American Journal of Health-System Pharmacy最新文献

{"title":"Using machine learning to predict pharmaceutical interventions during medication prescription review in a hospital setting.","authors":"Erin Johns, Ahmed Guendouz, Laurent Dal Mas, Morgane Beck, Ahmad Alkanj, Bénédicte Gourieux, Erik-André Sauleau, Bruno Michel","doi":"10.1093/ajhp/zxaf089","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf089","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>Objective: </strong>Medication errors are a worldwide public health issue. Reducing inappropriate medication use is a daily challenge for clinical pharmacists. Computerization of the medication process and the rise of artificial intelligence make it possible to develop tools to detect inappropriate prescriptions. Our main goal was to compare the performance of two machine learning models capable of predicting the probability of a prescription requiring pharmaceutical intervention (PI) using hospital data.</p><p><strong>Methods: </strong>The study was conducted in a single hospital, with data collected over 4 years, including 2,059,847 prescription lines ([INSERT DEFINITION]) associated with 260,611 PIs. Two tree-based binary classification machine learning models were tested: the Light Gradient Boosting Machine (LGBM) model and the Random Forest (RF) model. The dataset was split (70% for training and 30% for testing), and training and testing were performed on the global dataset and on data stratified by medical care department.</p><p><strong>Results: </strong>For the global dataset, the LGBM model outperformed the RF model in most metrics: accuracy (86% vs 85%), precision (80% vs 42%), specificity (97% vs 89%), area under the curve (83% vs 71%) and F1-score (58% vs 47%). However, the RF model had superior recall (53% vs 46%). Furthermore, the LGBM model trained on the global database was generally more effective than models trained on the care departments' databases.</p><p><strong>Conclusion: </strong>The LGBM model showed superior performance in detecting inappropriate prescriptions, potentially improving the thoroughness and efficiency of prescription review. While further studies are needed to confirm these findings, the model holds significant promise for advancing hospital clinical pharmacy and enhancing patient care through optimized prescription management.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963808","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":"Suzetrigine.","authors":"","doi":"10.1093/ajhp/zxaf054","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf054","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959608","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":"Dulaglutide use to improve binge eating behaviors in a person with type 2 diabetes and obesity.","authors":"Britnee Innocent, Amre A Elmaoued, Kevin Cowart, Raechel T White","doi":"10.1093/ajhp/zxaf088","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf088","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>Binge eating disorder (BED) is a psychological disorder that poses several functional consequences for those affected. Management of BED centers around psychological and pharmacological treatment modalities, which have been associated with variable efficacy and the potential for severe adverse effects. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), approved by the Food and Drug Administration for conditions such as diabetes and weight management, are an emerging therapy of interest in BED.</p><p><strong>Summary: </strong>In this case report, we describe use of dulaglutide for treatment of a patient with BED, obesity, and type 2 diabetes mellitus. The patient's baseline binge eating scale (BES) score, glycated hemoglobin level, body mass index (BMI), and weight were obtained. Following these baseline assessments, dulaglutide 0.75 mg once weekly was initiated to optimize management of the patient's type 2 diabetes. Follow-up measurements were obtained 6 weeks after initiation, at which time reductions in the patient's BES score, BMI, weight, and BED symptoms were observed. Moreover, dulaglutide was well tolerated without adverse drug events.</p><p><strong>Conclusion: </strong>This case report describes the use of dulaglutide in the management of mild BED in the setting of comorbid type 2 diabetes and obesity. Further research is necessary to evaluate the long-term effectiveness of GLP-1 RAs in the management of BED and to determine the optimal duration and dose.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963088","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":"Cosibelimab.","authors":"","doi":"10.1093/ajhp/zxaf055","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf055","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965909","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":"Description of a pharmacist-led employee wellness hypertension program utilizing remote monitoring devices.","authors":"Megan Gushrowski, Michael J Rush, Karen L Kier, Jessica Hinson","doi":"10.1093/ajhp/zxaf084","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf084","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>The design, implementation, and impact of a pharmacist-led employee wellness hypertension program that utilizes remote blood pressure monitoring are described.</p><p><strong>Summary: </strong>Employees of a private university and health insurance beneficiaries with a diagnosis of hypertension or a documented high blood pressure reading at a previous screening encounter were eligible to participate in the program. Participants received a remote blood pressure monitoring device and followed up with a pharmacist in person or via telehealth throughout the program. The pharmacist provided education on lifestyle modifications to improve blood pressure control, and recommendations regarding changes to the participant's medication therapy were made to the participant's primary care provider. Participants completed an in-person appointment at month 3 of the program for blood pressure reassessment. Twenty-four participants were enrolled in the program. The mean baseline systolic and diastolic blood pressures were 134 mm Hg and 85 mm Hg, respectively. Of the total of 24 participants, 18 participants (75%) had a blood pressure above their goal at baseline. At month 3 of the program, 7 of these 18 participants (39%) had achieved their blood pressure goal, with average systolic and diastolic blood pressure decreases of 8.9 mm Hg and 7.8 mm Hg, respectively. Pharmacist recommendations to primary care providers regarding medication changes had an acceptance rate of 70%.</p><p><strong>Conclusion: </strong>A pharmacist-led employee wellness hypertension monitoring program that utilized remote monitoring devices improved employee blood pressure control through education on lifestyle modifications and medication recommendations to the participants' primary care providers.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967045","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 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}