Multidimensional analysis of clinical pharmacist intervention impact on hospital length of stay in pulmonary tuberculosis: a random forest-driven retrospective study

BackgroundPharmacist-led interventions can significantly improve antimicrobial use, optimize outcomes, and reduce antimicrobial resistance and adverse drug reactions. This initiative aimed to evaluate the impact of an anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy bundle on pharmacist interventions and therapy use.Table 1.Baseline CharacteristicsFigure 1.Primary OutcomeMethodsThis single-center retrospective project evaluated pharmacist impact before and after implementation of an anti-MRSA therapy bundle (January-March 2024 versus January-March 2025). The bundle included expanded VigiLanz® alerts, MRSA nasal polymerase chain reaction (PCR) use, an “Antibiotic Time-Out Tool: MRSA” document with pharmacist education, and daily VigiLanz® generated reports of active orders for daptomycin intravenous (IV), linezolid IV/by mouth (PO), and vancomycin IV. Hospitalized adult patients with orders for scheduled stated anti-MRSA agents were included. Patients were excluded if orders for “pre-op,” “on-call,” or “once” frequencies, indication of surgical or Group B Streptococcus prophylaxis, on chronic suppressive or prophylactic antimicrobial therapy, hospice and comfort measures only, incarcerated, or pregnant. The primary outcome was the number of patients who received at least one pharmacist intervention regarding daptomycin, linezolid, or vancomycin de-escalation, discontinuation, or optimization. Secondary outcomes included total number of pharmacist interventions, pharmacist intervention details, intervention acceptance rate, VigiLanz® adult hospital-wide inpatient days of therapy per 1000 patient days, hospital length of stay, incidence of adverse drug events, and 30-day mortality rate. This project was exempt from Institutional Review Board review.Table 2.Secondary OutcomesResultsBaseline characteristics are listed in Table 1. Primary outcomes are detailed in Figure 1. The post-group had a 93% acceptance rate and 14% per-protocol completion. A total of 48 interventions were observed in the pre-group and 100 interventions in the post-group. Secondary outcomes are included in Table 2.ConclusionA pharmacist-led anti-MRSA therapy bundle significantly increased interventions related to therapy de-escalation, discontinuation, and optimization, with high provider acceptance.DisclosuresAll Authors: No reported disclosures

BackgroundImplementing a formal program for the review of oral antibiotic discharge prescriptions (AbxRx) is often limited by staffing constraints. At our institution, primary teams can choose to reach out to an antimicrobial stewardship pharmacist (ASP) for guidance on AbxRx at discharge via curbside consultation (DCC). We described DCC and compared clinical outcomes between ASP vs. team-based (TB) groups.MethodsThis was a retrospective study of adult inpatients who received an AbxRx between 1/2024 to 6/2024 with or without ASP intervention. TB group consisted of a medicine (MD/DO) attending and an advanced practice provider (APP) without ASP intervention. The primary composite outcome was the appropriateness of AbxRx, defined as use of narrow spectrum of activity, dosing and duration consistent with local ASP guidelines. Secondary outcomes include length of stay (LOS), readmission, and incidence of Clostridiodies difficile infection (CDI).ResultsOf 359 reviewed, 299 patients prescribed an AbxRx were included (ASP n=150, TB n=149). Age and Charlson comorbidity index were similar between groups. The most common infection was pneumonia (38%), urinary tract (27.8%), and skin soft tissue infections (16.7%). APPs were more likely to initiate DCC (64.4% vs 19.5% attending). DCC were triggered by bacteremia (13.7% vs 0%, P=< 0.001), intravenous abxRx with Pseudomonal coverage (69.1% vs 40.7%, P< 0.001) and presence of positive cultures (54.4% vs 30.7%, P< 0.001). Median time from admission to ASP intervention was 3 days (IQR 2-4), from ASP intervention to discharge was 4.7h (IQR 1.7-25.1h). More patients in the ASP group were discharged on cefuroxime (20.1% vs. 4%, P< 0.001) while more patients in TB group were discharged on cefpodoxime (10.7% vs. 29.3%, P< 0.001). Patients in the ASP group were more likely to have appropriate AbxRx (96% vs. 60%, P< 0.001) and higher adherence to AS guidelines (97.1% vs. 75%, P< 0.001). LOS (3 vs. 3 days, P=0.34), readmission (4.7% vs. 2%, P=0.22) and CDI (0%) were similar between groups.ConclusionDCC were more commonly triggered by APPs, likely for the need of higher-level infectious disease training and comfortability in interpreting cultures. ASP improved the appropriateness of AbxRx with increased narrow spectrum antibiotic use and adherence to AS guidelines.DisclosuresAll Authors: No reported disclosures

