Journal of the American Pharmacists Association最新文献

{"title":"Implementation of a Pharmacist-led Outpatient Penicillin Allergy Testing Clinic.","authors":"Eric Linn, Michael Sanchez, Brekk DelHomme, Meera Baldeosingh, Theodore Heierman, John Perry, Adam Fier","doi":"10.1016/j.japh.2025.102346","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102346","url":null,"abstract":"<p><strong>Background: </strong>Penicillin allergies affect approximately 10% of the population, leading to increased healthcare costs, treatment failures, and multidrug resistant organisms.</p><p><strong>Objective: </strong>To determine the feasibility of implementing a pharmacist-led outpatient penicillin allergy testing program.</p><p><strong>Methods: </strong>This single-site, retrospective cohort study was conducted from July 2022 through December 2023. The study site consisted of an outpatient clinic within a non-academic community hospital. The primary outcome was the percentage of patients who had their penicillin allergy de-labeled. Secondary outcomes included percentage of patients who received appropriate antibiotics following allergy de-labeling, incidence and type of IgE mediated penicillin reactions, number of patients who were relabeled with a penicillin allergy, number of orthopedic patients with a post-operative surgical site infection, average reimbursement per patient, and average appointment time.</p><p><strong>Results: </strong>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 de-labeled. All de-labeled patients received appropriate antibiotics following testing. There were 17 patients who developed minor itching with or without a localized rash following the amoxicillin, 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 re-labeled. Of the 192 orthopedic patients, 0 patients had a post-operative surgical site infection. The average reimbursement was $423 per patient with the average appointment lasting 96 minutes.</p><p><strong>Conclusion: </strong>Pharmacists, in collaboration with multiple physician specialties, successfully implemented an outpatient penicillin allergy testing service to safely de-label patients and support antimicrobial stewardship.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102346"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","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":"Effects of Mental Health First Aid Training in Hospital and Community Pharmacists: A Systematic Review.","authors":"Trisha Joy Advincula, Mindraani Abubakar, Rogie Royce Carandang","doi":"10.1016/j.japh.2025.102344","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102344","url":null,"abstract":"<p><strong>Background: </strong>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 healthcare providers to address rising mental health needs, its impact on pharmacists remains underexplored, warranting this systematic review.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>The authors systematically searched nine 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 nine articles from 1,258 identified studies, representing diverse study designs and populations. Risk of bias and the certainty of evidence were assessed using appropriate tools.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102344"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","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":"How to optimize aseptic medicine services: Qualitative insights from pharmacists' experience.","authors":"Chairun Wiedyaningsih, Fita Rahmawati, Chintya Gilang Ghaisani, Niken Nur Widyakusuma","doi":"10.1016/j.japh.2025.102342","DOIUrl":"10.1016/j.japh.2025.102342","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>This study aimed to examine practical challenges experienced by pharmacists during aseptic medicine services.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102342"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","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":"Comparing in-person versus telephone Medicare counseling: Beneficiary satisfaction, cost-savings, and plan selection decisions from 2014 to 2021.","authors":"Asia White, Nicholas McCormick, Yi Zhao, Kavon Diggs, Salisa C Westrick, Lindsey Hohmann","doi":"10.1016/j.japh.2025.102350","DOIUrl":"10.1016/j.japh.2025.102350","url":null,"abstract":"<p><strong>Background: </strong>A pharmacy school and a State Health Insurance Assistance Program developed a Medicare plan selection assistance program in 2013. In 2020, the program changed from in-person to telephone counseling.</p><p><strong>Objective: </strong>To compare the impact of in-person vs. telephone Medicare counseling on beneficiary satisfaction, cost-savings, and plan selection decisions.</p><p><strong>Methods: </strong>Outcomes were assessed via anonymous postcounseling survey, including the following: 1) program satisfaction (4-items); 2) annual cost-savings (2-items); and 3) plan selection decisions (1-item). Beneficiary satisfaction was measured using a Likert-type scale (1 = strongly disagree, 5 = strongly agree). Projected cost-savings was calculated as the difference between the total annual drug plus premium costs of the patient's current vs. newly selected plan (actual costs-savings) or least expensive plan option (potential cost-savings) for the next benefit year. Plan selection decision was measured via multiple-choice with response categories of \"enrolled in or selected a new plan,\" \"undecided,\" or \"stayed with their current plan.\" Differences in mean satisfaction scale scores, cost-savings, and plan selection decisions between in-person (2014-2019) and telephone counseling (2020-2021) were analyzed using Mann-Whitney U and Fisher's Exact tests. Predictors of plan selection decision were assessed via logistic regression.</p><p><strong>Results: </strong>Beneficiaries (N = 632; in-person n = 564; telephone n = 68) were mostly female (59.8%), White (52.1%), and 69 years on average. The overall mean [SD] satisfaction scale score was higher among recipients of in-person (4.55[0.575]) vs. telephone counseling (4.30[0.645]; P = 0.002), but there was no statistically significant difference in mean projected annual cost-savings. Further, in-person vs. telephone counseling recipients more often enrolled in or selected a new plan (46.5% vs. 27.8%; P < 0.05), while telephone vs. in-person recipients were more frequently undecided (37.0% vs. 24.4%; P < 0.05). Overall satisfaction (adjusted odds ratio [aOR] = 11.548; P = 0.009) and potential cost-savings (aOR = 1.001; P = 0.020) predicted selection of a new plan.