American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists最新文献

{"title":"Impact of an Integrated Health System Specialty Pharmacy on Clinical and Operational Outcomes in Patients with Cystic Fibrosis.","authors":"Vi Nguyen, Martha Stutsky, Sarah Kubiak, Ryan C Perkins, Shreevidya Periyasamy, Y Caleb Chun","doi":"10.1093/ajhp/zxag275","DOIUrl":"https://doi.org/10.1093/ajhp/zxag275","url":null,"abstract":"<p><strong>Purpose: </strong>Pharmacist inclusion in the cystic fibrosis (CF) multidisciplinary care team is essential to optimize patient management and outcomes. We evaluated the impact of an integrated health system specialty pharmacy (HSSP) model paired with a pharmacist-led collaborative drug therapy management (CDTM) program on outcomes for people with CF (pwCF).</p><p><strong>Summary: </strong>In a single-center, retrospective, observational cohort study of 191 pwCF (52% male, mean age of 23) from an academic medical center who were filling prescriptions at the affiliated HSSP and enrolled in the CDTM program from September 2023 to September 2024, 67% were initiated in fewer than two days and 78% had a proportion of days covered > 80%. The average medication out-of-pocket cost for the cohort was $5.14 per prescription, with 91% having no copay. Over 12 months, there were three unplanned emergency department visits, five hospitalizations, and seven CF pulmonary exacerbations reported.</p><p><strong>Conclusions: </strong>The integration of a CDTM program with a HSSP demonstrated positive outcomes for pwCF, highlighting the value of an integrated pharmacy model and role of pharmacists in the CF care team.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Clinical Pharmacy Technician Roles to Scale Pharmacogenomics Services in a Large Integrated Health System.","authors":"Amanda McQuillan, Lisa Bryan, Shawn Dalton, Jill Bates","doi":"10.1093/ajhp/zxag270","DOIUrl":"https://doi.org/10.1093/ajhp/zxag270","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the development and early implementation of a clinical pharmacy technician model to support pharmacogenomics (PGx) services within Veterans Health Administration (VHA).</p><p><strong>Summary: </strong>VHA is the largest integrated health system implementing PGx, with 157 facilities offering testing and over 150,000 PGx orders completed. As the National Pharmacogenomics Program (NPP) scaled, Clinical Pharmacist Practitioners (CPPs) faced increasing operational demands from tasks such as patient identification, outreach and consent, laboratory coordination, and post-test triage that did not require advanced clinical training. In 2023, national PGx leaders, regional pharmacy executives, and local PGx champions designed a PGx Clinical Pharmacy Technician (CPhT) role to reallocate operational duties while preserving pharmacist responsibility for advanced PGx care and program leadership. Six CPhT positions were created in 2024 at national, regional, and local levels as a pilot in 2 regions with differing models and nationally to support targeted PGx care.PGx CPhT responsibilities include reviewing dashboards to identify patients for testing, providing scripted PGx education and answering common questions, documenting oral informed consent, triaging low- and moderate-risk gene-drug alerts, and preparing draft notes for pharmacist review. PGx pharmacists provided standardized training in PGx fundamentals, communication, informatics tools, and electronic health record workflows. CPhTs also coordinated lab appointments when needed and reminded Veterans when PGx orders were nearing expiration. Early qualitative experience suggests reduced administrative workload for CPPs, improved timeliness and reliability of PGx processes, and enhanced technician career advancement, with no voluntary CPhT turnover to date.</p><p><strong>Conclusion: </strong>This paper describes a PGx technician-pharmacist model that has been successfully piloted within our healthcare system and may be feasible in other settings. It outlines roles and training structures to support replication and offers a potentially adaptable approach for health systems seeking to operationalize PGx within existing pharmacy resources.