Pharmacy Providers Research Articles

Improving care for patients with depression: A collaborative project with community pharmacy and primary care providers

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

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

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

Factors associated with COVID-19 vaccination intentions among adults in the deep South

The recent approval of several COVID-19 vaccines signals progress toward controlling the pandemic. Although social distancing and masking have been effective, vaccines are an important additional measure of protection to reduce COVID-19 spread. Adequate uptake is essential to reach herd immunity, estimated to be approximately 67%. However, vaccine hesitancy, the fast-tracked nature of the COVID-19 vaccines, and misinformation circulating through various forms of media have contributed to lower vaccination intention than desired. The current research study developed an online survey conducted via Facebook to explore the attitudes and perceptions of adult Alabama residents about COVID-19 and the COVID-19 vaccines. Of the 3,781 respondents, only 44.3% reported intent to receive a vaccine, with a large proportion reporting they were unsure (28.1%). Lack of intention to vaccinate was associated with low educational attainment, low COVID-19 knowledge levels, low income, and African American race. The current survey also explored participants’ influenza vaccine behavior as this information can also be used to inform successful COVID-19 vaccine distribution. Of the respondents, 56% report receiving the yearly influenza vaccine and the majority receive it at a pharmacy or healthcare provider office. This informs likely successful locations for COVID-19 vaccine distribution. Appropriate education targeted to populations most likely to refuse COVID-19 vaccination is essential to promote uptake. The information collected from the current study should be utilized to inform effective and efficient vaccine distribution strategies.

Evaluating proactive outreach for prior authorization recertifications in Medicaid patients.

To assess the effectiveness of a proactive provider intervention in prompting prior authorization (PA) submissions or provider response prior to PA expiration for medically complex Medicaid patients. Pre-post outreach study with data from pharmacy claims and provider outreach. The intervention and historical comparison (control) groups included expired PAs from December 2019 to February 2020 and from December 2018 to February 2019, respectively. Provider outreach, including telephonic and fax attempts, was conducted over a 2-week period prior to PA expiration. Outcomes were classified as positive or negative based on provider conversation coupled with the result (eg, PA submission) for the intervention group and based solely on pharmacy claims for the control group. The primary end point was the percentage of positive outcomes between the groups, analyzed via χ2 test. The time from PA expiration to the new PA submission was evaluated via t test. A total of 342 outreach attempts were conducted for 270 PAs representing 193 unique patients. Outreach was more likely to result in positive outcomes in the intervention group vs no outreach in the control group (87% vs 25%; P < .00001). On average, PAs were submitted 3.5 days prior to expiration in the intervention group vs 13.0 days after expiration in the control group (t = -7.50; P < .00001). Proactive outreach resulted in a greater percentage of PA submissions and a significantly reduced time to PA submission. These findings provide important information for payers in guiding clinical programs to enhance continuity of care among at-risk populations.

PMU41 Clinical Pharmacy Provider Dashboards May Prevent Avoidable Adverse Events and Reduce Total Cost of Care

Medication Therapy Opportunities (MTOs) consist of avoidable medication errors and adverse drug events that may lead to patient harm as well as opportunities to optimize medication treatment. Blue Cross Blue Shield of Louisiana, in keeping with their mission to improve the health and lives of Louisianans, have launched an innovative clinical pharmacy dashboard making actionable data available to providers to minimize avoidable adverse events and optimize medication treatment. The Medication Therapy Opportunities component of the dashboard focuses on the following key elements (1) Therapy Duplication – multiple medications within the same or a similar therapeutic class taken at the same time (2) Drug-Drug Interactions – medications known to have an adverse event when taken together (3) Condition Related – medications known to exacerbate a medical condition or potential opportunity to optimize care and (4) Omissions of Care – discrepancy between guideline recommendations and/or standards of care.

Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives

As countries scale up pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models are needed to expand access to populations at HIV risk that are unwilling or unable to access clinic-based PrEP care. To identify factors that may influence implementation of retail pharmacy-based PrEP delivery in Kenya, we conducted in-depth interviews with 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers from two provinces. Most participants expressed strong support for expanding PrEP to retail pharmacies, though conditioned their acceptance on assurances that care would be private, respectful, safe, and affordable. Participant-reported determinants of feasibility centered primarily on ensuring that the intervention is compatible with retail pharmacy operations (e.g., staffing levels, documentation requirements). Future research is needed to develop and test tailored packages of implementation strategies that are most effective at integrating PrEP delivery into routine pharmacy practice in Kenya and other high HIV prevalence settings.

