and safety of switching from intravenous (IV) to oral PPIs therapy. Patients and methods A retrospective, single-center, pre- intervention (early -stage)- and intervention (later -stage) study was performed in a Chinese hospital. Results A total of 1736 patients were included in the study. After 12 months of interventions, significant improvements in the number of rational IV to oral switch in patients with oral switch indications were found. The median duration of oral therapy was increased, while the duration of PPIs therapy was decreased. Pharmacist interventions led to significant reductions in mean PPI costs, mean total drug costs, mean hospitalization costs, and the risk for long-term adverse events. Conclusion This study provides important evidence on the beneficial effect of pharmacist interventions on promoting an optimal IV to oral switch of PPIs and substantial cost saving by shortening the duration of IV PPIs therapy and reducing the risk for long-term AEs.

Impact of Pharmacist Interventions at an Outpatient US Coast Guard Clinic.

US Coast Guard (USCG) active-duty service members (ADSMs) are required to maintain medical readiness to maximize operational success. USCG pharmacists serve the traditional pharmacist role while maintaining oversight of regional pharmaceutical services. This study aimed to quantify the number, duty status impact, and replicability of medication interventions made by one pharmacist at the USCG Base Alameda clinic in California over 6 months. Medication interventions made at the USCG Base Alameda clinic from July 1, 2021, to December 31, 2021, were categorized as a drug therapy problem (DTP) or non-DTP. Each DTP was further evaluated in a retrospective record review by a panel of USCG pharmacists to assess 2 additional factors: duty status severity (potential to affect duty status) and replicability (potential for the same intervention to be made in the absence of access to the patient health record). USCG Base Alameda pharmacy dispensed 1751 prescriptions and made 116 interventions (7%), of which 111 (96%) were accepted by the prescriber. Of the interventions, 64 (55%) were DTPs, and 14 of those (22%) had potential to change duty status, and 18 DTPs (28%) were made because the pharmacist had access to the health record. Pharmacists' role in USCG clinics includes collaborating with the patient care team to make medication interventions that have significant impact on ADSMs' wellness and the USCG mission.

Analysis of Various Parameters and Impact of Pharmacist Intervention at Retail Medical Stores or Pharmacies of Sindh, Pakistan

A cross-sectional, interventional study was conducted on 1000 retail medical stores/pharmacies selected conveniently from seven divisions of Sindh. A well-designed questionnaire was developed for the collection of data, and SPSS Version 25 was used to analyze the data. All the particpants were males, and majority of them were in the age group of 26-35 years (379 - 37.9%) followed by the age group of 18-25 years (260 - 26.0%), 36-45 years (248 - 24.8%), and &gt; 45 years (113 - 11.3%). The majority of the participants were owners (647 - 64.7%). Knowledge of the participants before and after education was for generic drugs (718 - 71.8% vs. 794 - 85.3%), proper storage temperature of vaccine/insulin (458 - 45.8% vs. 572 - 61.4%), and counseling of patients for dose (236 - 23.6% vs. 379 - 40.7%). The unavailability of qualified pharmacists is also one of the major problems that results in the failure of the provision of pharmaceutical care to patients. Keywords: intervention, retail pharmacy, pharmacist, awareness, Pakistan. https://doi.org/10.55463/issn.1674-2974.50.2.21

1656. Impact of Pharmacist Intervention on Antibiotic Prescribing at Hospital Discharge for Community-Acquired Pneumonia, Urinary Tract Infection, and Skin and Soft Tissue Infections

