Evaluating the feasibility of implementing a prescription drug misuse prevention intervention in the community: a mixed methods study.

BACKGROUND: This study is part of a state-wide effort to promote the safe disposal of prescription medications and mitigate prescription drug misuse. The objective of this study was to evaluate the implementation of a two-component prevention intervention through Community Prevention Organizations (CPOs) in Texas. The first component involved the distribution of in-home disposal products (IHDP) and the second focused on providing education of the risks of prescription drug misuse. METHODS: This study followed a mixed methods sequential explanatory study design. In the quantitative phase, the extent to which CPOs carried out the intervention was determined by the distribution rate - a proportion representing the number of IHDP distributed to end users from the amount of IHDP the CPO was shipped. This measure was used to organize the CPOs in to one of three performance categories. In the qualitative arm of the study, stratified random sampling was used to select five CPOs from each performance strata to participate in an in-depth, semi-structured interview about their distribution activity. The interview guide and the data analysis were guided by Bowen's Feasibility Framework. The interviews were transcribed and analyzed using a content analysis approach by two research team members. All qualitative analyses were conducted in ATLAS.ti© V7. RESULTS: There was a total of 47 CPOs contacted and asked to be part of this study. Of them, 44 CPOs participated in the quantitative phase of the study. This phase revealed that all CPOs had existing relationships with organizations throughout the community such as pharmacies and schools that could act as points of distribution. Following the quantitative phase, 15 CPOs were selected for more in-depth interviews about their distribution practices. In the qualitative phase, this finding was reinforced through the theme "partnerships with local institutions and ability to implement the intervention at community events". Similarly, education promotion efforts were unanimously emphasized as a strategy to increase utilization of IHDP among end users. All CPOs indicated that the intervention was supplemental to their overall goals. CONCLUSION: CPOs have unparalleled access to community events, local institutions, and the general population they serve, thus, they have the potential to be active facilitators in implementing prevention interventions.

Bempedoic Acid: A New Drug for an Old Problem.

OBJECTIVE: To review the pharmacology, pharmacokinetics, safety, and efficacy of bempedoic acid for low-density lipoprotein cholesterol (LDL-C) reduction. DATA SOURCES: A PubMed search was conducted from January 2000 to June 15, 2020, using the keyword bempedoic acid for phase III clinical trials published in the English language. STUDY SELECTION AND DATA EXTRACTION: Articles related to the Food and Drug Administration (FDA) approval of bempedoic acid and other trials relating to the safety and efficacy of this drug were included. DATA SYNTHESIS: The findings from this review show that bempedoic acid is a safe and effective option for lowering LDL-C levels in patients requiring LDL-C lowering for primary or secondary prevention of cardiovascular events. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Statin therapy remains the mainstay of treatment for both primary and secondary prevention. However, many patients cannot tolerate statin therapy because of statin-associated muscle symptoms. Bempedoic acid may be a reasonable adjunct for LDL-C reduction, though further evaluation of cardiovascular outcomes with bempedoic acid in this population is needed. CONCLUSIONS: The recent FDA approval of bempedoic acid offers an additional option for lowering LDL-C levels in patients with atherosclerotic cardiovascular disease or heterozygous familial hyperlipidemia. Additional data regarding effect on long-term cardiovascular outcomes with bempedoic acid are currently being studied.

A comparison of anticoagulation, antiplatelet, and placebo treatment for patients with heart failure reduced ejection fraction in sinus rhythm: a systematic review and meta-analysis.

