Pharmacist-physician Collaboration Research Articles

P-1783. Differences in stewardship strategies across hospitals performing well and poorly on a risk-adjusted metric for post-discharge antibiotic use

Abstract Background Antibiotic overuse at hospital discharge is common, and it is unclear which antibiotic stewardship (AS) strategies are effective at improving post-discharge antibiotic-prescribing. In this study, we compared how hospitals’ AS processes differed based on their performance on a risk-adjusted metric for post-discharge antibiotic use.Figure 1.Risk-adjusted comparison of post-discharge antibiotic-prescribing frequency and duration across 124 VA hospitalsGroup 1 hospitals (n=40) had less frequent post-discharge antibiotic-prescribing and used shorter post-discharge antibiotic duration. Group 2 hospitals (n=26) had more frequent post-discharge antibiotic-prescribing and used shorter post-discharge antibiotic durations. Group 3 hospitals (n=34) had less frequent post-discharge antibiotic-prescribing and used longer post-discharge antibiotic durations. Group 4 hospitals (n=24) had more frequent post-discharge antibiotic-prescribing and used longer post-discharge antibiotic durations. Methods We performed a retrospective study of discharges to home from 124 acute-care VA hospitals. Discharges occurred 6 months before/after a mandatory hospital-level AS survey (11/10/20); patients who received ≥ 30 days of post-discharge antibiotics were excluded. We built a zero-inflated negative binomial mixed-model with two random intercepts for each hospital to predict post-discharge oral antibiotic exposure and duration. Key model covariates included patient comorbidities, discharge diagnoses of infection, and inpatient antibiotic duration. Using the predicted random intercepts, hospitals were categorized into 4 groups. Next, we used a multinomial logistic regression model to compare how often AS processes, as reported in the survey, were used at hospitals across these groups.Table 1.Characteristics of 124 VA hospitals, stratified by a hospital’s performance on a risk-adjusted metric for post-discharge antibiotic useAbbreviations: AS = antibiotic stewardship; FTEE = full time employee equivalents; IQR = interquartile range; LOT = length of therapy; PA = prior authorization; PAF = prospective audit-and-feedback; SD = standard deviation. (1) Facility complexity scores are created by the VA Healthcare Analysis and Information Group. Hospitals are scored according to their patient population, clinical services (e.g., intensive care unit and surgery services), education and research. A score of 1a and 1b is categorized as the highest complexity. Lower complexity facilitates are scored as 1c, 2, or 3. (2) This survey question was dichotomized to compare stewardship physicians and stewardship pharmacists who interact daily or several times a week versus teams that interact weekly, monthly or less frequently than monthly. (3) This variable ranges from 1-10 and captures whether certain antibiotics were managed by prior authorization (PA) or prospective audit-and-feedback (PAF). Each additional antibiotic managed with one of these strategies increased the PA or PAF score by 1, except as noted: vancomycin (intravenous), daptomycin, oral/IV linezolid (each formulation = 0.5 points), piperacillin-tazobactam, cefepime, ceftazidime, anti-pseudomonal carbapenems, ertapenem, ciprofloxacin + levofloxacin oral/IV (each 0.5), and moxifloxacin oral/IV (each 0.5). Results There were 399,234 discharges; 17.2% received post-discharge antibiotics (median duration 6). Hospital performance on the metric is shown in Figure 1, and Table 1 shows hospital characteristics, based on the group. Forty (32.3%) hospitals were in group 1, i.e., they prescribed antibiotics less frequently than expected at discharge and used shorter post-discharge duration. Twenty-four (19.4%) hospitals were in group 4, i.e., they prescribed antibiotics more often than expected at discharge and used longer post-discharge duration. Compared to group 1 hospitals, hospitals in group 4 were less likely to report interactions between their AS physician and AS pharmacist(s) every day or several times per week (0.17, 95% CI 0.05-0.64). No other AS processes significantly differed between the groups (Table 2).Table 2.Odds ratios for a hospital within each group reporting the use of specific antibiotic stewardship processes, based on a multinomial logistic regression modelAbbreviations: AS = antibiotic stewardship; FTEE = full time employee equivalents; LOT = length of therapy; OR = odds ratio; PA = prior authorization; PAF = prospective audit-and-feedback; Ref = reference group. (1) This survey question was dichotomized to compare stewardship physicians and stewardship pharmacists who interact daily or several times a week versus teams that interact weekly, monthly or less frequently than monthly. (2) The odds ratio reflects the effect on the odds of increasing the number of antibiotics managed with this strategy by a single unit (i.e., managing 10 antibiotics by PA versus managing only 9 by PA). Conclusion The findings of this mixed-methods study suggest that routine AS physician-pharmacist collaboration may be important to reducing antibiotic overuse at discharge. Future studies should more precisely measure AS processes to better understand how these are associated with differences in hospital performance at this transition of care. Disclosures Daniel J. Livorsi, MD, Merck: Grant/Research Support Michihiko Goto, MD MSCI, Merck: Grant/Research Support

