Christopher J Daly, Merin V Panthapattu, Frances Murray, Ryan Lindenau, Amanda A Foster, David M Jacobs
{"title":"Delivering Diabetes Education and Enhanced Services Within a Clinically Integrated Community Pharmacy Network.","authors":"Christopher J Daly, Merin V Panthapattu, Frances Murray, Ryan Lindenau, Amanda A Foster, David M Jacobs","doi":"10.1177/08971900251350509","DOIUrl":"https://doi.org/10.1177/08971900251350509","url":null,"abstract":"<p><p><b>Introduction:</b> With the increasing adoption of alternative payment models (APM) in the U.S. healthcare system there is a growing interest in measuring pharmacy performance with a focus on preventive care and chronic disease management. The Community Pharmacy Enhanced Services Network (CPESN) has been established throughout the U.S. to incorporate high-performing pharmacies to provide enhanced services for high-risk patients including those with diabetes. <b>Methods:</b> The primary objective of this study is to assess the readiness of community pharmacists within CPESN to deliver minimum enhanced services (MES) and diabetes self-management education and support (DSMES) among diabetes patients. A cross-sectional survey was distributed via email to all pharmacies within CPESN New York. Descriptive statistics were utilized to assess survey responses. <b>Results:</b> A total of 84 participants responded to the survey. Top DSMES services offered included: education on blood glucose monitoring (95%), education on lifestyle changes (88%), and monitoring medication adherence to diabetes-related medications (88%). The most time spent per week on DSMES services was for monitoring medication adherence to diabetes-related medications (5.9 +/- 7.0 hours). Top facilitators included technology to execute workflow (55%), adequate workflow design (54%), and proper training for pharmacy personnel (53%). Common barriers in executing services are lack of collaboration with other health professionals (54%) and proper training of pharmacy personnel (49%). <b>Conclusion:</b> CPESN-NY pharmacies demonstrate the opportunity to adapt clinical services including DSMES, which will enhance their performance measures in APMs. Facilitators and barriers have been identified thus next steps in the would be to address how to overcome these barriers.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251350509"},"PeriodicalIF":1.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258267","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}
Anna Sharow, Joey Champigny, John-Michael Gamble, Sherilyn K D Houle, Caitlin Carter, Jeff Nagge
{"title":"The Comparative Effectiveness and Safety of Ambulatory Care Warfarin Management by Non-physician Providers Versus Usual Medical Care: A Systematic Review and Meta-analysis.","authors":"Anna Sharow, Joey Champigny, John-Michael Gamble, Sherilyn K D Houle, Caitlin Carter, Jeff Nagge","doi":"10.1177/08971900251347506","DOIUrl":"https://doi.org/10.1177/08971900251347506","url":null,"abstract":"<p><p><b>Introduction:</b> Growing evidence suggests that non-physician providers (NPPs) can effectively and safely manage warfarin therapy. This systematic review and meta-analysis aimed to evaluate warfarin management by NPPs compared to usual medical care (UMC) in ambulatory patients. <b>Methods:</b> We conducted a systematic search of PubMed (MEDLINE), Ovid Embase, Ovid International Pharmaceutical Abstracts, Scopus, CINAHL (EBSCO), and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to January 2024. Studies were included if they were randomized controlled trials or quasi-experimental designs comparing warfarin management across professions. Two independent reviewers performed title and abstract screening, full-text review, data extraction, and risk of bias assessment. Results were pooled using random effects models. <b>Results:</b> Of 19 122 citations identified, 6 met the inclusion criteria. NPPs included pharmacists (4), nurse practitioners (1), and multidisciplinary teams (1). Meta-analysis showed no significant difference in time spent in therapeutic range (TTR) (mean difference [MD] 1.64%; 95% confidence interval [CI]-1.86 to 5.16, I<sup>2</sup> = 0%)) for NPPs vs UMC. There were no differences in thrombosis (relative risk [RR] 1.23; 95% CI 0.36 to 4.23, I<sup>2</sup> = 0%), hemorrhage (RR = 1.07; 95% CI 0.44 to 2.63, I<sup>2</sup> = 0%), mortality (RR = 0.94; 95% CI 0.33 to 2.67, I<sup>2</sup> = 0%), or patient satisfaction (standardized mean difference [SMD] 0.56; 95% CI -0.04 to 1.15, I<sup>2</sup> = 85%). <b>Conclusion:</b> NPP management resulted in similar TTR as UMC. Due to few thromboembolic and hemorrhagic events, more studies are needed to determine the effects of NPP warfarin management on clinical outcomes.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"8971900251347506"},"PeriodicalIF":1.