Implementing a Pharmacist-Led Primary Care Pharmacogenomics Medication Management Service.

Background: Pharmacogenomics (PGx) is a tool to guide optimal medication selection. Increased demand for personalized medicine and the growing occurrence of chronic diseases are drivers for pharmacogenomic medication management services. A review of implementation models identified a paucity of models delivering these services utilizing pharmacists in primary care. Lack of standardization of this process remains a barrier to widespread implementation within health systems. Purpose: Describe the process of developing an institutional guidance document and applying it to implement a pharmacogenomics medication management service at clinic sites within an integrated health system in the United States. Measure the growth in the number of PGx visits completed. Method: A task force of pharmacists reviewed literature, guidelines, and institutional policies to create a comprehensive guidance document. The document included six minimum practice requirements for implementation in the primary care setting, and six additional recommendations. A retrospective chart review of all face to face, phone and eConsult PGx visit types occurring from January 1, 2022 through September 30, 2022 was conducted. Results: A pharmacist-led pharmacogenomics medication management service is now offered at all primary care sites within the health system. During the study timeframe, 1378 patients had a PGx visit, resulting in 1939 PGx visits. Of those visits, 1777 (92%) were referred by a primary care provider and 1675 (86.7%) were conducted by a primary care pharmacist. Twenty-nine primary care pharmacists offered the PGX service and 25 (89%) completed at least one visit. Patients were referred by providers from 56 of the 64 (87.5%) primary care departments. Conclusions: Developing an institutional process and guidance document for the implementation of a new pharmacist-led pharmacogenomics medication management service at clinic sites within an integrated health system was beneficial in developing and standardizing the workflow. Dissemination of workflow expectations to the primary care providers and pharmacists resulted in adoption of the service.

Impact of a Pharmacist-Led Warfarin to Direct Oral Anticoagulant Conversion Initiative during the COVID-19 Pandemic.

Purpose: To assess the impact of a pharmacist-led warfarin to DOAC conversion initiative during the COVID-19 pandemic. Methods: Patients who were prescribed warfarin and followed with the anticoagulation clinic for INR monitoring were assessed by outpatient clinical pharmacists as potential candidates for transition to DOACs from March-August 2020. Results: 530 patients were assessed for transition to DOACs, of which 373 (70.4%) were deemed by clinical pharmacists to be candidates for DOACs. Of the patients who were candidates for DOACs, 66 (17.7%) were transitioned from warfarin to a DOAC. Of the patients who transitioned to a DOAC, 59 (89.4%) remained on a DOAC after one year. Conclusion: Outpatient clinical pharmacists are an effective resource to help identify patients who are candidates for DOACs and assist with transition from warfarin. Further, high persistence rates with DOAC therapy after one year demonstrate the positive impact of the clinical pharmacist on medication adherence.

Effect of an Integrated Clinical Pharmacist on the Drivers of Provider Burnout in the Primary Care Setting.

PURPOSE: As the prevalence of provider burnout continues to increase, it is critical to identify interventions that may impact provider satisfaction, such as an integrated clinical pharmacist. This study aimed to assess the perceived effect of pharmacist integration on primary care provider satisfaction and drivers of provider burnout in the primary care setting. METHODS: A cross-sectional survey with 11 questions across 4 domains was distributed to primary care providers in a large integrated health system. RESULTS: Of 295 providers invited to take the survey, 119 responded (40% response rate). Most providers had worked with a pharmacist for at least 2 years and utilized them weekly or daily. At least 87% of provider respondents strongly agreed or somewhat agreed that the integrated clinical pharmacist reduced their workload by working directly with patients and non-provider staff, improved overall medication use, helped patients meet health goals and quality measures, and overall helped them to effectively manage their panel of patients. Providers found greater meaning in work through the presence of the clinical pharmacist, which allowed them more time to focus on professionally fulfilling aspects of their work and helped them feel less emotional exhaustion. Overall, 91% of providers were extremely satisfied with the clinical pharmacy service. CONCLUSIONS: These findings may be used to justify the expansion of clinical pharmacy services in primary care to practice areas experiencing problems with 4 specific drivers of provider burnout: workload and job demands, efficiency and resources, meaning in work, and social support and community at work.

Challenges in the Treatment of Restless Legs Syndrome: A Case Report.

