Providing Patient Education Research Articles

Identifying key roles of the pharmacy technician in primary care settings.

As the pharmacist's role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist's professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature. The duties of primary care pharmacy technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians. Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects. Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

Reproductive Health Services: Attitudes and Practice of Japanese Community Pharmacists.

The provision of sexual and reproductive health (SRH) services is an important part of a community pharmacist’s role in many countries. However, such services are not traditionally provided by pharmacists in Japan. We surveyed the practice and attitudes regarding the provision of SRH services among Japanese community pharmacists with a focus on reproductive health (RH) topics. The participants were asked about the provision of RH services, attitudes toward their role as SRH providers, and self-reported confidence in providing education to patients on RH topics. We obtained 534 effective responses. About half of the participants reported providing RH services, and only 21% were involved in dispensing emergency contraception pills. Although the proportion of pharmacists providing education on these topics was considerably lower, about 80% recognized the importance of their role as SRH advisors. Confidence in providing patient education about RH topics depended on their experience in providing such services. Most participants were interested in additional SRH training (80%). Our results suggest that training programs could help to expand Japanese community pharmacists’ roles as SRH providers and increase their confidence in the education of patients. This study provides useful insights to expand pharmacists’ roles in Japan as providers of comprehensive SRH services.

Pharmacists’ stigma toward patients engaged in opioid misuse: When “social distance” does not mean disease prevention

Background: Health professionals may stigmatize and prefer social distance from patients with opioid misuse, leading to poorer quality of care provided. The degree to which pharmacists prefer social distance from patients with opioid misuse and opioid use disorder (OUD) is not known. Methods: Pharmacists (n = 187) completed a survey comprised of demographics, attitudinal, and Social Distance Scale (SDS) questions based on a vignette patient who displayed opioid misuse. SDS question responses and total scores (maximum of 30; higher scores representing great preference for social distance) were tallied and associations with attitudes and demographics were examined. Results: Mean SDS total score was 16.32 (range 9–23). More than 59% of respondents had an SDS score >15, indicating overall lack of willingness to interact with the vignette patient. Females had a higher mean SDS score vs male pharmacists (16.58 vs. 15.36, respectively; p = 0.023). Pharmacists were more likely to prefer social distance from the vignette patient in personal situations (i.e. renting a room) than work-related interactions (i.e. providing patient education). Pharmacists with >10 years of experience, those without personal experience with a substance use disorder, those who strongly agreed that patients with OUD require excessive time and effort, and those who agreed that some people lack self-discipline to use prescription pain medication without becoming addicted had significantly higher SDS scores than pharmacists without these characteristics. Conclusions: Pharmacists expressed significant preference for social distance indicating stigmatization of patients with opioid misuse. Pharmacists were comfortable performing pharmacy tasks with patients with opioid misuse, but were less comfortable forming therapeutic relationships, an important tenet of patient-centered care. Efforts are needed to examine contributions to social distance preferences and implement measures to reduce them. Targeting of pharmacists with >10 years’ experience and without personal experience with OUD may also be most beneficial.

Mobile-health tool for timely management of cancer treatment toxicity.

321 Background: Treatment related side effects after chemotherapy are common, with significant toxicities seen in 78.2% to 98.3% of patients allocated to two study arms of a lymphoma trial [1]. While most oncology clinics provide patient education before treatment, onetime delivery of large amounts of information without reiteration of crucial facts results in information gaps, delay in seeking care, culminating in potentially avoidable ED visits and hospitalizations. Technology based symptom monitoring can facilitate early detection of complications, reduce symptom burden and cost of care. Here we update our study [2] of utility of a mobile-health tool for timely management of cancer treatment related toxicities in a community-based oncology practice. Methods: A web-based mobile application consisting of a patient interface, a provider interface and an embedded analytic platform was developed. Patient ‘check-ins’ incorporating a brief introduction and chemotherapy toxicity questionnaires are delivered through automated text or email. Toxicity questionnaires are based on the NCI-PRO-CTCAE ITEMS-ENGLISH form builder. The provider interface incorporates a ‘patient records summary’ page and a ‘tracker’ page, allowing the oncology care team to monitor responses in real-time. Responses exceeding pre-specified thresholds generate a color-coded ‘flag’ and are marked for follow up. Flags result in a phone call followed by in-person evaluation if necessary. All interventions are time stamped. Patient experience is measured concurrently using a Likert-scale as well as free-text response box. Results: 310 patients were enrolled as of January 21, 2021. Median age was 64 years. There were 49% females.8916 check-ins were sent out and 2963 responses recorded for an overall response rate of 33.23%. 531 responses provided by 109 unique patients were flagged for follow up, amounting to 6% of all responses. Fatigue was the most common symptom flagged for follow-up (454), followed by nausea/vomiting or diarrhea (167), abdominal pain (140), cough/dyspnea (140) and numbness/tingling (138). Follow up was prompt, with 60% of patient symptoms followed up on the same day and of these, 84% followed-up within 4 hours of patient reported symptom. Patient experience was consistently favorable. 72% of patients reported an experience score of ≥ 4 (1-5 scale, 5 being the most favorable). Conclusions: Electronic capture of symptoms using connected technology is feasible and can be used for timely management of treatment related complications.

