American Journal of Health-System Pharmacy最新文献

{"title":"AKHOMM initiative curriculum and learning and action collaborative.","authors":"Calvin J Meaney, Joanna Q Hudson, Brendan Bowman, Andrew Traynor","doi":"10.1093/ajhp/zxaf046","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf046","url":null,"abstract":"<p><strong>Purpose: </strong>The Advancing Kidney Health through Optimal Medication Management (AKHOMM) initiative was developed with the vision that every person with kidney disease receives optimal medication management through team-based care including a pharmacist to improve kidney health. Due to the need for education and clinical practice implementation strategies, the AKHOMM initiative designed 2 educational programs to help achieve our vision: a continuing education curriculum and a learning and action collaborative (LAC).</p><p><strong>Summary: </strong>The curriculum is online, interactive, and case based, with interprofessional accreditation, to provide baseline competency in comprehensive medication management (CMM) across chronic kidney disease and address health disparities in this population. The development process involved an interprofessional approach with input from persons with kidney disease and care partners. Modules have been well received based on postactivity surveys, with over 90% of respondents (970/1,044) indicating that the activity will improve their ability to treat and manage their patients. Ongoing quality assurance of existing modules, coupled with development of new modules in prioritized areas (cardiovascular-kidney-metabolic [CKM] syndrome, glomerular diseases) will continue to provide education to the pharmacy and broader healthcare communities. The LAC was designed using implementation science principles to facilitate pharmacist inclusion in patient care teams to provide CMM to patients with CKM. Site teams will include a pharmacist, provider champion, and others coupled with an implementation coach and field expert. Through a continuous quality improvement framework, the teams will work towards achieving their bold aim over a 12-month implementation period.</p><p><strong>Conclusion: </strong>The curriculum and LAC address the current void of pharmacist-based care in CKM.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762797","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":"Cardiovascular-kidney-metabolic syndrome medications: A time to rebrand?","authors":"Rebecca Maxson, Joshua J Neumiller, Dan Aistrope, Melanie R Weltman, Sheryl Chow","doi":"10.1093/ajhp/zxaf042","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf042","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762506","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 impact of a customized electronic health record clinical decision support tool on pharmacist renal dosing interventions.","authors":"Brandyn Wilcox, James Sanders, Candace Sutton, Meagan Johns","doi":"10.1093/ajhp/zxaf071","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf071","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>A customized Epic scoring tool for monitoring medications requiring renal dose adjustment utilizing Epic Bugsy and a custom renal function trend scoring column was developed and implemented in June 2023 at UT Southwestern Medical Center (UTSW) to replace the manual review and intervention (i-Vent) documentation process.</p><p><strong>Methods: </strong>This retrospective, observational cohort study evaluated pharmacist interventions and antimicrobial dosing before and after implementation of the UTSW renal clinical pharmacist responsibility (CPR) dose adjustment tool. Adult patients (aged 18 years or older) requiring renal dose adjustment were included. The preintervention group included patients admitted between July 1 and August 31, 2022, whereas the postintervention group included patients admitted from July 1 through August 31, 2023. Patients exempt from the institutional automatic adult renal dosing guideline (ie, those with cystic fibrosis, solid organ transplantation, or bone marrow transplantation) or actively receiving renal replacement therapy during the index encounter were excluded.</p><p><strong>Results: </strong>In a comparable 2-month timespan, implementation of the renal CPR dose adjustment tool resulted in a 68.2% increase in the number of renal dosing interventions completed (P < 0.0001), a 47.2% reduction in the number of unique alerts requiring pharmacist review (P < 0.0001), and an increase in the proportion of actionable interventions per alert requiring review from 11.1% before implementation to 39.4% after implementation (P < 0.0001). Pharmacist satisfaction with the renal monitoring workflow also improved with implementation.</p><p><strong>Conclusion: </strong>In a comparable 2-month timespan, implementation of the renal CPR dose adjustment tool at UTSW resulted iin improvements in interventions completed, a reduction in alerts requiring review, an increased total duration that selected antimicrobials were dosed appropriately, and improved pharmacist satisfaction.