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Unni et al.","authors":"Ravi Patel, Ryan Shirk, Ashish Advani, Indrani Kar, Faria Maisha Munir, Scott D Nelson, Maha Saad, Timothy Dy Aungst","doi":"10.1093/ajhp/zxag261","DOIUrl":"https://doi.org/10.1093/ajhp/zxag261","url":null,"abstract":"","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pharmacist practitioner-led clinic improves Helicobacter pylori treatment and eradication testing: A quality improvement initiative.","authors":"Samantha A Menegas, Sabrina Layne, Sachiko M Oshima, Collins Mbonu, Daniel Bernstein, Rachel Britt, Jill Moore, Brian A Sullivan","doi":"10.1093/ajhp/zxag269","DOIUrl":"https://doi.org/10.1093/ajhp/zxag269","url":null,"abstract":"<p><strong>Purpose: </strong>Many patients treated for Helicobacter pylori (HP) do not complete guideline-recommended post-treatment eradication testing. Patients diagnosed via esophagogastroduodenoscopy (EGD) face unique barriers due to fragmented handoffs between providers. We describe the development and early outcomes of a Clinical Pharmacist Practitioner (CPP)-led clinic designed to improve HP management for EGD-diagnosed patients.</p><p><strong>Summary: </strong>We developed a centralized CPP-led clinic to assume responsibility for HP regimen selection, eradication test ordering, and follow-up. The option for referral to this clinic was integrated into an existing EGD results notification workflow for patients with newly diagnosed HP. Comparing a pre-intervention period (October 2022-March 2024, n=105) to a post-intervention period (May 2024-October 2025, n=111), guideline-concordant prescribing increased from 32.4% to 90.8% (p<0.001), testing completion within 6 months increased from 37.1% to 61.3% (adjusted odds ratio 2.88, p<0.001), and eradication among tested patients improved from 82.1% to 92.6%. With extended follow-up, testing completion increased from 62.9% pre-intervention to 84.7% post-intervention (p<0.001), and eventual eradication among those tested increased from 87.9% to 98.9% (p=0.003).</p><p><strong>Conclusion: </strong>A centralized CPP-led clinic significantly improved guideline-concordant prescribing, eradication testing completion, and confirmed eradication for EGD-diagnosed HP patients. This scalable model addresses care fragmentation by centralizing the complete care pathway for HP management.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous ChatGPT-4o outputs for type 2 diabetes pharmacotherapy: Accuracy, usefulness, and impact variability.","authors":"Joshua Caballero, Beth Bryles Phillips, Rebecca H Stone, Robin Southwood, Sharmon P Osae, Devin Lavender, Michelle McElhannon, Katie Smith, Richard Lamb, Lorenzo Villa Zapata, Russ Palmer","doi":"10.1093/ajhp/zxag265","DOIUrl":"https://doi.org/10.1093/ajhp/zxag265","url":null,"abstract":"<p><strong>Purpose: </strong>The primary objective of the study was to determine how clinically accurate and useful are ChatGPT-4o-generated outputs when identical prompts are entered simultaneously in three independent ChatGPT sessions utilizing the same user-facing model. The secondary objective was to identify if differences in outputs affect clinical outcomes (i.e., impact variability).</p><p><strong>Methods: </strong>Five clinical prompts were developed focusing on diabetes management and counseling. Each clinical prompt was simultaneously inputted into three separate devices using ChatGPT-4o to generate outputs. A modified Delphi technique was then utilized involving five diabetes management clinical pharmacists. Each clinical pharmacy faculty independently rated each ChatGPT-generated output based on accuracy (i.e., poor, borderline, good) usefulness (i.e., not useful, somewhat useful, very useful) and impact variability (i.e, low, moderate, high). After initial assessment, responses were collated and anonymously shared among the pharmacy faculty. The faculty members were invited to revise their evaluations based on collective feedback. Pharmacy faculty then convened in a virtual panel with moderators to discuss evaluations and work towards consensus.</p><p><strong>Results: </strong>Consensus was achieved for all ChatGPT outputs. Accuracy ratings ranged from borderline to good. Two of the clinical prompts yielded outputs receiving different accuracy ratings which may have impacted variability. Usefulness ratings ranged from somewhat useful to very useful, with one clinical prompt yielding outputs that received different usefulness ratings.</p><p><strong>Conclusion: </strong>While outputs were generally accurate and useful, limitations and inconsistencies were noted. Users should be aware simultaneously generated outputs across multiple devices using ChatGPT can vary in their accuracy and usefulness in diabetes management.