Journal of the American Pharmacists Association最新文献

{"title":"Increasing SGLT-2 inhibitor prescribing through an integrated case-finding algorithm-guided interdisciplinary intervention","authors":"Cindy Leslie A. Roberson,&nbsp;Abby F. Hoffman,&nbsp;Pamela Cohen,&nbsp;Victoria Lee Jackson,&nbsp;Susan E. Spratt","doi":"10.1016/j.japh.2024.102320","DOIUrl":"10.1016/j.japh.2024.102320","url":null,"abstract":"<div><h3>Background</h3><div>Use of sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors) falls short of their cardiorenal protective benefits. Patient and provider-level barriers hinder the adoption of these life-saving medications. Innovative practices to provide primary care providers (PCPs) with added clinical-decision support via a dedicated remote interdisciplinary diabetes rounds (IDRs) team could promote SGLT-2 inhibitor selection.</div></div><div><h3>Objective</h3><div>To evaluate the impact of the IDR's proactive provider outreach on the prescribing rate of SGLT-2 inhibitors and assess the application of an SGLT-2 inhibitor case-finding algorithm to allow targeted intervention in a population-health-based setting.</div></div><div><h3>Methods</h3><div>This is a quality improvement prospective cohort observational study from October 2021 to May 2022. Patients who met the prespecified criteria for SGLT-2 eligibility were reviewed via IDR with recommendations sent to the PCP via the electronic health record. The primary analysis employed a multivariate logistic regression to assess the difference in SGLT-2 inhibitor prescription rates between reviewed and not reviewed patients, adjusting for variables affecting SGLT-2 inhibitor prescribing. The secondary analysis measured the algorithm's accuracy in identifying patients with compelling indications.</div></div><div><h3>Results</h3><div>The IDR team reviewed a total of 206 patients (mean age, 63 years; 53.9% women; 42.7% Black; mean A1c 8.3%) with a successful PCP appointment. Patients reviewed by the IDR team had an increased prescribing rate within 90 days of the visit (adjusted odds ratio 5.1, 95% CI 3.06–8.47). The algorithm identified 1084 SGLT-2 inhibitor-eligible patients with a sensitivity of 90.4% (95% CI, 86.4%, 94.4%) and specificity of 85.1% (95% CI, 79.9%, 90.4%).</div></div><div><h3>Conclusion</h3><div>IDR team's review of eligible patients with recommendations to PCPs was associated with significantly increased SGLT-2 inhibitor prescription rates. Development of an algorithm with high sensitivity and specificity for targeted intervention may provide a pathway for channeling therapy and decreasing clinical inertia in population health management efforts.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102320"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902869","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":"Pharmacist perceptions of motivation and well-being using self-determination theory: A qualitative study","authors":"Kayla Walker,&nbsp;Alexcia S. Carr,&nbsp;Andrew Wash,&nbsp;Leticia R. Moczygemba","doi":"10.1016/j.japh.2024.102321","DOIUrl":"10.1016/j.japh.2024.102321","url":null,"abstract":"<div><h3>Background</h3><div>Many US hospitals and health systems have implemented well-being programs to address the clinician well-being and burnout crisis. Most community pharmacists experience at least one symptom of burnout, yet they have been overlooked for inclusion in well-being initiatives.</div></div><div><h3>Objective</h3><div>To explore community pharmacists' perceptions of how motivation and burnout impact patient care and how fulfillment of basic psychological needs (autonomy, competence, and relatedness) impacts motivation and well-being.</div></div><div><h3>Methods</h3><div>Focus groups were conducted with 20 community pharmacists. A semistructured focus group guide was developed using Self-Determination Theory (SDT). Transcriptions from the focus groups were analyzed using deductive qualitative analysis with SDT as a framework and inductive analysis to code subthemes.