American Journal of Health-System Pharmacy最新文献

{"title":"A systematic analysis of package insert information referencing race and ethnicity for 100 medications commonly used in critically ill patients.","authors":"Brian L Erstad, Jason Agundez, Naomi Nishikawa, Ali Qasemi, Nancy A Alvarez","doi":"10.1093/ajhp/zxaf087","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf087","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>To evaluate the use of terms denoting race/ethnicity in product labeling for 100 of the medications most commonly used in critically ill patients and to assess this information for overall frequency, frequency by drug class, and frequency within package insert sections to highlight the need for standardized and consistent use of Food and Drug Administration-approved terminology in drug packaging and other informational materials.</p><p><strong>Methods: </strong>Data were collected by reviewing individual drug manufacturer package inserts. Each package insert was assessed for terminology that explicitly referenced race or ethnicity, and these terms were coded and quantified. After evaluating each of the 100 package inserts, a spreadsheet detailing the usage and presence of race and ethnicity terminology, including its location within the insert and frequency was created. This composite list was then analyzed to identify patterns in using such terminology.</p><p><strong>Results: </strong>A cumulative analysis of all race/ethnicity-based terminology found in the package inserts for the top 100 intensive care unit drugs demonstrated that race/ethnicity-related terminology occurred 94 times in 21 package inserts. Summarizing these categories by number of occurrences showed that the race/ethnicity-based term \"Black\" occurred most frequently (in 29.8% [28/94] of package inserts]). Concerning the frequency of race/ethnicity-related terminology by agent class, the most frequent use of these terms was (in descending order): diabetes medications, anticoagulation, antimicrobials, antihypertensives, and medications used for cholesterol/lipid lowering. Regarding the frequency of the terms in the main sections of a package insert, most of these terms (a third of the total occurrences) were in the \"Adverse Reactions\" section (in 31.9% [30/94] of package inserts]).</p><p><strong>Conclusion: </strong>Some of the terminology found in the package inserts in our study was either not listed or specifically not recommended for use in federal government reporting. These findings elucidate the prevalence and contexts in which race/ethnicity-related terminology is employed, highlighting its potential impact on clinical decision-making and drug use evaluation.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810080","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":"A pharmacy resident-driven virtual pharmacogenomics clinic: Utilizing population dashboard management tools to identify veterans who may benefit from testing.","authors":"Lauren Jackson, Emily Brandl, Daniel Neu, Jacob Marler","doi":"10.1093/ajhp/zxaf090","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf090","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Expanding access to pharmacogenomics (PGx) testing to veterans has been an emphasis in the Veterans Health Administration (VHA); using population dashboard tools (PDTs) may identify additional patients who qualify for testing. Involving pharmacy residents in PGx can help prepare them for precision medicine practice and more efficiently provide PGx care to patients.</p><p><strong>Methods: </strong>Veterans treated in the outpatient setting at the Lt. Col. Luke Weathers, Jr. Veterans Affairs (VA) Medical Center from March 2023 to June 2024 were included in this study. Upon creation of a virtual PGx clinic, a PGx PDT was used to identify patients newly prescribed medications on the VA PGx gene testing panel. The clinic was driven by a postgraduate year 2 pharmacy resident with a preceptor overseeing the practice, and patients were contacted for consent and testing. The number and type of PGx gene variants identified were assessed, with results discussed with patients and recommendations made to providers.</p><p><strong>Results: </strong>A total of 130 patients were screened, of whom 104 had PGx testing, corresponding to an 80% consent rate. Overall, 247 PGx gene variants were identified, including 149 informational and 78 actionable drug-gene variants, 18 variants indicating inheritable conditions, and 17 variants corresponding to phenoconversion. A total of 90 recommendations were made to providers, and patients had an average of 2.3 PGx-impacted medications prescribed. Of the actionable drug-gene variants, the majority were related to use of clopidogrel, statins, sertraline, and proton pump inhibitors.</p><p><strong>Conclusion: </strong>Novel use of a PDT was helpful in identifying patients qualifying for PGx testing. Creation of the resident-driven clinic resulted in PGx interventions for the majority of patients who underwent testing.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810163","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":"Developing an autoverification framework for medication orders at UNC Health.","authors":"Noemie M Kanene, Kayla Waldron, Mary-Haston Vest, Stephen F Eckel","doi":"10.1093/ajhp/zxaf081","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf081","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Autoverification (AV) is the process in which a medication is automatically verified in the electronic health record, bypassing a pharmacist's approval. If concerns of safety and efficacy for AV are addressed, broad implementation can allow AV to be a powerful tool within a hospital system to verify high-volume, low-risk medication orders. This study aims to identify parameters for risk stratification of medications and develop a replicable framework model for identifying medications appropriate for AV at UNC Health.