Journal of the American Pharmacists Association最新文献

{"title":"Development and implementation of a best practice alerting process for naloxone prescribing at rural community pharmacies in Wisconsin: A pilot study","authors":"Sura O. AlMahasis,&nbsp;Martha A. Maurer","doi":"10.1016/j.japh.2025.102382","DOIUrl":"10.1016/j.japh.2025.102382","url":null,"abstract":"<div><h3>Background</h3><div>The opioid overdose epidemic continues to worsen in the United States, with opioid-related deaths increasing by 13 folds from 2000 to 2022 in Wisconsin. Naloxone, an opioid antagonist, can save lives by reversing opioid overdose in a matter of minutes. However, naloxone access and utilization remain suboptimal.</div></div><div><h3>Objective</h3><div>This study examined the development and implementation of best practice alerting (BPA) processes within community pharmacies. This study assessed to what extent the BPA processes (1a) prompted pharmacists to discuss naloxone with high-risk patients; (1b) increased the number of naloxone prescriptions dispensed; and (2) evaluated the facilitators and barriers to implementing the BPA processes.</div></div><div><h3>Methods</h3><div>A pilot study was conducted to develop and implement a BPA process in 3 rural community pharmacies in Wisconsin. The process involved staff identifying high-risk patients, initiating naloxone discussions, and offering naloxone prescriptions. Quantitative monthly data were recorded by pharmacies. Semi-structured interviews were conducted with one pharmacist from each pharmacy to assess the implementation process and outcomes. Descriptive statistics were used to analyze quantitative data. Interview transcripts were analyzed for key themes describing facilitators and barriers to the implementation process.</div></div><div><h3>Results</h3><div>The naloxone alerting process resulted in a notable increase in naloxone discussions and naloxone prescriptions dispensed. Pharmacists reported that pharmacy staff buy-in and engagement, adequate staffing, developing meaningful partnerships, and using depersonalizing, destigmatizing, and normalizing approaches in discussing naloxone with patients were key facilitators. Key barriers included naloxone cost or co-payment and time constraints.</div></div><div><h3>Conclusion</h3><div>Implementing a BPA process in community pharmacies can notably increase naloxone prescribing for high-risk patients. Positive message framing, staffing, meaningful partnerships, and staff buy-in were key facilitators of implementation. Identified barriers were cost or co-payment and time constraints.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102382"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a pharmacist-led outpatient penicillin allergy testing clinic","authors":"Eric Linn,&nbsp;Michael Sanchez,&nbsp;Brekk DelHomme,&nbsp;Meera Baldeosingh,&nbsp;Theodore Heierman,&nbsp;John Perry,&nbsp;Adam Fier","doi":"10.1016/j.japh.2025.102346","DOIUrl":"10.1016/j.japh.2025.102346","url":null,"abstract":"<div><h3>Background</h3><div>Penicillin allergies affect approximately 10% of the population, leading to increased health care costs, treatment failures, and multidrug resistant organisms.</div></div><div><h3>Objective</h3><div>To determine the feasibility of implementing a pharmacist-led outpatient penicillin allergy testing program.</div></div><div><h3>Methods</h3><div>This single-site, retrospective cohort study was conducted from July 2022 through December 2023. The study site consisted of an outpatient clinic within a nonacademic community hospital. The primary outcome was the percentage of patients who had their penicillin allergy delabeled. Secondary outcomes included percentage of patients who received appropriate antibiotics following allergy delabeling, incidence and type of immunoglobulin E mediated penicillin reactions, number of patients who were relabeled with a penicillin allergy, number of orthopedic patients with a postoperative surgical site infection, average reimbursement per patient, and average appointment time.</div></div><div><h3>Results</h3><div>A total of 457 outpatients received penicillin allergy testing during the study period. Physician specialties who referred patients were orthopedics, obstetrician-gynecologists, infectious disease, urology, urogynecology, cardiothoracic surgeons, and primary care providers. For the primary outcome, 439 patients (96%) were successfully delabeled. All delabeled patients received appropriate antibiotics following testing. There were 17 patients who developed minor itching with or without a localized rash following the amoxicillin challenge, and one patient had a delayed reaction of rash 12 hours after the amoxicillin that resolved with an antihistamine. One patient had their penicillin allergy relabeled. Of the 192 orthopedic patients, 0 patients had a postoperative surgical site infection. The average reimbursement was $423 per patient with the average appointment lasting 96 minutes.</div></div><div><h3>Conclusion</h3><div>Pharmacists, in collaboration with multiple physician specialties, successfully implemented an outpatient penicillin allergy testing service to safely delabel patients and support antimicrobial stewardship.