Journal of pharmacy practice最新文献

{"title":"Evaluation of Four-Factor Prothrombin Complex Concentrate Dosing for Major Bleeding Following Cardiac Surgery.","authors":"Bethany T Mullinax, Kaitlyn Pinkos, Atul Dilawri, Melissa Santibañez, David Salerno, Karen Berger","doi":"10.1177/08971900261497555","DOIUrl":"https://doi.org/10.1177/08971900261497555","url":null,"abstract":"<p><p>Four-factor prothrombin concentrate complex (4F-PCC) may be used for significant bleeding following cardiac surgery but the optimal dosing has not been established. The purpose of this study was to compare two dosing strategies of 4F-PCC in cardiac surgery patients. This retrospective chart review evaluated 4F-PCC dosing of 25 units/kg compared to 12.5 units/kg in cardiac surgery patients following a protocol change for 4F-PCC dosing. The primary outcome was major bleeding, defined as the number of patients receiving ≥3 packed red blood cell (PRBC) transfusions within 24 h of 4F-PCC administration. Secondary outcomes included other surrogate markers for bleeding (eg, Use of other blood products and hemostatic agents), thrombotic events within 14 days of surgery, hospital length of stay, and all-cause mortality. A total of 42 patients were included (31 patients in the 25 units/kg group and 11 patients in the 12.5 units/kg group). There was no difference in the number of patients that received ≥3 PRBC transfusions between the two groups with 15 patients (47.4%) in 25 units/kg group and 3 patients (27.3%) in 12.5 units/kg (<i>P</i> = .299). Additionally, no difference was observed in amount of additional hemostatic agents administered, hospital length of stay or mortality between the two groups. A higher rate of thromboembolic events was observed among patients receiving 25 units/kg vs 12.5 units/kg (22.6% vs 0%, <i>P</i> = .161). Reduced dosing of 4F-PCC from 25 units/kg to 12.5 units/kg following cardiac surgery resulted in no difference in clinical or effectiveness outcomes.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900261497555"},"PeriodicalIF":1.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194568","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":"Accuracy, Usefulness, and Expert-Perceived Clinical Impact of Response Variability in ChatGPT-4o for Hyperlipidemia-Related Questions.","authors":"Sharmon P Osae, Robin Southwood, Devin L Lavender, Rebecca H Stone, Sarah Grace White, Russ Palmer, Richard Lamb, Lorenzo Villa Zapata, Joshua Caballero","doi":"10.1177/08971900261498069","DOIUrl":"https://doi.org/10.1177/08971900261498069","url":null,"abstract":"<p><p>ChatGPT-4o, an advanced Artificial Intelligence based large language model, has demonstrated utility for providing medical information. Data regarding its accuracy and usefulness for hyperlipidemia pharmacotherapy are limited. Additionally, the clinical implications of variability in responses generated from simultaneous identical prompts across multiple sessions remains poorly understood. This research aimed to (1) assess accuracy, (2) evaluate usefulness, and (3) examine perceived impact variability of ChatGPT-4o generated responses to hyperlipidemia-related clinical questions. Five questions addressing hyperlipidemia management and patient counseling were developed. Responses to the questions were collected simultaneously from three independent ChatGPT-4o sessions initiated in separate, newly opened ChatGPT windows. A modified Delphi technique using clinical pharmacy faculty evaluated responses for accuracy, usefulness, and impact variability. Scores were evaluated using a 3-point Likert scale. After initial scoring, responses were collected, collated, and redistributed to faculty for review and optional revision. Final evaluations and consensus were facilitated by a moderator during a virtual panel. Consensus was reached for all responses. Evaluations of response accuracy ranged from poor to good, while usefulness ranged between somewhat useful and very useful. Impact variability ranged from none to high across responses, which faculty concluded could impact patient management. Response variability may have potential clinical implications; however, the present study evaluated expert-perceived potential impact rather than actual patient outcomes. Users should be aware concurrently generated ChatGPT responses can differ in accuracy and usefulness. Clinical judgment and patient-centered multidisciplinary collaboration remain essential. Future directions include using a larger data set to corroborate findings.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900261498069"},"PeriodicalIF":1.