Reducing opioid use in post-operative otolaryngology patients: A quality improvement project

PurposeIn opioid-naive patients, many low-risk surgical procedures are associated with an increased risk of chronic opioid use. The goal of this quality improvement project was to reduce the amount of opioid prescriptions after commonly performed surgeries in otolaryngology. Materials and methodsPre-intervention opioid prescribing state was measured using anonymous provider and patient surveys, as well as pharmacy provider prescription data. Next, this information was used to develop an opioid prescription protocol that both standardized opioid prescribing practices and encouraged multimodal analgesia following routine surgery. Finally, post-intervention data were gathered and compared to pre-intervention data to assess changes in prescribing patterns. ResultsBy patient survey, the worst pain and average pain after surgery (scale of 1–10) were unchanged after the intervention (5.1 to 4.8, p = 0.52; 4.1 to 3.6, p = 0.35, respectively). Post-intervention, 41% of patients reported receiving no opiates, whereas pre-intervention 100% of patients surveyed received opiates. The amount of ibuprofen and acetaminophen prescribed post-intervention increased 113% and 71%, respectively. By survey, the average number of opioid doses decreased from 24.0 ± 7.0 to 18.4 ± 6.6 (p = 0.018). ConclusionsThe implementation of a standardized physician opioid prescription protocol did not affect patient pain perceptions, resulted in an increase in multimodal analgesia prescription, and increased provider awareness of opioid over prescription.

Meeting the affordability challenges posed by orphan drugs: a survey of payers, providers, and employers.

BACKGROUND: As an increasing number of orphan drugs are FDA approved, health care payers, employers, and providers are attempting to strike a balance between patient access to innovative treatments and overall affordability. Payers and employers are evaluating how traditional specialty pharmacy management strategies and innovative models can support continued coverage of orphan drugs. OBJECTIVE: To understand how health care stakeholders are meeting the financial challenges posed by the increasing number and cost of orphan drugs and how these strategies are affecting orphan drug acquisition for providers. METHODS: A survey was conducted with payer, provider, and employer decision makers recruited from both AMCP and a proprietary database of market-access decision makers in July and August 2020. Respondents were asked about their experiences and activities in the orphan disease space, including tactics to manage affordability of drugs to treat orphan diseases. RESULTS: Reinsurance was the most commonly utilized strategy to maintain affordability of the benefit for both payers (42%) and employers (55%). Although 31% of payers have adopted gene therapy carve-outs, no employers had done so. Approximately three quarters (76%) of payers believe that limited distribution networks impede their abilities to manage orphan drugs, compared with 4% who believe limited networks improve orphan drug management. For most payers (78%), the decision to cover orphan drugs on either the medical or pharmacy benefit depends on the specific drug. Medical benefit coverage was driven primarily by site-of-care policies (55%) and the lower drug cost of average sales price pricing (50%). Pharmacy benefit coverage was driven primarily by a greater ability to manage the orphan drug (71%) and by rebates (62%). One in 3 (33%) of providers with experience treating orphan diseases acquire orphan drugs exclusively through buy and bill, whereas 10% acquire them exclusively through a specialty pharmacy provider. Buy-and-bill acquisition by providers was driven primarily by improved patient affordability (47%) and 340b pricing (47%). Specialty pharmacy provider acquisition was driven primarily by payer requirements (64%) and reduced administrative burden (64%). CONCLUSIONS: Payers and employers are adopting innovative benefit designs and strategies to cover orphan drugs while maintaining plan affordability. Cost considerations are prominent factors in determining whether orphan drugs will be covered under the pharmacy or medical benefit and how providers will acquire orphan drugs. DISCLOSURES: This research was sponsored by AMCP and PRECISIONvalue. Lopata, Terrone, and Gopalan are employees of PRECISIONvalue. Ladikos and Richardson are employees of AMPC. The authors have nothing further to disclose. This research was presented during the AMCP Partnership Forum "Preparing for and Managing Rare Diseases" held virtually September 8-10, 2020.