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102346"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacists as gate keepers in suicide prevention: Assessing support needs of pharmacy teams","authors":"Pauline Stas,&nbsp;Elien Cornelis,&nbsp;Eva De Jaegere,&nbsp;Céline Claus,&nbsp;Kirsten Pauwels,&nbsp;Kees van Heeringen,&nbsp;Gwendolyn Portzky","doi":"10.1016/j.japh.2025.102353","DOIUrl":"10.1016/j.japh.2025.102353","url":null,"abstract":"<div><h3>Background</h3><div>Gatekeeper training is an effective suicide prevention strategy. Pharmacy teams are among the most visible and accessible health care providers, making them important as possible gatekeepers. Given the pharmacists’ role in dispensing medication, which is a common method of suicide and suicide attempts in Flanders and internationally, they are uniquely positioned to contribute to suicide prevention—not only by restriction or management of means but also by engaging with individuals at risk and facilitating referrals to appropriate care.</div></div><div><h3>Objectives</h3><div>This study aimed to assess pharmacy teams’ support needs regarding their role as gatekeepers in suicide prevention.</div></div><div><h3>Methods</h3><div>Participants completed an online questionnaire examining their perceptions, attitudes, perceived barriers in suicide prevention, self-efficacy, and need for gatekeeper training. Furthermore, experience with suicide(prevention) and suicidal behavior among pharmacists was investigated.</div></div><div><h3>Results</h3><div>A total of 110 participants gave an informed consent, of whom 69 (62.7%) completed the questionnaire. Although nearly three-quarters (73.6%) had encountered suicidal individuals in their pharmacy, only 9.7% felt confident addressing potential suicide risk. Moreover, many indicated that they lacked training in screening mental health issues (81.8%) and did not know which actions to undertake with suicidal individuals (64.8%) or how to ask about suicidal thoughts (63.6%). Most participants indicated the need for training (91.3%), and nearly all (97.1%) were willing to follow such a training. They preferred an online training, including topics such as recognizing signs, starting a conversation about suicide and referring to other caregivers.</div></div><div><h3>Conclusion</h3><div>These findings contribute to the growing body of evidence on the important role of pharmacists as gatekeepers in suicide prevention and provide insight into their current perceptions, attitudes, and barriers. The study identifies the topics of importance for inclusion in a gatekeeper training. Overall, this study shows a clear need and willingness to participate in such a training among pharmacists.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102353"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing academic detailing to take a bite out of antibiotic prophylaxis prior to dental procedures","authors":"David Brennan Portman","doi":"10.1016/j.japh.2025.102351","DOIUrl":"10.1016/j.japh.2025.102351","url":null,"abstract":"<div><h3>Background</h3><div>Within the United States, dentists represent the top specialty prescriber of antibiotics in the ambulatory care setting. With the growth of antimicrobial stewardship programs an overall decrease in antibiotic prescribing has been observed. However, prescribing within the dental subset has remained steady.</div></div><div><h3>Objective</h3><div>To describe implementation of an antibiotic stewardship initiative targeting proper utilization of antibiotic prophylaxis by dentists prior to dental procedures.</div></div><div><h3>Practice description</h3><div>Academic detailing, a form of educational outreach, was utilized to facilitate prescribing behavior change. An academic detailer met with dental staff in a face-to-face one-on-one manner to align prescribing with current evidence-based practice. During the encounter, developed resources were utilized to deliver key messages focusing on specific prescribing improvements, while robust conversation allowed the detailer to identify and address any prescriber motivations and/or perceived barriers.</div></div><div><h3>Practice innovation</h3><div>An antimicrobial stewardship initiative specific to the dental setting, utilizing academic detailing, has not been previously described in the literature.</div></div><div><h3>Evaluation methods</h3><div>Comparisons of prescribing appropriateness before and after the intervention was performed using a one-way analysis of variance model. Additionally, a single-group generalized least-squares interrupted time series analysis was performed to estimate the impact of the intervention on the level and slope changes before and after implementation on the number of inappropriate prescriptions.</div></div><div><h3>Results</h3><div>There were 257 prescriptions for dental prophylaxis included in the preimplementation period and 42 prescriptions for dental prophylaxis included in the postimplementation period. Dental prophylaxis prescribing appropriateness was greater in the postimplementation period (17.6% vs. 89.8%; <em>P</em> &lt; 0.001). The incidence of inappropriate prescriptions decreased by 25.39 per 1000 population (<em>P</em> &lt; 0.001) between the periods.