Optimize Medication Use Research Articles

BulletinToday: ACC recommends diabetes meds to reduce CV risk in those with type 2 diabetes; One in three Americans would not get COVID-19 vaccine, poll says

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Identification of the optimal primary care clinical pharmacy comprehensive medication management practice in the veterans health administration

AbstractClinical pharmacists are well‐positioned as the medication experts on the health care team to work collaboratively with providers and patients to achieve optimal medication use in order to maximize patient benefit and outcome. Comprehensive medication management (CMM) is defined as a patient‐centered approach to optimizing medication use and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. Lack of fidelity in practice model design and implementation make generalization of results of clinical pharmacy CMM practice difficult. There is currently no organization that evaluates standardized implementation of clinical pharmacists providing CMM in a Patient‐Centered Medical Home (PCMH) leading to wide variability of CMM implementation within the PCMH model. The Veterans Health Administration (VA) is the largest integrated health care system in the United States. Clinical pharmacy specialists (CPS) in the VA work autonomously but collaboratively under a practice area‐based scope of practice with prescriptive authority. The goal of the Clinical Pharmacy Practice Office Platinum Practice Designation was to develop a standardized review process to recognize sites that have achieved core elements of desired primary care pharmacy practice. In this paper, we describe the creation and implementation of this process. The submission process consisted of three rounds ranging from survey, data submission, data review and validation, and a facility interview. A total of 19 submissions were completed with two sites identified as achieving greater than 90% fidelity to the CMM model and were considered best practices. The creation of a rigorous set of implementation tools and measurement metrics creates the necessary fidelity to evaluate programs across different geographic areas. Identified sites provide examples for other facilities to emulate and creates momentum for pharmacy practice advancement throughout the nation.

Dexmedetomidine combined with suprascapular nerve block and axillary nerve block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair.

PurposeSuprascapular nerve block (SSNB) is the most commonly used block for the relief of postoperative pain from arthroscopic rotator cuff repair and can be used in combination with axillary nerve block (ANB). Dexmedetomidine (DEX) is a type of alpha agonist that can elongate the duration of regional block. The aim of this study was to compare the effects of the use of dexmedetomidine combined with SSNB and ANB with those of the use of SSNB and ANB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair.MethodsForty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single-center, double-blinded randomized controlled trial study. Twenty patients were randomly allocated to group 1 and received ultrasound-guided SSNB and ANB using a mixture of 0.5 ml (50 μg) of DEX and 9.5 ml of 0.75% ropivacaine preemptively. The other 20 patients were allocated to group 2 and underwent ultrasound-guided SSNB and ANB alone using a mixture of 0.5 ml of normal saline and 9.5 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were postoperatively checked within 48 h. The plasma interleukin (IL)-6, IL-8, IL-1β, cortisol, and serotonin levels were also postoperatively measured within 48 h.ResultsGroup 1 showed a significantly lower mean VAS (visual analog scale of pain) score 1, 3, 6, 12, 18 and 24 h after operation, and a significantly higher mean SAT (patient satisfaction) score 1, 3, 6, 12, 18, 24 and 36 h after the operation than group 2. Group 1 showed a significantly lower mean plasma IL-8 level 1 and 48 h after the operation, and a significantly lower mean IL-1β level 48 h after the operation than group 2. Group 1 showed a significantly lower mean plasma serotonin level 12 h after the operation than group 2. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (36 h > 23 h, p = 0.007). Six patients each in groups 1 and 2 showed rebound pain. The others did not show rebound pain.ConclusionsUltrasound-guided SSNA and ANB with DEX during arthroscopic rotator cuff repair resulted in a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h after the operation than SSNB and ANB alone. Additionally, SSNB and ANB with DEX tended to result in a later mean timing of rebound pain accompanied by significant changes in IL-8, IL-1β, and serotonin levels within 48 h after the operation. The present study could provide the basis for selecting objective parameters of postoperative pain in deciding the optimal use of medication for relieving pain.Level of EvidenceLevel I.Trial Registration2015–20, ClinicalTrials.gov Identifier: NCT04398589.IRB number2015–20, Hallym University Chuncheon Sacred Heart Hospital.

Community pharmacies have an even bigger role during COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Understanding salicylate intoxication during the COVID-19 era

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Pharmacies across the country have begun administering COVID-19 tests. Can yours?

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Patient Characteristics and Concerns about Drug Allergy: A Report from the United States Drug Allergy Registry

Drug allergy is frequently reported, but uncommonly confirmed with diagnostic testing. Although drug allergy assessments can improve clinical care, patient concerns may impact the optimal diagnostic approach and/or the clinical effectiveness of diagnostic testing. To assess drug allergy patient concerns. Using data from a multisite, prospective longitudinal cohort study, the United States Drug Allergy Registry (January 16, 2019, to January 24, 2020), we determined patient self-reported characteristics and qualitatively coded free-text patient concerns about their drug allergy/allergies. We assessed associations between patient characteristics and drug allergy concerns using multinomial logistic regression models. Of 592 patients (mean age, 49 [standard deviation, 17] years, 74% female, 88% white), the most commonly reported drug allergies were penicillins (78%), cephalosporins (12%), and sulfonamides (12%) with common reactions of rash (62%), hives (54%), itching (48%), flushing or facial redness (28%), and swelling or angioedema (24%). Patient concerns, coded from free text, were optimal medication use (41%), no concern (17%), allergic reaction (14%), diagnosis (12%), and severe allergic reaction (12%). Using multinomial regression, the presence of drug allergy concerns increased with greater age, higher number of reported drug reactions, more antibiotic use, and certain reaction symptoms, most notably mouth or palate itching. Female sex was associated with increased severe allergic reaction concern. Poorer general and mental health was associated with increased allergic reaction concern. Patients with drug allergy were concerned about their options for medical treatment, having an allergic reaction, and receiving clarity about their diagnosis. Capturing and addressing patient concerns may improve the approach to patients with drug allergy and/or the effectiveness of drug allergy testing.