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194505","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":"Therapeutic and Pharmacokinetic Challenges With Treatment of Nontuberculous Mycobacteria Infection in Two Lung Transplant Recipients: Case Report.","authors":"Regina Jung, Alicia Ali, Tricia Royer, Mollie Tucker, Neeraj Sinha","doi":"10.1177/08971900261497551","DOIUrl":"https://doi.org/10.1177/08971900261497551","url":null,"abstract":"<p><p>Lung transplant (LTx) recipients are susceptible to pulmonary nontuberculous mycobacteria (NTM) infections due to pre-transplant colonization and post-transplant immunosuppression. This presents a challenge when managing immunosuppression and infection prophylaxis post-LTx due to drug-drug interactions (DDIs) with antimycobacterial agents. We present two cases of LTx recipients requiring concomitant rifabutin and isavuconazole. A 62-year-old male receiving rifabutin for pre-LTx pulmonary <i>Mycobacterium avium complex</i> (MAC) infection was initiated on isavuconazole for post-LTx fungal prophylaxis. A rifabutin peak level on post-operative day (POD) 6 was 0.43 mcg/mL (range 0.3-0.9 mcg/mL) and an isavuconazole trough was 1.96 mcg/mL (range ≥1 mcg/mL). Acid fast bacilli (AFB) stains and cultures were followed serially with no growth and NTM therapy was continued for 3 months post-LTx. The patient developed leukopenia that was managed conservatively without changes to the antimycobacterial regimen. A 45 year-old female was similarly diagnosed with MAC pre-LTx and required a triple-drug regimen including rifabutin. The rifabutin peak levels were 0.33 mcg/mL and 0.22 mcg/mL on POD 7 and 14, respectively. Isavuconazole trough levels were 1.33 mcg/mL and 1.04 mcg/mL on POD 7 and 18, respectively. This patient experienced severe, prolonged leukopenia, prompting discontinuation of rifabutin. She remained on dual therapy with ethambutol and azithromycin. Despite this adverse reaction, neither patient required antimicrobial dose adjustments due to DDIs. Therapeutic drug monitoring of rifabutin and isavuconazole may be necessary to confirm therapeutic serum concentrations when used concomitantly. The effect of this drug interaction on the incidence or severity of rifabutin-associated leukopenia needs further evaluation.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900261497551"},"PeriodicalIF":1.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167162","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":"Isopropyl Alcohol-Induced Peripheral Neuropathy After Transdermal Exposure: A Case Report.","authors":"Jack Shapiro, Thomas Cranmer, Emma Formaro, Cristian Herrera, Zane Elfessi","doi":"10.1177/08971900261416821","DOIUrl":"10.1177/08971900261416821","url":null,"abstract":"<p><p>Peripheral neuropathy is a common neurological condition with diverse etiologies, including metabolic, infectious, and toxic exposures. While isopropyl alcohol (IPA) toxicity is well-documented in ingestion cases, transdermal exposure leading to neuropathy is rare. IPA is readily absorbed through intact skin and metabolized to acetone, which may exert neurotoxic effects. Chronic dermal exposure can lead to peripheral nerve damage via oxidative stress, mitochondrial dysfunction, and local inflammation. We report an 80-year-old male who developed left lower extremity numbness following topical application of IPA multiple times daily for 3 months for pain relief. After differential diagnoses were ruled out, cessation of the IPA led to complete resolution after 3 weeks.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"472-474"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952417","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":"Risk Factors for the Development of Dexmedetomidine-Related Fevers in Critically-Ill Patients.","authors":"Hyun A Jae, Karina Muzykovsky, Jose Orsini","doi":"10.1177/08971900251408935","DOIUrl":"10.1177/08971900251408935","url":null,"abstract":"<p><p><b>Background:</b> The Society of Critical Care Medicine's 2025 update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption suggest the use of dexmedetomidine over propofol for sedation in critically-ill, mechanically ventilated patients. With widespread use of dexmedetomidine, reports have been published describing development of fever with its use. Drug-induced fevers are usually a diagnosis of exclusion, making them hard to recognize, and misdiagnosis can lead to utilization of additional medications and resources. The objective of this study was to identify risk factors associated with dexmedetomidine-related fever in critically-ill patients. <b>Methods:</b> This was a single-center retrospective study conducted at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients, admitted to the intensive care unit, who received at least 12 hours of continuous dexmedetomidine infusion were included. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for dexmedetomidine-related fever. <b>Results:</b> Eighty one patients were included, of whom 31 (38.3%) were febrile and 50 (61.7%) were afebrile while receiving dexmedetomidine infusion. Multivariate analysis showed higher likelihood of developing fever if patients received dexmedetomidine continuously for ≥72 hours (OR 5.97, 95% CI 1.90-18.75) and if dexmedetomidine rate was ≥1 mcg/kg/hr at Tmax (OR 6.16, 95% CI 1.80-21.09). <b>Conclusion:</b> Dexmedetomidine infusion for 72 hours or longer and dexmedetomidine infusion rate at 1 mcg/kg/hr or greater were risk factors for developing a fever in critically ill patients in a community teaching hospital.