BackgroundAntimicrobial stewardship (AS) initiatives are critical for combating antibiotic resistance, improving patient outcomes, and ensuring optimal use of antimicrobials. Despite national guidelines and regulatory support, consistent documentation of AS interventions across pharmacy teams remains a challenge. This study evaluates the impact of integrating an infectious diseases (ID) pharmacist into a pharmacy team on AS documentation practices in a large academic medical center.MethodsThis quasi-experimental pre-post study was conducted at University of Missouri Health, a 709-bed tertiary care academic hospital. The intervention involved onboarding a dedicated ID/ASP pharmacist in August 2023. Documentation of AS interventions was tracked using the Cerner electronic medical record and Power BI analytics from January 2023 to December 2024. Intervention volumes, types, and pharmacist contributions were analyzed using Mann-Whitney U and chi-square tests.ResultsFollowing the addition of the ID/ASP pharmacist, the average number of monthly documented interventions increased from 152.4 ± 52.2 to 387 ± 122 (p < 0.00001). The ID/ASP pharmacist independently contributed an average of 104.3 ± 30.6 interventions monthly. The types of interventions shifted significantly, with the ID pharmacist more frequently documenting high-impact activities such as de-escalation (p < 0.00001) and escalation (p < 0.00001), compared to general pharmacists who primarily documented dose adjustments and communication-related activities.ConclusionThe integration of an ID/ASP pharmacist into the pharmacy team led to substantial improvements in both the frequency and complexity of documented interventions. These findings highlight the importance of pharmacist-driven stewardship and underscore how focused documentation efforts can foster a culture of accountability and clinical excellence in AS programs.DisclosuresBlain Thayer, PharmD, BCIDP, AAHIVP, AbbVie Inc: Honoraria

BackgroundSignificant medical errors have been described during transitions of care (TOC) from inpatient to outpatient health care settings. A common gap in TOC from acute hospitalization is lack of follow up on pending inpatient microbiology cultures. Although emergency department culture call-back programs have been frequently described, published literature from inpatient settings is limited.MethodsThis was a descriptive, single-center retrospective study conducted in a 356-bed community hospital. All microbiology cultures that resulted after a patient’s inpatient hospitalization were reviewed by a clinical pharmacist. The study period was from November 1, 2024 to March 31, 2025. A real-time clinical decision support tool was utilized to generate alerts when a microbiology culture resulted positive with the growth of a microorganism after the patient’s inpatient discharge. A clinical pharmacist evaluated these alerts and if warranted, contacted the physician for modification of antimicrobial therapy. The pharmacist would send prescriptions to the patient’s outpatient pharmacy and provide patient education as clinically indicated. The primary outcome was the percentage of patients requiring a pharmacist intervention, and the secondary outcome was 30-day all cause readmission rates.ResultsDuring the study period, 496 unique patients with 1,088 alerts of microbiology cultures were identified and reviewed. Clinical pharmacists intervened on 87 patients (18%), of which 16 (18.4%) interventions were assigned a category 1 severity rating (failure to intervene could result in significant patient harm). Thirty-six (41.4%) interventions were assigned a category 2 severity rating (failure to intervene could result in minor or temporary patient harm), and 35 (40.2%) interventions were assigned a category 3 severity rating (interventions included therapy optimization). Acute bacterial skin and skin structure infections and osteomyelitis made up the majority 47% (n=41) of the interventions. Of the patients intervened on by a pharmacist, the 30-day all cause readmission rate was 10% (9/87).ConclusionPost-hospitalization review of microbiology results can improve patient safety during TOC, and provides an avenue to further improve patient care and health system outcomes.DisclosuresAll Authors: No reported disclosures

