Impact of Pharmacist-Led Education on Proper Prophylactic Enoxaparin Dosing in Obese Patients.

Background/Purpose: Venous thromboembolism (VTE) is a common cardiovascular complication in middle-aged adults. There is a likelihood a patient may experience VTE when admitted to a hospital. Prophylactic medications such as low-dose unfractionated heparin and enoxaparin are started to prevent VTE. A pharmacist-led health system-wide Grand Rounds promoted prophylactic enoxaparin 40 mg twice daily instead of once daily in patients with a body mass index (BMI) 40 kg/m2 or greater. Methodology: This case-control study was conducted at a Essentia Health - Fargo, in the Upper Midwest. Data of acute care patients were extracted from electronic health records 2 years before and after the pharmacist-led education. Patients in the study were 18 years old or older, hospitalized with a need for prophylactic anticoagulation receiving enoxaparin, and had a BMI 40 kg/m2 or greater. Patients with a diagnosis of COVID-19 and recent bleeding were excluded. Groups were compared to determine the effect of pharmacist-led education. The outcome was the number of patients who received enoxaparin 40 mg twice daily compared to once daily. Results: In the control group, 9 out of 15 hospitalizations received enoxaparin 40 mg subcutaneous twice daily and in the case group 34 out of 70 hospitalizations received the twice daily dosing. The odds ratio of receiving enoxaparin 40 mg twice daily after the pharmacist-led education compared to before the education was OR = .99, 95% CI = .96, 1.02. Conclusions: There was no difference in enoxaparin 40 mg once daily and twice daily dosing after the pharmacist-led education.

Evaluation of a Pharmacist-Led COVID-19 Vaccination Program in a Hospital Setting.

PURPOSE: A pharmacist-led COVID-19 vaccination screening and administration tool was implemented at a tertiary care hospital in the Upper Midwest, allowing pharmacists to determine if an inpatient is a candidate for the COVID-19 vaccination. The purpose of this observational study was to examine the feasibility of a pharmacist-led, COVID-19 vaccination administration workflow to the inpatient population in a tertiary care hospital. METHODS: This observational study was conducted at an Upper-Midwest facility and includes a study population of adult patients admitted to the hospital between 10/1/2021 - 1/1/2022. The primary outcome of this study was the number of COVID-19 vaccinations administered. Secondary outcomes included the number of attending physician approvals, pharmacist time dedicated to the vaccination program, patient demographics, and patient acceptance of vaccination. Group differences were evaluated using odds ratios, 95% confidence intervals, Pearson's chi-square test, the Mann-Whitney U test, and multivariate logistic regression. RESULTS: There were 715 patients eligible to receive COVID-19 vaccination. Of those, 23 (3.2%) patients received a COVID-19 vaccine while inpatient. After adjusting for sex at birth, age at admission, and length of hospital stay, compared to previously unvaccinated patients, those with their second dose due were 7.3 times more likely to have been given a vaccination (95% CI 1.3-42.1, P = 0.026), while patients with their booster due were 4 times more likely to have been given a vaccination (95% CI 1.3-12.3, P = 0.014). CONCLUSIONS: Although unvaccinated patients were successfully identified, only 23 were able to be vaccinated. Additional barriers need to be addressed to make this program successful.

Outcomes of same-day discharge following percutaneous coronary intervention in a rural population.

