American Journal of Health-System Pharmacy最新文献

{"title":"Evaluation of clinical factors associated with discordant estimated glomerular filtration rate values determined from creatinine vs cystatin C.","authors":"Shemual Tsai, April Wayne, Brian L Erstad, David E Nix","doi":"10.1093/ajhp/zxaf097","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf097","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>Estimated glomerular filtration rate (eGFR) is the standard for categorizing renal function. Current creatinine-based estimates have been demonstrated to have limited accuracy, with national organizations encouraging use of cystatin C to calculate eGFR. This study aimed to describe the relationship between eGFR calculated using serum cystatin C (eGFRcysC) vs serum creatinine (eGFRcreat) using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.</p><p><strong>Methods: </strong>A retrospective review was performed for the period from July 2018 through June 2022 that included inpatient adults with a measured serum cystatin C level and a paired serum creatinine level obtained within 24 hours of each other. eGFRcreat and eGFRcysC were calculated using the CKD-EPI equations. The primary objective was to identify factors that were significantly associated with discordance between eGFRcysC vs eGFRcreat, which was expressed as the percentage difference in eGFR (eGFRpct_diff). Differences in eGFRpct_diff by patient subgroup were assessed using a paired t test or ANOVA as appropriate. Univariate and multivariate regression analyses were performed to further identify variables associated with eGFRpct_diff.</p><p><strong>Results: </strong>The study population included 226 patients. The mean (95% confidence interval) eGFRpct_diff by patient subgroup was as follows: CKD stage 4, 45.0% (25.6% to 64.4%); weight loss of greater than 10% in 1 year, -33.9% (-45.6% to -22.2%); cancer, -36.1% (-48.2% to -24.1%); and hemiplegia, -32.7% (-46.2% to -19.2%). Thirty-seven patients had at least one 24-hour urine collection for determination of creatinine clearance. Measured 24-hour creatinine clearance was better correlated with eGFRcysC (R2 = 0.754) than it was with eGFRcreat (R2 = 0.557) or creatinine clearance calculated using the Cockcroft-Gault creatinine equation (R2 = 0.288).</p><p><strong>Conclusion: </strong>Cautious interpretation is recommended when estimating renal function from serum creatinine alone in patients with conditions associated with loss of muscle mass, including weight loss, cancer, hemiplegia, and immobility.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964259","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":"Cultivating expert thinking skills for experiential pharmacy trainees.","authors":"Taryn B Bainum, Chelsea Krueger, W Anthony Hawkins","doi":"10.1093/ajhp/zxae366","DOIUrl":"10.1093/ajhp/zxae366","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e472-e478"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754563","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":"Assessing the utilization of Current Procedural Terminology codes in pharmacists' services using MarketScan data.","authors":"Smita Rawal, Jianing Xu, Xianyan Chen, Daniel B Hall, Lazara Cabrera Ricabal, Henry N Young, Joshua Caballero","doi":"10.1093/ajhp/zxae314","DOIUrl":"10.1093/ajhp/zxae314","url":null,"abstract":"<p><strong>Purpose: </strong>The Medicare Prescription Drug, Improvement, and Modernization Act and Centers for Medicare and Medicaid Services affirmation enabled pharmacists to use Current Procedural Terminology (CPT) codes for documentation and billing of clinical services. Despite legislative support and potential availability of pharmacists' clinical services, a gap may exist between the reported availability and actual prevalence of these services in real-world settings. The objective was to assess the prevalence of selected CPT codes (99605-99607, 98966-989968, and 99211-99215) in documenting and billing potential pharmacists' clinical services using recent available data.</p><p><strong>Methods: </strong>This retrospective study utilized the Merative MarketScan Medicare database from the period January 1, 2016, to December 31, 2020. The dataset included deidentified patient information and CPT codes. Patients with CPT codes for face-to-face medication therapy management (MTM) services (99605-99607), codes for telephonic assessment and management (A/M) services (98966-98968), and/or codes for evaluation and management (E/M) services (99211-99215) were identified from outpatient claims. Descriptive statistics, including prevalence rates, were calculated. This study was approved by an institutional review board and followed STROBE guidelines.</p><p><strong>Results: </strong>There were claims data for 2,784,629 enrollees from 2016 through 2020. Prevalence rates varied during this period, with lower rates for MTM face-to-face CPT codes (0.06%) and telephonic A/M codes (0.58%), while E/M CPT codes showed higher prevalence rates (87%).