</p><p><strong>Conclusion: </strong>In-person counseling resulted in a greater proportion of beneficiaries selecting a new plan whereas telephone counseling resulted in greater decision inertia.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102350"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415865","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":"Dare 2 Discuss social media campaign: An educational initiative to improve opioid use disorder discussions between the pharmacist and patient.","authors":"Oliver Frenzel, Isaiah Ratz, Anna Skarphol, Amy Werremeyer","doi":"10.1016/j.japh.2025.102343","DOIUrl":"10.1016/j.japh.2025.102343","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) is a chronic substance use disorder that currently results in significant morbidity and mortality within the United States. The Opioid and Naloxone Education program is a pharmacy-centered opioid risk screening process to identify patients at risk for OUD and opioid overdose. Three years after inception, data indicated patients screened as high-risk for OUD were receiving opioid safety interventions; however the evaluation noted a lack of OUD education with patients.</p><p><strong>Objective: </strong>To describe and assess an educational initiative for pharmacists which is delivered via social media for the improvement of pharmacist-patient communication surrounding OUD education.</p><p><strong>Methods: </strong>The initiative was named 'Dare 2 Discuss' and video content was developed to align with prior research citing challenges to health care provider-patient OUD education. Data to evaluate pharmacist interventions/education delivered to patients was collected by a pharmacy services documentation platform and social media performance was captured by each respective social media dashboard.</p><p><strong>Results: </strong>The first video was posted on October 1, 2022 and the last video was posted on April 10, 2023. Each video took approximately 2.5 hours to create and averaged 42 seconds in length (17-168 seconds). On average, videos received 233 Facebook views (55-489 views) and 527 Instagram views (232-1434 views). The postintervention phase indicated that patient receipt of OUD education by the pharmacist increased by 23% and patient receipt of community support services information increased by 68%.</p><p><strong>Conclusion: </strong>'Dare 2 Discuss' campaign may have improved pharmacist self-efficacy with subsequent adjustment of patient education techniques when addressing OUD conversations. These findings highlight the feasibility of a social media-delivered educational initiative to have a potential impact on factors associated with the opioid crisis and risk-reduction education by pharmacists. Creating relevant and easy-to-digest educational materials for health professionals is an important step in advancing practice and improving patient care. Results from the Dare 2 Discuss campaign suggest that this educational initiative may be an effective method to reach a broad number of pharmacists to improve patient interactions.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102343"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416010","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, Jun Gong, Corey A Lester","doi":"10.1016/j.japh.2025.102349","DOIUrl":"10.1016/j.japh.2025.102349","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To assess the use of the RxChange process on e-prescription content, cost, and changes related to medication safety.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102349"},"PeriodicalIF":2.5,"publicationDate":"2025-02-10","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":"The effect of out-of-pocket costs on medications for opioid use disorder and overdose: A scoping review","authors":"Ronald Watema-Lord,&nbsp;Feng Xie,&nbsp;Chiranjeev Sanyal","doi":"10.1016/j.japh.2024.102299","DOIUrl":"10.1016/j.japh.2024.102299","url":null,"abstract":"<div><h3>Background</h3><div>The opioid epidemic is a major public health crisis in Canada and elsewhere. The increase in opioid prescriptions is a major contributor to this crisis. Medications for opioid use disorder (OUD) and overdose are effective and lifesaving treatments. Often, patients do not have adequate insurance coverage (or uninsured) for medications for OUD and have to pay out of pocket (OOP). OOP costs (OOPCs) result in financial burdens among patients, limiting their access to medications for OUD, and overdose.</div></div><div><h3>Objectives</h3><div>To identify the evidence on (1) the OOPCs of medications for OUD and overdose, and (2) the effect of insurance coverage (or being uninsured) and corresponding OOPCs on medications for OUD initiation, retention, and discontinuation.</div></div><div><h3>Methods</h3><div>This scoping review was conducted in accordance with methodological guidance from the Joanna Briggs Institute. The literature search aimed to identify peer-reviewed publications in English in MEDLINE, Embase, and CINAHL, which were searched from inception to March 22, 2024. Two reviewers independently completed title, abstract, and full-text screening against inclusion criteria. Data extracted were used to describe the body of literature using descriptive and qualitative approaches.</div></div><div><h3>Results</h3><div>Out of the 2003 search results, a total of ten studies met the inclusion criteria and were included in the review. Uninsured patients have paid higher OOPCs compared to private or publicly insured patients. Among privately insured patients with OUD, greater OOPC may result in poor retention of buprenorphine. The risk of discontinuation was higher with the buprenorphine/naloxone tablet compared with the sublingual buprenorphine/naloxone film. Generic substitution or providing coverage for these medications being dispensed from community pharmacies can potentially minimize the burden of OOPCs and improve access.