The Impact of Health Informatics on Radiologist, Laboratory Technician, Pharmacist-Physician Collaboration, and Patient Outcomes

The Impact of Health Informatics on Radiologist, Laboratory Technician, Pharmacist-Physician Collaboration, and Patient Outcomes

A bibliometric analysis of studies conducted over the last 10 years on cardiovascular disease risk identification and prevention in primary care

Objective: This bibliometric analysis was conducted to determine the trends of studies on cardiovascular disease risk identification and prevention in primary care from 2013 to 2024 and visualize the latest developments. Methods: The data were collected in February-March 2024 from the database “Web of Science Core Collection,” the analysis was carried out using the VOSviewer program. The change in the number of publications of the published articles by year, author, country, and institution citation analyses, country, institution, and author collaboration analyses, journal and author co-citation analyses, and keyword analyses were evaluated. Results: Five hundred and ninety-two authors from 64 countries and 377 institutions contributed to 443 studies published in 80 journals between 2013 and 2024 on determining and preventing cardiovascular disease risk in primary care. "BMC Family Practice" was the journal in which most articles were published, and "Circulation" was the most cited. The first three countries that support published articles most are the United States, England, and Australia. Focusing on the topics "blood-pressure control", "coronary-artery calcium", "physician-pharmacist collaboration", "low-density lipoprotein cholesterol", "health-risk assessment", "pollution", "primary care", "coronary heart disease", "prevention", "cardiovascular disease" and "mortality" will help fill the gap in the field. Conclusions: This bibliometric analysis has shown increasing interest in studies related to cardiovascular disease risk and prevention in primary care. Primary prevention guidelines are important resources in addressing risk factors. Global collaborations and long-term studies are necessary in this field, led by developed countries with a high disease burden.

The approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy.

Norm Balance is an approach under the Theory of Planned Behavior (TPB) where subjective norm is weighted by the relative importance of others and self-identity is weighted by the relative importance of self. The relative importance was measured previously by a trade-off measure. In this study, we developed separate measures for the relative importance. The study objectives were to: 1) assess the construct validity of the separate measures; 2) examine the approach of Norm Balance in predicting pharmacists' intention to collaborate with physicians to improve medication therapy; and 3) establish a modified TPB. We selected a random sample of 750 Iowa pharmacists and conducted two surveys. The first survey was to examine intention prediction, and the second survey was to examine behavior prediction by measuring behavior among respondents to the first survey. The relative importance was measured by both the trade-off measure and the separate measures. Exploratory factor analyses were performed for the relative importance of others (separate measures) and subjective norm, and for the relative importance of self (separate measures) and self-identity. Regressions for intention prediction were conducted for TPB with self-identity and the approach of Norm Balance. The same regressions were also conducted for three subgroups according to the median of the relative importance of others (trade-off measure). Moreover, another regression was conducted for behavior prediction. 239 practicing pharmacists responded to the first survey, and 188 responded to the second survey. The separate measures had cross factor loadings, whereas the trade-off measure had low correlations with other constructs. Both regressions for intention prediction explained 75% of the variance, with self-efficacy and attitude being strong predictors. Self-identity was not a predictor in the TPB with self-identify, but self-identity weighted by the relative importance of self was a significant predictor in the approach of Norm Balance. Regression coefficients of subjective norm and self-identify varied across subgroups. The regression for behavior prediction explained 30% of the variance, with intention and self-efficacy being two predictors. The trade-off measure was better than separate measures. The approach of Norm Balance appears to be a better model than the TPB with self-identity to examine pharmacist-physician collaboration.