</div></div><div><h3>Results</h3><div>Our findings revealed that pharmacists who feel burnout experience depersonalization toward patients which lowers the quality of patient-pharmacist interactions. Pharmacists who did not feel burnout expressed a sense of professional fulfillment, which motivated them to provide patient-centered care. Pharmacists indicated that unrealistic expectations from patients and corporate management, such as pressure from patients to fill prescriptions quickly and management expectations to meet prescription fill quotas, negatively impacted autonomy. Conversely, having access to clinical information, workflow optimization, and realistic job expectations supported autonomy. Poor relationships with patients and coworkers negatively impacted relatedness and contributed to communication barriers, workplace negativity, and emotional detachment from work. Relatedness was facilitated by building relationships and mutual respect with patients and coworkers and cultivating a positive work culture. Expectations for perfection and the need for multitasking when understaffed diminished competency. Adequate staffing and allocation of time to complete job duties served to support competency.</div></div><div><h3>Conclusion</h3><div>Community pharmacists are faced with situations that undermine autonomy, relatedness, and competency, which according to SDT need to be fulfilled to facilitate well-being.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102321"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903070","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":"Characterizing pharmacy deserts and designing a model to minimize inequities in pharmacy distribution in Virginia","authors":"Joseph Boyle,&nbsp;Rachel Wittenauer,&nbsp;Shreya Ramella,&nbsp;Caroline Juran,&nbsp;John D. Bucheit,&nbsp;Evan M. Sisson,&nbsp;Jean-Venable (Kelly) Goode,&nbsp;Sharon S. Gatewood,&nbsp;Teresa M. Salgado","doi":"10.1016/j.japh.2025.102334","DOIUrl":"10.1016/j.japh.2025.102334","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacy closures have become increasingly prevalent in the United States in recent years. Previous literature highlights socioeconomic and racial disparities in the distribution of pharmacy deserts.</div></div><div><h3>Objectives</h3><div>To identify and characterize pharmacy deserts in Virginia and to simulate potential locations to minimize inequities in pharmacy distribution.</div></div><div><h3>Methods</h3><div>This cross-sectional study used active pharmacy permits data from the Virginia Board of Pharmacy to identify census tracts considered pharmacy deserts by simultaneously satisfying 2 criteria: 1) low-income status (&gt;20% residents living below the federal poverty line, or median household income &lt;80% of a local comparator); and 2) low-access to pharmacies (distance &gt;1, 5, or 10 miles for urban, suburban, and rural census tracts, respectively). Demographic and socioeconomic characteristics of desert vs. nondesert tracts were compared using Wilcoxon rank-sum tests. Locations within identified pharmacy deserts were randomly generated in 10,000 independent iterations.</div></div><div><h3>Results</h3><div>Of 2198 census tracts, 51 were considered pharmacy deserts, and 69 met the low-access criterion only. Pharmacy deserts were significantly more common in urban census tracts (5.5%), followed by rural (2.9%), and suburban (0.1%). Compared to nondesert, pharmacy desert tracts had significantly lower percentage of residents under 18 year-old, greater percentage of Black residents, uninsured, with Medicare or Medicaid coverage only, lower median household income, and greater percentage of residents living in poverty. Through geospatial simulation, 44 locations were identified where adding pharmacy services could significantly improve access, each potentially benefiting over 10,000 individuals.</div></div><div><h3>Conclusion</h3><div>Fifty-one tracts in Virginia, primarily in urban areas, were considered pharmacy deserts. Compared to nondeserts, pharmacy desert status was associated with a lower proportion of residents under 18 year-old, greater proportion of Black and uninsured/publicly insured residents, and high poverty level, highlighting disparities in pharmacy access. Geospatial simulation identified several locations where placement of pharmacy services could benefit the largest number of residents living in desert tracts.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102334"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411340","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":"Availability of and attitudes toward harm reduction services: A rural pharmacy perspective","authors":"Grace Marley,&nbsp;Erin Blythe,&nbsp;Salisa Westrick,&nbsp;Delesha M. Carpenter","doi":"10.1016/j.japh.2024.102291","DOIUrl":"10.1016/j.japh.2024.102291","url":null,"abstract":"<div><h3>Background</h3><div>There's limited information available about the range of harm reduction (HR) services provided by rural pharmacies.