</div></div><div><h3>Conclusion</h3><div>Academic detailing improved the prescribing appropriateness of antibiotic prophylaxis prior to dental procedures at Veterans Affairs Butler Healthcare System.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102351"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a multidose ophthalmic medication policy change at a large health system","authors":"Gregory Mak,&nbsp;Cecilia (Cece) Speck,&nbsp;Indrani Kar,&nbsp;Douglas J. Rhee","doi":"10.1016/j.japh.2025.102356","DOIUrl":"10.1016/j.japh.2025.102356","url":null,"abstract":"<div><h3>Background</h3><div>In response to a multidose ophthalmic medication (topical eye drop) shortage, the health system had to evaluate the current policy for multidose medications and propose changes to the policy to provide patient care while managing the drug shortage. The use of multidose eye drops on multiple patients is accepted in ophthalmology care per the Centers for Medicare and Medicaid Services updated guidance for ambulatory surgical centers. Before this, the use of multidose eye drops on multiple patients had not been in practice at our health system owing to contamination risk from repeated use in the preoperative setting. Given the ambiguity of the current policy with regard to multidose ophthalmic drop usage and the available literature, an updated policy was developed.</div></div><div><h3>Objectives</h3><div>This report aimed to describe the evaluation, assessment, and implementation of a policy change supporting the use of multidose ophthalmic medications on multiple patients.</div></div><div><h3>Methods</h3><div>Key stakeholders met and assessed the impact of the shortage and potential policy needs. After the evaluation of available literature and regulatory guidance, the proposed change was brought through the necessary formulary, safety, and policy channels for review.</div></div><div><h3>Results</h3><div>After a review of the available literature, a determination was made that there is sufficient support for the practice of using multidose eye drops in multiple patients provided that there are appropriate infection control guidelines. The policy edits were approved by the appropriate committees and subsequently the organization’s policy oversight committee.</div></div><div><h3>Conclusions</h3><div>Our organization was able to make a substantial policy change through a collaborative, interdisciplinary review of literature and best practices to address a critical patient care need resulting from a medication shortage.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102356"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the impact of pharmacy-led RxChange interventions on medication use and cost outcomes for electronic prescriptions","authors":"Yifan Zheng,&nbsp;Jun Gong,&nbsp;Corey A. Lester","doi":"10.1016/j.japh.2025.102349","DOIUrl":"10.1016/j.japh.2025.102349","url":null,"abstract":"<div><h3>Background</h3><div>The RxChange process provides a streamlined solution within electronic prescribing workflows for a pharmacist-led team to address prescription issues with providers. Its use and effectiveness need to be evaluated to enhance pharmacy-provider communication, improve patient access to care, and increase patient safety.</div></div><div><h3>Objective</h3><div>To assess the use of the RxChange process on e-prescription content, cost, and changes related to medication safety.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of national RxChange transactions from 2022 to 2023, using stratified random sampling. All data was obtained from Surescripts. The dataset directly included RxChange response data, shared under agreements to provide limited, time-shifted, and de-identified information. We measured the changes in active ingredients, strengths, dose forms, therapeutic classes, and associated costs before and after the RxChange process. Cost analysis was based on data from the 2021 Medical Expenditure Panel Survey by comparing medication unit costs before and after interventions. Additionally, we analyzed the associations between adverse drug reaction (ADR) codes and the resulting medication modifications.</div></div><div><h3>Results</h3><div>Our analysis included 1,361,528 RxChange transaction records, focusing on 721,415 prescriber-approved transactions. Medication data mapping using RxNorm API was successful in 93.4% of these records, with 31.3% undergoing significant modifications due to pharmacy interventions. Of these, 43,293 records were linked to cost data, revealing an average unit cost saving of $3.5. Strength changes emerged as the most frequent medication adjustment, particularly in therapeutic interchange scenarios. Out-of-stock situations led to most complex modifications involving simultaneous multiple changes in ingredients, strength, and dose form. ADR-related RxChange requests mostly prompted simultaneous strength and ingredient adjustments in 25.8% of ADR-related transactions.