Health-system specialty pharmacy impact on oral chemotherapy outcomes.

240 Background: Oral chemotherapy usage has grown significantly over the years as it provides a more convenient and less invasive administrative option for patients.In 2019, 89% of large hospitals owned and operated their own Health System Specialty Pharmacies (HSSP)1.Pharmacist-led medication therapy management services are crucial to provide patient education, monitoring of medication adherence and adverse effect management. With the current vertical integration of health plans and pharmacy benefit managers (PBMs) increasing their dominance over specialty dispensing channels, HSSP are often excluded from specialty networks. The objective of this study is to compare outcomes of oncology patients filling their oral chemotherapy at Cedars Sinai Medical Center (CSMC) Specialty Pharmacy versus those who are filling their medications at outside specialty pharmacies (OSP). Methods: Electronic health records were used to conduct a retrospective chart review of patients started on oral chemotherapy at CSMC between January 2019 to January 2021. Primary endpoints included time to treatment (TTT) and proportion of days covered (PDC). Secondary endpoints included drug-related problems (DRPs) and treatment-related ED visits and hospitalizations. DRPs were categorized by severity and type of intervention. Results: There were 100 patients included in the study: CSMC group (n = 50) and OSP group (n = 50). Patients in the CMSC group had significantly shorter TTT compared to OSP group (4 days vs. 9.5 days, respectively [P < 0.0026]), as well as a higher PDC (99.5% vs 91%, respectively [P < 0.0005]). Pharmacists identified and resolved 31 DRPs in CSMC arm with 19 DRPs categorized as serious and 1 DRP categorized as life-threatening. For the OSP group, 23 preventable DRPs were identified with 12 DRPs categorized as serious and 1 DRP categorized as life-threatening. There were no treatment-related ED visits or hospitalizations in either group. Conclusions: Patients filling their oral chemotherapy at CSMC Specialty Pharmacy had significantly quicker TTT and higher adherence rates as measured by PDC. Numerous DRPs were identified for OSP patients; potential pharmacist-interventions could have led to optimized and safer medication therapy if filled at a HSSP. Continued research comparing treatment outcomes and interventions made between HSSP and OSP can create a strong argument for health plans and PBMs to consider inclusion of HSSPs into their specialty networks.

Remote monitoring for heart failure: Assessing the risks of readmission and mortality

Study objectiveRemote monitoring (RM) can help patients with heart failure (HF) remain free of hospitalization. Our objective was to implement a patient-centered RM program that ensured timely clinical response, which would be associated with reduced mortality. DesignThis was a retrospective, observational, propensity-matched study. SettingA large regional health system between 9/1/2016–1/31/2018. ParticipantsPatients admitted with acute HF exacerbation were matched on key variables. Up to two comparison patients were selected for each RM user. InterventionsWe used an algorithmic approach to assess daily physiologic data, assess symptoms, provide patient education, encourage patient self-management, and triage medical problems. Main outcome measuresWe assessed all-cause mortality using Kaplan-Meier and log rank analysis. We used Cox proportional hazards to compare risk of death. ResultsOur cohort of 680 RM users and 1198 comparisons were similar across baseline characteristics except age (74.7 years versus 76.6 years, p < 0.001, respectively). Having one or more admissions in the preceding 120 days was more prevalent in the RM group (35.9% versus 29.8%, p = 0.013). The 30- and 90-day all-cause readmission rates were each higher among the RM users compared with the comparison patients (p = 0.013 and p < 0.001 for 30 and 90 days, respectively). Mortality was lower in the RM group at 30 and 90 days post-discharge (p < 0.001). ConclusionsRM that responds to biometric data and encourages patient self-management can be used in a large hospital system and is associated with decreased all-cause mortality. Our findings underscore RM technology as a method to improve HF care.