Previous meta-analyses have not recommended routine warfarin use in heart failure (HF) patients but included limited data on contemporary anticoagulants and practices. We conducted an updated meta-analysis in light of newer literature evaluating rivaroxaban in this patient population. The aim of this meta-analysis was to assess if anticoagulation is associated with a decrease in all-cause mortality, myocardial infarction (MI), stroke, and hospitalization for HF exacerbation without an increased risk of major bleeding. A systematic search was conducted for randomized controlled trials to evaluate the use of antithrombotic therapy in patients with HF in sinus rhythm. Outcomes evaluated included all-cause mortality (ACM), non-fatal stroke, MI, hospitalization for HF exacerbation, and major bleeding. Five trials met criteria with a total of 9390 patients included. Four of the five trials evaluated warfarin use and one trial evaluated rivaroxaban. When anticoagulation was compared to control (antiplatelet and placebo groups), a significant reduction in ischemic stroke was found (OR 0.57; 95% CI, 0.42 to 0.78; P = 0.0005, I2 = 6.9%) and no significant difference was found in the risk of ACM, MI, or HF hospitalization. A significant increase in major bleeding was observed in the anticoagulation group when compared to the control group (OR 2.00; 95% CI, 1.45 to 2.75; P = < 0.0001, I2 = 25.79%). Anticoagulation in HF patients in normal sinus rhythm does not appear to reduce mortality rate, prevent MI, or decrease HF hospitalizations. Use reduces risk of ischemic stroke but is counterbalanced with an increase in major bleeding.

Is There Still a Role for Aspirin in Primary Prevention in Women in 2020?

PURPOSE OF REVIEW: Aspirin's place in primary prevention for females has not been well delineated and has been under increased scrutiny in light of recent literature and guideline recommendations. The purpose of this review is to discuss current literature reviewing aspirin use for primary prevention in women and to discuss when use is appropriate. RECENT FINDINGS: The Women's Health Study found no differences in major adverse cardiovascular events (MACE) in women randomized to aspirin vs. placebo, though a significant reduction was observed in women ≥ 65 years. More recent literature evaluated outcomes for primary prevention use in patients at increased cardiovascular risk, patients with diabetes, and patients who are elderly. These trials found either no benefit in MACE outcomes or a slight benefit accompanied by an increased risk of bleeding. Furthermore, no difference in outcomes were found in subgroup analyses comparing females receiving aspirin vs. placebo or comparing events in males vs. females. With improvements in risk factor reduction, such as blood pressure control, statin use, diabetes management, and smoking cessation, the role of aspirin for primary prevention in women is still uncertain. Aspirin use for primary prevention in females has failed to show a clear benefit except in women ≥ 65 years old, with a potential increase in bleeding events. An effort to better study aspirin in female patients would allow for better identification of women who would or would not benefit from therapy.

Prescription drug disposal: Products available for home use.

OBJECTIVE: Unused medications in the home are often improperly stored and may lead to unintentional harm, misuse, and diversion. Single-use disposal systems products allow consumers to safely inactivate unused medication and provide an environmentally friendly alternative to flushing medication down the toilet or discarding in the trash. The objective of this commentary was to review current medication disposal options and inform pharmacists of new products that may be used by patients to dispose of medications in the home setting. DATA SOURCES: Current recommendations on medication disposal from U.S. regulatory agencies (e.g., the Environmental Protection Agency) were reviewed and summarized comparatively. Information on the mechanism of action, price, and method of use of 8 new single-use disposal systems suitable for outpatient use were taken from each product manufacturer's website. SUMMARY: Eight single-use disposal systems were identified. Seven products used chemical deactivation to render medication safe for disposal, and 1 product allowed consumers to mail medication to a central processing facility for incineration. Products ranged in size from 2 oz to 1 gal, offering consumers the ability to dispose of anywhere from 60 to 3000 tablets per unit, respectively. Unit costs varied widely from $5 per single-use pouch to $190 for a 40-gal box intended for incineration. CONCLUSION: Pharmacists and consumers must consider cost, effectiveness, and environmental impact when recommending and selecting products for medication disposal at home. More research is needed to understand the cost-effectiveness of each disposal system and to identify strategies to encourage uptake by health systems and use by consumers. Including content on home medication disposal in pharmacist-continuing education activities and raising workforce awareness of these products are critical to improving public safety.

Management of Anticoagulation with Impella® Percutaneous Ventricular Assist Devices and Review of New Literature.

