Long-term Care Pharmacy Research Articles

Practice outcomes for the first decade of Rural Pharmacy Education (RPHARM) Program graduates

BackgroundThe maldistribution of pharmacy services in underserved areas is a national issue. Analysis of data from the 2019 National Pharmacist Workforce Study indicated that 13.9% of pharmacists were working in a rural community. However, the percentage of people living in rural communities in the United States is 20.0%. Currently, there are 20 rural pharmacy programs in the United States, including the Rural Pharmacy Education (RPHARM) Program at University of Illinois Chicago (UIC) College of Pharmacy, which contain both didactic and experiential rural components. This research project examines the practice outcomes of the RPHARM Program graduates.MethodsDescriptive analysis was used to examine the practice outcome characteristics of RPHARM Program graduates between 2014 and 2023. The characteristics of the RPHARM graduates included the rurality of hometowns, practice locations and populations, and distance of practice locations to hometowns. Rural practice outcomes were described utilizing frequently used rural definitions. The practice locations of 54 of the 61 RPHARM graduates were used in the analysis.ResultsApproximately 41% of the practicing RPHARM graduates were from rural hometowns and two-thirds were female. RPHARM graduates mostly work in either a community setting (44.4%) or a hospital setting (37.0%). Approximately 11% worked in a federal government organization and 5.6% worked in a long-term care pharmacy. When examining job location, 42.6% were working in a rural location based on Rural–Urban Commuting Area Version 3.0 and 35.2% of RPHARM graduates had always worked in a rural location. Approximately 57% of practicing RPHARM graduates are working in a location < 50 miles from their hometown, and 13% are working 50 to 100 miles from their hometown. Approximately 74% of RPHARM graduates are practicing in Illinois.ConclusionsApproximately 40% of RPHARM graduates practice in rural locations. A significant portion (35.2%) of RPHARM graduates have always practiced in rural locations, and many (57.4%) are practicing near their hometowns. Results indicate that the RPHARM Program is making meaningful contributions to increasing the rural pharmacy workforce. Due to the lack of information on rural pharmacy practice outcomes, all programs with rural pharmacy content are encouraged to track graduates’ practice locations.

Preparation Times and Estimated Costs for Vancomycin Formulations: Does the Difference Matter?

Objective Infections from methicillin-resistant Staphylococcus aureus are increasingly treated in longterm care facilities, but long-term care pharmacies face high costs in the provision of sterile vancomycin for intravenous administration. This study compares pharmaceutical costs of outsourced, compounded, and room temperature premixed vancomycin formulations in a long-term care pharmacy. Design This retrospective observational study reviewed 124 orders of vancomycin. Means for total pharmacy preparation time, pharmacist labor time, and extrapolated time over complete course of treatment were compared for three vancomycin preparations: outsourced, compounded by pharmacy, and room temperature premixed vancomycin formulations. Cost calculations were generated using ingredient costs as reported by the pharmacy and median pharmacist labor costs as published from national sources. Results Mean total preparation times and pharmacist preparation times were shortest for premixed vancomycin. Over full courses of treatment, mean pharmacy preparation time for compounded was 5 hours 3 minutes (mean of 28 treatments) and 2 hours 8 minutes for premixed (mean of 54 treatments). Data on pharmacist time in outsourced orders were not available. Total pharmacy costs were $993.94 for compounded vancomycin, $2220.34 for outsourced, and $809.36 for room temperature premixed vancomycin. Conclusion There were reduced preparation times for room temperature premixed vancomycin compared with compounded and outsourced formulations for skilled nursing facilities. As multiple drug-resistant organism infections are increasingly treated in long-term care, finding cost-effective approaches to medication provision from pharmacies is critical.

