JAPhA Practice Innovations最新文献

{"title":"Innovating an end-user drug donation program after Ohio Repository Law Expansion","authors":"Treston Warren,&nbsp;Lydia Bailey,&nbsp;Rusty Curington","doi":"10.1016/j.japhpi.2025.100078","DOIUrl":"10.1016/j.japhpi.2025.100078","url":null,"abstract":"<div><h3>Background</h3><div>St. Vincent de Paul Charitable Pharmacy (SVDPCP), located in Cincinnati, OH, is a last-resort, safety-net pharmacy for uninsured and underinsured individuals living in Southwestern Ohio that provides prescriptions and other clinical services for no charge. Approximately 87% of prescriptions are filled with medication donations from licensed redistributors, but many medications remain unavailable. In January 2023, Ohio House Bill 558 was signed into law, permitting end users to donate their unexpired, unused medications to Ohio drug repository programs.</div></div><div><h3>Objectives</h3><div>This program aimed to establish a sustainable workflow for accepting end-user donations, increase the portion of prescriptions dispensed from this donated source, reduce expenditures on drug procurement, and collaborate with community partners for donation referrals.</div></div><div><h3>Practice description and innovation</h3><div>SVDPCP assists donors in completing the donation record. Donated medications are quarantined in a designated area until a licensed pharmacist can conduct a quality assurance check, ensuring that products are suitable for redispensing. Medications are marked before integration into the pharmacy’s inventory. Prescriptions filled with donated medications are reflected in the pharmacy processing software. Records are filed for 3 years.</div></div><div><h3>Results</h3><div>There were 209 end-user donations in the first 6 months of the program. Diabetes medications were the most common donation (53%). SVDPCP saved more than $5000 in drug procurement, permitting reallocation of funds toward more costly medications.</div><div><em>Evaluation and quality improvement</em>: This program was conducted via 3 2-week-long Plan-Do-Study-Act cycles with a global aim of increasing donation acceptance efficiency.</div></div><div><h3>Implications and conclusions</h3><div>This new end-user drug donation program is one of the first of its kind in Ohio and could serve as a framework for other repository programs in the state. Repository programs aiming to implement end-user donations should take into consideration the personnel and storage space needed for quarantined donations and donation processing.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 4","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creation of the Ew Meds List-a comprehensive list of bad-tasting liquid medicines","authors":"Amy Kruger Howard,&nbsp;Jill A. Morgan","doi":"10.1016/j.japhpi.2025.100076","DOIUrl":"10.1016/j.japhpi.2025.100076","url":null,"abstract":"<div><h3>Background</h3><div>The direct link between poor palatability and nonadherence is well-documented. It is essential to assess which medicines are known to be poorly tolerated due to taste, find alternatives that may be more palatable, and highlight home taste-masking interventions to mitigate poor palatability.</div></div><div><h3>Objective</h3><div>To increase awareness about medicine palatability, we created the Ew Meds List - a comprehensive list of bad-tasting oral liquid medicines and evidence-based recommendations to mask poor palatability.</div></div><div><h3>Methods</h3><div>EMBASE searches were conducted using the terms child, bitter, flavor, masking, and adherence. Articles containing scored medicine taste perception were used to rank medicines to assess eligibility for the Ew Meds List . All scales were aligned to a 5-point Likert scale with 1 being “dislike it very much” and 5 being “like it very much.” Medicines scoring less than 2.5 were added to Ew Meds. Medicines scoring 2.5 and above were added to “Better Tasting Meds.” Studies with taste-masking evidence related to specific medicines were used to create evidence-based taste-masking recommendations. Pharmaceutics literature provided flavoring recommendations to mask basic taste properties, like bitter or sour.</div></div><div><h3>Results</h3><div>Twenty articles contained ranked taste perceptions for 32 medicines. Of those, 18 met criteria as Ew Meds, and 14 for better-tasting meds. Eleven medicines had evidence-based masking recommendations. Additional sections were created to address common taste masking recommendations and food science flavor masking techniques.