Adventures in getting paid

Adventures in getting paid

Exploring standardized persons' expectations for practice-readiness among student pharmacists

IntroductionAlthough patient expectations and preferences for healthcare selection have been described in the literature, there are no studies exploring what qualities and behaviors standardized persons (SPs) identify for the practice-ready pharmacist. This manuscript explores those qualities and behaviors within an objective structured clinical examination (OSCE) to determine SP interest in having the student as their pharmacy provider. MethodsUsing open-ended questions via a Qualtrics survey, SPs were asked to provide qualities and behaviors they associated with each of three practice-readiness rating levels. Using a constant comparative approach, the researchers coded the collected data over multiple stages to allow for authentic reflection and interpretation of the data. Coders used both inductive and deductive processes prior to establishing a unified understanding and corresponding codebook. ResultsA total of 55 SPs (61.1% response rate) participated in the survey, with the majority of participants working for the organization no more than two years (58.2%). Through the coding process, several major themes emerged across each of the three ratings including professionalism, patient-centered skills, communication, and preparation. Findings indicated the differences in ratings were influenced by the degree that students demonstrated each theme. ConclusionsOverall, these findings provide a better understanding of the qualities and behaviors SPs associate with student pharmacists completing OSCEs acting as practicing pharmacists. However, additional research is needed to determine if the same qualities and behaviors would be viewed as essential with SPs at other academic institutions.

Supporting Medical Providers to Combat Vaccine Hesitancy.

Supporting Medical Providers to Combat Vaccine Hesitancy Magdi Awad, PharmD, MSA, Kenneth Furdich, PharmD, BCACP, Dana Webb, PharmD, and E. Demond Scott, MD, MPH To the Editor: COVID-19 vaccine hesitancy during the SARS-CoV-2 public health crisis has the potential to significantly increase disease burden throughout the world.1 Vaccinations currently available have an increasing amount of data to support both their safety and efficacy at preventing disease.2,3 However, serious efforts, both educational and logistical, must take place to maximize the public's vaccination uptake.4 Polls assessing vaccine hesitancy in the general population have shown hesitancy persisting despite vaccination campaigns being underway. National polling data as of February 2021 has demonstrated up to 44% of the general population is still displaying vaccine hesitancy. Specifically, 22% report they would want to wait and see how the vaccine is working before getting it, 7% would get the vaccine if required by school or work, and 15% would definitely not get the vaccine.5 Despite Centers for Disease Control recommendations, health care workers are also displaying vaccine hesitancy. A study conducted in a large university health care system observed attitudes towards COVID-19 vaccination among health care personnel. The various personnel being surveyed ranged from physicians to non-clinical ancillary staff. Results from this survey showed 58% of respondents said they would get vaccinated, 26% were unsure, and 16% reported they would not get vaccinated. Additionally, 20% of physicians and 45% of master's-level clinicians reported they were not sure or strongly disagreed to getting a COVID-19 vaccine if one were offered to them for free.6 Among the most significant contributors to vaccine hesitancy is the misinformation projected on social media. Misinformation being spread to the public include assertions the vaccine trials were rushed, the vaccine technology is new, or that the vaccine alters one's genetic makeup.7 While this information is false, clinicians must be ready to provide demonstrated facts and recommendations to combat the spread of misinformation. Health care providers have not only an opportunity, but an obligation, to dispel the myths about COVID-19 and its vaccines. They must anticipate, validate, and be prepared to address patients' questions and concerns about the vaccine. To do so, health professionals must be able to demonstrate their own confidence in the benefits of the vaccine being greater than any possible difficulties.8 Moreover, health care providers' ability to combat vaccine myths is especially important in underserved and minority [End Page xiv] communities. Patients tend to accept preventative medicine recommendations from providers with the same ethnicity and race as themselves, and providers of color are disproportionately likely to practice in communities of color.9 Educational interventions for providers may be helpful to increase confidence in deflating vaccination myths and help them to promote vaccination in their patients. As an example, a small community health center with multiple locations serving underserved communities in Ohio used its pharmacy-led academic detailing approach to educate the medical and pharmacy providers about the COVID-19 vaccines.10 Before and during the educational presentation, questions were sought from the providers and free engagement was promoted to share insights. The academic detailing session also covered common misinformation as well as factual information refuting common erroneous claims. A survey of the medical providers was then circulated to assess comfort in recommending the COVID-19 vaccination to patients (item #1), addressing vaccine hesitancy (item #2), and addressing use of the vaccine in special populations (e.g., immune-deficient, previous COVID-19 exposure) (item #3). Results from the survey (n=12, 75% response rate) were analyzed using Cohen's D to evaluate effect size.11 The analysis revealed the academic detailing session had a medium positive effect on item #1, a large positive effect on item #2, and a very large positive effect on item #3. Education and the dissemination of factual data are pathways to reduce vaccine hesitancy. This education empowers providers to educate their patients regarding COVID-19 vaccines and dispel misinformation which could lead to greater public harm. Educational interventions as described above should be considered by clinics and health centers to aid in combatting the SARS-CoV-2 pandemic. References...