Abstract Background The high incidence of suboptimal antibiotic use at transitions of care represents a novel area for antimicrobial stewardship for community-acquired pneumonia (CAP), urinary tract infection (UTI), and skin and soft tissue infections (SSTIs). The objective of this study was to investigate the role of a pharmacist intervention at discharge to improve antibiotic use. Methods This was a single-center, retrospective, crossover analysis of patients admitted to general medicine units from 11/1/21 to 3/31/22 with a diagnosis of CAP, UTI, or SSTI. The study was divided into two phases separated by a one-month washout. Each two-month phase included two pre-specified units, an intervention and control. During phase 2, the intervention and control units were switched. Patients on antibiotics identified for discharge were reviewed and interventions were communicated by the pharmacist to the provider. Interventions were made based on predefined guidance for oral step-down therapy and total duration. The primary outcome, discharge antibiotic days of therapy (DOT), was compared between the intervention and control cohorts. Secondary outcomes included total DOT, hospital length of stay (LOS), 30-day readmission, and appropriateness of drug selection, dose, and duration. Results Records of 161 patients were included in this study, 85 in the intervention cohort (47 in phase 1, 38 in phase 2) and 76 in the control (41 in phase 1, 35 in phase 2). Overall discharge DOT was 3 (IQR 0–4.5) in the intervention cohort and 3 (IQR 0-5) in the control cohort (P = 0.8), and overall total DOT was 7 (IQR 5-9) and 7 (IQR 5-10) respectively (P = 0.27). Patients in the intervention group were more likely to have appropriate total duration (61.2% vs 44.7%, P = 0.001) and discharge duration of antibiotics (67.1% vs 53.9%, P = 0.013) for all three indications based on predefined guidance. Hospital LOS was 4 (IQR 3-5) vs 5 days (IQR 3-6.3) in the intervention and control cohorts (P = 0.001) respectively, and a lower 30-day readmission (14.1% vs. 23.7%, resp.). Conclusion Despite similar antibiotic DOTs, pharmacist intervention at discharge appeared to improve overall antibiotic total duration and discharge duration for CAP, UTI, and SSTI. Opportunities to improve discharge stewardship processes should be further explored. Disclosures Joseph L. Kuti, PharmD, Abbvie: Honoraria|bioMeriuex: Advisor/Consultant|bioMeriuex: Grant/Research Support|Contrafect: Grant/Research Support|Entasis: Grant/Research Support|Merck and Co: Grant/Research Support|Roche Diagnostics: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Shionogi: Honoraria|Summit: Grant/Research Support David P. Nicolau, PharmD, Shionogi: Grant/Research Support.

Impact of Pharmacist Intervention on Improving Knowledge, Attitude and Practice among Hypothyroid Patients

BACKGROUND Hypothyroidism causes considerable morbidity. Lack of awareness can lead to poor disease management. This study aimed to investigate the effect of pharmacist-provided counselling in terms of knowledge, attitude, and practice outcomes in hypothyroid patients.&#x0D; METHODS This was a prospective interventional study conducted in a tertiary care hospital of Nepal from September 2019 to February 2020. Based on the inclusion and exclusion criteria, a total of 94 hypothyroid patients were enrolled in this study. Simple Random sampling technique was used. The study population was divided into a test group and control group. The knowledge, attitude, and practice of patients regarding hypothyroidism were assessed and recorded at baseline using questionnaire and counselling was done. After one-month follow-up patients were again assessed using same questionnaire. Data was analyzed using Statistical Package for the Social Sciences version 25.&#x0D; RESULTS The mean knowledge, attitude, and practice scores before intervention of the test group were 6.16±2.14, 18.90±2.29 and 4.53±1.12 respectively, and these scores were changed to 12.48±1.53, 22.04±0.92 and 6.00±0.00 respectively, after the intervention (p &lt; 0.05). Likewise, the mean knowledge, attitude, and practice scores of the control group at baseline were 8.90 ± 3.69, 18.85 ± 2.01 and 4.71 ± 1.29 respectively, and after one-month follow-up the mean scores were changed to 7.88 ± 0.77, 11.50 ± 1.59 and 4.40 ± 0.76 respectively.&#x0D; CONCLUSION The pharmacist-provided counselling is useful in enhancing the knowledge, attitude, and practice of hypothyroid patients.