THE IMPACT OF COLLABORATIVE CARE ON COST OF TREATMENT FOR THE MANAGEMENT OF HYPERTENSION- A SYSTEMATIC REVIEW

Introduction: For evaluation of the long term costs and benefits of physician-pharmacist collaboration associated with physician management for the treatment of essential hypertension. Around the world the major cause of death is hypertension. It is an incurable condition that requires proper therapeutic regimens for its life-long management. Due to this, hypertension therapy can be financially burdensome to the patient, and the rates of non-compliance are increased. Aims and Objectives: To observe the results of collaborative, clinical, and interventive approaches to hypertension management, on the cost-effectiveness of therapy, this study aimed to collect and compare cost information on hypertension management, mortality, and morbidity across different countries and cost groups. Using this information, future healthcare expenses can be better planned; for example, by initial emergency response or by changing the way money is distributed. This will lead to more high-pressure jobs. Therefore, it will be more costly to control blood pressure. Method: A systematic review was conducted using 6 major electronic databases that investigated the influence of collaborative care upon healthcare expenses in hypertensive patients and hypertension therapy costs, before and after the intervention of medical personnel, was observed. Conclusions: It was concluded that interventions provided by the collaboration of medical personnel, in the management of hypertension, made the therapy more cost-effective and hence the rate of patient compliance and adherence to the therapy were increased. Peer Review History: Received 18 May 2024; Reviewed 11 July 2024; Accepted 26 August; Available online 15 September 2024 Academic Editor: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, summitpharm@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Pharmaceutical Interventions in Benzodiazepine users during the COVID-19 Pandemic

Pharmaceutical Intervention aims to optimize and rationalize the use, effectiveness, and safety of dispensed medications resolving drug-related problems (DRPs) and negative medicine outcomes (NMOs). To evaluate Pharmaceutical Interventions in Benzodiazepines users during the COVID-19 pandemic from a Community Pharmacy. Prospective observational, descriptive, and cross-sectional study (AEMPS code: DAA-CLO-2020-01) of Pharmaceutical Interventions offered by the community pharmacy between August 2020 and February 2021. A total of 306 Pharmaceutical Interventions were conducted involving 127 patients. Health education and personalized medication information were the most common Pharmaceutical Interventions after detecting a high level of unfamiliarity with the Benzodiazepines among patients. Pharmaceutical Interventions leading to medical referrals accounted for 37.8% of the total, triggered by the detection of DRPs and/or NMOs or after identifying the patient as candidate for deprescription. These referrals included patients with a very high level of depression according to the Euroqol 5D-3L test. Pharmaceutical Interventions resulting in Medication Review with Follow-up Service were performed in 3.1% of patients. The patient acceptance rate of Pharmaceutical Interventions reached 98.4%. The high acceptance rate of Pharmaceutical Interventions reinforces the value of Community Pharmacy in optimizing and rationalizing Benzodiazepines usage, while strengthening the pharmacist-patient relationship. The COVID-19 pandemic posed challenges to pharmacist-physician collaboration despite of the availability of telecommunication protocols among healthcare professionals.

Current State of Community Pharmacist-Physician Collaboration — A Cross-sectional Survey Among Pharmacists in Poland

A patient-centered partnership between different healthcare professionals is critical to improving the quality of health services. While the cooperation of physicians, nurses, midwives, and paramedics is well documented, more and more attention is paid to the role of pharmacists in interdisciplinary care. This study aimed to evaluate the pharmacist’s perception of the current state of community pharmacist-physician collaborative working as well as to identify barriers to the implementation of the community pharmacist-physician collaborative working model in Poland. This cross-sectional survey was carried out between October and December 2022 among community pharmacists in Poland. A total number of 1327 pharmacists from one of the largest franchise chain pharmacy networks in Poland were invited to take part in this study. The study questionnaire included 23 questions on the current state of pharmacist-physician collaborative working, the scope of cooperation, barriers to cooperation, and educational and organizational needs. Completed questionnaires were received from 635 pharmacists (response rate of 47.9%). Formal correction of the prescription (91.3%) was the most common cause of pharmacist-physician collaborative working. Moreover, 62.7% of pharmacists indicated that modification of ordered drugs was the reason for pharmacist-physician collaborative working. Only 3.3% of community pharmacists indicated that they collaborate with physicians during the drug review. Lack of IT systems enabling pharmacist-physician collaborative working (67.6%) and lack of recommendations on pharmacist-physician collaborative working (57.3%) were the most common barriers to collaboration with the physician. Pharmacists declare their readiness to cooperate with physicians, but there is a need to strengthen trust between both groups.

