Impact of Pharmacists in Therapeutic Optimization Relative to the 2020 American Diabetes Association Standards of Medical Care in Diabetes Guidelines in Patients with Clinical Atherosclerotic Cardiovascular Disease.

In 2020, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes Guidelines newly recommended adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist in patients with both type 2 diabetes and atherosclerotic cardiovascular disease, regardless of hemoglobin A1c (HbA1c) levels. In this study, the primary objective was to assess the pharmacist's role in the therapeutic optimization of patients with both type 2 diabetes and atherosclerotic cardiovascular disease relative to the new recommendations. The secondary objectives were to assess other factors affecting therapeutic optimization and clinician familiarity with the recommendations. This study, conducted at the East Hawai.i Health Clinic, included 60 patients with type 2 diabetes and atherosclerotic cardiovascular disease. Anonymous surveys were sent to clinicians at the clinic to assess recommendation familiarity. Patients seen by a pharmacist were significantly more likely to be therapeutically optimized per the 2020 ADA guidelines than those not seen by a pharmacist. HbA1c and age also influenced SGLT-2/GLP-1 therapy use. All clinicians were more likely to prescribe SGLT-2/GLP-1 therapy for patients with uncontrolled HbA1c but were less likely to prescribe additional therapy for patients with controlled HbA1c, even in patients with previous atherosclerotic events.

Generational awareness education as a strategy to prepare IPPE and APPE students for the modern workplace.

INTRODUCTION: There is limited literature on generational awareness improving the student-preceptor relationship and student experiences. The primary objectives of this study were to determine the level of generational awareness of pharmacy students and to examine whether didactic instruction on generational diversity leads to student-perceived improvements in learning and student-preceptor relationships. METHODS: This was a longitudinal, quasi-experimental design study, including pharmacy students at two different institutions from May 2019 to May 2020. A generational lecture was delivered to students in pharmacy years 1, 2 and 3 (P1, P2, and P3). Pre-, post-, and follow-up surveys were created and collected from each student cohort. RESULTS: A total of 388 respondents were included in the pre- and post-survey analysis. Overall scores for each question were significantly improved in the post- compared to the pre-period (P < .001). A total of 124 responses were received for the follow-up survey. Seventy-one percent of respondents agreed or strongly agreed that understanding generational differences improved their learning, communication, and professional relationships during their experiential rotations. Majority of respondents (82.3%) agreed or strongly agreed that further education on generational differences should be provided. CONCLUSIONS: This study indicates that providing education on generational differences to students is beneficial and positively impacts student experiential rotations.

Prescription Renewal Request Reviews by Student Pharmacists in a Family Medicine Clinic.

Prescription renewal requests were reviewed by student pharmacists on advanced pharmacy practice experiences (APPE) at a primary care and family medicine clinic. Student pharmacists reviewed requests and triaged them to the respective primary care provider (PCP), along with any recommendations to optimize the medication regimen. This study aims to assess the acceptance of these recommendations as well as the student's perception of this activity as a learning tool. A total of 35 4th-year pharmacy students participated in this activity during APPE rotations from May 2019 to March 2021. A total of 184 recommendations were made, with 128 (70%) being accepted by PCPs. Based on a post-rotation anonymous survey, students reported high levels of agreeance that this activity had a positive impact on their education in a variety of ways. This prescription renewal request review process has been shown to have a positive impact on patient care and clinic workflow while also providing pharmacy students with a helpful educational activity.

Instagram as a tool to enhance pharmacy student learning of ambulatory care pharmacy.