Long-Term Care Pharmacy Market Shares and Differences in Skilled Nursing Facilities Served

ABSTRACT Medications and pharmacy services are critical to post-acute care (PAC) in skilled nursing facilities (SNFs), yet little is known about the long-term care (LTC) pharmacies that provide them. We estimated the market shares of LTC pharmacies and how SNFs differed between pharmacies. This cross-sectional study used data from SNFs that provided PAC services in Rhode Island (RI) in 2019. We applied the parametric g-formula to compare SNF pharmacy-related deficiencies and medication use measures between LTC pharmacies while standardizing for SNF membership in a chain and number of beds. Among 75 SNFs, 68 (91%) were served by either Omnicare (n = 32, 43%) or PharMerica (n = 36, 48%), and 7 (9%) by other LTC pharmacies. After covariate adjustment, PharMerica SNFs had the lowest prevalences of any pharmacy-related deficiency (PharMerica, 63.2%; Omnicare, 80.2%; other LTC pharmacy, 69.1%) and antianxiety medication use (PharMerica, 9.7%; Omnicare, 13.6%; other LTC pharmacy, 13.5%), but estimates were imprecise. The RI market is highly concentrated between LTC pharmacies. If similarly high LTC pharmacy market concentration exists nationally, there is enormous promise for efficiently delivering interventions to improve medication management in SNFs. However, it may also present a risk of harm if policies do not maintain sufficient competition and innovation is stifled.

Long-term care professionals' views on pharmacists: a qualitative study using Role Theory.

BackgroundQualitative research investigating pharmacists’ participation in Long-Term Care (LTC) within interdisciplinary teams is scarce.AimTo characterize how pharmacists’ participation in a national network of LTC is perceived by healthcare professionals and other key stakeholders.MethodIndividual, in-depth, semi-structured interviews of participants (nurses, physicians, pharmacists, and LTC researchers) enrolled purposively or through snowballing sampling techniques, with the final sample being comprised of fourteen participants. Data analysis followed a deductive coding approach framed by Role Theory and supplemented with an inductive coding for additional themes.ResultsFour Role Theory constructs were identified from the primary data—role identity, overqualification, ambiguity, underqualification. Clinical pharmacy services, logistics and educational activities were pointed out as representing the identity of pharmacists’ interventions. Despite the clear identification of LTC pharmacists’ interventions, pharmacist expertise on medicine optimization seemed to be underused (role overqualification), as a result of lack of time, lower proactivity in healthcare teams’ integration, and the absence of a legal framework targeted to LTC pharmacy practice (role ambiguity). Additional clinical training, including in the management of older people’s health conditions, nutrition, and palliative care were missing (role underqualification).ConclusionLTC pharmacists can provide essential services (e.g., clinical pharmacy, logistics, educational interventions), although additional training and a clearer legal framework are missing to better define pharmacists’ roles in LTC pharmacy practice.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11096-022-01482-9.

Direct Oral Anticoagulants in Long-term Care Facilities: Rates of FDA-Approved Dosing.

Objective To determine rates of compliance with Food & Drug Administration (FDA)-approved dosing of direct oral anticoagulants (DOACs) in long-term care residents. Design A retrospective chart review of 90 patients, utilizing an electronic health record, and a longterm care pharmacy's dispensing record. Patient electronic health records were reviewed to collect the following data: prescribed DOAC, dose, therapy duration, diagnosis, age, height, weight, and serum creatinine. This information was used to determine the FDA-recommended DOAC dose and recommended duration, which was compared with the prescribed dose and duration. Main Outcome Measure The rate of incorrect DOAC doses, defined as a discrepancy from the FDA-recommended dose, based on patient characteristics. Setting Two chains of long-term care facilities in Michigan, Ohio, North Carolina, Tennessee, and Virginia serviced by a long-term care pharmacy. PATIENTS: Patients prescribed one of three targeted DOACs (apixaban, rivaroxaban, or dabigatran) between August and October 2019. Patients had to be a resident within two long-term care chains. Results Thirty-three out of 90 residents were treated with an incorrect DOAC dose. This broke down into 20% of patients on a dose that was too low and 17% of patients on a dose that was too high. Conclusion The results of the study identify the need for pharmacists to closely review the dosing of DOACs and recommend therapeutic changes based on treatment guidelines.