Benzodiazepine Use and Deprescribing in Belgian Nursing Homes: Results from the COME-ON Study.

To describe the use and deprescribing of benzodiazepine receptor agonists (BZRAs) among nursing home residents (NHRs), to evaluate appropriateness of use and to identify factors associated with BZRA use and deprescribing. Posthoc analysis of the Collaborative Approach to Optimize Medication Use for Older People in Nursing Homes (COME-ON) study, a cluster controlled trial that evaluated the impact of a complex intervention on potentially inappropriate prescriptions (PIPs) in nursing homes (NHs). A total of 54 NHs in Belgium. A total of 797 NHRs included in the study who had complete medical, clinical, and medication information at baseline and at the end of the study (month 15). Data were recorded by participating healthcare professionals. Reasons why BZRA use was considered as PIPs were assessed using the 2019 American Geriatrics Society Beers Criteria® and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria, version 2. Deprescribing included complete cessation or decreased daily dose. We identified factors at the NHR, prescriber, and NH levels associated with BZRA use and BZRA deprescribing using multivariable binary and multinomial logistic regression, respectively. At baseline, 418 (52.4%) NHRs were taking a BZRA. The use of BZRA for longer than 4 weeks, with two or more other central nervous system active drugs, and in patients with delirium, cognitive impairment, falls, or fractures was found in more than 67% of BZRA users. Eight NHR-related variables and two prescriber-related variables were associated with regular BZRA use. Deprescribing occurred in 28.1% of BZRA users (32.9% in the intervention group and 22.1% in the control group). In addition to four other factors, dementia (odds ratio [OR] = 2.35; 95% confidence interval [CI] = [1.45-3.83]) and intervention group (OR = 1.74; 95% CI = 1.07-2.87) were associated with deprescribing. Use of BZRAs was highly prevalent, and reasons to consider it as PIP were frequent. Deprescribing occurred in one-fourth of NHRs, which is encouraging. Future interventions should focus on specific aspects of PIPs (ie, indication, duration, drug-drug and drug-disease interactions) as well as on nondementia patients.

Considering superinfections and antimicrobial resistance during COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Patients with COVID-19 may experience abnormal clotting

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

COVID-19 as a catalyst for change

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Pharmacists’ role in mental health expands during COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Crooks are using COVID-19 to scam patients

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

What we do and don’t know about flu in the COVID-19 era

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Pharmacists Embrace Telehealth During COVID-19

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

COVID-19 ‘alternative’ treatments

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Best practices for COVID-19 preparedness for health systems

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

Guidance specifies data that COVID-19 testers must collect and report to HHS

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.

4012 Positive Deviants for Medication Therapy Management: A Mixed-Methods Comparative Case Study of Community Pharmacy Practices

OBJECTIVES/GOALS: To optimize medication use in older adults, Medication Therapy Management (MTM) was launched as part of Medicare Prescription Drug (Part D) policy. The objective of this study was to generate hypotheses for strategies that contribute to community pharmacies’ ability to achieve high performance on policy relevant MTM quality measures. METHODS/STUDY POPULATION: This mixed-methods comparative case study design incorporated two conceptual models; the Positive Deviance model and Chronic Care Model. The study population consisted of pharmacy staff employed by a Midwestern division of a national supermarket-community pharmacy chain. Data consisted of semi-structured interviews and demographics. Qualitative and quantitative data were analyzed abductively or using descriptive statistics, respectively. Case comparisons were synthesized using the Framework Method. MTM quality measures used to evaluate participant pharmacies’ MTM performance mirrored quality measures under Domain 4 (Drug Safety and Accuracy of Drug Pricing) of the 2017 Medicare Part D Plan’ Star Rating measures. RESULTS/ANTICIPATED RESULTS: Staff at 13 of the 18 selected pharmacies (72.2%) participated in interviews. Interviewees included 11 pharmacists, 11 technicians and three student interns. Strategies hypothesized as contributing to MTM performance included: 1. Strong pharmacist-provider relationships and trust, 2. Inability to meet patients’ cultural, linguistic, and socioeconomic needs (negatively contributing), 3. Technician involvement in MTM, 4. Providing comprehensive medication reviews in person vs. phone alone, 5. Placing high priority on MTM, 6. Using maximum number of clinical information systems (CISs) to identify eligible patients. 7. Technicians using CISs to collect information for pharmacists, 8. Faxing prescribers adherence medication therapy problems (MTPs) and calling on indication MTPs. DISCUSSION/SIGNIFICANCE OF IMPACT: Our study resulted in eight strategies hypothesized to contribute to community pharmacy performance on MTM quality measures. To inform MTM policy recommendations, future research should engage stakeholders to assist with prioritizing hypotheses to be tested in a larger representative sample of pharmacies. CONFLICT OF INTEREST DESCRIPTION: This research was supported, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by grant number TL1TR001107 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. Dr. Adeoye-Olatunde is a part-time employee and Dr. Lake is a full-time employee at the Midwestern division, national supermarket-community pharmacy chain, where study procedures were conducted. Dr. Snyder reports personal fees from Westat, Inc., outside the submitted work.

Telehealth basics for pharmacists during COVID-19 and beyond

APhA is the leading advocate for the pharmacy profession and a driving force in creating opportunities for pharmacists to play a key role in integrated patient care, and ensuring the profession is recognized as essential in optimal medication use.