</div></div><div><h3>Conclusion</h3><div>Pharmacists can make medicines more manageable for children by using the guidance provided in the Ew Meds List to improve the palatability of oral liquid medicines, recommend taste masking, or use better-tasting medicines when available. Research is needed to expand this list and document the efficacy of common taste masking practices.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 4","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to comprehensive diabetes measures in people with HIV managed in a primary care clinic","authors":"Maya M. Hardman,&nbsp;Kelsea Gallegos Aragon,&nbsp;Carly B. Cloud Floyd,&nbsp;Emily Bransford,&nbsp;Bianca Gonzales,&nbsp;Jeremy Westerfield,&nbsp;Bernadette Jakeman","doi":"10.1016/j.japhpi.2025.100075","DOIUrl":"10.1016/j.japhpi.2025.100075","url":null,"abstract":"<div><h3>Background</h3><div>People with HIV (PWH) have higher rates of diabetes and cardiovascular disease, yet often receive inadequate screening for related comorbidities. This study assessed adherence to comprehensive diabetes care metrics in PWH and diabetes and identified predictors of poor screening compliance.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted for patients ≥18 years of age with HIV and diabetes, receiving primary care at a Federally Qualified Health Center Look-Alike site in New Mexico during 2019 or 2020. Diabetes care was evaluated using Healthcare Effectiveness Data and Information Set metrics: hemoglobin A1c, foot and eye exams, urine albumin-to-creatinine ratio, blood pressure, and statin use in patients aged 40 to 75 years. Patients overdue for one or more metrics were identified for quality interventions by clinical pharmacists.</div></div><div><h3>Results</h3><div>A total of 121 patients met study inclusion criteria and were included for data analysis. The average age of the cohort was 57.5 ± 10.2 years. The majority of patients were white (76.9%) and identified as male (86.8%). During the evaluation period, the majority of patients, 119 (98.3%), missed one or more clinic appointments, and 114 (94.2%) were overdue for ≥1 screening metrics; 14 patients (11.5%) were overdue for all screening metrics. Eye exams were the most commonly overdue. In multivariate analysis, polypharmacy predicted hemoglobin A1c screening completion. Other factors, including demographics, rural residence, statin use, number of appointments attended, estimated atherosclerotic cardiovascular disease risk, glycemic control (last recorded hemoglobin A1c value), CD4 count, and viral load, did not predict A1c screening.</div></div><div><h3>Conclusion</h3><div>Comprehensive diabetes care measures were alarmingly low in PWH, highlighting a need for targeted interventions to improve chronic disease management in this high-risk population.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 4","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discovering hidden reasons for nonadherence: A telehealth student experience addressing social determinants of health","authors":"Kelsey D. Frederick,&nbsp;Andrew Beard,&nbsp;Dawn E. Havrda,&nbsp;Kenneth C. Hohmeier,&nbsp;Christopher K. Finch,&nbsp;Danielle Case,&nbsp;Collin Albrecht,&nbsp;Catherine M. Crill","doi":"10.1016/j.japhpi.2025.100074","DOIUrl":"10.1016/j.japhpi.2025.100074","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore student perceptions and experiences addressing social determinants of health (SDOH) and medication adherence upon completion of a telehealth medication therapy management (MTM) introductory pharmacy practice experience (IPPE). Telehealth MTM has expanded rapidly, particularly since the coronavirus disease 2019 pandemic. MTM services play a crucial role in assessing medication adherence and SDOH affecting patient outcomes. Although student pharmacists should gain experience in this important aspect of patient care, guidance on effectively integrating SDOH training into pharmacy curricula remains limited.</div></div><div><h3>Design, Setting, and Participants</h3><div>A novel, 40-hour telehealth MTM experience was implemented in fall 2021 in collaboration with a nationwide MTM vendor as a required IPPE for all second-year student pharmacists at the University of Tennessee Health Science Center College of Pharmacy. Students engaged weekly in MTM outreach to address adherence barriers for patients with a proportion of days covered of less than 80% and gained experience in motivational interviewing, SDOH, patient counseling, interprofessional collaboration, and documentation.