MM-093: Isatuximab Updates for Nurses: Isatuximab (Isa) Plus Carfilzomib (K) and Dexamethasone (d) Versus Carfilzomib and Dexamethasone in Relapsed Multiple Myeloma Patients (IKEMA)

Background Based on the ICARIA-MM study, Isa-pomalidomide-d is approved in relapsed/refractory multiple myeloma (RRMM) after ≥ 2 prior therapies, including lenalidomide and proteasome inhibitor. Isa can be administered as a 250 mL fixed-volume infusion with a median infusion time of 75 minutes for the third and subsequent infusions. Based on IKEMA study, Isa-Kd is approved in the US for RRMM after 1–3 prior lines of therapy and in EU for relapsed MM after ≥1 prior therapy. Here, we review the IKEMA data including specific considerations for nurses. Methods 302 patients with 1–3 prior lines of therapy were randomized (179 Isa-Kd, 123 Kd). Nurses should ensure blood typing, and premedication (to reduce the risk of infusion reactions [IRs]). Isa was administered intravenously (using a 0.20-pm filter) at 10 mg/kg weekly for 4 weeks, and every other week thereafter. Vigilance is required for IR detection and their management, and nurses must provide patient education. Results In a pre-specified interim analysis, PFS was significantly improved in patients receiving Isa-Kd with the median not reached for Isa-Kd vs 19.2 months with Kd (HR 0.53; 99% CI: 0.32–0.89; one-sided p=0.0007). Overall response rate: 86.6% Isa-Kd vs 82.9% Kd, one-sided p=0.1930. Very good partial response or better: 72.6% Isa-Kd vs 56.1% Kd, p=0.0011. Minimal residual disease negative (10–5): 29.6% Isa-Kd vs 13.0% Kd, p=0.0004. More patients were still on treatment with Isa-Kd (52.0%) vs Kd (30.9%). Grade ≥3 treatment-emergent adverse events (TEAEs): 76.8% Isa-Kd vs 67.2% Kd. Serious TEAEs and fatal TEAEs were similar in Isa-Kd vs Kd: 59.3% vs 57.4% and 3.4% vs 3.3%, respectively. IRs: 45.8% (0.6%, Grade 3–4) Isa-Kd and 3.3% (0%, Grade 3–4) Kd. Most frequent Grade ≥3 TEAEs were hypertension and pneumonia: 20.3% and 16.4% Isa-Kd vs 19.7% and 12.3% Kd, respectively. Grade 3-4 thrombocytopenia and neutropenia: 29.9% Isa-Kd vs 23.8% Kd and 19.2% Isa-Kd vs 7.4% Kd, respectively. As measured by QLQ-C30 Global Health Status scores, HRQOL was maintained with Isa-Kd. Conclusion The clinical activity and manageable safety profile of Isa offer an important new treatment option for patients with relapsed MM.

Teledermatology: The New Normal?

Teledermatology: The New Normal?