Dispensing of HIV and Hepatitis C Antivirals During COVID-19: An Interrupted Time-Series Analysis of U.S. National Data

IntroductionLittle is known about the potential changes in the dispensation of life-saving hepatitis C virus (HCV) and HIV antivirals after the initial U.S. outbreak of COVID-19. The objective of this study was to describe the immediate and 1-year impacts of the U.S. outbreak of COVID-19 on monthly dispensing of HIV and HCV antivirals, specifically direct-acting antivirals (DAA) to treat HCV, antiretroviral therapy (ART) to treat HIV, and pre-exposure prophylaxis (PrEP) to prevent HIV.MethodsAuthors used interrupted time-series analysis, examining IQVIA National Prescription Audit (includes 92% of U.S. retail pharmacies and 70% of U.S. mail order and long-term care pharmacies) for changes in monthly dispensed prescriptions, 2 years before and 1 year after the initial U.S. COVID-19 outbreak. Fitted linear segmented regression models were used to assess immediate level and slope changes, excluding data from April 2020 as a washout period. Authors stratified analyses by new/refill, age group, payer type, and delivery channel.ResultsAfter the initial outbreak, DAA prescription dispensing declined by almost one third. The COVID-19 outbreak was associated with an immediate-level decrease in total DAA prescriptions, followed by a slope increase in monthly dispensing. However, by April 2021, monthly DAA dispensing had not recovered to prepandemic levels. In contrast, ART and PrEP dispensing changed little over the same time period.ConclusionsU.S. dispensing of DAAs to treat HCV fell at the start of the U.S. COVID-19 outbreak and has yet to fully recover to prepandemic levels. Addressing barriers to care is crucial to reaching national HIV and hepatitis C elimination goals.

Comparison of Preparation Times and Cost for Compounded, Outsourced and Premixed Vancomycin Products in a Long-Term Care Pharmacy

Multiple drug resistant organism (MDRO) infections are increasingly being treated in post-acute long-term care (PA-LTC) settings, due to high costs associated with treating MDRO in the hospital. While MDRO therapies are increasingly given in PA-LTC settings, studies suggest PA-LTCs may also be a reservoir of MDROs, perhaps more so than hospital settings. Intravenous antimicrobial agents effective against MDRO, such as vancomycin, must increasingly be provisioned to PA-LTC settings, but preparation time and cost of provisioning vancomycin is not well characterized in the literature.

The Centers for Medicaid & Medicare Memo: What Does it Mean for Long-term Care Pharmacy in Part D?

Paul Baldwin discusses the December 15, 2020 release of a CMS memo aimed at Medicare Part D sponsors. The thrust of the memo was to explain the agency's current interpretation of appropriate dispensing fees under the provisions of CMS regulations concerning the Medicare Prescription Drug Benefit. The focus of this memo is how the LTC Guidance (Prescription Drug Benefit Manual Chapter 5. 50.5) would apply across the spectrum of pharmacy providers and Medicare beneficiaries.

Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method.

Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as ‘appropriate’, ‘uncertain’, or ‘inappropriate’ a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as ‘appropriate’ for pharmacy practice targeted to long-term care patients, while 3 were classified as ‘inappropriate’. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.

Evaluation of Electronic Health Record and Long-Term Care Pharmacy Data for Tracking and Reporting Antibiotic Use in the United States