</div></div><div><h3>Outcome Measures</h3><div>Students completed a pre- and post-IPPE written reflection, and the post-IPPE reflection specifically asked about the impact of SDOH on medication adherence and how MTM services benefit patients and help pharmacists deliver high-quality patient care. Postreflections were analyzed qualitatively using inductive thematic analysis to capture and represent themes.</div></div><div><h3>Results</h3><div>A total of 174 second-year students completed the MTM IPPE between fall 2021 and spring 2022; 172 student reflections were completed and analyzed. Three themes were identified: students recognized the crucial impact of SDOH as a barrier to medication adherence, helped patients overcome adherence barriers related to SDOH, and recognized the value of MTM in addressing SDOH and improving patient care.</div></div><div><h3>Conclusion</h3><div>The telehealth MTM IPPE provided students with real-world insights into the impact of SDOH on medication adherence and empowered them to develop practical skills and interventions to improve patient care. Integrating an IPPE dedicated to MTM into pharmacy curricula can enhance student preparedness to address SDOH in practice.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 4","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early implementation of Pharmacist eCare Plan and electronic health record integration: A proof-of-concept study on health information interoperability","authors":"Kenneth C. Hohmeier,&nbsp;Jason Ausili,&nbsp;Laila Hajyani,&nbsp;Selwa Kanakrieh,&nbsp;Muhammad Shehroze Malik,&nbsp;Jon Allmon,&nbsp;Kristi Hawn,&nbsp;Karina Hoffmann,&nbsp;Justin Gatwood","doi":"10.1016/j.japhpi.2025.100073","DOIUrl":"10.1016/j.japhpi.2025.100073","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacy software interoperability is critical to the expansion of access to pharmacist-delivered patient care services. Although electronic health record (EHR) interoperability was considered from the beginning of its use, pharmacy software systems have remained largely on the sidelines of these conversations, and as a result, their current state of interoperability has been limited. Small-scale pilot projects investigating health information technology (HIT) and pharmacy interoperability show promise; however, there is still a paucity of literature on the use and feasibility of HIT in the pharmacy setting.</div></div><div><h3>Objective</h3><div>This study aimed to report on the implementation and feasibility of HIT interoperability between a medical office and pharmacy in Tennessee using the Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard.</div></div><div><h3>Methods</h3><div>This is a proof-of-concept study reporting the development and implementation of a data integration intervention to facilitate data sharing between an independent community pharmacy and medical office using implementation science frameworks.</div></div><div><h3>Results</h3><div>Pharmacist eCare Plan (PeCP)/EHR integration was successfully implemented to facilitate an existing referral pathway for patients from a medical office to an independent pharmacy for transitions of care (TOC) pharmacy services. Thirty-six patients were referred to the service through the PeCP-EHR pathway. Several important facilitators were uncovered during the early phase of implementation, including (1) cocreation of a project charter, (2) leadership engagement, (3) champion identification, (4) adapting the intervention, and (5) establishing a communication strategy.</div></div><div><h3>Conclusion</h3><div>It is feasible to integrate pharmacy and EHRs using the HL7 FHIR format in an independent pharmacy setting. This study demonstrated that HIT interoperability is possible in the community pharmacy and may aid in the accessibility of pharmacist care services, such as TOC. More research is needed to understand the impact of such data integrations on economic, clinical, and humanistic outcomes.