Treatment resistant restless legs syndrome (RLS) in the setting of psychiatric comorbidities can be difficult to manage. Our patient is a 69-year-old Caucasian gentleman with bipolar disorder type I, unspecified anxiety disorder, obstructive sleep apnea (OSA), and treatment-refractory RLS. At initial presentation, the patient's prescribed medication regimen included fluoxetine 40 mg daily, gabapentin 800 mg in the morning and 3200 mg at bedtime, pramipexole 0.375 mg daily, lamotrigine 200 mg daily, trazodone 200 mg at bedtime, and temazepam 15 to 30 mg as needed for insomnia and RLS. Over the course of nearly 4 years, treatment interventions for this patient's RLS included: cognitive behavioral therapy for insomnia, discontinuation of exacerbating medications, switching dopamine agonists, use of pregabalin and iron supplement. This report demonstrates a challenging case of RLS in the setting of psychiatric comorbidities, development of augmentation, and polypharmacy.

Novel Use of Text-Bot Automation for Residency Recruitment.

Purpose. To describe the employment of an automated text messaging text-bot during the 2019 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting Residency Showcase and its impact on the number of applications received for the postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residency programs at a medium-sized community hospital. Methods. Visitors at the residency showcase booth were asked to text a code word to a program number. The text-bot collected the visitor's contact information and program of interest (PGY1 or PGY2). A series of automated messages were sent to all visitors following the showcase and up until the residency application deadline. Results. 71% (20/28) of visitors to the program's showcase booth registered with the text-bot and of these, 65% (13/20) submitted applications to the residency program in phase I of the match. Both the PGY1 and PGY2 programs saw an increase in the amount of applications received compared to previous year. Conclusion. A text messaging text-bot may be a useful residency recruitment tool.

Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls.

Pathologic alcohol use affects more than 2 billion people and accounts for nearly 6% of all deaths worldwide. There are three medications approved for the treatment of alcohol use disorder by the US Food and Drug Administration (FDA): disulfiram, naltrexone (oral and long-acting injectable), and acamprosate. Of growing interest is the use of anticonvulsants for the treatment of alcohol use disorder, although currently none are FDA approved for this indication. Baclofen, a γ-aminobutyric acid B receptor agonist used for spasticity and pain, received temporary approval for alcohol use disorder in France. Despite effective pharmacotherapies, less than 9% of patients who undergo any form of alcohol use disorder treatment receive pharmacotherapies. Current evidence does not support the use of pharmacogenetic testing for treatment individualization. The objective of this review is to provide knowledge on practice parameters for evidenced-based pharmacologic treatment approaches in patients with alcohol use disorder.

Developing a dashboard for benchmarking the productivity of a medication therapy management program.

OBJECTIVES: To describe a method for internal benchmarking of medication therapy management (MTM) pharmacist activities. SETTING: Multisite MTM pharmacist practices within an integrated health care system. PRACTICE DESCRIPTION: MTM pharmacists are located within primary care clinics and provide medication management through collaborative practice. MTM pharmacist activity is grouped into 3 categories: direct patient care, nonvisit patient care, and professional activities. PRACTICE INNOVATION: MTM pharmacist activities were tracked with the use of the computer-based application Pharmacist Ambulatory Resource Management System (PhARMS) over a 12-month period to measure growth during a time of expansion. RESULTS: A total of 81% of MTM pharmacist time was recorded. A total of 1655.1 hours (41%) was nonvisit patient care, 1185.2 hours (29%) was direct patient care, and 1190.4 hours (30%) was professional activities. The number of patient visits per month increased during the study period. There were 1496 direct patient care encounters documented. Of those, 1051 (70.2%) were face-to-face visits, 257 (17.2%) were by telephone, and 188 (12.6%) were chart reviews. Nonvisit patient care and professional activities also increased during the period. IMPACT: PhARMS reported MTM pharmacist activities and captured nonvisit patient care work not tracked elsewhere. Internal benchmarking data proved to be useful for justifying increases in MTM pharmacist personnel resources. Reviewing data helped to identify best practices from high-performing sites. Limitations include potential for self-reporting bias and lack of patient outcomes data. CONCLUSION: Implementing PhARMS facilitated internal benchmarking of patient care and nonpatient care activities in a regional MTM program.