BackgroundAntibiotic Stewardship Programs (ASP) play a key role in curbing unnecessary antibiotic use and slowing the development of resistance. Vancomycin is a known contributor to the rise of vancomycin-resistant Enterococcus (VRE), a challenging healthcare-associated infection linked to longer hospital stays, higher costs, and fewer treatment options. Studies have demonstrated a direct correlation between vancomycin use and VRE emergence. ASPs have been shown to reduce VRE colonization by up to 70%. Rising VRE rates at Washington Regional Medical Center (WRMC) prompted a review of antibiotic use.MethodsFrom Q1 to Q4 of 2024, WRMC implemented a multipronged stewardship strategy to investigate and guide vancomycin use. Vancomycin utilization was tracked in Days of Therapy (DOT). The intervention included diagnostic stewardship with automatic PCR nasal screening when vancomycin was ordered for respiratory infections, rapid S. aureus PCR on gram-positive cocci blood cultures, and multiplex PCR assays to identify positive blood cultures. ASP engagement included daily ICU handshake stewardship rounds, daily virtual audits for medical-surgical patients, asynchronous staff education supported by evidence-based order sets, and direct pharmacist interventions featuring automatic pharmacokinetic dosing using AUC targets.ResultsThese combined stewardship efforts led to reduced vancomycin utilization, with vancomycin use declining from 18% to 14% of total antibiotic use, the lowest since ASP inception. Total use declined by 29% (213 DOT to 151 DOT). Over the same period, VRE rates decreased by 48% (0.324 to 0.169 cases per 1000 patient days). The trend is noted in Figure 1.ConclusionAlthough direct causation cannot be established, the temporal correlation and magnitude of both changes are compelling and align with previous studies linking reduced vancomycin use to decreased VRE incidence. WRMC’s initiative highlights the value of multidisciplinary collaboration, rapid diagnostics, and pharmacist-led stewardship, offering a replicable model for stewardship programs aiming to improve patient safety and resistance trends.DisclosuresAll Authors: No reported disclosures

Methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction implementation combined with pharmacist oversight across four hospitals resulted in a 20.2% reduction in anti-MRSA agent standardized antimicrobial administration ratios with significant reductions across 17 of 23 patient care units, further supporting this approach as an effective, multi-center, antimicrobial stewardship strategy.

Clinical pharmacists are increasingly recognized as essential members of multidisciplinary palliative care teams, yet their specific roles and impact have not been comprehensively summarized. This scoping review aimed to systematically map and synthesize published evidence on the clinical roles, interventions, and professional contributions of pharmacists within multidisciplinary palliative care services for patients with non-communicable diseases. A scoping review was conducted by searching PubMed, Embase, Web of Science, and Scopus from January 2000 to May 2024. Eligible studies reported clinical pharmacist interventions in palliative care. Data were extracted on study characteristics, pharmacist activities, and clinical outcomes. Twelve studies were included, predominantly from the United States. Pharmacist-led interventions encompassed medication reconciliation (91.7%), symptom management (83.3%), adverse drug event prevention (75.0%), patient and caregiver education (58.3%), and policy-level contributions (33.3%). High physician acceptance rates (≥90%) were consistently reported. Outcomes included improved symptom control, reduced drug-related problems, and enhanced patient-reported quality of life. This scoping review synthesizes current evidence on the roles of clinical pharmacists in palliative care teams. The findings highlight their essential contributions to medication safety, symptom management, deprescribing, and opioid stewardship, reinforcing the need for pharmacist integration into multidisciplinary palliative care models to improve patient-centered outcomes. Future research should focus on implementation models, cost-effectiveness analyses, and service expansion in community-based settings.