Background: Antibiotics are frequently prescribed in nursing homes, often inappropriately. Data sources are needed to facilitate measurement and reporting of antibiotic use to inform antibiotic stewardship efforts. Previous analyses have shown that the type of nursing-home stay, that is, short stay (&lt;100 days), is a strong predictor of high antibiotic use compared to longer nursing-home stays. The study objective was to compare 2 different data sources, electronic health record (EHR) and long-term care (LTC) pharmacy data, for surveillance of antibiotic use and type of nursing-home stay. Methods: EHR and pharmacy data during 2017 were included from 1,933 and 1,348 US-based nursing homes, respectively. We compared data elements available in each data source for antibiotic use reporting. In each data set, we attempted to describe antibiotic use as the proportion of residents on an antibiotic, days-of-therapy (DOT) per 1,000 resident days (RD), and distribution of antibiotic course duration, overall and at the facility level. Facility proportion of short-stay and long-stay (&gt;100 days) nursing-home residents were calculated using admission dates and census data in the EHR data set and a payor variable in the pharmacy data set (Figure 1). The 2 data sources also provided antibiotic characteristics, including antibiotic class, agent, and route of administration. The deidentified nature of facility data prevented direct comparison of antibiotic use measures between facilities. Results: The EHR and pharmacy data sets contained 381,382 and 326,713 residents, respectively (Table 1). Within the EHR, 51% of residents were prescribed an antibiotic in 2017, at a median rate of 77 DOT per 1,000 RD. In the LTC pharmacy, 46% of residents were prescribed an antibiotic at a median rate of 79 DOT per 1,000 RD (Table 1). Short-stay residents contributed a smaller proportion of total RDs in the EHR relative to the pharmacy cohort (21% vs 50%, respectively). Conclusions: Nursing-home antibiotic use data obtained from EHR and pharmacy vendors can be used for calculating antibiotic use measures, which is important for antibiotic use reporting and facility-level tracking to identify opportunities for improving prescribing practices and provide facility-level benchmarks. Further validation of both data sources in the same facilities is needed to compare antibiotic use rates and to determine the most appropriate proxy for type of nursing-home stay for facility-level risk adjustment of antibiotic use rates.Funding: NoDisclosures: None

Adventures in getting paid

Adventures in getting paid

199. Evaluating long-term care pharmacy dispense data to monitor antibiotic use in U.S. nursing homes

BackgroundAutomated reporting of antibiotic use (AU) in nursing homes (NHs) may help to identify opportunities to improve antibiotic prescribing practices and inform implementation of stewardship activities. The majority of U.S. NHs contract with long-term care (LTC) pharmacies to dispense prescriptions and provide medication monitoring and reviews. We investigated the feasibility of leveraging LTC pharmacy electronic dispensing data to describe AU in NHs.MethodsWe analyzed all NH antibiotic dispenses and monthly resident-days in 2017 reported by a large LTC pharmacy. The dispense-level data included facility and resident identifiers, antibiotic class and agent, dispense date and days of therapy (DOT) dispensed. We identified NH antibiotic courses, inclusive of both antibiotic starts and continuations from hospital-initiated courses, by collapsing dispenses of the same drug to the same resident if the subsequent dispense was within three days of the preceding end date. The course duration was the sum of DOT for all dispenses in the course. The AU rate was reported as DOT and courses per 1,000 resident-days.ResultsAU was described in 326,713 residents admitted to 1,348 NHs (9% of U.S. NHs), covering 38.1 million resident-days. There were 576,228 dispenses for a total of 3.3 million antibiotic DOT at a rate of 86 DOT/1,000 resident-days. After collapsing dispenses, 324,306 antibiotic courses were defined at a rate of 9 courses/1,000 resident-days. During the year, 45% of residents received an antibiotic. The most frequently prescribed classes by DOT and courses were cephalosporins, penicillins, urinary anti-infectives and quinolones (Fig. 1). The top agents by DOT were levofloxacin (12%), sulfamethoxazole/trimethoprim (12%) and cephalexin (11%). Most course durations were 1–7 days (54%) or 8–14 days (35%) (Fig. 2). Long-term antibiotic courses (> 30 days) contributed to 5% of courses and 30% of overall DOT. The mean duration per course was 7.5 days when courses > 30 days were excluded.Figure 1. Distribution of antibiotic courses and days of therapy by antibiotic class for 324,306 antibiotic courses and 3.3 million days of antibiotic therapy dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017 Figure 2. Distribution of antibiotic course duration and cumulative percent of total antibiotic days of therapy for 324,306 antibiotic courses dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017 ConclusionLTC pharmacy dispenses may be an accessible data source to report NH AU rates and prescribing patterns by antibiotic class and agent. Further evaluation of data sources for facility- and national-level AU reporting in NHs is needed to support stewardship implementation.Disclosures All Authors: No reported disclosures