Current Status and Issues of Collaboration Between Physicians and Pharmacists in Fertility Preservation.

Purpose: This study addresses the critical issue of fertility preservation among young patients with cancer in Japan, recognizing the brief decision-making window and the need for comprehensive support. Pharmacists, well-versed in the side effects of anticancer drugs, can play a vital role in this support process. However, the extent of pharmacists' involvement in fertility preservation remains unclear. We aimed to investigate pharmacists' roles in addressing cancer treatment-induced fertility concerns and their collaboration with physicians, offering insights into enhancing pharmacist participation in fertility preservation. Methods: A survey conducted between April and July 2022 targeted doctors and pharmacists at cancer treatment hospitals, along with pharmacists affiliated with the Japanese Society of Pharmaceutical Health Care and Sciences. Results: Our findings indicated that although pharmacists had limited knowledge about gonadotoxicity and fertility, they expressed readiness to conduct research and provide information when consulted. Approximately 10%-20% of the pharmacists participated in explaining the primary disease at diagnosis. Pharmacists played a more prominent role after establishing chemotherapy regimens, with less involvement in its formulation. Notably, treatment decision case conferences emerged as crucial forums for gathering patient data, confirming treatment plans, and identifying those in need for fertility preservation information. Roughly half of the pharmacists attended these conferences, suggesting a need for increased participation. Conclusion: Enhancing physician-pharmacist collaboration could be pivotal for effective fertility preservation. This requires augmenting the knowledge and awareness of both professions and encouraging greater participation in case conferences to create a conducive environment for addressing this critical aspect of cancer care.

Interpretative phenomenological analysis of the collaboration among healthcare professionals in the nursing home setting

BackgroundThe theory of planned behavior (TPB) postulates that behavioral performance is guided by the intention to perform that behavior, influenced by attitudes, subjective norms, and perceived behavioral control. This framework can be applied to studying interprofessional collaboration among healthcare professionals to enhance patient safety and public health within nursing homes. ObjectivesThis study aimed to explore the roles of physicians, pharmacists, and nurses in the interprofessional collaboration process while identifying facilitators and barriers to effective collaboration among healthcare professionals. MethodsA qualitative interpretative phenomenological analysis (IPA) was carried out. Individual semi-structured interviews were conducted with 19 healthcare professionals. Qualitative data were then integrated and analyzed through the lens of the TPB. FindingsThe IPA revealed the ten following themes, considered as both facilitators and barriers to interprofessional collaboration among healthcare professionals in the nursing home setting: communication, roles and responsibilities, willingness and recognition of collaboration's importance, mutual knowledge, trust, confidence, support from decision-makers, protocols, and technology were considered as facilitators while distance was considered as a barrier. ConclusionEnhancing pharmacist-physician collaboration and refining pharmacist-nurse collaboration were essential goals. Intention for collaboration was influenced by attitudes (such as communication and mutual understanding), subjective norms (including support from decision-makers), and perceived behavioral control (such as confidence and adherence to protocols and technology). Addressing these factors could improve collaboration, enhancing residents' quality of life and professionals' sense of achievement.

Building Statewide Quality Improvement Capacity to Improve Cardiovascular Care and Health Equity: Lessons from the Tennessee Heart Health Network