Background Almost 900,000 patients in the United States living with chronic obstructive pulmonary disease (COPD) require home health care each year. Pharmacists are integral members of the home health care team, especially for older adults living with COPD, because of their expertise in identifying and resolving medication therapy problems (MTPs) during transitions of care. Objective To identify, characterize, and compare the quantities and categories of MTPs in older adults living with COPD who require home health care following hospital discharge. Methods This cross-sectional study involved adults aged 65 years and older living with COPD who were discharged from an academic medical center between June 1, 2023, and November 30, 2023. MTPs were classified using two frameworks: the American Society of Health-System Pharmacists (ASHP) and the Pharmacy Quality Alliance (PQA). Results During the study period, 535 older adults were prescribed home health care, 15 of whom had a hospitalization discharge diagnosis of COPD and were screened for inclusion. Among the 13 patients eligible for inclusion, 92.3% experienced one or more MTPs. Almost 80% of the identified MTPs involved issues related to medication indication: 50% of this cross-sectional cohort were not prescribed medications when clinically indicated, and up to 40% of patients were prescribed medications without apparent indications. The ASHP framework identified more than twice the number of MTPs compared to the PQA framework. Conclusion The ASHP framework may identify more MTPs than the PQA framework in older adults living with COPD who require home health care upon discharge. Further research evaluating pharmacist interventions related to MTPs would be beneficial across diverse settings and patient populations.

Pharmaceutical interventions (PIs) are essential for ensuring medication safety in high-risk settings like intensive care units (ICUs). Assessment of the potential relevance of PIs generally considers their clinical, economic, and organizational impacts. To analyze PIs in an ICU and to evaluate the level of agreement on their impact across clinical, economic, and organizational dimensions. A retrospective study was conducted in a 10-bed ICU. All documented PIs performed by clinical pharmacists for patients admitted to the ICU and meeting the inclusion criteria were included. The clinical, economic, and organizational (CLEO) tool was used to assess the impacts of each intervention. Agreement among 3 health care professionals regarding the impact of these interventions was evaluated using the Fleiss kappa (κ) statistic. A total of 178 PIs were documented, of which 145 (involving 158 patients) were included in the analysis, after exclusion of PIs with incomplete data. The mean age of the 158 patients was 48 (standard deviation 20) years, and 117 (74%) were male. According to the clinical pharmacist evaluator, clinical impact was rated as "major" for 30 (21%) of the 145 PIs. In addition, 62 (43%) of the PIs were considered to have a "favourable" organizational impact, and 46 (32%) had a positive economic impact (i.e., decreased cost). The Fleiss κ coefficient revealed a low level of agreement among health care professionals regarding their evaluation of PIs across all 3 dimensions. In the ICU setting, PIs play a vital role in improving patient outcomes; however, standardization of evaluation methods is essential to ensure consistency, reduce subjectivity, and enhance the overall impact of such interventions.