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist-led kidney transplant care leads the path to innovation in transitions of care and ambulatory care.","authors":"Alicia Lichvar, Amanda Condon-Martinez, Adam Diamond, Jillian Descourouez, Kevin Fowler, Monica Fox, Prince Anand, David Taber","doi":"10.1093/ajhp/zxaf052","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf052","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741841","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":"Perspectives of medication-related experiences in Black persons with kidney diseases: The patient voice.","authors":"Lisa A Hillman, Curtis Warfield, Wendy L St Peter","doi":"10.1093/ajhp/zxaf043","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf043","url":null,"abstract":"<p><strong>Purpose: </strong>Black persons comprise 13.4% of the US population but represent 36% of those with kidney failure. Medication-related disparities likely contribute to these outcomes. Patient perspective provides valuable insight into what they need and want from their medications and their care.</p><p><strong>Methods: </strong>We conducted five 1.25-hour online focus group sessions via a videoconferencing app between March 30 and June 27, 2022. Our nationally recruited sample consisted of 19 adults 37 to 72 years of age who represented a broad range of educational backgrounds, all with CKD (non-dialysis-dependent, dialysis-dependent, or post kidney transplant). Semistructured guides were constructed by our team and used by moderators. Inductive thematic analysis procedures were followed. Patients representative of our study population were integral members of our research team.</p><p><strong>Results: </strong>Our analysis includes 3 major themes and associated subthemes: (1) meet patients where they are (subthemes: patient autonomy and empowerment, experience with illness, home and community support, barriers to understanding, and barriers to access; (2) the patient journey with medications (subthemes: fears with medications, frustrations and burdens with medication use, adjusting to medications, desire for awareness and explanation, preferences with medications, and helpful tools and supports; and (3) significant interactions with healthcare professionals (subthemes: barriers to building trust, type of care and interactions desired, and care team communication).</p><p><strong>Conclusion: </strong>Recognizing the patient as an individual, addressing their frustrations and needs with medications, and attending to implicit biases and strategies to overcome barriers and empower Black persons with CKD are anticipated to reduce medication- related disparities and improve health outcomes experienced by this population.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741835","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":"Transforming professional pharmacy student education and residency training in kidney disease.","authors":"Katherine H Cho, Katie E Cardone, Jean Moon, Calvin J Meaney","doi":"10.1093/ajhp/zxaf047","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf047","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741849","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's role in transforming nephrology care.","authors":"Melissa R Laub, Paul T Conway, Danuta Trzebinska, Ryan Wargo, Amanda J Condon Martinez","doi":"10.1093/ajhp/zxaf048","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf048","url":null,"abstract":"<p><strong>Purpose: </strong>To describe how pharmacists can enhance the care of individuals with chronic kidney disease by examining the role of the pharmacist in new care models.</p><p><strong>Summary: </strong>The implications of chronic kidney disease for the healthcare system, particularly for the Centers for Medicare and Medicaid Services, are profound. New payment models and the development of medications that slow progression of kidney disease are transforming the landscape of nephrology care in the US. Pharmacists can play a pivotal role as part of the interdisciplinary care team to optimize medication therapy for this population. In particular, the Kidney Care Choices value-based care model is encouraging a more holistic approach to managing kidney disease that aligns with the goals of comprehensive medication management by pharmacists. Pharmacists can leverage fee-for-service and value-based care reimbursement models in primary care and nephrology care settings to successfully implement guideline-directed medical therapy for patients with chronic kidney disease.</p><p><strong>Conclusion: </strong>The changing landscape of nephrology offers many opportunities for pharmacists to enhance patient care. More studies are needed to demonstrate the cost-effectiveness of pharmacists in this specialty to promote the expansion and impact of this role.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741845","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":"Cabotegravir/rilpivirine resistance in a patient living with HIV despite on-time administration: A case report.","authors":"Trent G Towne, Travis R Hays","doi":"10.1093/ajhp/zxaf078","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf078","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>Cabotegravir/rilpivirine (CAB/RPV) is the first long-acting antiretroviral therapy for patients with human immunodeficiency virus (HIV). It is administered via intramuscular injection into the gluteal muscle, requiring precise technique. We report the case of a patient living with HIV who developed resistance to CAB despite on-time administration of all doses.