Many states with high rates of cardiovascular disease (CVD) lack statewide quality improvement (QI) infrastructure (for example, resources, leadership, community) to address relevant health needs of the population. Academic health centers are well positioned to play a central role in addressing this deficiency. This article describes early experience and lessons learned in building statewide QI infrastructure through the Tennessee Heart Health Network (Network). A statewide, multistakeholder network composed of primary care practices (PCPs), health systems, health plans, QI organizations, patients, and academic institutions was led by the University of Tennessee Health Science Center (UTHSC), an academic health center, to improve cardiovascular health by supporting dissemination and implementation of patient-centered outcomes research (PCOR) evidence-based interventions in primary care. PCPs were required to select and implement at least one of three interventions (health coaching, tailored health-related text messaging, and pharmacist-physician collaboration). Thirty statewide organizational partners joined the Network in year one, including 18 health systems representing 77 PCPs (30.0% of 257 potentially eligible PCPs identified) with approximately 300,000 patients. The organizational partners share EHRs for the ongoing tracking and reporting of key health metrics, including hypertension control and delivery of tobacco cessation counseling. Of the 77 PCPs, 62 continue participation after year two (80.5% retention). Main barriers to participation and reasons for discontinuing participation included reluctance to share data and changes in leadership at the health system level. These 62 PCPs selected the following interventions to implement: health coaching (41.9%), tailored health-related text messages (48.4%), and pharmacist-physician collaboration (40.3%). Academic health centers have broad reach and high acceptability by diverse stakeholders. Tennessee's experience illustrates how academic health centers can serve as platforms for building a statewide infrastructure for disseminating, implementing, and sustaining QI interventions at the practice level. Assessment of Network impact is ongoing.

The Impact of Health Informatics on Radiologist, Laboratory Technician, Pharmacist-Physician Collaboration, and Patient Outcomes

Health informatics has revolutionized the way healthcare professionals collaborate and deliver care, with significant implications for patient outcomes. This abstract explores the impact of health informatics on the collaboration between radiologists, laboratory technicians, pharmacists, and physicians, and its influence on patient outcomes. The abstract provides an overview of the role of health informatics in facilitating communication, information sharing, and decision-making among these healthcare professionals. It also discusses the potential benefits and challenges associated with integration of health informatics in collaborative care, and highlight the importance of leveraging technology to improve patient safety, treatment efficacy, and overall healthcare quality. The review concludes that, the professions of radiologists, laboratory technicians, chemists, doctors, and patient outcomes have all been significantly impacted by health informatics. Healthcare practitioners are now able to make better decisions thanks to the increased efficiency and accuracy of diagnostic imaging and laboratory tests brought about by the integration of technology and data management systems. Electronic prescribing and medication management systems have improved collaboration between chemists and doctors, guaranteeing safe and efficient pharmaceutical use. The application of health informatics has also helped patients receive more individualized care, better communication, and access to health information. All things considered, the use of health informatics has changed the way that healthcare is delivered and may continue to enhance patient outcomes in the future.

Pharmacists' Perceptions of Physician-Pharmacist Collaboration-A 2022 Cross-Sectional Survey in Poland.

Patient-centered care requires close collaboration among multiple healthcare professionals, including physician-pharmacist collaboration (especially as a part of pharmaceutical care). This study aimed to assess pharmacists' perceptions of physician-pharmacist collaboration as well as to identify factors associated with the willingness to provide pharmaceutical care services in Poland. This questionnaire-based survey was carried out in 2022 among community pharmacists from one of the largest franchise chain pharmacy networks in Poland. Completed questionnaires were received from 635 community pharmacists (response rate of 47.9%). Almost all the pharmacists agreed with the statement that there is a need for physician-pharmacist collaboration (98.2%), and 94.8% declared that pharmacists can help physicians in patient care and pharmacotherapy. Most pharmacists (80%) believed that physicians were not aware of the competencies of pharmacists resulting from Polish law. Patient education (89.9%), detection of polypharmacy (88%), and detection of interactions between drugs and dietary supplements (85.7%) were the most common tasks in the field of pharmaceutical care that can be provided by a pharmacist. Females were more likely (p < 0.05) to declare the need for physician-pharmacist collaboration. Age and location of the pharmacy were the most important factors (p < 0.05) associated with pharmacists' attitudes toward physician-pharmacist collaboration.

Interprofessional collaboration between prescribers, managers, nursing staff and on-site pharmacists within residential aged care facilities: a mixed-methods study.