Study of the Knowledge Attitudes and Practices of the Dispensing of Anxiolytics in Pharmacies in Senegal

<i>INTRODUCTION</i>: An anxiolytic is a psychotropic drug used in the treatment of pathological anxiety. Because of the risks associated with the irrational use of these drugs, their prescription and dispensing must be strictly controlled. The objective of this research is to evaluate the knowledge, attitudes and practices of dispensing anxiolytics by providers of dispensing pharmacies in the region of Thies in Senegal. <i>METHODOLOGY</i>: This is an observational, cross-sectional, descriptive and analytical study at the level of providers of dispensing pharmacies in the departments of Mbour and Thies, in October 2018. Data collection was done by direct interview with administration of a questionnaire after informed consent from the provider. They were entered and analysed using EPI-Info. 7 software. <i>RESULTS</i>: A total of 221 pharmacy providers were surveyed. The average age of the providers was 36.8 years with a standard deviation of 9.5 years. Married people represented 68.8%. Full time pharmacists represented 24.4%. Anxiolytic dispensing practice was good in 78.3% of the providers. Good dispensing practice depended on professional level in the pharmacy (OR=14.0 (6.2 - 33.2)), good knowledge of pharmacological effects (OR=5.5 (2.5 - 12.2)) and good knowledge of adverse effects of anxiolytics (OR=5.0 (2.0 - 12.2)). The better the knowledge of anxiolytics, the better the dispensing practice. <i>CONCLUSION</i>: In order to improve the practice of dispensing anxiolytics and other psychotropic drugs in general, it will be necessary to strengthen the knowledge of providers through regular continuous training and to strengthen the supervision of dispensing sites by Ministry of Health inspectors.

Design of a care pathway for pharmacy-based PrEP delivery in Kenya: results from a collaborative stakeholder consultation

IntroductionIn Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya.MethodsIn January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions.ResultsStakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting.ConclusionsPrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings.

Opioid-Related Education Provided by Continuing Education Divisions at US Pharmacy Schools

Objective. To quantify the number and type of new opioid-related continuing pharmacy education (CPE) activities offered by continuing education divisions (CEDs) at US schools and colleges of pharmacy from 2015 through 2018, and to determine the number of pharmacists who completed opioid-related CPE activities. Methods. Data was derived from the database of CPE activities maintained by the Accreditation Council for Pharmacy Education (ACPE), which is the sole accreditation agency for all providers of CPE, including pharmacy schools. Data were filtered to include only pharmacy school CPE providers. A search for six keywords (opiates, opioids, pain, pain management, drug overdose, and opioid antagonist) was conducted for the years 2015-2018. The data extracted included title of the CPE activity, contact hours, activity type, activity format, and the number of pharmacists who participated in the activity. Descriptive statistics were used. A content analysis of activity titles was performed. Results. Overall, the CEDs of US schools and colleges of pharmacy delivered 20.3% of all ACPE-approved opioid-related CPE activities from 2015-2018. A total of 1,237 unique opioid-related CPE activities were identified. The number of new CPE activities increased from 249 in 2015 to 297 in 2016 to 349 in 2017, then decreased to 342 in 2018. These activities reached 149,373 pharmacists and were most commonly affiliated with the following keywords: opioids (34.8%) and pain management (30.2%). Conclusion. The opioid epidemic creates an opportunity for pharmacists to increase their role in public health, but education and training are necessary. The study findings indicate that many pharmacists participate in opioid-related CPE provided by ACPE-accredited CEDs of pharmacy schools. This number is likely to increase as a growing number of states are beginning to require opioid-related CPE for pharmacist license renewal.