Impact of Training Consultant Pharmacists on Antimicrobial Stewardship Programs in Long-Term Care Facilities

Background: The CDC recommends that consultant pharmacists support antimicrobial stewardship programs (ASPs) in long-term care facilities (LTCFs). We studied CDC-recommended ASP core elements implementation and antibiotic use in LTCFs before and after training consultant pharmacists. Methods: Between August 2017 and October 2017, consultant pharmacists from a regional long-term care pharmacy attended 5 didactic sessions preparing them to assist LTCFs in implementation of CDC-recommended ASP core elements. Training also included creating a process for evaluating appropriateness of all systemic antibiotics and providing prescriber feedback during their monthly mandatory drug-regimen reviews. Once monthly “meet-the-expert” sessions were held with consultant pharmacists throughout the project (November 2017 to December 2018). LTCF enrollment began in November 2017 and &gt;90% of facilities joined by January 2018. After enrollment, consultant pharmacists initiated ASP interventions including antibiotic reviews and feedback using standard templates. They also held regular meetings with infection preventionists to discuss Core Elements implementation and provided various ASP resources to LTCFs (eg, antibiotic policy template, guidance documents and standard assessment and communication tools). Data collection included ASP Core Elements, antibiotic starts, days of therapy (DOT), and resident days (RD). The McNemar test, the Wilcoxon signed-rank test, generalized estimating equation model, and the classic repeated measures approach were used to compare the presence of all 7 core elements and antibiotic use during the baseline (2017) and intervention (2018) year.Results: In total, 9 trained consultant pharmacists assisted 32 LTCFs with ASP implementation. When evaluating 27 LTCFs that provided complete data, a significant increase in presence of all 7 Core Elements after the intervention was noted compared to baseline (67% vs 0; median Core Elements, 7 vs 2; range, 6–7 vs 1–6; P &lt; .001). Median monthly antibiotic starts per 1,000 RD and DOT per 1,000 RD decreased in 2018 compared to 2017: 8.93 versus 9.91 (P &lt; .01) and 106.47 versus 141.59 (P &lt; .001), respectively. However, variations in antibiotic use were detected among facilities (Table 1). When comparing trends, antibiotic starts and DOT were already trending downward during 2017 (Fig. 1A and 1B). On average, antibiotic starts decreased by 0.27 per 1,000 RD (P &lt; .001) and DOT by 1.92 per 1,000 RD (P &lt; .001) each month during 2017. Although antibiotic starts remained mostly stable in 2018, DOT continued to decline further (average monthly decline, 2.60 per 1,000 RD; P &lt; .001). When analyzing aggregated mean, antibiotic use across all sites per month by year, DOT were consistently lower throughout 2018 and antibiotic starts were lower for the first 9 months (Fig. 1C and 1D). Conclusions: Consultant pharmacists can play an important role in strengthening ASPs and in decreasing antibiotic use in LTCFs. Educational programs should be developed nationally to train long-term care consultant pharmacists in ASP implementation.Funding: Merck &amp; Co., Inc, provided funding for this study.Disclosures: Muhammad Salman Ashraf and Scott Bergman report receipt of a research grant from Merck.

Role of Medical Students in Responding To COVID-19: Identifying and Addressing Vital Deficiencies

To address the shortage of personal protective equipment (PPE) that occurred as a result of Coronavirus disease 2019 (COVID-19), three first-year medical students at Western University developed an initiative to deliver handmade gowns to primary care providers in London, Ontario, Canada. They partnered with the local branch of the Canada Sews organization to sew the gowns, and created a gown order form which was distributed in the community. Following gown delivery by the authors, an optional feedback form was sent to the gown recipients for quality assurance purposes. As of June 10, 2020, 411 gowns were delivered to medical and dental locations, long-term care homes, emergency shelters, and pharmacies. Feedback from the recipients indicated that the gowns were comfortable to wear and consistently useful to primary care practices. The successful execution of the initiative within a month of its inception, the delivery of more than 400 gowns within the subsequent month, and the positive feedback from the gown recipients, indicates that medical students can play an important role during the COVID-19 pandemic, and other periods of crisis, even outside of clinical settings. Specifically, they are able to demonstrate the qualities of leadership, collaboration, and advocacy to spearhead initiatives to fulfill unmet community needs. They are also uniquely situated to help their communities due to factors such as the skills and knowledge they have attained in their academic training. Thus, the ability of medical students to assist primary care providers should be taken into consideration for future pandemics.