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208758","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":"Eco-Sustainability in Hospital Pharmacy: A Pilot Survey on 'Going Green'.","authors":"Ariane Blanc, Delphine Moulin, Jameason Cameron","doi":"10.1177/08971900241295285","DOIUrl":"10.1177/08971900241295285","url":null,"abstract":"<p><p><b>Purpose:</b> Between 2009 and 2015, the Canadian health care system was estimated to be responsible for 4.6% of national carbon emissions. Determine awareness of and describe eco-initiatives that the department of pharmacy can implement to aim to reduce the carbon footprint in hospital pharmacy in an effort to 'go green'. <b>Methods:</b> In a quality improvement initiative, pharmacy employees (i.e. pharmacists and pharmacy technicians) completed a cross-sectional survey designed to gauge willingness to 'go green' at work, to identify actionable areas of waste, and to assess commuting practices. <b>Results:</b> A total of 15 respondents completed the survey conducted March 14th -April 7th, 2022. Most respondents (73%) were willing to engage in more sustainable practices at work. The main barriers to implementing green practices at work were 'too time consuming' (20%), 'adds too much complexity' (20%), and 'cost' (16%). For commuting, 60% indicated the primary mode of transportation as 'personal vehicle', where 'subsidized transit' and was listed as the greatest incentive that could encourage a greener commute. The three largest areas of waste cited were 'single use plastic' (36%), 'limited of awareness of green practices' (15%), and 'lights left on in empty rooms' (12%). <b>Conclusions:</b> Pharmacy staff shared willingness to engage in more sustainable 'go green' practices but raised challenges to do so. With the knowledge that Canada has the second most climate intensive health system, there is a need for future research to describe how hospital pharmacies can contribute strategically to 'go green', advancing with implementing low carbon sustainable pharmacy practices.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"322-327"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502631","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}
Rachel C Robinson, Ashley N Taylor, Amy W Cato, Vijay S Patel, Jennifer L Waller, Nathaniel B Wayne
{"title":"Low Versus Standard Intensity Heparin Protocols in Adults Maintained on Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study.","authors":"Rachel C Robinson, Ashley N Taylor, Amy W Cato, Vijay S Patel, Jennifer L Waller, Nathaniel B Wayne","doi":"10.1177/08971900241285248","DOIUrl":"10.1177/08971900241285248","url":null,"abstract":"<p><p><b>Background:</b> Patients maintained on extracorporeal membrane oxygenation (ECMO) often require systemic anticoagulation to prevent circuit clotting and systemic thromboembolic complications. The optimal intensity of anticoagulation to balance the risk of bleeding and prevention of thrombotic complications in this patient population is not well described. <b>Objective:</b> To compare bleeding events in patients on ECMO anticoagulated with standard vs low intensity heparin protocols. <b>Methods:</b> This single-center, retrospective cohort study included adult patients on VA- or VV-ECMO and anticoagulated with low or standard intensity heparin protocols. The primary outcome was the incidence of major bleeding; secondary outcomes included the incidence of minor bleeding, thrombotic complications, heparin-induced thrombocytopenia, in-hospital mortality, time in therapeutic range, anti-Xa correlation with aPTT, intensive care unit and hospital lengths of stay, oxygenator exchanges, and rate of protocol switching. <b>Results:</b> A total of 27 patients (14 low intensity, 13 standard intensity) were included. There were six major bleeding events in the low intensity group and four in the standard intensity group (<i>P</i> = 0.69); there were four minor bleeding events in the low intensity group and five in the standard intensity group (<i>P</i> = 0.69). Seven patients in the standard intensity group switched protocols; zero patients in the low intensity group switched protocols (<i>P</i> = 0.002). There were no differences in any other outcomes. <b>Conclusions:</b> There was no difference in the incidence of any bleeding or thrombotic events when using a low vs standard intensity heparin protocol in patients on ECMO. A low intensity heparin strategy for patients on ECMO may be feasible and safe.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"299-304"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289749","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}
Rebecca M Khaimova, Yuliana Toderika, Justin Ramnarain, Claudette Donatien