Evaluation of An Inpatient Pharmacy Consult on Discharge Medications in Bariatric Surgery Patients

Purpose: To evaluate the impact of an inpatient pharmacy consult on discharge medications following bariatric surgery. Methods: A pharmacy consult for discharge medication review for bariatric surgery patients was instituted at an academic medical center. The intervention included conducting a medication history, reviewing home medications for updates post-bariatric surgery, creating and documenting a discharge medication plan, and providing patient education. The impact of the intervention was evaluated by comparing medication classes, doses, and formulations prescribed during the intervention relative to a historical control group. Results: The study included 85 patients who received pharmacist intervention and 167 patients who did not receive pharmacist intervention following bariatric surgery. The prescription of an extended-release medication at discharge in the intervention group was reduced by 19.3% (28.7% vs. 9.4%, p = 0.0005). For patients on hypertension medications, 94.0% had their regimen reduced in the intervention group compared with 37.5% of patients in the control group (p < 0.001). Of patients on insulin at baseline, 87.5% of patients in the intervention group had dose reductions at discharge vs. 66.7% of patients in the control group (p = 0.37). No patients in the intervention group were discharged with oral antihyperglycemic medications or non-insulin injectable medications vs. 33.3% (p = 0.12) and 20.0% (p = 0.47), respectively, in the control group. Readmission rates at 30 days were insignificantly lower in the intervention group (3.5% vs. 4.2%, p = 1). Conclusions: Clinical pharmacist involvement in the discharge medication reconciliation process for bariatric surgery patients reduced prescribing of unadjusted medication classes, doses, and drug formulations.

Implementation of a clinical pharmacist-led service to optimize management of refractory chemotherapy-induced nausea and vomiting in adult hematology/oncology clinic.

Chemotherapy-induced nausea and vomiting (CINV) is a common and potentially debilitating adverse effect of chemotherapy. Refractory CINV can be particularly difficult to control. This report provides details on the implementation and evaluation of a pharmacist-led program for the management of refractory CINV in hematology and oncology clinics. A pharmacist-led program open to adult outpatients with refractory CINV was implemented at University of Wisconsin. Pharmacists conducted baseline and follow-up assessments, provided patient education, and started, discontinued, and/or adjusted antiemetics as clinically necessary for all enrolled patients. Retrospective chart review was used to describe the proportion of patients whose CINV improved through pharmacist intervention, effect of the program on antiemetic adherence, categorization of pharmacist interventions, and duration of patient enrollment. Forty-six patients were enrolled between February 2019 and January 2020. Forty-one patients (89.1%) had an overall reduction in their nausea and vomiting from baseline. Eleven patients (23.9%) met criteria for nonadherence to prescribed antiemetics at baseline; all patients were adherent at unenrollment. A total of 111 pharmacist interventions were made. The most common intervention was addition of new breakthrough antiemetic. The least common intervention was dose escalation of a previously prescribed antiemetic. The average number of interventions made per patient was 2.5. On average, patients were enrolled in the program for 16.6 days and met with a pharmacist three times. Implementation of this program standardized and streamlined pharmacist involvement with refractory CINV. Enrollment resulted in a measurable reduction in nausea and/or vomiting for patients with refractory CINV.

Ontario COVID-19 assessment centre practices in patient counselling, education, and follow-up care: A provincial survey

In March 2020, COVID-19 assessment centres were launched across the province of Ontario to facilitate COVID-19 testing outside of emergency departments. We aimed to study the degree to which assessment centres provide education and follow-up care for patients with suspected COVID-19. We conducted an online survey of Ontario COVID-19 assessment centre directors between September 15 and October 15, 2020. The primary outcomes studied were the types of educational modalities employed and information conveyed, methods and frequency of test result communication, and any follow-up care that was offered. Survey respondents were also asked to provide descriptions of barriers to patient education and test communication. A total of 56 directors (representing 73 assessment centres) completed the survey. The most frequent educational modalities employed were educational handouts (92%), direct in-person counselling (89%), and referral to website (72%). Seventy-one percent of respondents indicated patients with positive test results would be notified, and 61% of respondents indicated that follow-up care would be offered. The most frequently reported barriers to patient education were insufficient time and high volume of tests, while the most frequently reported barriers to communication of test results were difficulty accessing online health portals and high volume of tests. The ability of many assessment centres to provide patient education is limited by both individual patient and system-level factors. Assessment centres may benefit from standardization of educational materials, improved accessibility to test results for patients in marginalized groups, and virtual pathways to facilitate additional counselling and care for individuals who test positive.

Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia

ObjectivesIn recent years, hospital pharmacists have gained more importance in the clinical support of patients. However, most of the studies evaluating the impact of clinical pharmacy have only studied patients’...