Medication errors during hospital discharge are a leading source of avoidable patient harm and healthcare resource strain. Pharmacist-led medicines reconciliation in hospital has demonstrated benefits in improving patient safety and reducing adverse drug events post-discharge. The aim of this study was to evaluate the clinical and financial implications of a pharmacist discharge service on a surgical ward in an Irish hospital setting. A prospective single-centre pilot study was conducted to evaluate the impact of a clinical pharmacist discharge medication reconciliation service. The study was conducted over 8 weeks on a 31-bed surgical ward. Eligible patients were discharged during pharmacy working hours, on ≥3 medications, with pharmacist admission medicines reconciliation completed. A clinical pharmacist reviewed draft discharge prescriptions and communicated interventions to prescribers prior to discharge. Identified discrepancies were assessed by an expert panel for severity (visual analogue score), probability of adverse drug events and potential remedial healthcare use. Financial impact was estimated using cost avoidance modelling. Of 50 discharge prescriptions reviewed (646 medications), 184 discrepancies were identified in 40 prescriptions (126 prescribing and 58 communication errors). Most errors (84.8%) were rated as having moderate potential harm; 2.2% were classified as severe. Expert panel assessments indicated that pharmacist interventions prevented adverse drug events likely to result in additional healthcare utilisation by 74.7%. A potential annual net cost benefit of €554 921.53 and a cost-benefit ratio of 52.5 was calculated for the provision of a clinical pharmacist discharge service when all discharge prescriptions from the surgical ward (n=665) are reviewed. The results show the clinical and financial benefits of a pharmacist-led discharge medication reconciliation service, resolving high-risk prescribing errors and reducing downstream healthcare utilisation. This represents a highly cost-effective intervention with potential for substantial system-wide savings by enhancing patient safety and resource efficiency at transitions of care.

Background and Aims: Pediatric patients are considered a special patient population for medication use. The study aims to assess the role of clinical pharmacists in the appropriate use of antibiotics among inpatient pediatrics and to evaluate some infection-related outcomes. Method: The study was designed as an interventional randomized controlled trial, where 132 patients from the internal pediatric ward in a main hospital in Jordan were included. Pediatric patients were divided into three age groups. Each age group was sub-grouped into control and intervention groups. All patients` caregivers were interviewed, and patients’ medical files were reviewed. All antibiotic-related problems and their side effects were documented. Recommendations to solve these problems were made to the treating physician or administering nurse in the intervention group. Follow-up data were collected for each group. Results: After a review of cases, the most frequent antibiotics-related problems found were administration errors. The antibiotic-related problems were reduced in the intervention group by 70.67% with a high response rate from the medical team. The mean length of stay in the control group and implemented intervention group was 8.02 days and 6.7 days respectively, with a significant difference (p=0.039). The incidence of side effects associated with the inappropriate use of antibiotics was also reduced. Conclusions: The clinical pharmacist interventions in our study resulted in enhancing the appropriate use of antibiotics among inpatients pediatrics and decreasing the mean length of stay as well as the incidence of side effects associated with the inappropriate use of antibiotics.

The purpose of this study was to evaluate the early impact of embedded pharmacists on diabetes outcomes in patients with type 2 diabetes in the primary care setting. This study assessed pharmacists' impact on quality of care by comparing the diabetes outcomes of patients managed by newly embedded clinical pharmacists to those of patients managed exclusively by providers. A multicenter, observational, retrospective cohort study was conducted examining adults with a diagnosis of diabetes and a glycated hemoglobin (HbA1c) level above 8%. The primary outcome was the reduction in HbA1c from baseline to follow-up 3 to 6 months later. A total of 98 patients were included, with 49 patients in the pharmacist intervention group and 49 patients in the comparator primary care provider group. In the pharmacist group, HbA1c levels decreased by 2.14%, compared to a decrease of 0.15% in the provider group (P < 0.001). Secondary outcomes of the number of telephone encounters, the number of medication adjustments, continuous glucose monitor use, and assistance with medication access had statistically significant differences between the groups. Pharmacists also implemented more evidence-based medications when looking at patient comorbidities. Pharmacist management of type 2 diabetes significantly lowered HbA1c levels. Pharmacists provided closer follow-up allowing for more timely therapeutic adjustments, implemented additional evidence-based medications, assisted with medication access or barriers, and increased use of continuous glucose monitors more than primary care providers alone.