</div></div><div><h3>Conclusion</h3><div>The literature highlights beneficiaries of private/commercial health plans experience a substantial burden of OOPCs, creating barriers to treatment initiation, retention, and adherence to medications for OUD.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102299"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory care pharmacy specialty training","authors":"Raechel T. White,&nbsp;Kevin Cowart,&nbsp;Nicholas W. Carris","doi":"10.1016/j.japh.2024.102137","DOIUrl":"10.1016/j.japh.2024.102137","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102137"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288830","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 a generative artificial intelligence accuracy in providing medication instructions from smartphone images","authors":"Yusef Yassin,&nbsp;Thien Nguyen,&nbsp;Krishna Panchal,&nbsp;Katharine Getchell,&nbsp;Timothy Aungst","doi":"10.1016/j.japh.2024.102284","DOIUrl":"10.1016/j.japh.2024.102284","url":null,"abstract":"<div><h3>Background</h3><div>The Food and Drug Administration mandates patient labeling materials like the Medication Guide (MG) and Instructions for Use (IFU) to support appropriate medication use. However, challenges such as low health literacy and difficulties navigating these materials may lead to incorrect medication usage, resulting in therapy failure or adverse outcomes. The rise of generative AI, presents an opportunity to provide scalable, personalized patient education through image recognition and text generation.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the accuracy and safety of medication instructions generated by ChatGPT based on user-provided drug images, compared to the manufacturer's standard instructions.</div></div><div><h3>Methods</h3><div>Images of 12 medications requiring multiple steps for administration were uploaded to ChatGPT's image recognition function. ChatGPT's responses were compared to the official IFU and MG using text classifiers, Count Vectorization (CountVec), and Term Frequency-Inverse Document Frequency (TF-IDF). The clinical accuracy was further evaluated by independent pharmacists to determine if ChatGPT responses were valid for patient instruction.</div></div><div><h3>Results</h3><div>ChatGPT correctly identified all medications and generated patient instructions. CountVec outperformed TF-IDF in text similarity analysis, with an average similarity score of 76%. However, clinical evaluation revealed significant gaps in the instructions, particularly for complex administration routes, where ChatGPT's guidance lacked essential details, leading to lower clinical accuracy scores.</div></div><div><h3>Conclusion</h3><div>While ChatGPT shows promise in generating patient-friendly medication instructions, its effectiveness varies based on the complexity of the medication. The findings underscore the need for further refinement and clinical oversight to ensure the safety and accuracy of AI-generated medical guidance, particularly for medications with complex administration processes.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102284"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607318","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":"Real-world treatment patterns in drug naïve type 2 diabetes population: Initial combination therapy vs. sequential step-therapy","authors":"Zahra Majd,&nbsp;Hua Chen,&nbsp;Michael L. Johnson,&nbsp;Kim K. Birtcher,&nbsp;Omar Serna,&nbsp;Susan Abughosh","doi":"10.1016/j.japh.2024.102295","DOIUrl":"10.1016/j.japh.2024.102295","url":null,"abstract":"<div><h3>Background</h3><div>Despite evidence-based guidelines and available therapies, many patients with type 2 diabetes (T2D) have suboptimal glycemic control. The current standard of care suggests initial monotherapy followed by add-on therapy to achieve and maintain target HbA1c. However, clinical trials revealed that intensive glycemic control, especially at the early stages of the disease, could result in earlier and better long-term glycemic control in addition to reducing diabetes-related complications and mortality risk.</div></div><div><h3>Objective</h3><div>This population-based study aimed to investigate treatment initiation patterns among newly diagnosed drug-naïve patients with T2D in real-world clinical settings, focusing on two recommended approaches: initial combination therapy and step-therapy.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted using claims data from the Merative MarketScan Research Databases between 2017 and 2019. The study included drug-naïve patients with T2D with continuous enrollment in medical and pharmacy plans. Patients were categorized into the initial combination therapy or step-therapy cohorts based on their initial treatment regimen. Baseline characteristics of the cohorts were recorded, and logistic regression analysis was performed to identify factors associated with receiving each approach.</div></div><div><h3>Results</h3><div>The study included a total of 117,419 patients in the Commercial/Medicare population and 18,574 patients in the Medicaid population. About 10% to 12% of patients received initial combination therapy as their initial pharmacotherapy regimen. Several patient demographic and clinical characteristics were significantly associated with the use of initial combination therapy vs. step-therapy. Results also showed a greater usage of loose-dose combination pills over fixed-dose combinations.</div></div><div><h3>Conclusion</h3><div>Given the lack of real-world studies on combination vs. step-therapy, the study findings provide insights into the current treatment initiation patterns and associated factors among drug-naïve patients with T2D. These findings contribute to understanding the real-world clinical practices in diabetes management and may help guide clinicians in making informed decisions regarding pharmacotherapy approaches.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102295"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631395","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}