</p><p><strong>Methods: </strong>The modified Delphi methodology was utilized to reach consensus on parameters used in a risk stratification tool for medication orders. This tool was applied retroactively to a sample of medication orders at UNC Health during a 1-month period (October 2023) to determine risk of adverse event for potentially autoverified orders.</p><p><strong>Results: </strong>Fifty-five criteria met consensus for consideration for use for an AV risk appraisal tool. Results from a consensus meeting for criteria that would be used in the autoverification risk appraisal tool (AVRAT) to flag medication orders as \"high-risk for AV\" were age, estimated glomerular filtration rate, hemoglobin level, platelet count, body weight, and EHR documentation of continuous renal replacement therapy. Twenty medications were selected for an initial proof-of-concept evaluation of the AVRAT. Using AVRAT criteria, it was determined that a total of 6.89% of all October medication orders at UNC Health posed a low risk of a potential adverse event with AV.</p><p><strong>Conclusion: </strong>A proof-of-concept study for the utilization of AV was effectively developed. The study results indicated that AV can possibly reduce time for medication order review across a hospital system, with a relatively small number of orders being potentially eligible for AV.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810219","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":"Reflections on nephrology pharmacy practice.","authors":"Katie E Cardone","doi":"10.1093/ajhp/zxaf049","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf049","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810224","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":"Antimicrobial-induced neutropenia in patients receiving OPAT or COpAT: A large multisite retrospective cohort study.","authors":"Megan Edwards, Amy Van Abel, Omar Abu Saleh, Doug Challener, Kristin Cole, Kelsey Jensen, Peter Martin, Margaret Pertzborn, Abinash Virk, Christina G Rivera","doi":"10.1093/ajhp/zxaf086","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf086","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Data regarding the incidence, onset, and management of complex outpatient antimicrobial therapy-induced neutropenia (COIN) are limited, and pharmacist involvement in COIN management has not been reported. This report describes the incidence, onset, and management of COIN at a large academic medical center.</p><p><strong>Methods: </strong>This multisite retrospective cohort study examined adult patients undergoing serum laboratory monitoring for antimicrobials over a 4-year period. Patients receiving chemotherapy or immunosuppressants were excluded. Data collected included the antimicrobial regimen, complete blood count, duration of antimicrobial therapy until outcome occurrence, infectious syndrome, type of intervention, outcome, and pharmacist involvement. Logistic regression was used to assess risk factors for COIN incidence. The primary outcome was the incidence of COIN by antimicrobial drug.</p><p><strong>Results: </strong>From 4,261 treatment episodes, 161 cases of COIN were identified (3.8% COIN incidence). The most common antimicrobials associated with COIN were intravenous piperacillin/tazobactam, cefepime, and meropenem. The majority of COIN events were attributed to a combination of at least 2 antimicrobials. Piperacillin/tazobactam was significantly associated with higher odds of developing COIN (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.04-3.34; P = 0.038), whereas ertapenem was associated with significantly lower odds of COIN (OR, 0.43; 95% CI, 0.24-0.77; P = 0.005). The median time to neutropenia diagnosis was 22 days (interquartile range, 14-29 days) from the time of inpatient antimicrobial start. Intervention for COIN occurred in 66.5% of cases, with neutrophil count recovering in 96.9% of these patients. Clinical pharmacists initiated 74.8% of interventions.</p><p><strong>Conclusion: </strong>COIN can be effectively identified and managed by a multidisciplinary team reviewing routine laboratory monitoring, enabling most patients to safely complete antimicrobial treatment.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810113","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":"Deprescribing in chronic kidney disease: An essential component of comprehensive medication management.","authors":"Marisa Battistella, Jo-Anne Wilson, Angelina Abbaticchio, Patrick Gee, Rasheeda Hall","doi":"10.1093/ajhp/zxaf051","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf051","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802258","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 pharmacist as a key member of the kidney care team.","authors":"Christie Schumacher, Obidiugwu K Duru, Saugar Maripuri, Glenda Roberts, Elizabeth Van Dril","doi":"10.1093/ajhp/zxaf050","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf050","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802266","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":"On the Frontlines of Cardiovascular-Kidney-Metabolic Syndrome: A Review of GLP-1 and Dual GLP-1/GIP Receptor Agonists in Cardiovascular and Kidney Health.","authors":"Lavinia Salama, Levi Sinn","doi":"10.1093/ajhp/zxaf053","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf053","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this review is to highlight the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists (GLP-1/GIP RAs) in managing cardiovascular-kidney-metabolic (CKM) syndrome, focusing on their cardiovascular (CV) and kidney-protective effects beyond glycemic control.