Introduction: Heart failure is a leading cause of morbidity and mortality worldwide. Literature suggests that the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors can be beneficial to decrease hospitalizations and cardiac mortality in patients with heart failure with an ejection fraction >40%. Research Question: This study assessed the impact of a pharmacist monitoring program on the use of SGLT2 inhibitors for patients hospitalized with heart failure with an ejection fraction >40%, accounting for documented reasons for not prescribing. Study Design: This was a single-center, retrospective, pre/post interventional study. The pre-intervention cohort was assessed for usage prior to initiation of the pharmacist monitoring program, whereas the post-intervention group was assessed after initiation. Methods: Hospitalized patients were identified retrospectively through a report of intravenous diuretic use on the cardiology floor in conjunction with a documented diagnosis of heart failure and ejection fraction >40%. Data Analysis: Data was assessed via Chi-squared or student's t-test for comparison between the pre-intervention and post-intervention groups. Results: There was a statistically significant increase in documented appropriate use of SGLT2 inhibitors after implementation of pharmacist monitoring program (40.9% pre-intervention vs 62.7% post-intervention, P = <0.001). The most common reasons they were held was due to risk of infection and renal dysfunction. Conclusion: Implementation of a pharmacist monitoring program was associated with an increase in utilization of SGLT2 inhibitors in eligible patients, driven by an increase in documentation. There was an increase in prescribing in patients that were eligible for the medication.

Background: We investigated the role of pharmacists in adverse event (AE) management during renal cell carcinoma (RCC) drug therapy by surveying patients, physicians, and pharmacists. We identified the types of AEs for which pharmacist involvement is beneficial and explored measures to promote pharmacist intervention. Methods: This was an ad hoc analysis of a questionnaire-based cross-sectional web survey conducted from May to June 2022 among patients undergoing RCC drug therapy, physicians prescribing RCC treatments, and pharmacists involved in oncology care in Japan. Results: A total of 83 patients with metastatic RCC, 165 physicians, and 218 pharmacists were included. Among patients, 28.9% reported experiencing AEs or symptoms requiring pharmacist intervention. Most physicians (78.2%) and pharmacists (96.3%) supported pharmacist involvement in AE management. Notably, 35.6% of patients who reported no AEs or symptoms requiring pharmacist intervention acknowledged difficulty in communicating AEs to their physicians. Regarding desired pharmacist interventions for AEs, patients prioritized rash/pruritus, fatigue, and diarrhea; physicians emphasized stomatitis and anorexia; pharmacists identified constipation, stomatitis, and diarrhea. The most common reason patients valued pharmacist involvement was the reassurance of support from multiple healthcare providers. Physicians and pharmacists valued pharmacists' greater familiarity with AE management, particularly considering physicians' limited time. Raising awareness among patients and healthcare professionals, patient requests, and improving institutional support were strategies to enhance pharmacist involvement. Over 86% of healthcare professionals considered pharmaceutical outpatient clinics necessary to strengthen interdisciplinary collaboration. Conclusions: This study highlights widespread support among patients, physicians, and pharmacists for pharmacist involvement in managing AEs during RCC drug therapy.

Background and objectives: Helicobacter pylori infection is prevalent and persistent in some cases. The rising incidence of drug resistance in this infection necessitates enhanced treatment methodologies. Our aim was to compare the efficacy of conventional therapy with that of a clinical pharmacist-led intervention for the management of Helicobacter pylori infection. Methods: This randomized controlled trial included 100 therapy-naïve patients with confirmed Helicobacter pylori infection, recruited from an outpatient private clinic in Koye-Erbil, Iraq, between May and November 2023. Patients were randomly assigned to either the control group (receiving conventional therapy) or the intervention group (receiving additional clinical pharmacist-led interventions focused on personalized treatment plans, patient education, and adherence support). Treatment success was assessed using the Helicobacter pylori stool antigen test for follow up one-month post-treatment. Medication compliance was evaluated using the Morisky-Green scale. Results: In this study, 54 (54.0) patients were female and 46 (46.0) patients were male. The intervention group showed a significantly higher rate of H. pylori eradication, with 42 (84%) patients testing negative in the second stool antigen test compared with 28 (56%) patients in the control group (p ? 0.002). Furthermore, medication compliance was significantly better in the intervention group of 36 (72%) patients compared to the control group of 18 (29%) patients (p &lt; 0.013). Conclusion: Clinical pharmacist interventions improve therapeutic outcomes and medication compliance in patients with Helicobacter pylori infection. Although integrating into peptic ulcer disease management teams enhances the treatment effectiveness.