</div></div><div><h3>Conclusions</h3><div>The study concludes that pharmacy-initiated RxChange communications within the electronic prescription workflow play a crucial role in enhancing e-prescription quality and making pharmacy team interventions more traceable. The findings highlight the importance of pharmacy-provider collaboration in addressing prescribing challenges, facilitating medication adjustments, and supporting efforts to improve medication safety through the RxChange process.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102349"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to optimize aseptic medicine services: Qualitative insights from pharmacists' experience","authors":"Chairun Wiedyaningsih,&nbsp;Fita Rahmawati,&nbsp;Chintya Gilang Ghaisani,&nbsp;Niken Nur Widyakusuma","doi":"10.1016/j.japh.2025.102342","DOIUrl":"10.1016/j.japh.2025.102342","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacy aseptic services are essential for many critical hospital services as they provide sterile and controlled environments under which highly qualified staff prepares injectable medicines. Although quantitative studies on problems of aseptic medicine services have been previously documented, there is a paucity of data to explain the cause of those problems.</div></div><div><h3>Objective</h3><div>This study aimed to examine practical challenges experienced by pharmacists during aseptic medicine services.</div></div><div><h3>Methods</h3><div>This was a qualitative study conducted using semistructured interviews. The participants were pharmacists working in various inpatient clinical environments in Yogyakarta Province, Indonesia. Participants were purposefully recruited through maximum variation and snowball sampling. The interview guide was developed after comprehensive literature review and discussions with some experts related to concepts in aseptic medicine service. Data were collected from April to August 2023 and analyzed via reflexive thematic analysis using the NVivo software.</div></div><div><h3>Results</h3><div>A total of 19 pharmacists working in 12 hospitals (7 public and 5 private) across the 5 regions in Yogyakarta Province were interviewed. The challenges in aseptic services can be grouped into 5 themes (1) unreliable physical facilities and equipment are the problems that should be solved, (2) shortage of the quality and quantity of human resources hinder the optimum aseptic medicine services, (3) competence, responsible, and accountable aseptic dispensing services management are needed to counter issues related work delegation, supervision, coordination, and communication between health staff, (4) various problems of production systems are needed to be considered, and (5) there is lack of pharmacist involvement in board of directors in making policy regarding aseptic services.</div></div><div><h3>Conclusion</h3><div>By addressing the 5 main themes of challenges to aseptic medicine services, institutional leadership can begin to improve the patient safety and hospital performance. Incorporating experienced pharmacists into the decision-making processes at the executive level is a strategy to address these challenges.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102342"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of mental health first aid training in hospital and community pharmacists: A systematic review","authors":"Trisha Joy Advincula,&nbsp;Mindraani Abubakar,&nbsp;Rogie Royce Carandang","doi":"10.1016/j.japh.2025.102344","DOIUrl":"10.1016/j.japh.2025.102344","url":null,"abstract":"<div><h3>Background</h3><div>Mental health is essential for overall well-being but is often overlooked or stigmatized. Mental health first aid (MHFA) provides initial support to reduce stigma, encourage help-seeking, and guide individuals toward appropriate care. While MHFA equips health care providers to address rising mental health needs, its impact on pharmacists remains underexplored, warranting this systematic review.</div></div><div><h3>Objective</h3><div>This systematic review aimed to comprehensively synthesize the effects of MHFA training for pharmacists on their knowledge, attitudes, and competency in providing mental health support.</div></div><div><h3>Methods</h3><div>The authors systematically searched 9 electronic databases, gray literature, and reference lists of included articles. Article selection was based on predefined criteria, and outcomes were analyzed using narrative synthesis. The review included 9 articles from 1258 identified studies, representing diverse study designs and populations. Risk of bias and the certainty of evidence were assessed using appropriate tools.</div></div><div><h3>Results</h3><div>The positive effects of MHFA training have been observed, including enhanced understanding of mental health conditions, reduced stigma surrounding mental health, and increased confidence and skills in mental health interventions among hospital and community pharmacists. Most pharmacists recognize the importance of MHFA training and demonstrate a strong willingness to engage in both initial and ongoing training. However, mixed effects were noted regarding their preparedness to administer MHFA.