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"404-410"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794157","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":"Presentation of Acute Pancreatitis After Initiation of Phentermine/Topiramate for Weight Loss: An Adverse Drug Event Case Report.","authors":"Michelle Balli","doi":"10.1177/08971900261416787","DOIUrl":"10.1177/08971900261416787","url":null,"abstract":"<p><p><b>Background:</b> Risk of acute pancreatitis is possible with several weight management medications including glucagon like peptide-1 receptor agonists. Acute pancreatitis has not been reported with the phentermine/topiramate combination product used as an appetite suppressant for chronic weight management. <b>Summary:</b> A 71-year-old male initiated phentermine/topiramate extended-release capsules for assistance with weight loss. Approximately 4 days after initiation, he presented to the emergency department with sudden mid-epigastric pain, nausea, and vomiting. He was subsequently diagnosed with acute pancreatitis, which was confirmed with imaging. Contributory factors for development of acute pancreatitis were ruled out including gallstones, alcohol intake, and hypertriglyceridemia. The phentermine/topiramate product was discontinued. Symptoms improved within 2 days, and his lipase was within normal limits at discharge. The Naranjo adverse drug reaction score was used to assess causality with a total score of 6, suggesting a probable cause for this adverse drug event. <b>Conclusion:</b> This report describes the presentation of acute pancreatitis shortly after initiation of phentermine/topiramate extended-release capsules for assistance with weight loss. Pancreatitis has not been previously reported with this combination product to the author's knowledge and impacts future prescribing for alternative agents.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"475-479"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010853","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 Pharmacist Intervention on Utilization of SGLT2 Inhibitors in Patients With Heart Failure With an Ejection Fraction Greater than 40.","authors":"Leanne Bockstruck, Kathryn Krei, Danielle Bozzardi-Jerome, Anne Robinson, Monica Kraus, Brandon Mullins","doi":"10.1177/08971900251408312","DOIUrl":"10.1177/08971900251408312","url":null,"abstract":"<p><p><b>Introduction:</b> Heart failure is a leading cause of morbidity and mortality worldwide. Literature suggests that the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors can be beneficial to decrease hospitalizations and cardiac mortality in patients with heart failure with an ejection fraction >40%. <b>Research Question:</b> This study assessed the impact of a pharmacist monitoring program on the use of SGLT2 inhibitors for patients hospitalized with heart failure with an ejection fraction >40%, accounting for documented reasons for not prescribing. <b>Study Design:</b> This was a single-center, retrospective, pre/post interventional study. The pre-intervention cohort was assessed for usage prior to initiation of the pharmacist monitoring program, whereas the post-intervention group was assessed after initiation. <b>Methods:</b> Hospitalized patients were identified retrospectively through a report of intravenous diuretic use on the cardiology floor in conjunction with a documented diagnosis of heart failure and ejection fraction >40%. <b>Data Analysis:</b> Data was assessed via Chi-squared or student's t-test for comparison between the pre-intervention and post-intervention groups. <b>Results:</b> There was a statistically significant increase in documented appropriate use of SGLT2 inhibitors after implementation of pharmacist monitoring program (40.9% pre-intervention vs 62.7% post-intervention, <i>P</i> = <0.001). The most common reasons they were held was due to risk of infection and renal dysfunction. <b>Conclusion:</b> Implementation of a pharmacist monitoring program was associated with an increase in utilization of SGLT2 inhibitors in eligible patients, driven by an increase in documentation. There was an increase in prescribing in patients that were eligible for the medication.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"397-403"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794083","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":"Case Report of Treatment of Polymicrobial Bacteremia Caused by Carbapenem-Resistant <i>Klebsiella pneumoniae</i>, and <i>Bacillus</i> Species in an Immunocompetent Patient With Meropenem-Vaborbactam.","authors":"Zoey Zagoria, John Cerenzio, Justin Andrade","doi":"10.1177/08971900251399587","DOIUrl":"10.1177/08971900251399587","url":null,"abstract":"<p><p><i>Klebsiella pneumoniae</i> carbapenemases (KPCs) are the most common carbapenemases in the United States. The Infectious Disease Society of America (IDSA) recommends meropenem-vaborbactam, ceftazidime-avibactam, or imipenem-cilastatin-relebactam as preferred options with cefiderocol as an alternative, all of which are also alternative options for CTX-M <i>Enterobacterales</i>. <i>Bacillus</i> species, comprising 22 different species, are not commonly pathogenic, but can cause invasive nosocomial infections typically in immunocompromised hosts commonly treated with vancomycin or carbapenems. This case report illustrates the treatment course of CTX-M and KPC-producing <i>Klebsiella pneumoniae</i>, and <i>Bacillus</i> species bacteremia that included cefiderocol, followed by vancomycin and meropenem-vaborbactam, and then meropenem-vaborbactam monotherapy. The patient was a 74-year-old female who had a prolonged hospital course and several courses of intravenous antimicrobials prior to the multidrug resistant (MDR) <i>Klebsiella pneumoniae</i>, and <i>Bacillus</i> species bloodstream infection. The IDSA does not have treatment recommendations for <i>Bacillus</i> species, though the Clinical & Laboratory Standards Institute (CLSI) reports breakpoints for vancomycin and meropenem. In our case, the patient's <i>Bacillus</i> isolate was susceptible meropenem-vaborbactam (0.023 mcg/mL) based on a meropenem breakpoint of 4 mcg/mL. In our report, an immunocompetent patient developed a polymicrobial bloodstream infection caused by an MDR <i>Klebsiella pneumoniae</i>, and <i>Bacillus</i> species, which was successfully treated with meropenem-vaborbactam. This unusual infection and treatment course also serves to promote awareness of another treatment option for invasive <i>Bacillus</i> species infection and furthermore encourages providers to request testing & sensitivities to consolidate therapy, particularly in cases of polymicrobial infection.