</div></div><div><h3>Objective</h3><div>This study’s objectives are to describe the types of HR services offered by rural pharmacies and examine pharmacists’ attitudes and willingness to offer those services.</div></div><div><h3>Methods</h3><div>A cross-sectional online survey was sent to pharmacists who are members of a practice-based research network for rural community pharmacies. Pharmacists reported the frequency to which their pharmacy engage in as well as their willingness to offer the following HR services: naloxone dispensing; buprenorphine dispensing; point of care testing for human immunodeficiency virus (HIV) and Hepatitis C (HCV); and nonprescription syringe (NPS) sales. Also, pharmacists' knowledge and willingness to sell drug test strips and attitudes toward people who inject drugs (PWIDs) were assessed. Descriptive statistics were calculated.</div></div><div><h3>Results</h3><div>A total of 61 pharmacists completed the survey (completion rate = 45.2%). Most reported dispensing naloxone 2-3 times per month (90.2%), and a third dispensed buprenorphine daily (32.8%). Only one pharmacy offered HIV testing, and none offered HCV testing. Most pharmacies (65.6%) had a policy regarding the sale of NPS, with 21.3% reporting they never dispense nonprescription syringes. Many pharmacists were willing to sell fentanyl test strips (67.2%) and xylazine test strips (50.8%). Pharmacists’ most negative attitudes related to believing PWID customers make other customers feel uncomfortable and that providers keep patients on buprenorphine for too long.</div></div><div><h3>Conclusion</h3><div>Many rural community pharmacists engage in HR services and are willing to offer more. However, stigmatizing attitudes highlight the need for pharmacy-focused HR training to reduce stigma and increase knowledge.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102291"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649546","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":"An analysis of the impact of a multimodal therapy order set on postoperative opioid prescribing after orthopedic shoulder procedures","authors":"Dan Arendt,&nbsp;Marisa Brizzi,&nbsp;Ryan Ruehl,&nbsp;Jacob Cryer,&nbsp;Christopher J. Utz,&nbsp;Brian Grawe","doi":"10.1016/j.japh.2025.102322","DOIUrl":"10.1016/j.japh.2025.102322","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are effective for postoperative pain control but are no longer considered appropriate as the sole method for managing pain after surgery. Newer, multimodal approaches to pain control are increasingly being employed to decrease reliance on opioids, but patient-related outcomes are not consistently reported with these interventions.</div></div><div><h3>Objective</h3><div>This study evaluated the effect of implementing a new multimodal therapy order set, coupled with new patient education materials, on postoperative outcomes after complex shoulder surgery.</div></div><div><h3>Methods</h3><div>This retrospective cohort study compared outcomes from patients who received medications via the new multimodal therapy order set (order set cohort) and patients who did not (nonorder set cohort). All patients were contacted on postoperative days 1,7, and 14 to answer questions about postoperative pain and general measures of function. Data on opioid prescribing and use were collected. There were 2 primary endpoints: median morphine equivalent daily dose (MEDD) prescribed at 14 days postsurgery and median satisfaction with pain control at 14 days postsurgery.</div></div><div><h3>Results</h3><div>There were 16 patients included in the nonorder set cohort and 19 in the order set cohort. At 14 days postsurgery, the median MEDD prescribed was significantly less in the order set cohort than in the nonorder set cohort (<em>P</em> = 0.003), and there was no significant difference in patient satisfaction scores between groups.</div></div><div><h3>Conclusion</h3><div>The implementation of a multimodal order set, coupled with new patient education materials, resulted in a significant reduction in the median MEDD of prescribed opioids without negatively influencing patient satisfaction after complex shoulder interventions.