Cardiogenic shock is a life-threatening condition that may occur secondary to a variety of cardiac conditions, and may require temporary support with percutaneous ventricular devices like the Impella®. Anticoagulation in patients with Impella® devices can often be complicated due to unpredictable purge flow rates, pre-existing coagulopathy, or heparin allergies. The purpose of this article is to discuss the various options for anticoagulation in the setting of Impella®. The article will also describe recent updates (2014-current) in literature surrounding anticoagulation therapy for Impella® devices. At total of 228 articles were initially obtained through the PubMed search, with inclusion of 6 articles. A total of 51 patients had data in the six studies that were included in the review. Heparin for anticoagulation in the purge solution, at two different dextrose concentrations (5% and 20%), was associated with similar therapeutic activated partial thromboplastin time rates, thrombotic and bleeding events. One case series described the use of argatroban in the purge solution for anticoagulation in two patients with suspected heparin-induced thrombocytopenia, without bleeding or thrombotic complications. Pump thrombosis was not reported in any of the six studies. Anticoagulation in the setting of mechanical circulatory support devices is a challenging aspect of critical care. Institutions should have set protocols that clearly define the options for anticoagulation. Future studies that look at longer durations of support and possible operation of the Impella® device with a heparin-free purge solution are needed.

Health care practitioner counseling encourages disposal of unused opioid medications.

OBJECTIVE: The objective of this study was to estimate the association between health care practitioner counseling on medication disposal and disposal of unused opioid medications. DESIGN: A 41-item survey instrument was created and administered to a nationally representative panel of adult opioid users with chronic pain using a cross-sectional, internet survey design via Qualtrics®. PARTICIPANTS: Four hundred adult opioid users with chronic pain were randomly selected from the Qualtrics® panel-base to participate. SETTING: United States. OUTCOME MEASURES: The dependent variable, disposal of unused opioid medications, was assessed with a single item asking participants how often they had disposed of unused opioid medications in the past year. Multiple logistic regression was used to assess the association between opioid disposal and the receipt of health care practitioner counseling on medication disposal. RESULTS: A total of 400 surveys were completed. Participants were mostly white (70.8%) and under the age of 40 (54.1%). Less than one-half of all participants (44.5%) had disposed of opioid medications in the past year, while 60.75% had received health care practitioner counseling on disposal. Of those counseled, only 21.4% were counseled by a pharmacist. Flushing medication down the toilet (33%) was the most common method of opioid disposal. After adjustment for covariates, those who received health care practitioner counseling were more likely to have disposed of opioid medications in the past year (adjusted odds ratio 1.66, 95% CI 1.03-2.69). CONCLUSIONS: Participants who received counseling on opioid disposal were more likely to have disposed of unused opioid medications. Pharmacists are uniquely positioned to counsel patients on opioid disposal and thus must be active in preventing harm and diversion due to improperly stored opioid medications. This study demonstrates the need for enhanced provider education and policy to ensure that patients are adequately counseled on proper opioid disposal.

Impact of automated alerts on discharge opioid overprescribing after general surgery.

DISCLAIMER: 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. PURPOSE: The objectives of this study were to identify the most performed surgical procedures associated with the highest rates of discharge opioid overprescribing and to implement an electronic health record (EHR) alert to reduce discharge opioid overprescribing. METHODS: This quality improvement, before-and-after study included patients undergoing one of the identified target procedures-laparoscopic cholecystectomy, unilateral open inguinal hernia repair, and laparoscopic appendectomy-at an academic medical center. The alert notified providers when the prescribed opioid quantity exceeded guideline recommendations. The preimplementation cohort included surgical encounters from January 2020 to December 2021. The EHR alert was implemented in May 2022 following provider education via email and in-person presentations. The postimplementation cohort included surgical encounters from May to August 2022. The primary outcome was the proportion of patients with a discharge opioid supply exceeding guideline recommendations (overprescribing). RESULTS: A total of 1,478 patients were included in the preimplementation cohort, and 141 patients were included in the postimplementation cohort. The rate of discharge opioid overprescribing decreased from 48% in the preimplementation cohort to 3% in the postimplementation cohort, with an unadjusted absolute reduction of 45% (95% confidence interval, 41% to 49%; P < 0.001) and an adjusted odds ratio of 0.03 (95% confidence interval, 0.01 to 0.08; P < 0.001). Among patients who received opioids, the mean (SD) opioid supply at discharge decreased from 92 (43) oral morphine milligram equivalents (MME) (before implementation) to 57 (20) MME (after implementation) (P < 0.001). The proportion of patients who received additional opioid prescriptions within 1 to 14 days of hospital discharge did not change (P = 0.76). CONCLUSION: Implementation of an EHR alert along with provider education can reduce discharge opioid overprescribing following general surgery.