Impact of pharmacist intervention on anticoagulation management and risk for potential COVID-19 exposure during the COVID-19 pandemic

IntroductionPatients taking warfarin require frequent international normalized ratio (INR) monitoring in healthcare settings, putting them at increased risk of Coronavirus disease 2019 (COVID-19) exposure during the pandemic. Thus, strategies to limit in-person visits to healthcare facilities were recommended by the Anticoagulation Forum. The objective of this study was to describe the number and types of changes made to anticoagulation therapy as a result of pharmacist intervention during the COVID-19 pandemic. Materials and methodsA retrospective chart review of patients included in a primary care COVID-19 anticoagulation intervention was conducted. During this intervention, pharmacists provided individualized recommendations for anticoagulation changes in patients taking warfarin to limit their healthcare facility exposure while also maintaining safe anticoagulation management practices. ResultsAs a result of pharmacist intervention, 83 (55.7 %) of the 149 patients included in the intervention had changes in anticoagulation including: switching to a direct oral anticoagulant (n = 12), extending the INR monitoring interval (n = 48), switching to home INR monitoring (n = 21), or stopping anticoagulation (n = 2). For those patients who were taking warfarin for the entire 6 months pre- and post-intervention, the total number of healthcare facility and laboratory visits with an INR completed decreased from 8.8 to 6.4 (p < 0.001) per patient without a statistically significant decrease in time in therapeutic range (p = 0.76). ConclusionsThis study depicts rapid implementation of a population health-based approach to assess all patients taking warfarin for options to minimize healthcare visits and decrease risk for COVID-19 exposure. Methods to reduce healthcare visit burden while maintaining patient safety should be considered as a regular component of anticoagulation management post-pandemic.

Pharmacist-led antimicrobial stewardship programme in a small hospital without infectious diseases physicians

Pharmacists may be tasked to lead antibiotic stewardship programmes (ASP) implementation in small hospitals in absence of infectious diseases (ID) physicians. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a hospital without ID physician support, with special focus on indicators of the hospital use of antimicrobial agents based on consumption and asess the potential clinical and economic impact of pharmacist interventions (PIs) through the CLEO tool. A prospective quasi-experimental study to implement an ASP in a 194-bed hospital. We evaluated changes in antimicrobial use measured as mean defined daily doses per 1000 patient-days (AUD) for intervention versus preintervention period. A total of 847 antimicrobial PIs were proposed, being 88.3% accepted. Discontinuation due to excessive duration was the most frequently performed PI (23.4%). Most of PIs was classified as major or moderate clinical impact, 41.7% and 37.8% respectively. The global consumption of antimicrobial was reduced from 907.1 to 693.8 AUD, with a signifcant drop in carbapenems and quinolones. Direct expenditure of antibiotics decreased significantly. Pharmacist-led ASP has being effective in reducing consumption of antibiotics. In the absence of ID physician´s support and oversight, pharmacists could lead the improvement of the use of antimicrobials.

Impact of interventions by a community pharmacist on care burden for people with dementia: development and randomized feasibility trial of an intervention protocol

BackgroundTraditionally, the role of pharmacists has been to manage and monitor pharmacotherapy for patients with dementia. However, additional intervention by community pharmacists to collect and share patient information with other professionals may help reduce the care burden among caregivers. The aims of this study were to examine (1) the feasibility of a designed community pharmacist working procedure in dementia care and (2) the expected impact of pharmacist intervention on care burden.MethodsThis was a randomized, open-label, parallel-group feasibility study, involving eight Nara City pharmaceutical association member pharmacies that provided consent to participate. These pharmacies were assigned to an intervention group or a control group at a 1:1 ratio. The subjects were patients with dementia and their primary caregivers that visited the participating pharmacies and provided consent to participate. Pharmacists in the intervention group actively collected information from the patients’ family physicians and care managers and intervened to address medication-related problems, while those in the control group only performed their normal duties. The primary endpoint was a change in the caregiver’s score on the Japanese version of Zarit Caregiver Burden interview (J-ZBI) from the baseline to after 5 months of follow-up. The changes in mean J-ZBI scores from the beginning to the end of the study period of the two groups were compared.ResultsObtaining consent from caregivers was certainly difficult, but possible. Pharmacists managed to fill out the survey form while practising pharmaceutical care. Totally, nine patients and nine caregivers in the intervention group and nine patients and eight caregivers in the control group completed the study. The changes in J-ZBI scores could be calculated for seven cases in the intervention group and five cases in the control group. The J-ZBI scores were found to decrease by 1.0 in the intervention group and increase by 3.0 in the control group.ConclusionsThe protocol presented was considered feasible, but, the intervention process needs to be simplified in order to conduct a large study. Also, improvements are needed in the various survey forms and in the explanatory documents for caregivers. Although the sample size was small, the effect sizes suggested that community pharmacist interventions for patient with dementia may reduce the care burden for caregivers.Trial registrationUMIN000039949 (registration date: 1 April 2020, retrospectively registered)

Impact of oncology clinical pharmacist intervention on clinical trial enrollment in The U.S. Oncology Network’s MYLUNG Consortium.