A new on-site pharmacist (OSP) intervention within residential aged care facilities (RACFs) is being investigated to help improve medication management. Interprofessional collaboration amongst prescribers, nursing staff and pharmacists is critical to improving RACF medication management. To explore the extent of interprofessional collaboration and the nature of the working relationships between OSPs and prescribers, managers and nursing staff. A mixed-methods study was undertaken within the context of a 12-month cluster randomised controlled trial. Semi-structured interviews were conducted with data analysed using framework analysis, and a survey based upon the Physician-Pharmacist Collaboration Index (PPCI) was distributed at two time points (T1 at 3months and T2 at 9months after OSP commencement) across seven intervention RACFs. The qualitative data (n =33 interviews) findings related to the processes supportive of these relationships e.g. on-site proximity, OSP personality and perceived (or beneficial) benefits of OSPs working with health care team members (such as OSPs being trusted and providing reassurance to RACF health care team members). The PPCI survey mean scores at T1 (n =33) and T2 (n =19) suggested that OSPs were able to establish positive working relationships at 3months and that positive relationships also existed at 9months. The integrated findings suggested that the working relationships between OSPs and health care team members were generally positive. This study is the first to explore interprofessional collaboration between OSPs and health-care team members in RACFs. The findings suggest that OSPs can positively contribute to interprofessional collaborative care within RACFs.

Pharmacist roles in the medication use process: Perceptions of patients, physicians, and pharmacists

ObjectivesIt is uncertain whether stakeholder perceptions of pharmacist roles in the medication use process (MUP) have evolved alongside pharmacist advanced scope of practice. This study aimed to examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP. DesignThis IRB-approved study used a cross-sectional design with online panels of patients, pharmacists, and physicians. Setting and ParticipantsA Qualtrics panel of 1,004 patients, 205 pharmacists, and 200 physicians completed the surveys between August-November 2021. Outcome MeasuresUsing role theory as framework, 12-item surveys were developed to examine perceptions regarding effectiveness of and best choice for improving each MUP step. Data analysis included descriptive statistics, correlations, and comparisons. ResultsMajority of the physician, pharmacist, and patient samples believed that physicians prescribe the best possible medications (93.5%, 83.4%, 89.0% respectively), prescriptions are filled accurately (59.0%, 61.4%, 92.6% respectively) and timely (86.0%, 68.8, 90.2% respectively). Majority of physicians (78.5%) opined prescriptions are generally error free and patients are monitored (71%); fewer pharmacists agreed (42.9%, 51%; p<0.05). Most patients (92.4%) reported taking medications as directed; only 60% professionals agreed (p<0.05). Physicians selected ‘pharmacists’ as top choice for reducing dispensing errors, providing counseling, and helping patients take medications as directed. Patients wanted pharmacists to help manage their medications (87.0%) and ‘someone’ to periodically check on their health (100%). All 3 groups agreed physician-pharmacist collaboration was important to improve patient care and outcomes (90.0%-97.1%); however, 24% of physicians were uninterested in collaboration. Both professionals reported lack of time, appropriate setup, and interprofessional communication as challenges to collaboration. ConclusionPharmacists believe their roles have evolved to align with expanded opportunities. Patients perceived pharmacists play comprehensive roles in medication management through counseling and monitoring. Physicians recognized pharmacist roles in dispensing and counseling, but not in prescribing or monitoring. Clarity in role expectations amongst these stakeholders is critical to optimizing pharmacist roles and patient outcomes.

Physician-Pharmacist Collaborative Drug Therapy Management in Pediatric Hypertension.

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

Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study.

Background: Physician-pharmacist collaboration is a well-established care mode for the management of type 2 diabetes mellitus (T2DM) in developed countries, but no study has been conducted in primary healthcare in China. This study aims to evaluate the effects of physician-pharmacist collaborative clinics to manage T2DM in primary healthcare in China, and to better understand the factors influencing the implementation of physician-pharmacist collaborative clinics. Methods: Two hundred and sixty-seven patients involved in a 12-month randomized controlled trial were assigned to physician-pharmacist collaborative clinics and usual clinics, completing surveys regarding medication compliance, quality of life (QoL) and care-seeking behavior at the baseline, 3rd, 6th, 9th and 12th month respectively, and diabetes knowledge at baseline and 12th month. A sample of twenty-two Patients, nine physicians and twelve pharmacists participated in semi-structured face-to-face interviews. The quantitative and qualitative data was integrated by triangulation. Results: Patients in physician-pharmacist collaborative clinics had significant improvements in medication compliance (p = 0.009), QoL (p = 0.036) and emergency visits (p = 0.003) over the 12-month. Pairwise comparison showed the medication compliance score in the intervention group had been significantly improved at 3rd month (p = 0.001), which is more rapidly than that in the control group at 9th month (p = 0.030). Factors influencing the implementation of physician-pharmacist collaborative clinics were driven by five themes: pharmaceutical service, team-base care, psychological support, acceptability of care and barriers to implementation. Conclusion: Integration of quantitative and qualitative findings showed the effectiveness of physician-pharmacist collaborative clinics in patient medication compliance and QoL in primary healthcare. The qualitative study uncovered barriers in insufficient clinical experience and understaffing of pharmacist. Therefore, the professional training of the primary pharmacist team should be improved in the future. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2000031839.