</p><p><strong>Summary: </strong>A 34-year-old man with a body mass index (BMI) of 38.42 kg/m2 who received therapy with CAB/RPV 600 mg/900 mg intramuscularly every other month for 15 months presented to the clinic for routine HIV care. An HIV viral load obtained just before the visit demonstrated a significant elevation in his viral load, which was previously undetectable. Further testing demonstrated the development of a G118R resistance-associated mutation in the virus with a class-wide effect on integrase inhibitors. Upon review, it was determined that the patient had received all doses of his medication with a 1.5-inch needle rather than the recommended 2-inch needle based on his BMI. He was subsequently switched to darunavir/cobicistat/emtricitabine/tenofovir alafenamide and quickly achieved viral suppression.</p><p><strong>Conclusion: </strong>This case demonstrates the potential for patients living with HIV to develop resistance to CAB/RPV despite on-time administration of the medication. Proper administration and timing of antiretroviral therapy for these patients is essential to ensure efficacy and safety in the management of HIV but does not completely prevent development of resistance.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727438","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":"Use of thrombin time to transition from dabigatran to intravenous unfractionated heparin in patients with acute kidney injury.","authors":"Donna Barakeh, Kevin R Donahue, Mahmoud Sabawi, Diane Dreucean","doi":"10.1093/ajhp/zxaf059","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf059","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>This case series explores the use of thrombin time (TT) to transition 2 patients from dabigatran to unfractionated heparin (UFH) in the setting of acute kidney injury (AKI) and coagulopathy concerning for dabigatran accumulation.</p><p><strong>Summary: </strong>Serial TT monitoring was employed until the value began to trend below 120 seconds, indicating ongoing drug clearance, at which point UFH was initiated. Patient 1 experienced rectal bleeding following initiation of UFH, while patient 2 experienced hemoglobin drops without an apparent bleeding source. No thrombotic events occurred during either hospitalization.</p><p><strong>Conclusion: </strong>Individualized management remains paramount to balance bleeding and thrombotic risk based on patient-specific factors. Further research is warranted to validate the safety and efficacy of a TT-guided transition strategy and optimize protocols for hospitalized patients transitioning from dabigatran to UFH.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699288","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":"Implementation of antimicrobial stewardship certification program and its impact on low-resource settings.","authors":"Richard Faator Dery, Emily Perry, Paul Carson, Elizabeth Skoy","doi":"10.1093/ajhp/zxaf077","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf077","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>Antimicrobial resistance has become an increasing concern worldwide. Antimicrobial stewardship (AMS) is a critical approach to protect against the danger of untreatable microbes. AMS programs frequently rely on the expertise of infectious diseases-trained physicians and pharmacists, yet access to such expertise is frequently limited in rural or smaller facilities like critical access hospitals (CAHs) and skilled nursing facilities (SNFs). However, nearly all these facilities have a staff or contract pharmacist available, even in more rural parts of the United States. These pharmacists may be important potential resources to promote stewardship in these low-resource settings.</p><p><strong>Summary: </strong>The North Dakota Department of Health and Human Services and North Dakota State University collaborated to provide free AMS certification to predominantly rural pharmacists through a program offered by the Society of Infectious Diseases Pharmacists (SIDP) between 2018 and 2022, except in 2020 (due to the COVID-19 pandemic). Eighty-five pharmacists out of 113 applications were selected to complete the program. The preferential selection was based on whether pharmacists worked in a CAH or SNF or were willing to assist the above healthcare facilities in AMS activities. Fifty-four percent of the participants completed the program and developed an AMS intervention at their facilities, with 32% having interventions in progress at the time of assessment and 9% lost to follow-up over 4 years.</p><p><strong>Conclusion: </strong>Pharmacists were incentivized to gain expertise in AMS in low-resource settings by providing free SIDP certification through the state health department. This may be a cost-effective use of state dollars to promote AMS in low-resource settings.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699343","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}