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 4","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying secondary stroke prevention treatment gaps in older patients with nonvalvular atrial fibrillation","authors":"Kevin Le,&nbsp;Amber Mercuro,&nbsp;Maureen Brady,&nbsp;Ashley Child,&nbsp;Jaclynne Gowen","doi":"10.1016/j.japhpi.2025.100035","DOIUrl":"10.1016/j.japhpi.2025.100035","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) recommend oral anticoagulation (OAC). The risk of stroke is particularly increased in older patients and those with a history of stroke. Previous studies suggested up to 67% of eligible patients with NVAF are not prescribed OAC.</div></div><div><h3>Objective</h3><div>This study aimed to identify gaps in OAC prescribing patterns for older patients with NVAF and previous stroke to allow for optimization of OAC prescribing.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study was conducted from a multispecialty group practice affiliated with a 178-bed community hospital. The sites are located in the Seacoast region of New Hampshire and Southern Maine. Participants included older adults aged 65-89 years with NVAF and previous stroke who were not prescribed OAC with at least1 ambulatory encounter between July 1, 2022, and June 30, 2023. Pharmacists identified patients using existing databases of ICD-10 codes, medication lists, and ambulatory clinic encounters. The primary outcome was to identify the cohort of patients not prescribed OAC.</div></div><div><h3>Results</h3><div>Among 391 eligible patients, 48 (12.3%) were not prescribed OAC therapy. Of the 48 elderly patients with NVAF and stroke history without OAC, 21 (43.5%) did not have a guideline-directed indication for OAC omission. Rationale for OAC omission included cost (6.3%), patient refusal (29.2%), bleeding from isolated trauma or procedural complication (4.2%), falls (18.8%), previous intracranial or intraspinal hemorrhage (8.3%), severe bleeding owing to nonreversible cause (4.2%), and transient NVAF (25%). Patients with Medicare were more likely to lack OAC (60%).</div></div><div><h3>Conclusion</h3><div>Not all patients who were indicated for OAC were prescribed OAC highlighting opportunity to improve prescribing practices. Uncovering real-world rationales for OAC omission equips pharmacists with valuable insights to address patient concerns effectively and highlights the critical role of pharmacist-led patient education in improving prescribing practices.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 3","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of antifungal prophylaxis in pediatric patients with acute lymphoblastic leukemia or acute myeloid leukemia","authors":"Ashley Galbreath,&nbsp;Mary Kathryn Vance,&nbsp;Caleb McMinn,&nbsp;Morgan Odom,&nbsp;Arunkumar Modi,&nbsp;Amanda Elchynski","doi":"10.1016/j.japhpi.2025.100043","DOIUrl":"10.1016/j.japhpi.2025.100043","url":null,"abstract":"<div><h3>Background</h3><div>Invasive fungal disease (IFD) is a leading cause of morbidity and mortality in patients with hematologic malignancies. The most recent practice guidelines, last updated in 2020, recommend using a mold-active azole or echinocandin when antifungal prophylaxis is warranted; however, there has historically been a lack of standardized prescribing practices at our institution.</div></div><div><h3>Objective</h3><div>This study’s primary aim is to characterize our institution’s current prescribing patterns by comparing the incidence of IFD among pediatric patients with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) with or without antifungal prophylaxis.</div></div><div><h3>Methods</h3><div>This single-center, retrospective chart review evaluated patients with ALL or AML treated at Arkansas Children’s Hospital from January 1, 2020, to August 31, 2023. Secondary analyses included evaluating IFD in high-risk patients, incidence of adverse events, and use of therapeutic drug monitoring. Descriptive statistics were calculated and statistical significance was determined using chi-square, Fisher’s exact, and Mann-Whitney U tests.</div></div><div><h3>Results</h3><div>A total of 114 patients were included, with 54 patients receiving antifungal prophylaxis. Patients receiving antifungal prophylaxis with fluconazole had a higher incidence of IFD than other prophylaxis agents and no prophylaxis (<em>P</em> &lt; 0.01). Among high-risk patients, 62.9% received antifungal prophylaxis. There was a lower incidence of IFD in those who received mold-active prophylaxis than those who did not (17.4% vs. 35.1%, <em>P</em> = 0.03) and in those who received guideline-directed prophylaxis than those who received fluconazole prophylaxis (19.7% vs. 57.1%, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>We found considerable variability in prescribing practices at our institution, particularly among high-risk patients. In addition, patients who received fluconazole prophylaxis had a statistically significant higher incidence of fungal infections and elevated QTc than those who received other prophylaxis agents and no prophylaxis. Overall, this study highlights the importance of evaluating institutional practices and using guideline-based prophylaxis agents in children at high risk of IFD.