Medical Students’ Attitude towards Physician-Pharmacist Collaboration in Dongola, Northern State, Sudan

Background: Assessing the attitude of collaborative relationship between physicians and pharmacists at the undergraduate level is an important aspect in determining their future collaborative outcome. Objective: To assess the attitudes of medical students at University of Dongola towards physician-pharmacist collaboration. Method: A cross-sectional descriptive study was conducted in the Faculty of Medicine, University of Dongola. Data was collected via online Google form questionnaire from medical students in their first and last two years. Descriptive and comparative analyses were performed using SPSS, version 26. Mann-Whitney Rank Sum Test was used to analyze the statistical significance at p Results: Two hundreds and thirty-three students completed the questionnaire with a response rate of 100%. Students expressed relatively positive attitude towards physician-pharmacist collaboration with a total mean score of (mean = 50.2; SD = 4.8). Female students revealed more collaborative attitude (mean = 51.4; SD = 4.4) than their male counterparts (mean = 47.5; SD = 5.2; p = 0.041). There was a significant correlation between age and score (p ≤ 0.001) and those who were ≥21 years old revealed more collaborative attitude. There was no significant score difference between students in the first two years and those in the last two years (p = 0.985). Conclusion: Students expressed relatively positive attitude towards physician-pharmacist collaboration. Besides, female students demonstrated more collaborative attitudes than their male counterparts. The study also revealed the significance of improving this collaborative relationship between physicians and pharmacists.

S-15-2: COMMUNITY-BASED APPROACHES TO PREVENTION AND MANAGEMENT OF HYPERTENSION

There are multiple level factors that contribute to hypertension prevalence and control across various racial/ethnic populations. Hypertension rates in non-Hispanic Black (African American) adults in the USA are among the highest globally, impacted by the social determinants of health. Clinical approaches include team-based care, encouraging self-measured blood pressure, and strengthening community-clinical linkages. Prevention of new-onset hypertension and complications has been clearly demonstrated with community-level NaCl substitution in China and Peru. In the USA, Black population treatment approaches as community interventions include early initiatives from the Association of Black Cardiologists and the Healthy Heart Community Prevention Project (HHCPP) in New Orleans. The HHCPP was one of the early adopters of using barbers and hair stylists as hypertension control centers, working with faith-based institutions, and doing community education and outreach. Evidence-based approaches, now proven to be effective, include the faith-based treatment program for hypertension in New York, NY and a very successful in cluster-randomized trial demonstrating hypertension control in Black barbershops in Los Angeles, CA. The positive components of the Los Angeles barbershop intervention include trusted site of blood pressure intervention, physician-pharmacist collaboration, and effective anti-hypertensive medication including initial two drug protocol with amlodipine and a long-acting RAS blocker, and the appropriate use of aldosterone antagonists. Ongoing research include a small pilot study, simple text messaging and social support in New Orleans for medication adherence which will be reported at the AHA 2022 scientific sessions, and a large church-based health intervention study addressing primary prevention, including hypertension in New Orleans among 42 selected African American churches using community health workers in a combination of exercise weight-loss programs, self-monitoring blood pressure, glucose, and physical activity, and group education centers. In the USA, the American Heart Association in conjunction with the US Department of Health and Human services have initiated a national hypertension control initiative. Overarching strategies include patient and public education, community outreach and integration, and healthcare organization including provider and clinician training, as well as management evaluation of the project. This national program will engage community partners with federal health centers. In conclusion, hypertension can be controlled with evidence-based medicines, not only in clinical settings, but also with interventions in the community environment. Therapeutic lifestyle and evidence-based pharmacotherapy along with self-monitored blood pressure can lead to blood pressure control, especially in racial/ethnic populations.

Pharmacist-Managed Refill Service Impacts on Clinician Workload and Medication Interventions in a Federally Qualified Health Center.