</p><p><strong>Conclusion: </strong>Study findings exhibited a limited adoption rate for MTM CPT codes for billing pharmacists' clinical services. Future research may focus on assessing pharmacists' perceptions and identifying facilitators and barriers to using CPT codes in billing clinical services.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e431-e437"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455878","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":"Development and implementation of an emergency alteplase kit for high-risk pulmonary embolism in cardiac arrest.","authors":"Matthew Li, Matthew Murphy, Aalok R Singh, Caitlin Aberle, Daniel M Miller","doi":"10.1093/ajhp/zxae391","DOIUrl":"10.1093/ajhp/zxae391","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e416-e418"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806039","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 risks and benefits of managing obesity in older adults.","authors":"Dana G Carroll","doi":"10.1093/ajhp/zxae288","DOIUrl":"10.1093/ajhp/zxae288","url":null,"abstract":"<p><strong>Purpose: </strong>This review discusses weight loss considerations in overweight and obese older adults.</p><p><strong>Summary: </strong>Current US guidelines do not address weight loss in older adults. Waist circumference rather than body mass index (BMI) may be a more accurate assessment tool for obesity in older adults. Weight loss interventions are not recommended in overweight older adults due to the decreased mortality in this population (known as the \"obesity paradox\"). While weight loss in obese older adults may be beneficial, it is not without risks. The greatest risks include loss of muscle mass, decline in bone mineral density, and development of sarcopenic obesity. Weight loss interventions may be considered in older adults with a BMI of greater than 30 kg/m2 who have metabolic derangements, cardiovascular disease, and/or functional impairments after carefully weighing the risks against the benefits of weight loss and the impact of interventions on the patient's quality of life. Medicare provides limited benefits for weight loss interventions. In older adults, there is no consensus on which lifestyle interventions are best for weight loss and there is a paucity of data on the use of weight loss medications. Careful consideration should be given before utilizing medications for weight loss in older adults given the enhanced adverse effect profiles, interactions, contraindications, and costs.</p><p><strong>Conclusion: </strong>Weight loss in older adults should be approached differently from that in the general adult population. More data are needed on the efficacy and safety of weight loss medications in older adults.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e419-e425"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455944","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":"Allodynia (skin tenderness) associated with semaglutide: A case series.","authors":"Jennifer Stark, Marian J Klass, Lauren Owen","doi":"10.1093/ajhp/zxaf008","DOIUrl":"10.1093/ajhp/zxaf008","url":null,"abstract":"<p><strong>Purpose: </strong>The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications are widely prescribed for management of diabetes mellitus as well as obesity or weight management. Although there have been rare reports of skin hypersensitivity associated with GLP-1RA medications, no published reports have documented allodynia or skin pain to the touch.</p><p><strong>Summary: </strong>We report 4 cases of allodynia associated with dose escalation of the GLP-1RA medication semaglutide. Each patient was prescribed semaglutide for management of obesity and developed symptoms of allodynia with the 2.4-mg subcutaneous once-weekly dose. Therapy was stopped in 2 patients, both of whom had resolution of symptoms. Two patients opted to continue semaglutide despite the adverse effect, with one experiencing resolution after 4 months. No pharmacological mechanism was identified for this unique adverse drug reaction. There was a clear temporal and dose-response relationship in each of the 4 cases.</p><p><strong>Conclusion: </strong>The 4 cases presented had scores of 5 or 6 (probable) on the Naranjo scale. It is not known whether this is a class effect of the GLP-1RA medications or if the adverse effect will consistently resolve or improve with continuation.