Protocol for the development of a consensus practice guideline To address clinical and regulatory barriers to buprenorphine dispensing in community pharmacy.

BACKGROUND: Less than half of community pharmacies in the United States stock buprenorphine products indicated for the treatment of opioid use disorder. This lack of access to buprenorphine in community pharmacies is a significant barrier to care. To address this issue, this protocol outlines a comprehensive approach to develop a practice guideline aimed at improving access to safe and effective opioid use disorder treatment in community pharmacies. METHODS: The guideline development process will proceed in three phases, following a technique closely aligned with the Institute of Medicine's guidance on guideline development. The first phase will involve conducting qualitative interviews with pharmacists in three states to identify their beliefs toward buprenorphine dispensing. As limitations on buprenorphine supply are related to constraints at all levels of the drug supply and regulatory system, the second phase, we will recruit representatives from regulatory agencies, pharmacy organizations, the Drug Enforcement Administration, pharmaceutical wholesalers as well as addiction medicine physicians and psychiatric pharmacists to develop consensus recommendations through a modified Delphi design. This will be followed by a public comment period and external expert review of the recommendations led by the National Association of Boards of Pharmacy. Finally, in the third phase, a national, mixed media dissemination campaign will be led by the National Community Pharmacists Association (NCPA) to convey recommendations to practicing pharmacists. DISCUSSION: The guideline development process aims to incorporate the perspectives of multiple stakeholders and emphasize the importance of addressing the regulatory and pharmacy-specific aspects of care in addition to clinical evidence and guidance. The development of this guideline will provide targeted, multidisciplinary guidance for pharmacists, improving access to safe and effective opioid use disorder treatment in the community setting. PREREGISTRATION: This protocol was registered with the Open Science Framework in March of 2023. Registration may be found at: https://doi.org/10.17605/OSF.IO/6S9DY .

Alternative monitoring of argatroban using plasma-diluted thrombin time.

OBJECTIVE: To report a case of heparin-induced thrombocytopenia (HIT) in a patient with concurrent liver dysfunction and a prolonged baseline activated partial thromboplastin time (aPTT) in whom argatroban therapy was monitored with aPTT and a novel plasma-diluted thrombin assay. CASE SUMMARY: An 80-year-old man with HIT and liver dysfunction was treated with argatroban, which was initiated at a dose of 0.5 µg/kg/min and gradually decreased to 0.09 µg/kg/min. The patient had a mildly prolonged aPTT at baseline (37.5 seconds). He was concurrently monitored with aPTT, per institution protocol, and plasma-diluted thrombin time. Plasma-diluted thrombin times were consistently lower than aPTTs, but mirrored the trend of the aPTTs. Eleven hours after argatroban was stopped, the aPTT remained elevated (53.9 seconds), while the plasma-diluted thrombin time returned to normal range (26.4 seconds). The patient's therapy was transitioned to warfarin and he had a hospital course with no thrombotic or bleeding complications. DISCUSSION: Plasma-diluted thrombin time is a novel laboratory test consisting of 1 part patient plasma diluted with 3 parts normal plasma. Plasma-diluted thrombin time has been shown to blunt the sensitivity of the thrombin time and may be more accurate for drug monitoring. A MEDLINE search revealed 2 studies using the plasma-diluted thrombin time assay. The first study compared aPTT and plasma-diluted thrombin times in blood samples mixed with argatroban, bivalirudin, or lepirudin at 3 different concentrations. Blood samples contained lupus inhibitors, vitamin k deficiency, or normal baseline aPTTs. The aPTT overestimated drug concentrations in all samples with lupus anticoagulant and vitamin k deficiency, while the plasma-diluted thrombin time correctly estimated drug concentrations in nearly all samples. The second study looked at monitoring dabigatran with plasma-diluted thrombin time and found a linear relationship between the plasma-diluted thrombin time and the dabigatran dose-response curve. CONCLUSIONS: Plasma-diluted thrombin time may be an alternative for direct thrombin inhibitor monitoring in patients with elevated aPTT values at baseline. Further randomized control trials are needed to determine its applicability in clinical practice.