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102322"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081785","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":"Development of a productivity model at a pharmacy consolidated service center","authors":"Amelia Hornaday,&nbsp;Philipp Monterroyo,&nbsp;Lindsay Reulbach,&nbsp;Catherine Bishop,&nbsp;Harrison Jozefczyk","doi":"10.1016/j.japh.2024.102298","DOIUrl":"10.1016/j.japh.2024.102298","url":null,"abstract":"<div><h3>Background</h3><div>Health systems have implemented pharmacy consolidated service centers (PCSCs) to address increased patient volume, elevated drug costs, and decreased reimbursements. Assessing pharmacy productivity remains a challenge given that metrics have historically been determined by calculations of variables that do not capture the actual work. Several investigators have demonstrated improved labor outcomes in health-system pharmacy with the use of novel productivity models. However, the utility of a novel productivity model at a PCSC has not been assessed.</div></div><div><h3>Objective</h3><div>This study aimed to develop a productivity model with validation by comparison to past time periods to represent work at a PCSC.</div></div><div><h3>Methods</h3><div>The amount of time needed to complete work was determined by performing time studies. A modified Delphi process was used to ensure an appropriate perception of workload. Time standards for each category were averaged to determine the specific relative value units, which were then multiplied by total biweekly orders and combined with fixed activities to determine the unit of service. Actual hours worked were obtained for 6 prior pay periods to compare tool productivity with actual productivity.</div></div><div><h3>Results</h3><div>Time studies were performed over a 3-month period. The total average hours per pay period calculated by the tool for repackaging was 167.4 or 2.1 full-time equivalents (FTEs) and for warehousing was 176.8 or 2.2 FTEs. Although tool productivity followed the same trends as historical calendar day productivity, it was consistently higher per pay period over the 12-week comparison.</div></div><div><h3>Conclusion</h3><div>By performing time studies, a productivity model was developed for a PCSC that generated productivity data that correlated with 12 weeks of data using a historical model. This study provides the ability to assess trends over time with a more precise evaluation of work leading to the discussion that this tool is superior to historical productivity models.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102298"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752096","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":"Long-term opioid therapy in older adults: Incidence and risk factors related to patient characteristics and initial opioid dispensed","authors":"Iftekhar Ahmed,&nbsp;Alan J. Zillich,&nbsp;Noll L. Campbell,&nbsp;Kevin M. Sowinski,&nbsp;David R. Foster","doi":"10.1016/j.japh.2024.102311","DOIUrl":"10.1016/j.japh.2024.102311","url":null,"abstract":"<div><h3>Background</h3><div>The clinical benefits of long-term opioid therapy (LTOT) are not clearly known; however, LTOT is associated with various adverse outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to estimate the incidence and risk factors associated with LTOT in adults aged ≥ 65 years.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study using Medicare claims data. Opioid-naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome variable was LTOT, defined as an opioid use episode longer than 90 days and having &gt; 60 cumulative days of supply. Predictor variables included patient characteristics, characteristics of initial opioid dispensed, and pain conditions. Multivariable logistic regression was performed to assess the association between predictors and LTOT.</div></div><div><h3>Results</h3><div>Among 162,287 participants, 10,296 (6.3%) met the definition of LTOT. Key patient characteristics associated with LTOT were age &gt; 85 years (adjusted odds ratio 1.13 [95% confidence interval 1.05–1.21]); &gt; 5 comorbidities (1.55 [1.45–1.65]); and history of drug use disorder (1.53 [1.35–1.74]), alcohol use disorder (1.38 [1.23–1.54]), tobacco use disorder (1.31 [1.23–1.40]), and opioid use disorder (2.00 [1.69–2.37]). Characteristics of initial opioid associated with LTOT were dispensing long-acting opioids (1.72 [1.21–2.44]) and concomitant use of benzodiazepines (1.16 [1.08–1.25]), gabapentinoids (1.57 [1.47–1.67]), and prescription nonsteroidal anti-inflammatory drugs (1.24 [1.17–1.31]). Anxiety disorders were associated with 1.4-1.5 times increased odds of LTOT. Moreover, initial opioid supply of ≥ 30 days led to 11-16 times higher odds of LTOT than days’ supply of 1-3 days.