{"title":"Apixaban as a Secondary Prophylaxis Agent for Patent Foramen Ovale-Associated Stroke.","authors":"Rebecca M Khaimova, Yuliana Toderika, Justin Ramnarain, Claudette Donatien","doi":"10.1177/08971900241287611","DOIUrl":"10.1177/08971900241287611","url":null,"abstract":"<p><p><b>Background:</b> The purpose of this case report is to describe a case of switching warfarin to apixaban in a patient on anticoagulant prophylaxis for a patent foramen ovale (PFO)-associated stroke. <b>Case Summary:</b> An 86-year-old Afro-Latina female with a past medical history of cerebrovascular accident (CVA) in 2012 secondary to PFO and diagnosed Atrial Fibrillation (AF). Patient was switched from warfarin to apixaban after 3 months of labile international normalized ratio (INR) levels. The patient's INR was monitored at a pharmacist-led anticoagulation clinic. As the patient's INR remained subtherapeutic while on warfarin, a shared decision was made to switch the patient to apixaban 2.5 mg twice daily due to consistently painful enoxaparin injections, inconsistent vitamin K intake, frequent clinic visits and unstable renal function. Patient tolerated the anticoagulant switch well and reported satisfaction with decreased clinic visits and variable vitamin K diet. At 12 months post-switch, the patient's complete blood count remains stable, no reported signs and symptoms of bleeding, and no new CVA or venous thromboembolism (VTE) events identified. Based on an improvement in renal function, the dose was increased to 5 mg twice daily.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"347-350"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348905","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}
Christine Veronica Misola, Zoe Nicolette Beatrice Oreta, Radha Kaur Lal, Maan Balt, Danica Resuello, Kevin Jace Miranda, Rogie Royce Carandang
{"title":"Assessing Patient Feedback on the Feasibility of the YourRx Telepharmacy Mobile Application.","authors":"Christine Veronica Misola, Zoe Nicolette Beatrice Oreta, Radha Kaur Lal, Maan Balt, Danica Resuello, Kevin Jace Miranda, Rogie Royce Carandang","doi":"10.1177/08971900241295286","DOIUrl":"10.1177/08971900241295286","url":null,"abstract":"<p><p><b>Background:</b> Telepharmacy is a method utilized in pharmacy practice that delivers pharmaceutical care services via telecommunication technology. In the Philippines, the current process for patients to avail of telepharmacy services utilizes a variety of existing applications or websites instead of a single application. <b>Objectives:</b> This study aimed to assess patient feedback on the feasibility of the newly developed telepharmacy mobile application, YourRx. Specifically, it evaluated the application's functionality, usability, security, and performance. <b>Methods:</b> The study had 3 phases: <b>(1)</b> the design and development phase, <b>(2)</b> the implementation phase, wherein the pharmacists and patients were oriented beforehand with the use of YourRx mobile application, and <b>(3)</b> the evaluation phase, where the mobile application was evaluated for its functionality, usability, security, and performance by the patients through the use of a survey questionnaire and an interview. <b>Results:</b> YourRx application was developed and evaluated successfully. It is available for Android users and has primary features, including video calls, sharing, and setting an appointment. A total of 46 patients used the YourRx. Most of the patients were very satisfied with the navigation, service acquisition, and overall design of the YourRx. They expressed convenience in acquiring telepharmacy services because the application was easy to understand, use, and navigate. <b>Conclusion:</b> YourRx is a pioneering telepharmacy mobile application in the Philippines. The results of this study substantiate that YourRx is a user-friendly platform that provides patients convenient access to telepharmacy services with less time and effort thus improving patient health outcomes.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"328-339"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502622","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}
Anna DeFrank, Shan Wang, Shahidul Islam, Kim Asmus, D'Andrea Joseph
{"title":"Evaluation of Plasma-Lyte Versus Lactated Ringer's in Surgical Intensive Care Unit Trauma Patients as Fluid Resuscitation.","authors":"Anna DeFrank, Shan Wang, Shahidul Islam, Kim Asmus, D'Andrea Joseph","doi":"10.1177/08971900241287854","DOIUrl":"10.1177/08971900241287854","url":null,"abstract":"<p><p>In critically ill patients, fluid resuscitation with balanced crystalloids close to plasma osmolarity have a lower risk of electrolyte imbalances and demonstrated better clinical outcomes compared to normal saline (NS). While lactated ringer's (LR) has shown benefit over NS, plasma-lyte (PL) with a higher osmolarity and different electrolyte formulation is hypothesized to be superior. We performed a retrospective observational cohort study over 37 months at a tertiary hospital. Inclusion criteria were hospitalization in the surgical intensive care unit (SICU), trauma indication, ≥18 years old, and received either PL or LR. All PL administrations and every fifth patient with LR as resuscitation were included in order to match the sample size in each group. Primary outcomes were SICU length of stay (LOS), hospital LOS, and mortality. Secondary outcomes were biomarker changes from baseline. There were 113 patients in both PL and LR groups. The PL arm had higher APACHE II scores (16 vs 13, <i>P</i> = .033) and were more likely ventilated (39.3% vs 20.4%, <i>P</i> = .002) compared to LR. Median hospital LOS (12.0 vs 8.0, <i>P</i> < .001) and SICU LOS (6.0 vs 3.0, <i>P</i> < .001) are significantly longer in PL group compared to the LR group. However, there was no difference in in-hospital mortality (5.3% vs 3.5% <i>P</i> = .519) and SICU mortality (9.7% vs 5.3%, <i>P</i> > .208) between PL and LR. Overall, PL use was associated with prolonged hospital and SICU LOS. PL use did not demonstrate mortality benefit. However, patients were more critically ill in PL group based on higher APACHE II scores and higher rates of mechanical ventilation, which could be contributing to these unfavorable outcomes.