INTRODUCTION: This project utilized the social media platform Instagram, which focuses upon posting images with accompanied captions, as a supplemental learning tool. The objective was to assess the impact of using a clinical pharmacy-focused Instagram account on students' knowledge of ambulatory care pharmacy. METHODS: A pre- and posttest quasi-experimental design was conducted in a third-year introductory pharmacy practice experience course during fall 2018. Pharmacy students were notified of the availability of an Instagram account managed by the principal investigator that posted ambulatory care clinical pearls as an optional supplemental educational tool. The primary outcome evaluated change in scores from pre- to posttest for the cohort of students in this course who followed the Instagram account (intervention group) compared to the cohort of students who did not follow the account (control group). RESULTS: A total of 69 third-year pharmacy students completed the course, with 37 students choosing not to follow the Instagram account (control group) and 32 students opting to engage with the Instagram account (intervention group). Pretest mean scores were nonsignificant between groups. The intervention group resulted in a higher increase in mean scores from pre- to the posttest (15% vs. 3.1%). CONCLUSIONS: Use of an educational Instagram account had a positive impact on students' knowledge relating to ambulatory care pharmacy as demonstrated by this comparison study.

Optimization of Medication Regimens in Patients with Type 2 Diabetes and Clinical Atherosclerotic Cardiovascular Disease.

The American Diabetes Association recommends that patients with type II diabetes and atherosclerotic cardiovascular disease be prescribed an SGLT-2 inhibitor or GLP-1 agonist for cardioprotective benefit. This project assessed the use of these medications in this patient population in a rural clinic by measuring prescribing rates of SGLT-2/GLP-1 therapy before and after pharmacist interventions. Of the 60 patients identified at baseline, 39.39% (13/33) managed by a pharmacist were prescribed SGLT-2/GLP-1 therapy compared to the 14.81% (4/27) who had not seen a pharmacist (p = 0.025). Of the 43 patients that were not on SGLT-2/GLP-1 therapy at baseline, 13 were lost to follow-up and 13 had contraindications. For the 17 remaining patients, pharmacists recommended initiating SGLT-2/GLP-1 therapy and were able to successfully initiate therapy for 9 patients (52.94%). Pharmacist interventions improved the prescription rates from a baseline of 36.17% (17/47) to 55.3% (26/47) (p = 0.002), with SGLT-2/GLP-1 therapy contraindicated in 27.66% (13/47) of patients. This suggests that patients managed by a pharmacist have medication regimens that were optimized at a greater rate and pharmacists can have a positive impact on the appropriate medication usage in this population.

Diabetes-Related Patient Outcomes through Comprehensive Medication Management Delivered by Clinical Pharmacists in a Rural Family Medicine Clinic.

Two clinical pharmacy faculty members from a college of pharmacy provide comprehensive medication management in a rural family medicine clinic. The data was assessed for patients with diabetes managed by the pharmacists from 1 January 2017 through to 31 December 2019 to determine the service's impact on patient outcomes. The primary outcome of this study is the change in the goal attainment rates of the three clinical goals of hemoglobin A1c, blood pressure, and appropriate statin therapy after pharmacist intervention. A total of 207 patients were included. At baseline, the patients had an average of 1.13 of the three goals met, improving to an average of 2.02 goals met after pharmacist intervention (p < 0.001). At baseline, 4.8% of the patients had met all three clinical goals, improving to 30.9% after pharmacist intervention (p < 0.001). There were significant improvements for the individual goal attainment rates of hemoglobin A1c (24.15% vs. 51.21%, p < 0.001), blood pressure (42.51% vs. 85.51%, p < 0.001), and appropriate statin therapy (45.89% vs. 65.70%, p < 0.001). This data adds to the evidence supporting the integration of clinical pharmacists into primary care clinics to improve patient outcomes related to diabetes.

Use of Psychotropic Medications by Older Adults Presenting to the Emergency Department After Fall-Related Injuries.

Falls are among the leading causes of morbidity and mortality in older adults in Hawai'i. According to a recent report, 101 older adults in Hawai'i died from falls from 2011 to 2015, while another 9,158 had fall injuries resulting in hospitalizations or emergency department visits. Because certain medications can increase the risk of falls, medication reviews should be a component of any fall treatment plan. The purpose of this column is to examine medication interventions attempted before hospital discharge in patients taking psychotropic medications upon admission after a fall. A retrospective review of electronic medical records was conducted for the year 2016. All older adults admitted to a large hospital in Hawai'i after a fall-related injury who were taking a psychotropic medication were included. During the study period, 19 patients were admitted to the hospital on a psychotropic medication after a fall. Of the 19 patients, 18 (95%) had no change in their psychotropic medication during hospitalization. In 15 patients (79%), EMR documentation did not demonstrate an attempt to review psychotropic medications. The study confirms the need for medication reviews to address potentially inappropriate medications in older adults who are admitted to the hospital after a fall.