BACKGROUND: Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is safe, yet the nationwide rate of SDD remains low. The impact that residing in a rural area has on the safety of SDD is unknown. OBJECTIVE: To investigate the safety of SDD compared to next-day discharge (NDD) among PCI patients living in a largely rural area. METHODS: There were 3502 outpatient elective PCIs at a tertiary care center between January 1, 2011 and December 31, 2017. Data from the National Cardiovascular Data Registry CathPCI Registry® and the electronic medical records were obtained for patient demographics, procedural characteristics, and procedural outcomes. Data from the initial PCI in each 365-day period were included in the analysis for each patient. Rural-Urban Commuting Area codes 4-10 were used to define rural status. RESULTS: A total of 2099 (59.9%) PCIs met the inclusion criteria (63% rural). The overall rate of SDD increased over time (4.7% in 2011 to 39.6% in 2017) as radial access increased (14.2% in 2011 to 59.9% in 2017). In this population, a total of 329 PCIs had SDD (15.7%; median (interquartile range) age 66.0 (14.0) years, 20.1% female, 52.3% rural status). Compared to NDD, SDD patients had less hyperlipidemia, atrial fibrillation, congestive heart failure, history of coronary artery bypass graft, and more radial access. SDD was noninferior to NDD for 30-day readmission but had a decreased 1-year (adjusted odds ratio [aOR]: 0.20, 95% confidence interval [CI]: 0.05-0.81, p = 0.024) and 5-year (aOR: 0.43, 95% CI: 0.28-0.66, p < 0.001) all-cause mortality compared to NDD. Rural status did not predict outcomes. CONCLUSIONS: SDD in patients in rural areas does not have a significantly higher rate of 30-day readmission. SDD patients had lower odds of 1- and 5-year mortality when compared to NDD. Future studies prospectively evaluating the safety of SDD in this population are warranted.

Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics-Phase 2: Quality Improvement Initiative Over 15 Months.

Objective: To evaluate the effectiveness of a quality improvement (QI) initiative to improve family medicine residents' metabolic monitoring of second-generation antipsychotics (SGAs) for patients comanaged across nonintegrated community mental health and family medicine clinics.Methods: Patients were aged ≥ 18 years seen by family medicine residents and prescribed at least 1 SGA (N = 175). Preparative and scheduled QI interventions were nonblinded and included collaboration across organizations, education, and monthly interprofessional care conferences. The QI outcome included evaluation of pre-post metabolic monitoring laboratory data over the 15-month study period. A subset of patients (n = 26) was reviewed at least once at monthly interprofessional care conferences. Patients were stratified by diagnosis of diabetes (n = 45) and no diabetes (n = 130) at baseline. Analyses of the QI intervention outcomes were framed by the time period of monthly care conferences (January 31, 2019-April 30, 2020) and compared to baseline (the historical time period) (October 31, 2017-January 29, 2019).Results: Improved adherence in glycated hemoglobin (HbA1c) (P = .042) and lipid (P < .001) monitoring per guidelines from baseline to follow-up was seen in the total patient population (N = 175). Patients without diabetes (n = 130) had significant improvement (P = .001) in HbA1c monitoring from baseline to follow-up. The subgroup of patient cases that were discussed at a care conference showed no significant improvement in HbA1c or lipid monitoring.Conclusion: Preparative and scheduled QI interventions provided family medicine residents powerful reminders of the SGA monitoring guidelines that improved the metabolic monitoring behaviors for all patients on SGAs.Prim Care Companion CNS Disord. 2023;25(3)22m03432. Author affiliations are listed at the end of this article.

Epidemiology of traumatic brain injuries at a rural-serving Level II trauma center, 2004 - 2016.

OBJECTIVE: To describe the epidemiology of traumatic brain injury (TBI) and quantify rural and urban differences. METHODS: Patient characteristics, injury characteristics, imaging, and outcomes were extracted from the trauma registry of the level II trauma center at Essentia Health-St. Mary's Medical Center, Duluth, MN, for patients admitted for a TBI from January 1, 2004, through December 31, 2016. Estimated relative risk (RR) per year, Wald 95% confidence intervals, and p-values were calculated. RESULTS: Of the 5,079 TBI admissions during the study period, just under half (2,510, 49.4%) resided in rural areas at the time of admission. Overall, there was a 3.8% unadjusted annual increase in TBI risk rom 2004-2016, with 2.9% and 4.7% annual increases among rural and urban U.S. residents, respectively. Rural residents had significant annual increases in risk of TBI admission resulting in 30-day post-discharge emergency department readmission and 30-day post-discharge combined inpatient/emergency department readmission of 35.2% and 22.4%, respectively. CONCLUSIONS: We found that risk of rural resident TBI admission due to MVC was significantly greater than that for urban residents. Public health and medical interventions to decrease the rural/urban disparity are warranted, including public health campaigns to increase seat belt use, and supportive care post-discharge into rural communities.