1503 Background: The Molecularly Informed Lung Cancer Treatment in a Community Cancer Network: A Pragmatic Consortium (MYLUNG) clinical trial platform aims to advance the use of precision medicine in non-small cell lung cancer patients through a series of prospective and iterative clinic trials. “Protocol 2” is evaluating the patient and tissue journey of newly diagnosed lung cancer patients presenting for care. Timely patient accrual to oncology clinical trials is a known practice challenge. The US Oncology Network recently implemented a clinical pharmacist (ClinReview) to provide remote clinical services to support Protocol 2 enrollment. Methods: An oncology-trained clinical pharmacist remotely reviewed chemotherapy regimen orders and a weekly custom recruitment report within six community network practices (n = 149 physicians). The ClinReview pharmacist identified, screened, and assisted with recruitment of eligible patients for enrollment in the MYLUNG study. Relevant and concise patient data were provided to the on-site research team to facilitate ease of enrollment. Enrollments and intervention data were tracked to monitor the impact of the pharmacist intervention. The primary outcome of monthly enrollment was evaluated using a paired t-test. Results: Over a 6-month period, the ClinReview pharmacist screened 367 potentially eligible patients, 325 patients were recommended for enrollment, and 103 patients (32%) were consented and enrolled. Enrollment due to this ClinReview intervention increased monthly and ranged from 5 in first month to 33 enrollments in month 6. Average monthly enrollment was significantly greater after ClinReview intervention (3.4 patients/month vs. 6.8 patients/month; p = 0.008). Of the 154 patients recommended for enrollment that were not enrolled, 104 (68%) exceeded their eligibility window allowed by the trial, 15 (10%) were deceased or enrolled into hospice care, 10 (6%) declined trial participation, and 25 (16%) transferred care or were treated at outside facilities. Conclusions: We demonstrate that incorporation of an oncology clinical pharmacist in clinical research teams significantly enhanced clinical trial enrollment. The remote pharmacist easily adapted into clinic workflows in community practices. Validation across a broader spectrum of differentially resourced oncology practices will be conducted as the MYLUNG clinical trials platform is executed. [Table: see text]

The Impact of Pharmacist Intervention on Clinical Outcome, Adherence, and Quality of Life of Patients with Type 2 Diabetes Mellitus

Diabetes Mellitus (DM) is a chronic disease that occurs when the body cannot produce enough insulin or cannot use insulin (insulin resistance) and diagnosed by measuring blood glucose level (BGL). BGLs of DM patients should always be controlled to prevent complications. The purpose of this analytical cohort study was to analyze the effect of pharmacy intervention (PI) on BGL, adherence, and quality of life (QOL) of DM Type 2 (T2DM) patients (n=48) admitted to Dr. Tengku Mansyur hospital in Tanjung Balai period December 2020 to May 2021. The BGL, adherence, and QOL of the patients were compared before and after PIs. The patients’ BGLs were recruited from their medical records, their adherence to medication was analyzed using MMAS-8 questionnaire, and the patients QOLs were analyzed using the EQ-5D-3L questionnaire and the scores were categorized into 3 categories (&lt; 0.60 = bad, 0.6 - &lt;0.80 = moderate, ≥0.80 = good). The obtained data were analyzed using descriptive and Wilcoxon Signed-Rank tests in the SPSS Program.&#x0D; Mean age of the patients was 59.20 ± 8.20 (years). Most (58.3%) of them were females. The mean BGLs (mg/dL) of the patients: before PI 1, 262.02±5.91; before PI 2, 259.39±5.53; after PI, 202.35±4.80; and follow up after PI, 168.60±3.07. The mean adherence scores: before PI 1, 4.833 ± 0.08; before PI 2 4.70±0.07; after PI 6.833±0.09; follow up after PI 7.793±0.05. The mean QOLs of the patients: before PI 1, 0.719±0.005; before PI 2, 0.719±0.001; after PI, 0.801±0.009; follow up after PI 0.977 ± 0.009. There were significant differences among BGLs, patients’ adherence, and their QOLs before and after PI. p=0.000&#x0D; The present study proved that PI improved medication adherence, BGLs, and QOLs of outpatients with T2DM.