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"456-459"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668544","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":"Perioperative Bleeding Risk of Direct Oral Anticoagulants Versus Warfarin in Kidney Transplantation.","authors":"Shana Katz, Luke Slotterback, Goni Katz-Greenberg, Aparna Rege, Ian Welsby, Jennifer Byrns","doi":"10.1177/08971900261416834","DOIUrl":"10.1177/08971900261416834","url":null,"abstract":"<p><p><b>Background:</b> Direct oral anticoagulants (DOACs) are commonly used for the treatment/prevention of thromboembolism. Data supporting the best practices for anticoagulation management, specifically with DOACs, at the time of solid organ transplant is limited. This study was designed to compare the perioperative bleeding risk of warfarin vs DOACs in kidney transplant recipients. <b>Methods:</b> This was a single center, retrospective, cohort study evaluating patients on either a DOAC or warfarin prior to kidney transplant. The primary outcome compared a composite of perioperative bleeding risk at 30 days of major bleeding and clinically relevant non-major bleeding. Secondary outcomes evaluated the incidence of type of bleeds, thromboembolism, hospital length of stay, blood product receipt, and patient/graft survival. <b>Results:</b> 67 kidney transplant recipients were included (n = 39 warfarin and n = 28 DOAC). The primary outcome of the composite of incidence of bleeding was no different between groups (21.4% vs 28.2% in DOAC vs warfarin groups, <i>P</i> = 0.52). More warfarin patients met criteria for major bleeding (20.5% vs 14.3%, <i>P</i> = 0.13) but this was not statistically significant. Minor bleeds were similar between DOAC vs warfarin groups (7.7% vs 7.1%, <i>P</i> = 0.99). Hospital length of stay was longer for warfarin patients (median [IQR] days 8 [5-12.3] vs 5 [4-6], <i>P</i> < 0.0001). There was no difference in the other outcomes. <b>Conclusions:</b> This study found no difference in risk of bleeding between groups, however warfarin patients required higher volumes of blood products and had longer hospital length of stays. This study supports DOAC use in the perioperative setting for kidney transplant recipients.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"416-423"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985069","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 Pharmacist Consultations in Management of Type 1 Diabetes in a Primary Care Clinic: A Retrospective Cohort Study.","authors":"Jacob Burger, Rick Hess","doi":"10.1177/08971900251408940","DOIUrl":"10.1177/08971900251408940","url":null,"abstract":"<p><p><b>Introduction:</b> Type 1 diabetes mellitus (T1DM) is a condition requiring lifelong insulin therapy and specialized care. Access to endocrinologists remains limited, leaving many primary care providers (PCPs) to manage insulin therapies and diabetes technologies. Pharmacists have demonstrated effectiveness in type 2 diabetes management, yet their role in T1DM within primary care remains underexplored. This study evaluated the impact of a pharmacist-led intervention for adults with T1DM in a primary care setting lacking in-house endocrinology services. <b>Methods:</b> This retrospective cohort study reviewed electronic health records of adults with T1DM referred to a clinical pharmacist in 2023. Individuals with ≥2 PCP visits, ≥2 A1c results, and ≥1 pharmacist consultation were included. The pharmacist provided individualized assessments, insulin adjustments, and technology counseling under a collaborative practice agreement. The primary outcome was change in A1c at 3-6 months post-consultation. Secondary outcomes included subgroup analyses by insulin delivery methods, visit frequencies and A1c comparison with non-referred T1DM patients. <b>Results:</b> Thirty-eight patients met inclusion criteria. Referred patients experienced a mean A1c reduction from 8.8% to 8.2% (-0.6%, 95% CI: -1.00 to -0.12; <i>P</i> = .013) at 3-6 months. No significant differences were observed in continuous glucose monitoring metrics or visit frequency. Compared with 49 non-referred patients, referred individuals initially had poorer glycemic control but showed convergence over time. <b>Discussion:</b> Pharmacist integration into primary care significantly improved glycemic outcomes for adults with T1DM, particularly in underserved regions with limited endocrinology access. This collaborative model may offer a scalable solution to expand advanced diabetes management in primary care.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"387-391"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708021","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}