Evaluation of student emotional intelligence at various points in a pharmacy curriculum.

INTRODUCTION: The purpose of this study is to evaluate emotional intelligence in doctor of pharmacy (PharmD) students at various points in the curriculum. METHODS: This was a cross-sectional, single site, observational study that included first- through fourth-year PharmD students, conducted from December 2021 to April 2022. The study used the Emotional Quotient Inventory, version 2.0 (EQ-i 2.0) to obtain student emotional intelligence scores. A survey in QualtricsSM (SAP) was used to obtain baseline characteristics. The primary endpoint was the mean total EQ-i 2.0 scores comparing professional years. Secondary endpoints included mean EQ-i 2.0 scores in the composite scales of self-perception, self-expression, interpersonal, decision-making and stress-management. Change in EQ-i 2.0 scores was evaluated using descriptive statistics and analysis of variance. Multivariable regression analysis identified associations between baseline characteristics and EQ-i 2.0 scores. RESULTS: A total of 137 (137/485, 28.2%) students completed the EQ-i 2.0 assessment. The mean (SD) total EQ-i 2.0 scores were 98.1 (15.5), 92.2 (15.9), 92.4 (12.9), and 103.5 (13.1), for first-, second- (P2), third- (P3), and fourth-year (P4) students, respectively. A statistically significant increase in total EQ-i 2.0 scores was noted in P4 students compared to P2 and P3 students. Work experience and leadership roles within student organizations may be associated with an increase in total EQ-i 2.0 scores. CONCLUSIONS: Emotional intelligence varied among students in different years of the pharmacy curriculum. P4 students were found to have the highest average emotional intelligence. The effect of curricular and co-curricular components on emotional intelligence development warrants further exploration.

Evaluation of Discharge Opioid Prescribing in Coronary Artery Bypass Patients Following an Opioid Stewardship Intervention for Providers.

Introduction: Opioid stewardship efforts can promote safe and effective use of opioids to optimize pain control and minimize unintended consequences. The purpose of this study is to assess the difference in post-operative opioid discharge prescribing in patients undergoing coronary artery bypass graft (CABG) surgery following implementation of a tripartite opioid stewardship intervention. Methods: This was a single-center, quality improvement study at a large, quaternary academic medical center. Adult patients undergoing CABG from July 2019 to June 2020 (pre-intervention) and November 2020 to February 2021 (post-intervention) were included. The intervention included adopting hospital-wide post-surgical opioid discharge prescribing guidelines, discharge prescriber education, and electronic medical record changes. The primary outcome was the proportion of patients receiving an opioid prescription at discharge. Secondary outcomes included total morphine milligram equivalents (MME) prescribed and non-opioid analgesics prescribed at discharge. Results: A total of 200 patients were included in the study; 100 pre- and 100 post-intervention. There was no difference in opioid discharge prescribing at discharge (74% pre-intervention vs. 72% post-intervention; P = .87). There was no difference in MMEs prescribed at discharge (145.6 ± 57 pre- vs. 162.2 ± 95 post-; P = .202). No difference was seen in non-opioid analgesic prescriptions prescribed at discharge (35% pre- vs. 40% post-; P = .56). Conclusion: A multipronged opioid stewardship intervention did not lead to a reduction in opioid prescribing at discharge. Post-intervention, there was a non-statistically significant increase in the proportion of patients who received non-opioid analgesics discharge. Future studies should assess the effect of different stewardship interventions on prescribing and patient outcomes.