A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial

BackgroundOpioids and benzodiazepines (BZDs) are some of the most commonly prescribed medications that contribute to falls in older adults. These medications are challenging to appropriately prescribe and monitor, with little guidance on safe prescribing of these medications for older patients. Only a handful of small studies have evaluated whether reducing opioid and BZD use through deprescribing has a positive impact on outcomes. Leveraging the strengths of a large health system, we evaluated the impact of a targeted consultant pharmacist intervention to deprescribe opioids and BZDs for older adults seen in primary care practices in North Carolina.MethodsWe developed a toolkit and process for deprescribing opioids and BZDs in older adults based on a literature review and guidance from an interprofessional team of pharmacists, geriatricians, and investigators. A total of fifteen primary care practices have been randomized to receive the targeted consultant pharmacist service (n = 8) or usual care (n = 7). The intervention consists of several components: (1) weekly automated reports to identify chronic users of opioids and BZDs, (2) clinical pharmacist medication review, and (3) recommendations for deprescribing and/or alternate therapies routed to prescribers through the electronic health record. We will collect data for all patients presenting one of the primary care clinics who meet the criteria for chronic use of opioids and/or BZDs, based on their prescription order history. We will use the year prior to evaluate baseline medication exposures using morphine milligram equivalents (MMEs) and diazepam milligram equivalents (DMEs). In the year following the intervention, we will evaluate changes in medication exposures and medication discontinuations between control and intervention clinics. Incident falls will be evaluated as a secondary outcome. To date, the study has enrolled 914 chronic opioid users and 1048 chronic BZD users. We anticipate that we will have 80% power to detect a 30% reduction in MMEs or DMEs.DiscussionThis clinic randomized pragmatic trial will contribute valuable evidence regarding the impact of pharmacist interventions to reduce falls in older adults through deprescribing of opioids and BZDs in primary care settings.Trial registrationClinicaltrials.govNCT04272671. Registered on February 17, 2020

Impact of pharmacist intervention in reducing vancomycin-associated acute kidney injury: A systematic review and meta-analysis.

The aim was to quantify the relationship between pharmacist intervention and vancomycin-associated acute kidney injury (AKI). Electronic databases were searched up to August 2020 for meta-analyses of cohort studies and/or randomized controlled trials. Studies that compared the incidence of AKI in patients between post- and prepharmacist intervention were investigated. The primary outcome was incidence of AKI. We also evaluated the influence of pharmacist intervention in risk factors of vancomycin-associated AKI. The search strategy retrieved 1744 studies and 34 studies with 19 298 participants were included (22 published articles and 12 abstracts from conference proceedings). Compared with the preintervention group, the postintervention group patients had a significantly lower incidence of vancomycin-associated AKI: 7.3% for post- and 9.6% for preintervention (odds ratio [OR] 0.52, 95% confidence interval [CI]; 0.41, 0.67], P< .00001). The rate of attaining target concentration was significantly higher in the post- than preintervention group (OR 2.86, 95% CI [2.23, 3.67], P< .00001). The postintervention group significantly improved the percentage of serum creatinine laboratory tests than preintervention group (OR = 3.24, 95% CI 2.02, 5.19], P< .00001). Patients postintervention had markedly lower risk of mortality than preintervention patients (OR 0.47, 95% CI [0.31, 0.72], P= .0004). Pharmacist intervention in vancomycin treatment significantly decreased the rate of vancomycin-associated AKI, while improving efficacy and reducing mortality. We speculate that this is because the pharmacist interventions optimized the rationality of vancomycin therapy, monitoring of vancomycin trough concentration and the monitoring of patients' renal function.