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 3","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring based glycemic control among underserved populations with type 2 diabetes at a health system of federally qualified health centers","authors":"Samantha M. Tiano,&nbsp;Leticia R. Moczygemba,&nbsp;April J. Hinds,&nbsp;Jason Jokerst,&nbsp;Kathryn Litten,&nbsp;Chelsey A. Roscoe,&nbsp;Roopali Sharma","doi":"10.1016/j.japhpi.2025.100045","DOIUrl":"10.1016/j.japhpi.2025.100045","url":null,"abstract":"<div><h3>Background</h3><div>Disparities and healthcare inequities exist among marginalized ethnic and racial groups with continuous glucose monitoring (CGM) use. Current evidence surrounding the impact of CGM use on hemoglobin A1C (HbA1c) reduction beyond 6 months among underserved populations, including non-English speakers with type 2 diabetes in the Federally Qualified Health Center (FQHC) setting, is limited.</div></div><div><h3>Objective</h3><div>To evaluate the impact of CGM use on the first HbA1c measured between 12 and 24 months after CGM initiation among underserved populations with type 2 diabetes at a health system of FQHCs.</div></div><div><h3>Methods</h3><div>A retrospective, cross-sectional study was conducted among adults with type 2 diabetes participating in a FQHCs’ CGM program. Patients were eligible if they received CGM supplies between July 2020 to 2022 at an in-house pharmacy via indigent care coverage and had an HbA1c more than 8% within three months prior to CGM initiation. The primary outcome was the impact of CGM use on the first HbA1c measured between 12 and 24 months after CGM initiation. A post-hoc analysis was conducted to assess the change in HbA1c from baseline over time, in 6-month increments, up to 24 months. Descriptive and bivariate statistics were used for data analysis.</div></div><div><h3>Results</h3><div>Of 205 patients who were initially screened, 46 met study inclusion criteria. Baseline characteristics included 65% female, mean age 56 ± 11.2 years, 76% Hispanic/Latino/a ethnicity, and 54% Spanish-speaking. The primary outcome resulted in a statistically significant decrease in HbA1c (%) from 10.6 ± 1.7 at baseline to 8.6 ± 1.9 (<em>P</em> &lt; 0.001) at the follow-up HbA1c measured between 12 and 24 months after CGM initiation.</div></div><div><h3>Conclusion</h3><div>In this analysis, CGM use led to a statistically significant and sustained reduction in HbA1c for up to 24 months among underserved populations with type 2 diabetes in the FQHC setting. Study findings suggest CGM use may offer long-term benefits in HbA1c reduction among underserved populations.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 3","pages":"Article 100045"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of diltiazem versus metoprolol for patients with atrial fibrillation presenting to the emergency department with rapid ventricular rate","authors":"Brittany McCoy,&nbsp;Jason Arevalo,&nbsp;Ashley Oliver,&nbsp;Katelyn Corcoran,&nbsp;Christopher R. Frei","doi":"10.1016/j.japhpi.2025.100029","DOIUrl":"10.1016/j.japhpi.2025.100029","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is one of the most common cardiac dysrhythmias and one of the most commonly encountered dysrhythmias in emergency departments (EDs). Rate control is vital to relieve symptoms and prevent complications in patients who present with AF and a rapid ventricular rate (RVR), defined as a heart rate (HR) &gt; 120 beats per minute (bpm). Both metoprolol and diltiazem are recommended for the management of RVR in AF; however, the comparative effectiveness of these medications is unclear.