</div></div><div><h3>Conclusions</h3><div>Factors related to patient characteristics (age, number of comorbidities, substance use disorders, anxiety disorders) and initial opioid dispensation (duration of action, certain concomitant medications, days’ supply) are associated with LTOT in older adults. Prescribers should consider these factors when prescribing opioids to senior patients.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102311"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820028","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":"Perceptions of PGY1 residency program directors toward online pharmacy students","authors":"Mohammad Sajjad,&nbsp;Michael R. Gionfriddo,&nbsp;Branden D. Nemecek","doi":"10.1016/j.japh.2024.102300","DOIUrl":"10.1016/j.japh.2024.102300","url":null,"abstract":"<div><h3>Background</h3><div>While research has identified characteristics that improve students’ chances of matching into a postgraduate year 1 (PGY1) residency, it is unclear how graduating from an online pharmacy program affects these chances.</div></div><div><h3>Objectives</h3><div>Our qualitative descriptive study aimed to explore perceptions of residency program directors (RPDs) toward online pharmacy students and how these perceptions may affect match rankings.</div></div><div><h3>Methods</h3><div>PGY1 RPDs were identified using the American Society of Health-System Pharmacists Residency Directory, recruited via email, and interviewed with a set of prespecified open-ended questions. Interviews were digitally recorded and transcribed, with transcripts being used to develop consensus codes and consequent themes and subthemes.</div></div><div><h3>Results</h3><div>Fourteen RPDs from a variety of residency program types were interviewed. Most RPDs had positive or neutral perceptions towards online pharmacy programs. Their perceptions of the students in these programs were mixed, with some extolling drive and motivation, while others assuming laziness as motivation for pursuing an online program. RPDs mentioned that being in an online pharmacy program could negatively affect students’ skills, such as patient care and communication skills, while others felt it could positively affect self-advocacy and time management skills. Despite these concerns, RPDs reiterated they use the same criteria and advice as they would for traditional students and that it would not affect their ranking.</div></div><div><h3>Conclusion</h3><div>RPDs’ perceptions toward online pharmacy programs and the students in them were mixed, with some being concerned the nature of these programs would negatively impact skills needed for residency. Despite these concerns, RPDs reiterated these students will be assessed no differently from traditional students.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102300"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741174","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":"Comparative effectiveness of buprenorphine adherence with telemedicine vs. in-person for rural and urban patients","authors":"Thomas J. Reese,&nbsp;Nana Addo Padi-Adjirackor,&nbsp;Kevin N. Griffith,&nbsp;Bryan Steitz,&nbsp;Stephen W. Patrick,&nbsp;Ashley A. Leech,&nbsp;Andrew D. Wiese,&nbsp;Adam Wright,&nbsp;Mauli V. Shah,&nbsp;Jessica S. Ancker","doi":"10.1016/j.japh.2024.102318","DOIUrl":"10.1016/j.japh.2024.102318","url":null,"abstract":"<div><h3>Background</h3><div>Policy changes during the COVID-19 pandemic allowed buprenorphine to be prescribed for opioid use disorder via telemedicine without an in-person visit. A recently proposed change will limit buprenorphine access to 30 days without an in-person visit. Given that people living in rural areas may be disproportionally impacted by this change, we sought to better understand how buprenorphine adherence may be impacted by requiring in-person visits.</div></div><div><h3>Objective</h3><div>Compare buprenorphine adherence after telemedicine to adherence after in-person visits for patients who live in rural and urban areas.