Identifying Opportunities for Impact of Community-Based Pharmacist-Led Biometric Health Screenings on ASCVD Risk.

Introduction: Community-based pharmacists are positioned uniquely to assist in the early detection of underlying cardiovascular disease (CVD) which affects approximately 50% of adults in the United States. Organizations utilize community-based pharmacists to conduct annual biometric health screenings to help employees identify health risks previously undetected. The goal of this study was to evaluate how community-based pharmacists could impact lifetime atherosclerotic cardiovascular disease (ASCVD) risk for a large population. Methods: This study was a retrospective analysis of annual pharmacist-led 15-minute biometric health screening data from a large regional community-based pharmacy chain. Employees between the ages of 20 and 79 who had completed at least three biometric health screenings between July 1, 2015 and June 30, 2020 were included. Incomplete biometric health screening records were excluded. To calculate lifetime ASCVD risk and identify perceived gaps in care, prescription fill history of study participants was used. The pharmacists did not make clinical interventions; however, education was provided with the information found. Results: A total of 10,001 patients were included. Median baseline ASCVD risk was 1.5% and increased to 1.8% (p < 0.001). Additionally, 1,187 patients with an elevated ASCVD risk ≥ 7.5%, showed statistically significant improvements in blood pressure, body mass index, and cholesterol. Conclusions: Improvements for high-risk patients were seen in several biometric health screening parameters including blood pressure, body mass index, and cholesterol. Community-based pharmacists were well positioned to intervene clinically to support reduction of ASCVD life-time risk.

Impact of state mandates on electronic prescribing of acute opioid prescriptions for the treatment of pain in Kansas and Colorado.

BACKGROUND: Government and health care entities are seeking solutions to optimize safe opioid prescribing practices. Electronic prescribing of controlled substance (EPCS) state mandates are becoming common, but lack thorough evaluation. OBJECTIVE: This study aimed to evaluate whether EPCS state mandates affect opioid prescribing patterns for acute pain treatment. METHODS: This retrospective study was designed to assess prescribing patterns via percent change for quantity, day supply, and prevalence of prescribing method utilized for opioid prescriptions 3 months pre- and post-EPCS mandate. Prescription data are extracted from two regional divisions of a large community-based pharmacy chain between April 1, 2021 to October 1, 2021. Relationships of patient geographical locations and prescribing methods were assessed. Likewise, the relationship of opioids prescribed between insurance types were evaluated. Data was evaluated utilizing Chi-Square and Mann-Whitney U tests, with an a-priori alpha of 0.05. RESULTS: There was an increase before to after state mandate of quantity and day supply (0.8% and 1.3% [P = 0.02; P < 0.001], respectively). There were significant decreases in total daily dose and daily morphine milligram equivalent (2.0% and 1.9% [P < 001; P = 0.254], respectively). A 16.3% increase was seen in electronic prescribing before to after state mandate for prevalence of electronic prescribing versus other prescribing methods. CONCLUSION: There is a correlation between EPCS and prescribing patterns for acute pain treatment with opioids. The use of electronic prescribing increased after state mandate. By promoting the use of electronic prescribing, the benefit of awareness and caution of opioid use draws attention to prescribers.

Pilot Evaluation of Pharmacists' and Pharmacy Technicians' Knowledge and Understanding of a Medication Synchronization Program.

Background: Medication synchronization (MS) improves adherence by allowing patients to pick up all medications at the same time. Pharmacy staff need training to utilize a MS program effectively. Objective: Evaluate the impact of a video tutorial with decreased extraneous and intrinsic load on pharmacists' and pharmacy technicians' knowledge and understanding of a MS program. Study Method: Participants completed a prequestionnaire to assess knowledge and understanding of the MS process. They then watched a step-by-step video tutorial and were reassessed by a postquestionnaire 2 weeks later. Study participants included pharmacists and pharmacy technicians employed at 1 of 2 pharmacies in 1 regional division of a large community-based chain pharmacy. Participants were eligible if they were registered and in good standing with the Kansas Board of Pharmacy and employed for greater than 30 days since July 1, 2018. Results: Twenty participants were included in the final analysis. The median age was 36 years, 14 (70%) were female, 13 (65%) were pharmacy technicians, and each study site had equal representation. Most participants, 15 (75%), had previously completed the standard MS training. There was a significant improvement in number of correct responses after the intervention with a prequestionnaire score of 61.3% to postquestionnaire score of 70% (P=.002). Significant improvement in knowledge was seen in participants who completed the previous training as well as first-time learners of the MS process. Conclusion: Optimizing training on MS processes by decreasing extraneous and intrinsic load improved the pharmacy team's knowledge and understanding of the MS process.