Evaluation of Fluoroquinolone Use in Hospice Patients (GP783)

• Recall risks associated with fluoroquinolone use in hospice patients• Identify a process for balancing risk vs benefit of fluoroquinolones in hospice patients. Since 2004, the Food and Drug Administration (FDA) has released eight safety communications regarding serious adverse effects associated with fluoroquinolones, including peripheral neuropathy, tendonitis/tendon rupture, worsening of myasthenia gravis, central nervous system effects (confusion, hallucinations), hypoglycemia, QTc prolongation, and aortic tear/rupture. An FDA Boxed Warning was issued to reserve use of fluoroquinolones for patients with no alternative treatment options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated urinary tract infections. Despite the warnings and risks, fluoroquinolone antibiotics are commonly prescribed. To evaluate risk factors for serious adverse effects in hospice patients taking fluoroquinolones. Retrospective chart review of a national hospice pharmacy provider was completed. Decedents with pharmacy claims for fluoroquinolones during January 2019 were reviewed. Demographics collected included hospice diagnoses, presence of cardiac disease or hypertension medications, concomitant corticosteroids, QTc prolonging medications, sex, and fluoroquinolone claims within 14 days of death. Nearly 15% (n=10,719) of decedents had at least one antibiotic claim during the review period, average age 80.1 years. Over 24% of patients filled the fluoroquinolone within 14 days of date of death. Fluoroquinolones comprised 24.4% of claims (n=4,651), the largest percentage of all antibiotic claims. Fluoroquinolone prescriptions were predominantly ciprofloxacin (51.4%) and levofloxacin (48.6%). The top 5 hospice diagnoses in the study population were cardiac (21.4%), dementia (21.3%), pulmonary (18.3%), cancer (15.6%), and stroke (8.7%). Known QTc prolongation risk factors included female patients (60.2%), age over 65 years (86.0%), and concomitant QTc risk medication use (51.5%). Additional FDA fluoroquinolone risk factors were present: hypertension (64.1%), concomitant corticosteroid use (22.9%). Our population review illustrates high utilization of fluoroquinolones in patients with multiple risk factors for serious adverse events. Increased awareness of patient risk factors identified by FDA warnings may help promote safer antibiotic prescribing for hospice patients.

Development of a screening tool to identify patients likely to benefit from clinical pharmacist review in a home-based primary care population

ObjectiveTo create a novel screening tool that identified patients who were most likely to benefit from pharmacist in-home medication reviews. DesignSingle-center, retrospective study. Setting and participantsA total of 25 homebound patients in Forsyth County, NC, aged 60 years or older with physical or cognitive impairments and enrolled in home-based primary care or transitional and supportive care programs participated in the study. Pharmacy resident-provider pairs conducted home visits for all patients in the study. Pharmacy residents assessed the subjective risk (high, medium, low) of medication nonadherence using information obtained from home visits (health literacy, support network, medications, and detection of something unexpected related to medications). An electronic medical record–based risk score was simultaneously calculated using screening tool components (i.e., electronic frailty index score, LACE+ index [length of stay in the hospital, acuity of admission, comorbidity, emergency department utilization in the 6 months before admission], and 2015 American Geriatric Society Beers Criteria). Outcome measuresThe electronic medical record–based screening tool numerical risk scores were compared with pharmacy resident subjective risk assessments using tree-based classification models to determine screening tool components that best predicted pharmacy residents’ subjective assessment of patients' likelihood of benefit from in-home pharmacist medication review. Following the study, satisfaction surveys were given to providers and pharmacy residents. ResultsThe best predictor of high-risk patients was an electronic frailty index score greater than 0.32 (indicating very frail) or LACE+ index greater than or equal to 59 (at high risk for hospital readmission). Pharmacy residents and providers agreed that homebound patients at high-risk for medication noncompliance benefited from pharmacist time and attention in home visits. ConclusionIn homebound older persons, this screening tool allowed for the identification of patients at high-risk for medication nonadherence through targeted in-home pharmacist medication reviews. Further studies are needed to validate the accuracy of this tool internally and externally.

Care Right Where You Are: Treating in Place to Avoid an Emergency Department Visit or Hospitalization

Care Right Where You Are: Treating in Place to Avoid an Emergency Department Visit or Hospitalization

American Society for Transplantation and Cellular Therapy Pharmacy Special Interest Group Position Statement on Pharmacy Practice Management and Clinical Management for COVID-19 in Hematopoietic Cell Transplantation and Cellular Therapy Patients in the United States.