“The gatekeepers in prevention”: Community pharmacist perceptions of their role in the opioid epidemic

Background: Community pharmacists are at the frontline of patient care, yet their role in the opioid epidemic remains unclear. This qualitative study examines the perception of community pharmacists about their role in the opioid epidemic and challenges to fulfilling this role. Methods: A secondary analysis of cross-sectional survey data from an Indiana census of community managing pharmacists was conducted. Qualitative data were coded using a priori and emergent themes. A priori categories included the perceived role of pharmacists in the opioid epidemic and perception of practice barriers. Results: A total of 215 Indiana community managing pharmacists participated in this study. Pharmacists understood themselves as gatekeepers in preventing opioid misuse and overdose. Reported pharmacy practices included providing patient education and communicating with prescribers. Challenges to fulfilling this role included pharmacy structure and operation, lack of patient and provider clarity about pharmacist scope of practice, and pharmacist perception that that there is no available discretionary time to support additional services. Conclusion: Pharmacists believe they have a vital role in combatting opioid misuse and overdose but are hampered by structural aspects of pharmacy practice and lack of recognition of their role. Pharmacy associations and policy partners are encouraged to identify opportunities to address these barriers.

Self-harm wounds: assessment and management

The management of self-harm (SH) wounds requires a non-judgemental holistic approach on the part of the health professional. It is important that SH wounds are assessed, and that interventions are agreed between the health professional and the patient. This article looks at definitions of SH and provides guidance on how health professionals can make an accurate assessment of the wound and, in addition to agreement treatment with the patient, provide patient education and guidance on self-care.

Virtually Serving the Underserved: Resident Perceptions of Telemedicine Use While Training During Coronavirus Disease 2019.

Introduction: To adapt during the coronavirus disease 2019 (COVID-19) pandemic, a large safety-net hospital in Atlanta, Georgia and other hospitals across the United Sates, increased telemedicine (TM) for outpatient visits. The impact on resident physicians, including minority providers, had not yet been reported. We aimed to assess how primary care residents perceived increased TM in clinics during the pandemic, and assess resident burnout. Materials and Methods: An online survey was sent to 60 internal medicine (IM) and 18 family medicine (FM) residents who used TM to treat underserved patients, from March to May 2020, at the onset of the COVID-19 pandemic. The questionnaire included questions on resident demographics, satisfaction with TM, screening capability for COVID-19, effectiveness for patient education on COVID-19, impact on patient interactions and time management. Burnout was assessed with the Abbreviated Maslach Burnout Inventory. Results: A majority (62 of 78) eligible residents (79.5%) responded to the survey. Ninety-one percent of residents agreed that TM was a secure alternative to face-to-face encounters. Seventy-nine percent used it to screen for signs/symptoms of COVID-19 and 93% provided patient education on COVID-19. Average visit length decreased by 10-20 min with TM. Post-TM, scores for overall burnout were decreased (p = 0.0003) and less residents in total exhibited burnout (p = 0.0156). Discussion and Conclusions: IM and FM residents viewed TM as an efficient way to screen for and provide education on COVID-19, as well as a secure alternative to face-to-face encounters. With increased used of TM during COVID-19, there was decreased burnout among primary care residents.

Feasibility of a pharmacy-led intervention to de-implement non-guideline-concordant proton pump inhibitor use