Increasing administrative workload is linked with lower quality of patient care and physician burnout. Conversely, models involving pharmacists can positively impact patient care and physician well-being. Research has consistently demonstrated that pharmacist-physician collaboration can improve outcomes for chronic diagnoses. Pharmacist-managed refill services may improve provider workload measures and clinical outcomes. This was an evaluation of a pharmacist-managed refill service at a Federally Qualified Health Center (FQHC). Under collaborative practice agreement, pharmacists addressed refill requests and recommended interventions. Data analysis evaluated effectiveness of the model, including clinical interventions, and involved descriptive statistics and qualitative approaches. Average patient age was 55.5 years old and 53.1% were female. Turnaround time was within 48 h for 87.8% of refill encounters. During an average of 3.2 h per week, pharmacists addressed 9.2% (n = 1683 individual requests in 1255 indirect patient encounters) of the total clinic refill requests during the 1-year study period. In 453 of these encounters (36.1%), pharmacists recommended a total of 642 interventions. 64.8% of these were need for appointment (n = 211) or labs (n = 205). Drug therapy problems and medication list discrepancies were identified in 12.6% (n = 81) and 11.9% (n = 76) of encounters, respectively. The results of this study are consistent with previous literature demonstrating the value of interprofessional collaboration. Pharmacists addressed refills in an efficient, clinically effective manner in an FQHC setting. This may positively impact primary care provider workload, patients' medication persistence, and clinical care.

1002. Complex Outpatient Antimicrobial Therapy (COpAT) Program at a Rural Academic Medical Center: Evaluation of First 100 Patients

Abstract Background Literature shows early intravenous (IV) to oral (PO) antimicrobial transition for infective endocarditis (IE) and bone and joint infection (BJI) is noninferior to prolonged IV antimicrobial therapy. COVID-19 pandemic peaks resulted in critical shortages of staffed hospital beds spurring innovation. Outpatient parenteral antimicrobial therapy (OPAT), a well-established program using prolonged IV antimicrobials, faces challenges such as infusion resource needs and social circumstance limitations. Complex outpatient antimicrobial therapy (COpAT) uses PO in place of IV antimicrobials. We hypothesized rapid adoption of COpAT would decrease hospital length of stay and open beds while retaining satisfactory clinical outcomes. Methods COpAT protocols (Image 1) and guidelines by infection type and isolated organism (Image 2) were created. Hospitalized patients including persons who inject drugs (PWID) were evaluated for IV to PO antimicrobial transition by an infectious diseases (ID) physician and then followed by an ID physician-pharmacist team. Demographic, ID, and clinical outcome data for the first 100 COpAT patients between December 2020 and February 2022 were obtained by retrospective chart review. Image 1.COpAT Inpatient and Outpatient Protocols Image 2. COpAT Guidelines by Infection Type and Isolated Organism MSSA = methicillin-susceptible Staphylococcus aureus; MRSA = methicillin-resistant Staphylococcus aureus; spp. = species; TMP/SMX = trimethoprim-sulfamethoxazole; DS = double strength; SSTI = skin and soft tissue infection; CAP = community-acquired pneumonia Results PWID accounted for 78% of COpAT patients. BJI followed by mixed infection (IE and BJI) was most prevalent (Image 3) with bacteremia in 53% of cases. Staphylococcus aureus was most frequently isolated (Image 4). Oral linezolid and fluoroquinolones, often in combination, were most commonly used. IV and PO antimicrobials were taken for a median 28 and 14 days, respectively. The COpAT program saved 1425 IV antimicrobial and 1363 hospital days. Assuming daily inpatient cost of $2050, cost avoided was $2,794,150. COpAT patients participated in ID follow-up and adhered to PO antimicrobials with low 30-day readmission rates (Image 5). Image 3.Infection TypeImage 4.Isolated Organism CoNS = coagulase-negative staphylococci Image 5.Clinical Outcomes Conclusion In a sample of 100 COpAT patients including PWID, IV to PO antimicrobial transition safely saved hospital days and mitigated critical bed shortages during pandemic peaks. A successful COpAT program requires a multidisciplinary group: close ID physician-pharmacist collaboration extending to OPAT and antimicrobial stewardship teams. With a COpAT program in place, even earlier IV to PO antimicrobial transitions should be studied. Disclosures All Authors: No reported disclosures.