</div></div><div><h3>Conclusion</h3><div>Pharmacists who completed MHFA training were found to engage in conversations about mental health more frequently, offer compassionate support, and demonstrate a willingness to assist individuals struggling with mental health crises. Future research utilizing robust study designs should investigate whether MHFA training significantly benefits patients and pharmacists.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102344"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a pharmacist collaborative practice agreement to improve a Medicare quality measure: Statin use in persons with diabetes","authors":"Anna Sandalidis,&nbsp;Christina M. Polomoff,&nbsp;Sean M. Jeffery","doi":"10.1016/j.japh.2025.102347","DOIUrl":"10.1016/j.japh.2025.102347","url":null,"abstract":"<div><h3>Background</h3><div>Statin use in persons with diabetes (SUPD) is a Centers for Medicare and Medicaid Services star quality measure used in Medicare Part D. This measure assesses the Part D plans' success in prescribing statins to individuals with diabetes between the age of 40–75 years. This paper illustrates how pharmacists can improve SUPD star ratings by using a collaborative drug therapy management (CDTM) agreement to initiate statin therapy.</div></div><div><h3>Methods</h3><div>In 2023, pharmacists in a clinically integrated delivery network implemented a CDTM for closing SUPD gaps in care (GICs). Utilizing payer claims data, the pharmacists analyzed multiple years of SUPD results. Open GICs were categorized by practice location, provider, and measurement year. Results were stratified into providers with lower SUPD closure rates (less than 80%) and higher open GIC. Practice locations with the highest number of GIC were prioritized for the pharmacist intervention.</div></div><div><h3>Results</h3><div>By close of member year 2022, 7529 individuals were identified as SUPD eligible individuals from within the employed medical group. Of the 7529 patients, 85.4% were prescribed a statin, leaving 1098 individuals, cared for by 277 providers with open GICs. There were 76 practice locations showing a range of 5–48 open GICs. Provider open GIC ranged from 1 to 13 (mean 2.57). By the end of measurement year 2023, pharmacists increased SUPD star ratings from 2 to 4 stars with two payers and from 2 to 3 stars with 1 payer.</div></div><div><h3>Conclusion</h3><div>Expanded CDTM law enables qualified pharmacists to play a pivotal role in influencing population health outcomes. With a CDTM agreement, pharmacists can overcome barriers to initiating statins for eligible individuals and thereby directly impact star ratings.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102347"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marginal structural models to evaluate the association between adherence to direct oral anticoagulants and safety or efficacy outcomes among patients with atrial fibrillation","authors":"Anjana Mohan,&nbsp;Hua Chen,&nbsp;Ashish A. Deshmukh,&nbsp;Matthew Wanat,&nbsp;Ekere James Essien,&nbsp;Rutugandha Paranjpe,&nbsp;Bilqees Fatima,&nbsp;Susan Abughosh","doi":"10.1016/j.japh.2025.102355","DOIUrl":"10.1016/j.japh.2025.102355","url":null,"abstract":"<div><h3>Background</h3><div>Although the management of atrial fibrillation (AF) has improved over the years, suboptimal adherence to direct oral anticoagulants (DOACs) is a major health concern. Adherence and long-term persistence to DOACs decline over time resulting in increased risks of stroke, major bleeding, and death.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the association between adherence to DOACs and composite or bleeding events using marginal structural models (MSMs).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted using the Medicare Advantage Plan from January 2016 to December 2020. Patients with AF prescribed any DOACs were identified. Adherence was calculated using the proportion of days covered (PDC). Patients with PDC ≥ 0.80 were considered adherent. Composite (stroke, systemic embolism, acute coronary syndrome) and bleeding (major and minor) events were calculated for each of the 4 time periods. An MSM was conducted to estimate the association between adherence and composite efficacy or bleeding events by controlling for time-dependent covariates and time-dependent exposure affected by the previous exposure.</div></div><div><h3>Results</h3><div>A total of 1969 patients with AF were included in the study. Adherence was suboptimal during all the 5 time periods, and it ranged from 39.8% to 53.12%. This study did not find any significant association between adherence to DOACs and composite efficacy or bleeding events. The safety and efficacy outcomes were comparable among apixaban, rivaroxaban, and dabigatran.</div></div><div><h3>Conclusion</h3><div>This study revealed that adherence declined over time among old patients with AF. Future studies should explore the association between adherence to DOACs and health outcomes for a longer duration of follow-up using MSM.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102355"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}