Pharmacists’ Role in Medication Consultation of Outpatients Type 2 Diabetes

This study aimed to evaluate the efficiency of pharmacists’ consultation about special dosage forms in diabetes outpatients at Ha Long Medical Center. Subjects and method: Diabetes type 2 patients were treated as outpatients and managed at Ha Long Medical Center between 01/3/2019 and 01/9/2019. This study is a prospective cohort study. Results: After the Pharmacist performs routine consulting duties, the percentage of patients with correct knowledge and appropriate use of insulin increased statistically (p&lt;0.05). The proportions of patients who did not swallow whole tablets of Diamicron MR and Glucophage XR decreased significantly from 62.3% to 15.8% and from 56.6% to 15.9%, respectively. Conclusion: Pharmacists’ consultation plays a vital role in improving knowledge and use of special dosage forms in diabetes outpatient.&#x0D; Keyword: Medication counseling, modified release, insulin, diabetes.*&#x0D; &#x0D; &#x0D; * Corresponding author.&#x0D; E-mail address: haint@hup.edu.vn&#x0D; https://doi.org/10.25073/2588-1132/vnumps.4360&#x0D; This study aimed to evaluate the efficiency of pharmacists’ consultation about special dosage forms in diabetes outpatients at Ha Long Medical Center. Subjects and method: Diabetes type 2 patients were treated as outpatients and managed at Ha Long Medical Center between 01/3/2019 and 01/9/2019. This study is a prospective cohort study. Results: After the Pharmacist performs routine consulting duties, the percentage of patients with correct knowledge and appropriate use of insulin increased statistically (p&lt;0.05). The proportions of patients who did not swallow whole tablets of Diamicron MR and Glucophage XR decreased significantly from 62.3% to 15.8% and from 56.6% to 15.9%, respectively. Conclusion: Pharmacists’ consultation plays a vital role in improving knowledge and use of special dosage forms in diabetes outpatient.&#x0D; Keyword: Medication counseling, modified release, insulin, diabetes.&#x0D; References&#x0D; [1] International Diabetes Federation, IDF Diabetes Atlas 9th Edition, 2019.[2] S. Ahmad, M. T. Osman et al., Education of Correct Insulin Injection Technique amongst Diabetic Patients: Outcome Study from Malaysia, International Journal of Medical Research &amp; Health Sciences, Vol. 5, No. 6, 2016, pp. 198-205.[3] F. A. Sefidani, E. P. Riazi, Impact of Pharmacist Intervention on Appropriate Insulin Pen Use in Older Patients with Type 2 Diabetes Mellitus in a Rural Area in Iran, Journal of Research in Pharmacy Practice, Vol. 6, No. 2, 2017, pp. 114-119, https://doi.org/10.4103/jrpp.JRPP_16_151.[4] D. T. Hang, N. T. Hai, et al., Survey Onknowledge and Impacts of Medication Consultation in Diabetes Patients in Phuc Yen Region General Hospital, VNU Journal of Science: Medical and Pharmaceutical Sciences, Vol. 33, No. 2, 2017, pp. 85-93, https://doi.org/10.25073/2588-1132/vnumps.4076 (in Vietnamese).[5] Electronic Medicines Compendium (EMC), Diamicron 30 mg MR Tablets, https://www.medicines.org.uk/emc/product/1321/smpc, (accessed on: January 10th, 2019).[6] Electronic Medicines Compendium (EMC), Glucophage XR 500 mg Prolonged Release Tablets, http:// www.medicines.org.uk/emc/ medicine /20952 (accessed on: January 10th, 2019).[7] Electronic Medicines Compendium (EMC), Lantus SoloStar 100 units/ml Solution for Injection in a Pre-filled Pen, http://www.medicines.org.uk/emc/medicine/22447, (accessed on: January 10th, 2019). [8] Electronic Medicines Compendium (EMC), Mixtard 100 units/ml Solution for Injection in a Pre-filled Pen, http://www.medicines.org.uk/emc/medicine/21366 (accessed on: January 10th, 2019).[9] J. Jiajia, L. Qingqing, Insulin Pen Injection Technique Survey in Patients with Type 2 Diabetes in Mainland China in 2010, Current Medical Research and Opinion, Vol. 30, No. 6, 2014, pp. 1087-1093 , https://doi.org/10.1185/03007995.2014.895711.[10] N. T. Kien, Implemented the Pharmacist's Consultation in Using Insulin in Diabetes Outpatients at Dan Phuong District General Hospital, Master Thesis, Hanoi University of Pharmacy, 2020, pp. 49-50.&#x0D; &#x0D; &#x0D;

The Impact of Pharmacist-Managed Service on Warfarin Therapy in Patients after Mechanical Valve Replacement.