Community-Based Pharmacy Travel Health Service Pilot Impact on Participant Understanding and Satisfaction.

BACKGROUND: Increased rates of international travel have led to a higher demand for healthcare professionals to provide travel health services. Community-based pharmacists are capable of meeting this need. OBJECTIVE: This study evaluates the impact of pharmacists providing travel health services in a community-based pharmacy on participant understanding and satisfaction of travel education and preparation. METHOD: A trained pharmacist met with participants to review their medical history, travel itinerary, and provide education. Indicated immunizations were administered and the participant's primary care provider was contacted if prescription medications were warranted. A questionnaire was administered before and after the travel health consultation assessing participants perceived understanding of travel health information, satisfaction, and perceived monetary value of the service. Data were collected by 5-point Likert-scale responses, with 5 equivalent to strongly agree. Wilcoxon signed-rank test and descriptive statistics were used for evaluation. Participants were included if they had international travel planned within 12 weeks of the consultation. RESULTS: A total of 12 participants were included. Participant understanding significantly increased for all 5 survey items relating to travel health information with a p value < 0.05 for each item. The largest change was for how to find medical help during international travel (medians and IQR were 3(2-3), and 5(5-5) for pre-and post-consultation, respectively, p = 0.003). Participant satisfaction questions received a median response of 5. Participants' perceived monetary value of the service was a median of $50 (IQR $50-50). CONCLUSION: Pharmacist-led travel health consultations improved participant understanding of travel health information and was of perceived value.

Semaglutide Initiation in a Type 2 Diabetes Mellitus, Post-Liver Transplant Patient.

Objective To describe the process of initiation of semaglutide for complex management of type 2 diabetes mellitus (T2DM) in a patient after liver transplantation. Setting Family medicine clinic. Practice Description A family medicine clinic comprising six physicians with an ambulatory care pharmacist. The pharmacist has direct interaction with patients and providers within the clinic assisting in the management of chronic disease states under a collaborative practice agreement. Practice Innovation A 63-year-old White male with a history of liver transplantation in the context of T2DM, treated with basal-bolus insulin therapy, was referred by his family medicine provider to the ambulatory care pharmacist for diabetes management because of a hemoglobin A1c (HbA1c) level greater than 10%. Semaglutide was initiated and titrated to improve blood glucose control in combination with basal-bolus insulin adjustments taking disease states, cost, and health literacy into consideration. Results The addition of semaglutide, over an eight-month period, assisted with glycemic control to an HbA1c of less than 7%. Conclusion Semaglutide, in addition to basal-bolus insulin therapy, allowed for overall improved glycemic control; however, further studies are needed to evaluate efficacy because of the complexity of diabetes management in this patient population. Throughout the course of treatment of patients with T2DM and organ transplantation, dual monitoring of antidiabetic therapy and antirejection medications is essential to reduce the risk of organ rejection.

Impact of Automated Notifications on Prescription Abandonment.

BACKGROUND: Prescription abandonment impacts patients' quality of life and disease progression. In addition, prescription abandonment can increase total healthcare costs. OBJECTIVE: This study compared effects of automated telephone calls (ATC), automated text messages (ATM), and control on prescription abandonment rates with Medicare defined Star Rated medications. The secondary objective compared prescription abandonment rates between age groups (18-64 versus ≥ 65 years) within each arm. METHODS: This was a retrospective observational analysis from a regional division of a large community-based pharmacy chain. Star Rated medication prescriptions consisting of hydroxymethylglutaryl-coenzyme A reductase inhibitors, renin-angiotensin system antagonists, and non-insulin type 2 diabetes mellitus medications were included. Prescriptions for patients who activated or deactivated automated notification enrollment during the study period were excluded. RESULTS: A total of 31,056, 33,278, and 20,299 prescriptions were included in the analysis of ATC, ATM, and control arms, respectively. Prescription abandonment occurred on 726 (2.3%) prescriptions within ATC arm, 864 (2.6%) prescriptions within ATM arm, and 513 (2.5%) prescriptions within control arm (p = 0.099). Prescription abandonment occurred on 390 (2.6%) prescriptions for 18-64 and 336 (2.1%) prescriptions for 65 years or older within the ATC arm (p = 0.002). Prescription abandonment occurred on 251 (2.9%) prescriptions for 18-64 and 262 (2.3%) prescriptions for 65 years or older within the control arm (p = 0.006). CONCLUSION: No difference in rates of prescription abandonment existed between each automated notification arm on Star Rated medications. ATC notifications decreased rates of prescription abandonment when utilized by patients 65 years or older.