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Going Beyond Green: Reframing Sustainability Within Health-System Priorities.","authors":"Polly Jen","doi":"10.1093/ajhp/zxag274","DOIUrl":"https://doi.org/10.1093/ajhp/zxag274","url":null,"abstract":"","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a coordinated national pharmacy workforce research and data strategy.","authors":"Brianne K Bakken, Taylor L Watterson, David A Mott","doi":"10.1093/ajhp/zxag267","DOIUrl":"https://doi.org/10.1093/ajhp/zxag267","url":null,"abstract":"<p><strong>Purpose: </strong>The pharmacy workforce is experiencing persistent challenges related to employee well-being, staffing shortages, turnover, and evolving practice and payment models. Despite widespread recognition of these issues, progress has been hindered by fragmented workforce data and the absence of a coordinated national research strategy. The purpose of this commentary is to articulate a vision for a coordinated national pharmacy workforce research and data strategy, describe the infrastructure needed to accelerate evidence-based workforce solutions, and propose immediate research areas of focus.</p><p><strong>Summary: </strong>Drawing on insights from the 2025 Implementing Solutions Summit 2.0, this commentary highlights critical limitations in the current approach to pharmacy workforce research, including inconsistent terminology and measures, siloed data collection, and limited capacity to conduct large, multi-site studies. These limitations impede benchmarking, supply and demand modeling, and the evaluation of workforce and workplace interventions. Expanding the scope and infrastructure of the existing Pharmacy Workforce Center (PWC) could address these gaps by leading workforce measurement standardization, conducting multi-site research studies, coordinating data aggregation through a centralized data warehouse, and developing more robust modeling of pharmacy workforce supply and demand.</p><p><strong>Conclusion: </strong>Broadening and strengthening the workforce research and data infrastructure within the existing PWC represents a necessary and critical next step for advancing the pharmacy workforce. A centralized national strategy is essential to generate robust and actionable evidence that supports pharmacy workforce sustainability, practice model advancement, as well as policy and payment reforms.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A missing voice at the ethical table: The role of pharmacists on institutional ethics committees.","authors":"Jared C Sheneman, Jeffrey S Farroni","doi":"10.1093/ajhp/zxag268","DOIUrl":"https://doi.org/10.1093/ajhp/zxag268","url":null,"abstract":"<p><p>Institutional ethics committees (IECs) are designed to support complex clinical and organizational decision making through interdisciplinary collaboration. Despite the central role of medications in many ethically challenging scenarios, pharmacists are often absent from formal IEC membership. This omission represents a structural gap in ethical deliberation within many modern health systems. Pharmacists routinely navigate decisions involving medication safety, access, cost, allocation, and appropriateness across both inpatient and outpatient settings, many of which carry significant ethical implications. Their training uniquely positions them at the intersection of clinical care, operational feasibility, and system-level stewardship. As healthcare complexity continues to increase, driven by rising drug costs, supply chain instability, and the expansion of high-cost and advanced therapies, medication-related ethical challenges are becoming more prominent. Pharmacists bring a clinical, operational, and patient-focused perspective that enhances the practicality and implementation of ethical recommendations, particularly in areas such as end-of-life care, drug shortage management, and transitions of care. Their involvement can help ensure that ethical decisions are not only theoretically sound but also feasible across the continuum of care. This commentary argues for the intentional inclusion of pharmacists on IECs and highlights their potential contributions to ethical deliberation, policy development, and case consultation. It also emphasizes the importance of engagement from both health systems and pharmacy professionals to close this gap. Expanding pharmacy representation on IECs aligns with national guidance on interdisciplinary ethics consultation and reflects the evolving role of pharmacists as integral contributors to patient care and health system leadership.