Student-led podcasts to enhance literature evaluation skills.

BACKGROUND AND PURPOSE: Critical evaluation and understanding of primary literature is essential to pharmacy practice. This project evaluated student confidence and learning outcomes in a critical care elective course where podcasts were used as an active learning assignment for literature evaluation. EDUCATIONAL ACTIVITY AND SETTING: Third-year pharmacy students created a 15- to 20-min podcast episode that reviewed a landmark critical care trial. A pre/post survey was used to assess student perceptions of confidence in evaluating primary literature. A standardized rubric was used to assess literature evaluation skills in several domains. FINDINGS: Ninety-two third-year pharmacy students were enrolled in the critical care elective course, and 93% (86 of 92) completed the survey. Student perceptions of their ability to evaluate literature improved for all seven questions, including comfort in interpreting study methodology and applying findings of literature to patient care. Students scored proficient on most components of the standardized rubric, with ability to discuss results and conclusions being the lowest performing domain (78.2% fully proficient). After completing the activity, students felt more confident in interpreting results, applying findings, and orally presenting a journal article to peers. Most students felt the podcast activity helped them strengthen their literature evaluation skills and recommended this activity to a peer. SUMMARY: Third-year pharmacy students reported an improvement in confidence in the interpretation and application of primary literature after creating a podcast episode reviewing a critical care trial. Additional research with creation of podcasts or other audio/visual methods should be studied in the future.

Identifying predictors of generalized anxiety among student pharmacists in response to the COVID-19 pandemic.

INTRODUCTION: To explore the prevalence of generalized anxiety (GA) among doctor of pharmacy (PharmD) students at an academic institution during the COVID-19 pandemic and use Alderfer's existence, relatedness, and growth (ERG) theory to elucidate which unsatisfied needs are predictive of higher levels of GA symptoms. METHODS: This was a cross-sectional, single-site survey administered to first- through fourth-year PharmD students from October 2020 to January 2021. The survey tool included demographic information, the validated Counseling Center Assessment of Psychological Symptoms-62 tool, and nine additional questions developed to assess Alderfer's ERG theory of needs. Predictors of GA symptoms were evaluated using descriptive statistics, multiple linear regression, correlation analysis, and multivariable analysis. RESULTS: A total of 214 of 513 students completed the survey (42%) . Among students, 49.01% had no-clinical, 31.31% had low-clinical, and 19.63% had high-clinical GA symptoms. The relatedness needs, which included feeling disliked, socially disconnected, and misunderstood had the strongest correlation (65%) to GA symptoms and was most associated with GA symptoms (ß = 0.56, P < .001). Students who did not exercise experienced more symptoms of GA (P = .008). CONCLUSIONS: Over 50% of PharmD students met clinical cut-offs for GA symptoms and the relatedness need was most predictive of GA symptoms among students. Future student-centered interventions should aim to create opportunities that increase social connections, build resilience, and provide psychosocial support.

Review of Best Practices for Diversity, Equity, and Inclusion Committees Within Colleges of Pharmacy.

Objective. To provide a review of best practices for diversity, equity, and inclusion (DEI) committees at United States colleges of pharmacy.Findings. In colleges of pharmacy, DEI committees can play a crucial role in promoting a culture change to ensure pharmacy graduates are equipped to provide equitable and representative care for the patients they serve. There is limited literature available on DEI committee composition, roles, and responsibilities, and their place within a college of pharmacy's organizational structure. A commitment to DEI should be part of the college's strategic plan and embedded and supported at all levels of the college and university to ensure success of DEI-related strategic initiatives. For a DEI committee to be effective, its composition should be intentional to include change agents, campus leaders, and members who are passionate and knowledgeable to execute the DEI goals. For sustainable change, involvement of the entire learning community and an organizational culture change is also important. Thus, DEI committees need to establish active bidirectional collaborations and communication with all key committees, offices, community leaders, and alumni to implement diversity goals.Summary. The DEI committee's established place in the organizational structure of the college is essential to ensure fair and appropriate representation of the community it serves. A clearly defined DEI committee with committee composition, roles, responsibilities, and its association with all constituents of the college and community can help achieve its intended strategic goals.