2055. Action: A Year in the Lives of Consultant Pharmacists Working on Antimicrobial Stewardship in Long-Term Care Facilities

BackgroundThe CDC recommends consultant pharmacists (CP) support antimicrobial stewardship (AS) activities in long-term care facilities (LTCF) by reviewing antimicrobial appropriateness. We initiated a project training CP from a regional long-term care pharmacy to support AS implementation in LTCF.MethodsCP were trained to evaluate the appropriateness of all systemic antimicrobial therapy (AT) and provide prescriber feedback during their monthly drug regimen review (DRR). An electronic database was developed to facilitate data reporting. Antimicrobial use (AU) and adverse events (AE) from 32 LTCF were analyzed for 2018 using descriptive statistics.ResultsA total of 5327 courses of AT with a median duration of 7 days (IQR 5–10) were reviewed. The majority of AT was started in the LTCF (55%) but was also initiated in hospitals (24%), clinics (11%) and emergency departments (2%). Of 2926 AT started in LTCF, 36% were based on nurse evaluation (NE) while 33% began after prescriber evaluation (PE). Fluoroquinolones (FQ) and first-generation cephalosporins were the most commonly prescribed agents (Table 1). Treatment or prophylaxis of urinary tract infections accounted for 40% of AU (Figure 1). Diagnostic testing was associated with 37% of AT courses. Urine cultures were the most frequent test performed (81%). Overall, 41% of AT was determined to be inappropriate resulting in > 800 feedback letters sent to prescribers. Unnecessary antibiotic starts (based on revised Mc Geer or Loeb’s criteria) were identified as the most common reason (Figure 2). AT appropriateness varied depending on the setting in which it was initiated. A majority (87%) of AT initiated in hospitals was found to be appropriate with 56% and 46% appropriate for ED and clinic starts. Appropriateness of LTCF initiated AT was 49% (59% after PE and 42% after NE). AE were associated with 3% of AT with allergic reactions and Clostridioides difficile infections occurring with 0.4% and 0.7% of AT, respectively. AE were most frequently associated with folate antagonists (5%) and FQ (3%).ConclusionThis study demonstrates many AU improvement opportunities exist in LTCF and CP can play an important role in identifying them if trained in AS principles. CP should review all AU for appropriateness and provide data to inform AS efforts in LTCF. Disclosures All authors: No reported disclosures.

First evidence for a pharmacist-led anticoagulant clinic in a medicare part A long term care environment.

Anticoagulation risks in older adult, long-term care patients are known to be high, especially in those with frequent transitions between care environments. Introduction of collaborative practice agreements (CPA) in specific settings is encouraged in the United States and has provided an additional option for the care of medically challenging patients. The aim of this study was to investigate the time in therapeutic range (TTR) in a Medicare Part A sponsored long-term care environment managed by pharmacists through a collaborative practice agreement in South-Central Appalachia. A retrospective review of all warfarin patient admissions from a large long-term care pharmacy's anticoagulant clinic was conducted for residents over an 18-month period. For all patients (n = 104), the overall TTR was 46.7% (INR 43% in range). Average management duration was 19.5days per patient. Further studies are required to optimize CPA and transition strategies for complex, advanced age warfarin patients.