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e426-e430"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035716","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":"Impact of using dosing criteria to refine pharmacogenomic clinical decision support for tricyclic antidepressants.","authors":"Amanda Massmann, Natasha Petry, Sarah Mills, Adwoa Adjekum, Joel Van Heukelom","doi":"10.1093/ajhp/zxae337","DOIUrl":"10.1093/ajhp/zxae337","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of dose-specific logic for tricyclic antidepressant (TCA) pharmacogenomics (PGx) clinical decision support (CDS). We aimed to provide guidance in an area with limited supporting literature, ensure optimal dosing through CDS, and limit alert fatigue. The primary outcome was the reduction in alerts prescribers encountered, while the secondary outcome included an analysis across specialties.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to examine TCA PGx CDS before and after implementation of dosing criteria for alerts. Data were abstracted from the electronic medical record. A χ2 test was performed to analyze the frequency of alerts in behavioral health and other specialties.</p><p><strong>Results: </strong>In the cohort lacking dose criteria, most TCA orders were for indications other than depression (76%) and guidelines would not apply to the majority of these orders. Using dosing criteria to refine CDS reduced the volume of TCA alerts by 74.8%. Alert volume decreased the most in specialties other than behavioral health due to prescriptions for indications other than anxiety or depression (P = 0.035).</p><p><strong>Conclusion: </strong>Dose-centric alerts may be used as a strategy to achieve optimal dosing. Alerting clinicians when dose modifications should occur contributes to getting the right dose to the right patient. Future efforts should focus on optimal dosing of medication through CDS enhancements.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e457-e464"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643238","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":"Longer-term compliance benefits of oncology-specific smart pump drug error reduction systems.","authors":"Jeanie Misko, Matthew D M Rawlins","doi":"10.1093/ajhp/zxae323","DOIUrl":"10.1093/ajhp/zxae323","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e412-e413"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492893","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 call to duty: Addressing Chicago's new migrant population's healthcare needs.","authors":"Renee Petzel Gimbar, Andrew K Posen, Matthew G Gimbar, Kirsten H Ohler, Lauren Smith, Terry L Vanden Hoek, Andrew Donnelly","doi":"10.1093/ajhp/zxae322","DOIUrl":"10.1093/ajhp/zxae322","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e413-e415"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805926","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":"Meeting the accreditation standard through implementation of a multiprogram residency advisory committee and ongoing quality improvement.","authors":"Kelsey M Rife, Colleen P LeHew, Katherine L Stypa, Candice M Wenzell","doi":"10.1093/ajhp/zxae342","DOIUrl":"10.1093/ajhp/zxae342","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the process utilized by a large multiprogram residency site to expand preceptor engagement and establish ongoing quality improvement efforts in order to meet the program's needs in response to evolving ASHP accreditation standards.</p><p><strong>Summary: </strong>A multiprogram residency advisory committee (RAC) primarily composed of residency program leadership was formed to focus on aspects of program management and accreditation compliance that were not being addressed at the monthly all-preceptor meeting. The ASHP standard and a recent residency accreditation survey guided the RAC agenda, which led to the creation of a combined manual for the institution's 5 residency programs and a preceptor manual. Preceptor engagement was improved through the establishment of local preceptor requirements, inclusion of preceptor representatives on the RAC, expansion of subcommittee opportunities, addition of a preceptor midpoint retreat, and optimization of the end-of-year preceptor retreat. Communication with residents and identification of continual improvement opportunities were improved through roundtables with residents, residency program directors, and the RAC chair; a monthly meeting with the rotating chief resident and RAC chair; and face-to-face exit interviews with the department's chief of pharmacy. The RAC chair has been a key figure in coordinating program change to meet the ASHP standard as well as leading planning for subsequent ASHP surveys.</p><p><strong>Conclusion: </strong>Through the establishment of a multiprogram RAC and a RAC chair, our program has been able to engage a large preceptor group that is dedicated to continual improvement and provides the ability to dynamically respond to ASHP's progressing guidance for pharmacy residency programs.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e465-e471"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612307","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}