Objective To evaluate the impact of pharmacist interventions on international normalized ratio (INR) control during the warfarin initiation phase after mechanical valve replacement. Methods This was a retrospective cohort study conducted in a cardiovascular surgery ward in a tertiary hospital from August 1, 2015, to July 31, 2019. Patients aged ≥20 years who were admitted for mechanical valve replacement were enrolled in this study and further classified into conventional and pharmacist-managed warfarin therapy (PMWT) groups. All participants were prospectively followed up until the first outpatient appointment after valve replacement. The effectiveness outcomes were time in therapeutic range (TTR), time to therapeutic INR, number of patients with therapeutic INR at discharge and at first outpatient appointment, and length of hospital stay. The safety outcome was the number of patients with any supratherapeutic INR during the hospital stay. Multivariate logistic regression analyses were also used to determine the predictors of a therapeutic INR at discharge or with any supratherapeutic INR during admission. Results A total of 39 and 33 patients were enrolled in the conventional and PMWT groups, respectively. At discharge, 18 patients (46.2%) in the conventional group and 24 patients (72.7%) in the PMWT group had achieved the therapeutic INR (P=0.023). Compared to the conventional group, fewer patients in the PMWT group had supratherapeutic INR during hospital stay (35.9% vs. 9.0%, P=0.008). No significant differences were found in TTR, time to therapeutic INR, number of patients with therapeutic INR at return appointment, and length of stay between the study groups. In the multivariate regression analyses, PMWT predicted achieving therapeutic INR at discharge (odds ratio (OR) and 95% confidence interval (CI), 3.14 [1.08–9.14]) and was inversely associated with supratherapeutic INRs during admission (OR = 0.21 [0.05–0.82]). Conclusions Among patients admitted for mechanical valve replacement, the implementation of PMWT was associated with optimal therapeutic INR at discharge and no supratherapeutic INR during admission. Therefore, pharmacist participation is essential for improving the quality of warfarin therapy.

QP3: Impact of Pharmacist Interventions on Patient Outcomes in Migraine and Cluster Headaches

"QP3: Impact of Pharmacist Interventions on Patient Outcomes in Migraine and Cluster Headaches." Journal of Pain & Palliative Care Pharmacotherapy, 35(4), p. 236

Effect of Pharmacist Interventions on Medication Adherence to Capecitabine in Cancer Patients: A Systematic Review

Oral chemotherapy poses challenges regarding patient medication adherence. Pharmacists play a vital role in supporting medication adherence to achieve the effectiveness of therapy. This review aimed to evaluate the impact of pharmacist interventions on medication adherence in patients with cancer taking capecitabine. The literature was systematically reviewed using Scopus, ScienceDirect, Sage Journal, Springer Link, PubMed, and Google Scholar. Key text words included “adherence, pharmacist intervention, capecitabine, oral chemotherapy, and cancer.” We collected original articles published from January 2010 to June 2021 in English that reported pharmacist interventions to enhance capecitabine adherence in adult patients with cancer and assessed adherence rates pre- and post-intervention. Two independent researchers extracted data relevant to inclusion criteria and determined the methodological quality of studies using the Joanna Briggs Institute Critical Appraisal Checklist Tools. A total of 4179 articles were retrieved, of which five were eligible for review. The most common pharmacist intervention strategy was a combination of patient education, with oral and written information provided. Components of patient education were the characteristics of capecitabine, including its mechanism of action, side effects, and their management; current therapeutic regimen; importance of adherence; and risk of non-adherence. Pharmacist interventions provide beneficial impacts on medication adherence, beliefs about medication, and tolerability of side effects. The findings suggest that pharmacist interventions support medication adherence improvement and highlight the role of pharmacist interventions in pharmaceutical oncology care services. Further studies are necessary to assess pharmacist interventions’ long-term effects and clinical outcomes.