Impact of a coordination of care program in an independent community pharmacy

ObjectiveThe first objective was to determine the impact on hospital readmissions at 30- and 90-days after discharge. The second objective was to examine the change in number of medications a patient was taking before enrollment versus after enrollment and potential health care savings. SettingIndependent community pharmacy in the southeastern United States. Practice descriptionBlue Ridge Pharmacy, Inc. is composed of 2 long-term care pharmacies, 2 community pharmacies, a compounding pharmacy, and a specialty pharmacy. Practice innovationThe Access Program is a transitions of care and coordination of care program. Sona Access helps patients who have undergone a transition of care from a skilled nursing facility, health system, physician office, or community partner. Access incorporates social care services and medication services such as free home delivery, home visit, monthly care calls, and adherence packaging. EvaluationThis retrospective study included participants age 18 years and older who enrolled in the program between March 2015 and March 2016 and had at least 3 months of data. Data collected included patient demographics, reason for referral, admissions to hospitals or skilled nursing facilities, number of medications before enrollment, and number of medications three months after enrollment. ResultsThe mean age (±SD) was 70 ± 13.8 years, and 65% of patients were female. The 123 patient enrollments yielded 113 total hospitalizations, resulting in a mean of 0.92 hospitalizations per patient. Pharmacist consultation and reconciliation decreased the average number of medications from 12 to 10 medications per patient. Within the 113 hospitalizations that occurred after enrollment, 5 occurred within 30 days, 13 occurred within 90 days, and 95 occurred at 91 days or greater. ConclusionThis study suggests that the delivery of coordination of care services through medication reconciliation, medication synchronization, and home visits has a positive effect on health outcomes for patients who have undergone a recent transition of care.

An electronic tool to aid community pharmacists in optimizing care for persons with diabetes

ObjectiveTo develop an electronic tool to aid community-based pharmacists in incorporating diabetes-specific clinical services into pharmacy workflow and to determine the utility of the tool. SettingThree independent community pharmacy locations. Practice descriptionRealo Discount Drugs is a group of 18 independent community pharmacies, a specialty pharmacy, and a long-term care pharmacy, all with a common owner, serving eastern North Carolina. Practice innovationAn electronic tool was developed to aid pharmacists in identifying gaps in therapy for patients with diabetes in alignment with the 2018 American Diabetes Association Standards of Medical Care in Diabetes. An RX edit (short code) alerted the pharmacist when a diabetes medication was verified. An electronic tool complemented the RX edit, through which the pharmacist would assess the patient record for the presence of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), aspirin, or a statin. EvaluationThe pharmacist used an electronic tool to identify gaps in therapy, to document medication therapy problems identified, to make therapeutic recommendations to the patient or provider, and to document interventions using the electronic tool. ResultsPharmacists used the tool 788 times during a 50-day period. Each completion of the tool represented 1 patient profile assessed. Pharmacists identified 99 patients (12.6%) who were not using an ACEI or ARB. Pharmacists recommended ACEI or ARB therapy for 56 patients (56.6%). Pharmacists identified 371 patients (47.1%) who were not using aspirin therapy, and recommended aspirin therapy for 198 patients (53.4%). Pharmacists identified 187 (23.7%) patients who were not given statin therapy and recommended statin therapy for 142 patients (76%). A total of 74 medication therapy problems (18.7%) were resolved. ConclusionAn electronic tool was developed and integrated into the dispensing workflow. The implementation of an electronic tool helped community-based pharmacists to identify gaps in therapy and to make recommendations in alignment with American Diabetes Association guidelines.

EPA Releases Final Rule on Hazardous Pharmaceutical Waste

Ten years in the making, the Environmental Protection Agency (EPA) has issued a final rule on how to manage hazardous pharmaceutical waste. The longterm care pharmacy industry has worked with the EPA in this process and has hosted pharmacy tours and discussions with the agency over the decade to help it better understand how drug waste is currently managed and how the EPA's various concerns could be met with as little disruption to pharmacies as possible.

EPA Releases Final Rule on Hazardous Pharmaceutical Waste.

Ten years in the making, the Environmental Protection Agency (EPA) has issued a final rule on how to manage hazardous pharmaceutical waste. The longterm care pharmacy industry has worked with the EPA in this process and has hosted pharmacy tours and discussions with the agency over the decade to help it better understand how drug waste is currently managed and how the EPA's various concerns could be met with as little disruption to pharmacies as possible.