</div></div><div><h3>Objectives</h3><div>The primary objective of this quality improvement project was to evaluate the achievement of rate control, defined as a HR &lt; 110 bpm or an HR reduction &gt; 20%, within 30 minutes of the first dose of IV diltiazem or metoprolol. The secondary objectives were rate control within 60 minutes of the first dose, rate control within 180 minutes of the first dose, occurrence of repeat dosing, additional medications required for rate control, worsening heart failure (HF) symptoms, admission and discharge diagnoses, hospital readmission within 7 days of discharge, and length of hospital stay. We also assessed the incidence of hypotensive and bradycardic events within 60 minutes of the first dose.</div></div><div><h3>Methods</h3><div>A total of 571 patient charts were screened for inclusion in this quality improvement project and 151 patients were included.</div></div><div><h3>Results</h3><div>In a multivariate logistic regression model, with controls for patient age, rate control within 180 minutes of the first dose, and repeat dosing of medication given, there was no statistically significant difference in the primary outcome of rate control within 30 minutes between IV diltiazem (77%) and metoprolol (65%) (odds ratio 0.56 [95% CI 0.22-1.39], <em>P</em> = 0.27). We also found no statistically significant differences in the multivariate models for the incidence of worsening HF, hypotension, or bradycardia. Minimal adverse effects were observed.</div></div><div><h3>Conclusions</h3><div>The results of this study expand upon previous literature that suggested that diltiazem is likely to be safe and effective in the acute management of AF with RVR, given that there was no statistically significant difference between the 2 study drugs in the achievement of rate control or documentation of worsening HF.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 3","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a community pharmacist referral on the completion of annual wellness visits","authors":"Cody Beldon,&nbsp;Stacey Frede,&nbsp;Sarah Blackburn,&nbsp;Brenda Barnes,&nbsp;Andrea Brookhart,&nbsp;Katelyn Johnson","doi":"10.1016/j.japhpi.2025.100041","DOIUrl":"10.1016/j.japhpi.2025.100041","url":null,"abstract":"<div><h3>Background</h3><div>Annual Wellness Visits (AWV) are preventive care visits designed to promote overall health and well-being for older adults, but patient completion is well behind the anticipated rate. Community pharmacists are accessible health care professionals who routinely provide preventive care education and could educate patients on AWV importance.</div></div><div><h3>Objectives</h3><div>The primary objective of this study was to evaluate the impact of a community pharmacist referral on acceptance and completion of Medicare AWVs. The secondary objectives were to describe the source of AWV completion, compare study results to Centers for Medicare and Medicare Services (CMS) AWV completion rate, and evaluate referral declination reasons.</div></div><div><h3>Methods</h3><div>Patients were eligible for study participation if they were at least 66 years of age, had active Medicare coverage, and were active pharmacy patients. During the referral intervention, pharmacists assessed the patient’s AWV completion status, provided AWV education, and referred the patient to complete an AWV if appropriate. A follow-up intervention was completed 8 to 12 weeks after referral intervention completion. Descriptive statistics were used to evaluate primary and secondary objectives, and a chi-square test was used compare the study AWV completion rate to the national CMS rate, which was 45.0% in 2020.</div></div><div><h3>Results</h3><div>Of the 3,171 completed interventions, 2,745 patients (86.6%) self-reported they completed an AWV in the past 12 months. Pharmacists identified 315 patients eligible for an AWV, with 238 accepted referrals. During the follow-up intervention, 146 patients reported completing an AWV, and 24 patients scheduled an appointment, for a completion rate of 54.0%, which was statistically significant compared to national CMS data (<em>P</em> = 0.026).</div></div><div><h3>Conclusion</h3><div>The community pharmacist AWV referral process increased the number of patients who completed an AWV, resulting in a higher completion rate compared to national CMS data. Pharmacists were well equipped to complete referrals, and real-time patient identification supported completion. Anecdotal evidence suggests there is still an opportunity to improve patients’ understanding of AWVs.</div></div>","PeriodicalId":100737,"journal":{"name":"JAPhA Practice Innovations","volume":"2 3","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}