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"314-321"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468339","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}
Stacy Lynn Harmon, Erik LaChance, Jessica L Miller, Sreya Patel, Amolee R Patel
{"title":"Standardized Clinical Infectious Diseases Pharmacy Care Delivery and Antimicrobial Stewardship Program Management Within a Large, Integrated Healthcare System.","authors":"Stacy Lynn Harmon, Erik LaChance, Jessica L Miller, Sreya Patel, Amolee R Patel","doi":"10.1177/08971900241308620","DOIUrl":"10.1177/08971900241308620","url":null,"abstract":"<p><p>PurposeInfectious Diseases (ID) pharmacy expertise is crucial for the success of antimicrobial stewardship (AMS) efforts. As health systems expand due to mergers and acquisitions, ID pharmacy teams strive to deliver consistent care across the enterprise. This report describes the fusion of multiple AMS practice models during the integration of health systems to optimize and standardize care delivery.SummaryThe merger of two large, community hospital systems necessitated the recalibration of services of both legacy antimicrobial stewardship programs (ASPs). While there was agreement that ID pharmacists perform daily prospective audit and feedback of antimicrobials and respond to diagnostics and cultures, the prioritization of practices across the enterprise that retained allowances for individual hospital nuance was paramount. The result was a practice model dedicated to consistent patient care regardless of geographic location, socioeconomic status, or reliance on a single ID pharmacist's availability. Additionally, the team coordinates the system ASP, in collaboration with medical staff. This includes implementation of stewardship initiatives, formulary management and guideline and document control. Lastly, ID pharmacists serve as a resource for prescribers and pharmacy staff and leadership.ConclusionThe development of a standardized ID pharmacy practice model delivered through a hybrid of remote and in-person coverage addressed disparities in clinical services, education and ASP management. Complexities such as care gaps during leave are reconciled with this process while maintaining the minimum expectations of every ID pharmacist. This was especially crucial to establish consistent patient care across state lines with the rise of virtual services and inability to develop on-site rapport.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"340-346"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817897","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":"Why Bisoprolol? A Neglected Beta-Blocker in the U.S.","authors":"Kazuhiko Kido, Maya Guglin","doi":"10.1177/08971900241308623","DOIUrl":"10.1177/08971900241308623","url":null,"abstract":"","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"285-286"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829053","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":"Great Expectations: Semaglutide as Antidiabetic Weight Management in a Psychiatric Hospital.","authors":"Krysta Shannon, Grace Shyh","doi":"10.1177/08971900241294122","DOIUrl":"10.1177/08971900241294122","url":null,"abstract":"<p><p>This report explores the potential role of glucagon-like peptide 1 (GLP-1) receptor agonists in minimizing the metabolic side effects of psychotropic medications in patients with underlying type 2 diabetes (T2D) in inpatient psychiatric settings. The introduction of novel antidiabetic medications such as GLP-1 receptor agonists has broadened the options for managing metabolic disorders, particularly T2D. These medications not only offer effective glycemic control but also provide cardiovascular and renal benefits and help with weight management. Given the tendency of psychotropic medications to cause weight gain and metabolic complications, this report presents 2 cases where weekly doses of semaglutide improved blood glucose levels and prevented weight gain in patients receiving chronic psychotropic medications. Integrating GLP-1 receptor agonists into inpatient psychiatric care can help mitigate the metabolic adverse effects of psychotropic medications. However, considerations such as cost, accessibility, and institutional formulary restrictions are essential to ensure comprehensive patient care.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"351-356"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502632","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}