</p><p><strong>Summary: </strong>In multiple randomized controlled trials, GLP-1 RAs were demonstrated to confer significant benefits in reducing CV events and preserving kidney function in patients with preexisting atherosclerotic cardiovascular disease (ASCVD) and those at high CV risk. Current guidelines, including those from the Kidney Disease: Improving Global Outcomes (KDIGO) initiative and the American Diabetes Association (ADA), underscore the therapeutic potential of these agents for managing chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and metabolic syndrome. Additionally, emerging data suggests their utility beyond T2DM. This review summarizes the evidence supporting these guidelines, along with newer findings not yet fully integrated into clinical practice. It also examines the role of pharmacists and multidisciplinary teams, safety considerations, and practical strategies for managing common adverse effects.</p><p><strong>Conclusion: </strong>The integration of GLP-1 RAs and dual GLP-1/GIP RAs into clinical practice offers substantial benefits for patients, both with and without diabetes. Pharmacists play a pivotal role in recommending evidence-based treatments for those at high CV and kidney risk, educating patients, addressing social determinants of health, and bridging gaps across multidisciplinary care teams.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802263","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":"Using guideline-directed medical therapies to improve kidney and cardiovascular outcomes in patients with chronic kidney disease.","authors":"Thelma Barber, Joshua J Neumiller, Michelle A Fravel, Robert L Page, Katherine R Tuttle","doi":"10.1093/ajhp/zxaf045","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf045","url":null,"abstract":"<p><strong>Purpose: </strong>An estimated 37 million people currently live with chronic kidney disease in the US, which places them at increased risk for kidney disease progression, cardiovascular disease, and mortality. This review discusses current standard-of-care management of patients with chronic kidney disease, identifies key gaps in care, and briefly highlights how pharmacists can address gaps in care as members of the multidisciplinary care team.</p><p><strong>Summary: </strong>Recent advances in guideline-directed medical therapies for patients with chronic kidney disease, including agents from the sodium-glucose cotransporter, glucagon-like peptide-1 receptor agonist, and nonsteroidal mineralocorticoid receptor antagonist classes, can dramatically improve cardiovascular-kidney-metabolic care and outcomes. Unfortunately, gaps in screening, diagnosis, and implementation of recommended therapies persist. Team-based models of care-inclusive of the person with chronic kidney disease-have the potential to significantly improve care and outcomes for people with chronic kidney disease by addressing current gaps in care.</p><p><strong>Conclusion: </strong>As members of the multidisciplinary care team, pharmacists can play a critical role in addressing current gaps in care, including optimized use of guideline-directed medical therapies, in patients with chronic kidney disease.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802268","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":"KDIGO 2024 clinical practice guideline on evaluation and management of chronic kidney disease: A primer on what pharmacists need to know.","authors":"Linda Awdishu, Rebecca Maxson, Chelsea Gratt, Tamara Rubenzik, Marisa Battistella","doi":"10.1093/ajhp/zxaf044","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf044","url":null,"abstract":"<p><strong>Purpose: </strong>To review the key updates in the 2024 KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease (CKD) and highlight the essential role of pharmacists in implementing these recommendations.</p><p><strong>Summary: </strong>The updated guideline introduces significant changes in CKD management, including the use of validated equations for estimating glomerular filtration rate (GFR) for drug dosing, with incorporation of serum cystatin C into GFR estimates for specific patient populations, and an emphasis on a comprehensive approach to delay disease progression. The guideline recommends sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy for kidney disease with proteinuria, with or without diabetes, renin-angiotensin-aldosterone system inhibitors (RAASi) blood pressure control and proteinuria management, and statins to reduce the risk of atherosclerotic cardiovascular disease. New evidence supports the use of finerenone in patients with type 2 diabetes and CKD, and GLP-1 receptor agonists for their kidney-protective effects. The guidelines also emphasize the importance of nephrotoxin stewardship and prevention of acute kidney injury through patient education on sick day medication management.</p><p><strong>Conclusion: </strong>Pharmacists play a crucial role in implementing these updated guidelines through comprehensive medication management, nephrotoxin stewardship, drug dosing adjustments, and patient education. Their involvement in interprofessional care teams is essential for optimizing health outcomes in patients with CKD.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802261","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}