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the consistency and efficiency of auxiliary labeling using EHR-integrated color printing technology.","authors":"Kevin Smith, Cindy Brasher, Nick Thomas, Justin Kelly, David Aguero, Alysa Baumann","doi":"10.1093/ajhp/zxag260","DOIUrl":"https://doi.org/10.1093/ajhp/zxag260","url":null,"abstract":"<p><strong>Purpose: </strong>Manual application of auxiliary labels to compounded sterile preparations (CSPs) can introduce variability, workflow inefficiencies, and risk for omitted safety information. This article describes the design, implementation, and evaluation of electronic health record (EHR)-integrated color auxiliary labels to improve labeling accuracy, consistency, and operational efficiency in a pediatric institution.</p><p><strong>Methods: </strong>Automated color auxiliary labels were embedded within EHR post-verification labels for CSPs across 3 pharmacy settings. The intervention included printer and label stock selection, standardized label design with prioritization logic, EHR rule development, medication record validation, and phased hardware deployment. Pre- and postimplementation surveys assessed perceptions of labeling accuracy and workflow impact. Operational metrics included estimated technician time savings, supply utilization, and cost analysis.</p><p><strong>Results: </strong>Automation eliminated a manual labeling step, averaging an estimated 12.5 seconds per dispense, corresponding to approximately 38 technician hours per month (0.22 full-time equivalents). Staff confidence in accurate auxiliary label application improved, with the frequency of low-confidence responses declining from 20% before implementation to 6.1% after implementation. The automated label logic standardized placement and reduced variability associated with manual processes. Implementation required capital investment for color printers and increased the annual label cost by approximately 29%. Postimplementation monitoring demonstrated stable supply utilization, which was below initial projections.</p><p><strong>Conclusion: </strong>Integration of automated color auxiliary labels within the EHR improved workflow efficiency, enhanced labeling consistency, and increased staff confidence with minimal cost implications. This offers a practical framework for health systems seeking to standardize labeling without major EHR infrastructure changes.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative evaluation of a fracture liaison service in an academic healthcare system.","authors":"Hannah D Bauguess, Lucia Hoang, Sara A Wettergreen, Alexandra Marcus, Lisa M Schilling, Micol S Rothman, Sunny A Linnebur, Danielle R Fixen, Sarah J Billups","doi":"10.1093/ajhp/zxag262","DOIUrl":"https://doi.org/10.1093/ajhp/zxag262","url":null,"abstract":"<p><strong>Purpose: </strong>Osteoporosis is an often underdiagnosed and undertreated disease despite its serious consequences. To bridge this gap, fracture liaison services (FLSs) have been implemented in institutions for patients with fractures. Our institutional FLS provides centralized outreach for patients with new fractures and is supported by embedded clinical pharmacists. It has been demonstrated to improve process outcomes, but there is still room for growth. This qualitative evaluation sought to capture healthcare professionals' perspectives on FLS processes, successes, and barriers, to determine how the service could be further improved.</p><p><strong>Methods: </strong>We conducted 22 semistructured interviews with those who delivered the service and primary care providers (PCPs) who utilized the service. We used thematic analysis and a rapid qualitative approach to identify emerging themes.</p><p><strong>Results: </strong>We identified 6 overarching themes. Successes included helping to identify patients whose new osteoporosis diagnosis might have been overlooked or gone untreated despite the presence of a new fracture, streamlining the process to make it easier for PCPs to address osteoporosis, and providing education for patients and PCPs. Challenges included programmatic issues such as workflow inconsistencies, systemic delays in obtaining laboratory results and dual-energy X-ray absorptiometry scans, and the inappropriateness of the service for some medically complex patients.</p><p><strong>Conclusion: </strong>PCPs recognize the value of the FLS program; however, challenges can hinder optimal execution of service components. Opportunities for improvement include more timely communication between the delivery team and PCPs, clearer documentation processes, and further disease state education for both PCPs and patients.</p>","PeriodicalId":520552,"journal":{"name":"American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}