Comprehensive and Collaborative Pharmacist Transitions of Care Service for Underserved Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Mortality risk from chronic obstructive pulmonary disease (COPD) increases significantly in the first year after a 30-day hospital readmission. OBJECTIVE: To evaluate a comprehensive and collaborative pharmacist transitions of care service for patients hospitalized with COPD compared to usual care. METHODS: In this within-site, retrospective study, discharge counseling, medication reconciliation, medication access assistance, therapy changes, and post-discharge long-term follow-up were provided to underserved adult patients with a primary care provider at the study clinic and admitted to the affiliated hospital with a primary diagnosis of COPD exacerbation. Primary outcome was a 180-day composite of COPD-related hospitalizations and emergency department (ED) visits. Secondary outcomes were 30-, 60-, 90-, and 180-day events, costs, pharmacist interventions, time to follow-up, and pneumonia. RESULTS: Sixty-five patients were identified with a total of 101 index admissions. The mean age was 62.5 years, approximately 55.3% were female, and 67.7% were black or African American. The primary composite was significantly lower in the pharmacist intervention group compared to usual care (mean difference 0.82, P=0.0364, 95% confidence interval [CI] 0.05-1.60), driven by lower 30-day hospitalizations in the intervention group (mean difference 0.15, P=0.0099, 95% CI 0.04-0.27). Cost associated with COPD-related hospitalizations was significantly lower in the pharmacist intervention group compared to usual care ($173,808, P = 0.0330) as well as before intervention ($79,662, P=0.0233). There was no significant difference in time to follow-up or pneumonia. CONCLUSIONS: A comprehensive, collaborative pharmacist transitions of care service significantly reduced 30-day COPD-related hospital readmissions, ED re-visits, and associated costs in an underserved population.

Evaluation of burnout among hospital and health-system pharmacists in North Carolina.

PURPOSE: To assess the current state of burnout among pharmacists who work in hospital and health-system settings in North Carolina. METHODS: The Maslach Burnout Inventory-Human Services Survey for Medical Professionals was used to assess burnout in this study. This survey measures 3 subscales of burnout: emotional exhaustion, depersonalization, and personal accomplishment. In addition to the Maslach Burnout Inventory, the survey asked questions addressing various modifiable and nonmodifiable demographic factors. To distribute the survey, an email listserv of all pharmacists licensed in the state was obtained from the North Carolina Board of Pharmacy. The survey was distributed through email in June 2018. A follow-up email encouraging participation in the survey was sent 2 weeks later. The survey was open for a total of 4 weeks. RESULTS: The survey was delivered to 2,524 pharmacists; 380 responses were received (15.1% response rate). Of the 380 individuals who responded, 357 completed the entire survey (93.9% completion rate), and 198 pharmacists (55.5%) were at risk for burnout. Following multivariate logistic regression, 3 factors were significantly associated with increased risk of burnout: female gender, working in a primarily distribution role, and longer hours worked per week. Two factors were significantly associated with decreased risk of burnout: being aware of burnout resources and working 4 to 6 months with learners. CONCLUSION: The results of this statewide survey revealed that more than half of hospital and health system-based pharmacists are at risk for burnout.

Evaluation of Different Methods Used to Calculate Ideal Body Weight in the Pediatric Population.

OBJECTIVES: Accurate determination of ideal body weight (IBW) in pediatric patients is important for the proper dosing of many medications and the classification of nutritional status. There is no consensus on the best method to calculate IBW. The purpose of this study is to evaluate and compare 7 different methods used to calculate IBW in the pediatric population. METHODS: This was a retrospective observational study. All subjects were pediatric inpatients at a 536-bed community teaching hospital between January 1, 2016, and June 30, 2017. Subjects were divided into 2 cohorts: cohort 1 was aged 12 months and 0 day to 35 months and 30 days, and cohort 2 was aged 36 months and 0 day to 17 years and 364 days. The McLaren method was used as the reference to compare with 6 other methods: Moore method, Devine method, American Dietetic Association (ADA) method, body mass index (BMI) method, Traub equation, and simplified Traub equation. RESULTS: For cohort 1 (n = 347), the Moore method was not statistically different from the McLaren method with a mean difference of -0.07 kg (95% CI: -0.14 to 0.01, p = 0.07). For cohort 2 (n = 1095), the BMI method was not statistically different from the McLaren method with a mean difference of 0.17 kg (95% CI: -0.07 to 0.40, p = 0.17). CONCLUSIONS: In both cohorts, the majority of methods used to calculate IBW in pediatric patients leads to statistically different results when compared with the McLaren method. For certain methods, these differences become pronounced at high and low height percentiles and in older age groups.