A Retrospective Analysis of Pharmaceutical Interventions in Outpatient Cancer Chemotherapy: Survey of Post-Consultation Pharmacist Interventions

To investigate the impact of an overnight critical care pharmacist shift on pharmacy services in a quality improvement initiative. The department of pharmacy implemented an overnight critical care pharmacist shift in October 2023 to better align with recommendations for critical care pharmacy services from the Society of Critical Care Medicine, American College of Clinical Pharmacy, and American Society of Health-System Pharmacy. This initiative focused on patient care services and aimed to increase compliance from 6.2% to 75% during overnight hours by May 2024. Characterization of the impact included time to order verification, time to administration, and number and type of pharmacist interventions. Plan-Do-Study-Act (PDSA) cycles were utilized to measure changes over time. Shift initiation (PDSA cycle 1) resulted in a mean time to order verification of 9.4 minutes (SD, 24.7 minutes) compared to 7.4 minutes (SD, 13.9 minutes) before initiation. There was no difference in the mean time to order verification of stat medications. Pharmacists documented an average of 214 interventions per month compared to 84 before initiation. For PDSA cycle 2, patient profile reviews of newly admitted patients occurred during 60 of 60 (100%) shifts, with an average of 9 patients reviewed per shift. Prospective profile review led to interventions for 93.3% of shifts. This initiative increased institutional compliance with foundational patient care recommendations from 6.2% to 67.2%. Implementation of overnight critical care pharmacists led to an increase in the number of interventions documented over time without a significant corresponding increase in the time to order verification and administration. Opportunities exist for further optimization of clinical activities during the overnight hours.

To determine the impact of pharmacist intervention with real-time continuous glucose monitors (rtCGMs) on glycated hemoglobin (HbA1c) levels and the number of pharmacist touchpoints compared to standard of care (SOC). Patients receiving care at a primary care clinic using an established pharmacist diabetes management protocol for patients with type 2 diabetes and an HbA1c value of 9% or higher despite taking basal insulin were included in this study. The SOC group comprised patients receiving ongoing care, while care for the rtCGM study group followed the same protocol with addition of Dexcom G6 rtCGMs. Data on patient demographics, comorbidities, and medications were collected for comparison. The primary outcome was the between-group difference in changes in HbA1c. The secondary outcome was the difference in pharmacist touchpoints, quantified as the number of patient telephone calls completed and attempted, along with medication interventions. Fifty-seven patients were included in the final analysis: 30 in the SOC group who received pharmacist intervention and 27 in the combined pharmacist intervention and rtCGM group. The mean (SD) reduction in HbA1c in the SOC group at 90 days was 2.05% (1.20%) compared to 2.94% (1.18%) in the rtCGM group (P = 0.0165). The secondary outcome failed to reach statistical significance (P = 0.1413). In suboptimally managed type 2 diabetes, augmentation of a standard diabetes management protocol with rtCGMs was associated with significantly greater HbA1c reduction.

Autoimmune bullous disorders, such as pemphigus vulgaris (PV), are rare but potentially life-threatening dermatological conditions. This case report presents a 60-year-old postmenopausal woman with PV and a history of type 2 diabetes mellitus (T2DM) who was admitted with skin ulcers and widespread fluid-filled blisters. Investigations confirmed PV through a positive Nikolsky sign, the presence of acantholytic cells, and an IgG fishnet pattern on direct immunofluorescence. Her treatment included corticosteroids, insulin adjustment, and antibiotics. Clinical pharmacist interventions contributed to the identification of adverse drug reactions, IV (intravenous) compatibility, and medication reconciliation. This case emphasizes the importance of individualized multidisciplinary care in autoimmune skin disorders, especially in elderly and comorbid patients.