BackgroundProton pump inhibitors (PPIs) are among the most prescribed medications and are often used unnecessarily. PPIs are used for the treatment of heartburn and acid-related disorders. Emerging evidence indicates that PPIs are associated with serious adverse events, such as increased risk of Clostridioides difficile infection. In this study, we designed and piloted a PPI de-implementation intervention among hospitalized non-intensive care unit patients.MethodsUsing the Systems Engineering Initiative for Patient Safety (SEIPS) model as the framework, we developed an intervention with input from providers and patients. On a bi-weekly basis, a trainee pharmacist reviewed a random sample of eligible patients’ charts to assess if PPI prescriptions were guideline-concordant; a recommendation to de-implement non-guideline-concordant PPI therapy was sent when applicable. We used convergent parallel mixed-methods design to evaluate the feasibility and outcomes of the intervention.ResultsDuring the study period (September 2019 to August 2020), 2171 patients with an active PPI prescription were admitted. We randomly selected 155 patient charts for review. The mean age of patients was 70.9 ± 9 years, 97.4% were male, and 35% were on PPIs for ≥5 years. The average time (minutes) needed to complete the intervention was as follows: 5 to assess if the PPI was guideline-concordant, 5 to provide patient education, and 7 to follow-up with patients post-discharge. After intervention initiation, the week-to-week mean number of PPI prescriptions decreased by 0.5 (S<0.0001). Barriers and facilitators spanned the 5 elements of the SEIPS model and included factors such as providers’ perception that PPIs are low priority medications and patients’ willingness to make changes to their PPI therapy if needed, respectively. Ready access to pharmacists was another frequently reported facilitator to guideline-concordant PPI. Providers recommended a PPI de-implementation intervention that is specific and tells them exactly what they need to do with a PPI treatment.ConclusionIn a busy inpatient setting, we developed a feasible way to assess PPI therapy, de-implement non-guideline-concordant PPI use, and provide follow-up to assess any unintended consequences. We documented barriers, facilitators, and provider recommendations that should be considered before implementing such an intervention on a large scale.

Physicians’ Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study

BackgroundTo mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic.ObjectiveThis study aimed to evaluate whether differences exist in physicians’ attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic.MethodsThis survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician’s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians’ sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians’ characteristics with the perceived outcomes of the web-based consultation.ResultsCompared to audio consultations, video consultations were significantly associated with physicians’ confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians’ confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008).ConclusionsThese results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.

A Quality Improvement Approach to Decreasing Postdischarge Acute Care Reuse Among Children With Asthma.

To reduce 7-day acute care reuse among children with asthma after discharge from an academic children's hospital by standardizing the delivery of clinical care and patient education. A diverse group of stakeholders from our tertiary care children's hospital and local community agencies used quality improvement methods to implement a series of interventions within inpatient, emergency department (ED), and outpatient settings. These interventions were designed to improve admission, inpatient care, and discharge processes for children hospitalized because of asthma and included a focus on (1) resident education, (2) patient access to medication and asthma education, and (3) gaps in existing asthma clinical care pathways in the ED and ICU. The primary outcome was the rate of 7-day acute care reuse (combined hospital readmissions and ED revisits) after discharge from an index hospitalization for asthma, measured through a monthly review of electronic health record data and compared with a 6-month baseline period of reuse data. The mean 7-day reuse rate for asthma after discharge was 3.7% during the 6 months baseline period (n = 107) and 1.0% during the 15-month intervention period (n = 302). This included a shift in our median from 3.3% to 0% with an 8-month period of no 7-day reuse. An interprofessional quality improvement team successfully achieved and sustained a 73% reduction in mean 7-day asthma-related acute care reuse after discharge by standardizing provider training, care processes, and patient education.

The pharmacist's responsibility to ensure appropriate use of direct‐to‐consumer genetic testing

AbstractMillions of consumers have chosen to pursue direct‐to‐consumer (DTC) genetic testing for personal health‐related and/or non‐health‐related information. However, genetic test results can be complex to interpret, and the regulatory landscape for DTC genetic tests is in flux. Given that these tests are easily accessible and may have implications for health, pharmacists need to be prepared to provide patient education on DTC genetic testing, particularly when the results may provide valuable insights into optimal pharmacotherapy. Pharmacists, regardless of practice site and specialty, are well positioned to provide patient education on the benefits, risks, and limitations of DTC pharmacogenomic tests in clinical practice and to advise patients about pursuing confirmatory clinical testing. This report highlights the responsibility of the pharmacist in the appropriate use of DTC genetic testing, particularly pharmacogenomic testing, using a patient case example across varied health settings.

Hospitalist perspectives on barriers to recommend and potential benefit of the COVID-19 vaccine

ABSTRACT Background: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients. Methods: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from 14 December 2020 through 4 January 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians. Results: The overall response rate was 42.7% (n = 128/300) and comprised of 53.9% women (n = 69/128) and 41.4% APPs (n = 53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n = 119/128) and influenza (97.7%; n = 125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and coworkers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32–6.59]; P< .008), whereas hospitalist age, gender, and profession showed no association. Conclusion: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.