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we used electronic health record data from a large medical center. The cohort included all adult patients prescribed buprenorphine for opioid use disorder during 2017–2022. The primary outcome was adherence, characterized by the Medication Possession Ratio (MPR) and gaps in buprenorphine treatment at 30 and 180 days. We conducted a longitudinal analysis at visit level, stratified by patient urbanicity, and controlled for patient, prescriber, prescription, and setting characteristics.</div></div><div><h3>Results</h3><div>From 511 patients, we followed 3302 in-person and 519 telemedicine visits. Compared to in-person visits we observed no difference in the adherence following telemedicine visits overall. However, telemedicine was associated with higher MPR for rural patients (30 days: adjusted marginal effects [AME], 3.7%; 95% CI, 2.0–5.5; <em>P</em> &lt; 0.001 and 180 days: AME, 8.5%; 95% CI 5.7–11.3; <em>P</em> &lt; 0.001) and fewer gaps (30 days: AME, −6.7%; 95% CI, −9.9 to −0.1; <em>P</em> &lt; 0.001 and 180 days: AME, −9.4%; −14.0 to −4.5; <em>P</em> &lt; 0.001) compared to in-person visits.</div></div><div><h3>Conclusion</h3><div>These findings suggest that telemedicine is a viable alternative to in-person visits, especially for patients living in rural areas, which should help guide future policies that preserve or increase access to buprenorphine in a manner that can reduce barriers for patients.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102318"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904002","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":"Medication therapy management lifestyle and wellness program for patients in rural Arizona","authors":"David R. Axon,&nbsp;Becka Eckert,&nbsp;Terra Leon,&nbsp;Sonia Morales,&nbsp;John Ehiri,&nbsp;Aminata Kilungo,&nbsp;Thelma Okotie,&nbsp;Tenneh Turner-Warren","doi":"10.1016/j.japh.2025.102324","DOIUrl":"10.1016/j.japh.2025.102324","url":null,"abstract":"<div><h3>Background</h3><div>Pharmacist-provided medication therapy management (MTM) services have demonstrated improved clinical outcomes for patients. MTM services could incorporate additional lifestyle and wellness counseling to potentially enhance health care for underserved patients.</div></div><div><h3>Objective</h3><div>To report the outcomes of a new pharmacist-provided MTM lifestyle and wellness counseling program for underserved rural Arizonans with diabetes and/or hypertension.</div></div><div><h3>Methods</h3><div>A community health center referred rural Arizonans with type 2 diabetes and/or hypertension to the MTM pharmacist for telephonic MTM lifestyle and wellness counseling between July 2020 and June 2023. Data were collected on clinical characteristics, adherence issues, and pharmacist recommendations. A nurse reviewed the patients' electronic health record to determine which recommendations had been accepted by the primary care provider after 90 days. Summary statistics were computed.</div></div><div><h3>Results</h3><div>For 93 patients in the program, pharmacists identified many drug-drug interactions, adverse drug reactions, utilization/cost concerns, and recommended preventative vaccines. Pharmacists provided counseling for exercise, nutrition, laboratory values, and disease state education. Twenty-nine patients reported missing any doses of their medications in the past 2 weeks. Patients used a variety of methods to remind them to take their medications. A total of 309 recommendations were made by the pharmacist averaging 3.3 ± 1.4 per patient. Of these, 113 (36.6%) were accepted within 90 days. The most common recommendations made were screening needed (n = 77) and vaccination due (n = 70). The most frequently accepted recommendations by the patients' provider were reinforcing lifestyle/disease self-management strategies (61.7%) and decreasing medication dose (60.0%).</div></div><div><h3>Conclusion</h3><div>This novel MTM lifestyle and wellness counseling program demonstrated some success for underserved Arizonans with diabetes and/or hypertension. Over one-third of recommendations made by the pharmacist to the patients' primary care provider were accepted, which is encouraging in showing the value of this program but suggests further work is needed to act upon them or understand why they are not implemented.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102324"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025490","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}