The coronavirus-19 (COVID-19) pandemic poses a significant risk to patients undergoing hematopoietic stem cell transplantation (HCT) or cellular therapy. The American Society for Transplantation and Cellular Therapy Pharmacy Special Interest Group Steering Committee aims to provide pharmacy practice management recommendations for how to transition clinical HCT or cellular therapy pharmacy services using telemedicine capabilities in the inpatient and outpatient settings to maintain an equivalent level of clinical practice while minimizing viral spread in a high-risk, immunocompromised population. In addition, the Steering Committee offers clinical management recommendations for COVID-19 in HCT and cellular therapy recipients based on the rapidly developing literature. As the therapeutic and supportive care interventions for COVID-19 expand, collaboration with clinical pharmacy providers is critical to ensure safe administration in HCT recipients. Attention to drug-drug interactions (DDIs) and toxicity, particularly QTc prolongation, warrants close cardiac monitoring and potential cessation of concomitant QTc-prolonging agents. Expanded indications for hydroxychloroquine and tocilizumab have already caused stress on the usual supply chain. Detailed prescribing algorithms, decision pathways, and specific patient population stock may be necessary. The COVID-19 pandemic has challenged all members of the healthcare team, and we must continue to remain vigilant in providing pharmacy clinical services to one of the most high-risk patient populations while also remaining committed to providing compassionate and safe care for patients undergoing HCT and cellular therapies.

Administration sequence for multi-agent oncolytic regimens.

The existence of a multitude of oncolytics regimens containing two or more agents (combination) outlines the need to define their most adequate sequence of administration. However, limited resources are currently available to specify a particular sequence, presenting challenges potentially impacting on patient safety, and Pharmacy & Infusion Nursing workflows. A comprehensive literature search was performed leading to the compilation of a document containing drug administration sequencing instructions for our Nursing, Pharmacy, and Oncology providers to follow. Regimens prioritized in our literature review represented regimens selected as part of our approved Clinical Pathways, regimens inquiries from Pharmacy or Nursing, as well as less frequently used regimens. We stratified the regimens by tumor type and arranged them alphabetically by indication. A table was compiled containing all the supporting literature for the recommended drug administration sequences. If, in certain instances, no literature support was identified outlining rationale such as enhanced management of adverse effects, a specific institutional decision was made by our enterprise Medical Oncology Committee with recommendations from Pharmacy experts. The primary guiding principles for outlining our recommendations were the following: administration of vesicant agents first; administration of biologic agents first; administration of taxanes prior to platinum agents; and duration of infusion (shorter infusions prioritized). This guideline is not exhaustive. The compilation provided here is intended to be utilized as guidance for oncolytics administration sequence. We will continue to review and incorporate treatment sequencing recommendations for additional regimens.

Finding the Sweet Spot: An Interactive Workshop on Diabetes Management in Older Adults.

Intensive glucose lowering in older adults with diabetes leads to increased risks with minimal benefits. Surveys indicate that clinician confidence for individualizing glycemic goals and regimens remains low. We created an interactive workshop and clinical tool kit to improve clinician knowledge of safe diabetes management in older adults. Finding the Sweet Spot was a 1-hour workshop taught by pharmacists to medical and pharmacy learners that introduced a five-step framework for diabetes management in older adults. The interactive presentation included cases and a clinical tool kit based on current recommendations from the American Diabetes Association and American Geriatrics Society. Pilot workshops were held for 6 months, allowing for real-time revisions based on feedback; final implementation occurred for 6 months thereafter. We evaluated learner self-efficacy (via a 5-point Likert scale) and knowledge (via multiple-choice questions) of diabetes management in older adults before and after the workshop. Thirty learners participated in Finding the Sweet Spot (70% medicine, 30% pharmacy). The percentage of confident learners increased from 55% to 97% (p < .05) after the workshop. All learners demonstrated improvements in knowledge, with the mean score on the knowledge assessment increasing from 61% to 80% (p < .05). Via open-ended feedback, learners expressed satisfaction and found the clinical tool kit especially helpful. Our Finding the Sweet Spot workshop demonstrated statistically significant changes in self-efficacy and knowledge among learners, indicating that this interactive workshop improves medical and pharmacy provider confidence and skills in caring for older adults with diabetes.