Academic Pharmacy Fellowship Programs are an Innovative Solution to Improve the Faculty Pipeline.

Academic pharmacy fellowship programs can offer an innovative training solution to help prepare pharmacists for successful careers as clinical faculty members. However, there is no well-defined program blueprint or recommendations for what a successful program should include. This commentary describes the program overview for the academic pharmacy fellowship at the University of Houston College of Pharmacy and discusses the implications of incorporating a similar program at a college of pharmacy. The purpose of the fellowship program is to prepare pharmacists for a career in pharmacy education through training in teaching, curriculum development, college service, mentoring, scholarship, and clinical practice. A structured program with monthly rotations in key academic areas, teaching experience and mentorship (didactics and skills labs), committee service, and leading a research project make up the core structure of the program. These experiences, coupled with significant student interaction, can prepare fellowship graduates to transition effectively into clinical faculty roles.

Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery.

OBJECTIVE: To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy. METHODS: This before-and-after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions. RESULTS: A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128/160) in the preimplementation cohort to 35% (28/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%-57%; P < .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04-0.19; P < .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre- vs 10% postimplementation; adjusted OR, 0.20; P = .001) or 5 days of therapy (17% pre- vs 6% postimplementation; adjusted OR, 0.34; P = .049). DISCUSSION: Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy. IMPLICATIONS FOR PRACTICE: Unnecessary opioid prescriptions generate unused opioids in patients' homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community. REGISTRATION: The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.

Completing the Academic Leadership Fellows Program During the Pandemic.

The COVID-19 pandemic caused the Academic Leadership Fellows Program (ALFP) of the American Association of Colleges of Pharmacy to shift to a virtual format for Cohort 17. Major differences compared to previous years included changes in networking strategies among fellows, lack of in-person team-building activities, and adjustments to the preparation and delivery of the team debates. Adaptations in fellow peer interactions and the learning approach proved that strong relationships and collaborations can be formed in a virtual setting. Concurrent mentorship and leadership opportunities at the fellows' home institutions remain fundamental components of the program to enhance personal growth. The ALFP program proved that it can still deliver a meaningful professional development opportunity for faculty leaders in a virtual setting.

Comparing Two Databases to Identify Access to Buprenorphine Treatment for Opioid Use Disorder.

OBJECTIVE: The objective of this study is to assess the differences in buprenorphine prescribers from a county level in the state of Texas by comparing the Substance Abuse and Mental Health Services Administration (SAMHSA) Buprenorphine Practitioner Locator to the Drug Enforcement Administration's (DEA) Controlled Substance Act (CSA) database. METHODS: County-level counts of buprenorphine prescribers were calculated from both the publicly available SAMHSA buprenorphine practitioner locator list and the DEA CSA database. These were then used to estimate the number of providers per 100,000 residents in each county. Regional variation in access to buprenorphine was compared descriptively across the state using poverty data from the US Census and county-level demography from the Texas Demographic Center. RESULTS: This study found 68.8% more X-waivered providers on the DEA CSA database (n = 2,622) with at least one provider reported in 125 of 144 counties in the state (49.2%) compared to the SAMHSA Buprenorphine Practitioner Locator (n = 1,553) with at least one provider reported in 103 counties (40.5%). CONCLUSIONS: The lack of a complete public registry of buprenorphine prescribers can inhibit the ability of patients to identify a convenient treatment. More work is needed to quantify the gap between treatment capacity and treatment need.