The Daniel K. Inouye College of Pharmacy Scripts: Improving the Accuracy of Patient Medication Lists: Performing Medication Reconciliation by Phone Prior to Appointments.

The purpose of this project was to utilize pharmacists and pharmacy students to perform comprehensive medication reconciliation by telephone prior to a patient's office visit with their primary care physician, to address any medication issues. The project's aims were to decrease polypharmacy, improve the accuracy of medication reconciliation, and to allow more time for the physician to meet with the patient. Patients were called prior to appointment and a thorough medication reconciliation was conducted including verification of current prescription medications, over-the-counter medications, and herbal supplements. A total of 21 patients were enrolled in the study, and in 36% of patients, the number of medications decreased after the intervention. However, overall, the average number of medications used by patients increased from an average of 8.9 to 9.5 medications (P = .39). All patients included in the study had at least one medication change in the electronic medical record system. Most of the changes were to add medications that were not on the medication list or to remove medications on the list that the patient was no longer taking. This study demonstrated improved accuracy with pharmacist/pharmacy student involvement in the medication reconciliation process.

The Effect of Clinical Pharmacist-Led Comprehensive Medication Management on Chronic Disease State Goal Attainment in a Patient-Centered Medical Home.

BACKGROUND: Clinical pharmacy services were initiated at 7 of 11 clinics within a primary care network (PCN), which was designated as a patient-centered medical home and was affiliated with a large academic medical center in October 2014. The goal of the service was to target patients with uncontrolled chronic conditions, specifically diabetes. Patients met with a clinical pharmacist through individual clinic and telephonic appointments, in addition to usual appointments with physicians as needed. While managing patients with diabetes, many clinicians assess a patient's hemoglobin A1c (A1c), along with blood pressure and cholesterol, as indicators of disease state control and cardiovascular risk. These 3 parameters were combined into a bundled response score (BRS) in order to assess whether the addition of the clinical pharmacy service had a positive effect on patient therapeutic goal attainment rates for these areas. OBJECTIVES: To assess the effect of pharmacist-led comprehensive medication management (CMM) on therapeutic goal attainment rates for glycemic, blood pressure, and dyslipidemia outcomes in PCN patients, which was represented by a BRS based on how many therapeutic goals were met. METHODS: This retrospective study was conducted using patients seen in clinics within the PCN between October 1, 2014, and October 31, 2015. Patients were included in the intervention group if they were actively managed by a PCN pharmacist and had a diagnosis of diabetes. A control group included patients without access to a PCN pharmacist and was matched to the intervention group by baseline A1c results. Based on current clinical practice guidelines, therapeutic goals for the BRS were set as A1c ≤ 8%, blood pressure ≤ 140/90 mmHg, and prescription of a moderate- to high-intensity statin for dyslipidemia. In addition to the primary outcome, the individual components of the BRS were assessed, as well as the average number of medications used between groups. RESULTS: There were 95 patients included in the intervention group, with 132 patients included in the usual care group. Patients in the intervention group had significantly higher rates of therapeutic goal attainment for the 3 endpoints (40% vs. 12%, P < 0.001). The intervention group had statistically significantly higher improvements in the individual areas of A1c, blood pressure, and statin goal attainment. There were no significant differences in the number of medications for diabetes or antihypertensive medications used between groups at the time of study termination. CONCLUSIONS: This study demonstrated that the addition of CMM services provided by clinical pharmacists in this PCN had a positive effect on therapeutic goal attainment rates for patients with diabetes. This finding suggests that the integration of clinical pharmacists into primary care clinics could have positive effects on the clinical outcomes of diabetic patients in glycemic control, blood pressure, and statin treatment, in accordance with current guidelines. DISCLOSURES: Support for this study was provided to Wilson by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number ULI TR001860. The content of this article is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. The authors have nothing additional to disclose.