Feasibility of preemptive pharmacogenetic testing in colorectal cancer patients within a community oncology setting.

INTRODUCTION: Pharmacogenetics, in hand with precision medicine in oncology, represents an opportunity to holistically tailor a patient's treatment regimen using both somatic and germline variants to improve efficacy and decrease toxicity. Colorectal cancer patients represent a population with frequent use of fluoropyrimidine and irinotecan and are an ideal opportunity for implementation of preemptive pharmacogenetics as evidence supports pharmacogenetic testing for DPYD and UGT1A1 to reduce fluoropyrimidine and irinotecan toxicities. METHODS: This was a single arm proof-of-concept study at a large community-based health system. Participants provided samples for pharmacogenetic testing via an external vendor prior to chemotherapy initiation and an oncology pharmacist was responsible for pharmacogenetic interpretation and pharmacogenetic-guided therapeutic recommendation to the treating provider. RESULTS: A total of 24 (60%) participants had a UGT1A1 variant. All participants (100%) were DPYD*1/*1. Results were available and interpreted for 29/40 (72.5%) participants prior to scheduled chemotherapy initiation (p value <0.014). Of the participants whose results were available in 5 weekdays or less (n = 23), 20 (87%) were communicated with the treating provider prior to scheduled chemotherapy administration. A total turnaround time of 5 days or less was significantly associated with PGx feasibility in a community-based oncology clinic (p = 0.03). CONCLUSIONS: In conclusion, we were able to show that implementation of preemptive pharmacogenetic testing into a community oncology clinic with results interpretation available prior to scheduled initiation of chemotherapy was feasible. As pharmacogenetic testing in oncology expands, pharmacists should be prepared to optimize supportive medication regimens as well as chemotherapy with pharmacogenetic results.

Development, Implementation, and Evaluation of an Early Mobility Protocol in a Regional Level II Trauma Center.

The purpose of this project was to develop and evaluate a collaborative nursing/therapist protocol for early mobility in a medical-surgical intensive care unit (MICU) in a regional level II trauma center. Data for patients in the MICU were compared for the periods August 3, 2015-August 2, 2016, and August 3, 2014-August 2, 2015. Semistructured interviews were conducted with 10 nurses and 1 therapist. Average MICU length of stay decreased from 3.81 to 3.50 days (P = .057). Mean time in mobility chairs did not change (0.12 days vs 0.11 days, P = .389). Mean number of days to first documented level 2-5 activity decreased significantly, from 1.81 to 1.51 days (P = .036). The percentage of hospitalizations with any documented level 3 or 4 activity increased significantly (from 3.8% to 7.4% and from 61.5% to 66.7%, P = .003 and P = .031, respectively). Barriers/challenges to implementation included having enough people to assist, space, documentation, having to coax the physician to place order for upright mobility, availability of therapists for later stages of protocol, patient variability, fear of patient falls, availability of therapy chairs, staff changes, time, and patient refusal. A multidisciplinary approach to protocol development for early mobility in an intensive care unit was successfully implemented at a regional level II trauma center.

Preventing Exercise-Associated Collapse Using Online Runner Education: A Randomized, Controlled Trial.

OBJECTIVE: To determine whether online exercise-associated collapse (EAC) prevention education decreases medical tent EAC visits among first-time marathoners. DESIGN: A prospective controlled study, with age- and sex-stratified randomization, evaluated rates of medical tent diagnosed EAC among runners randomized to the intervention group and intervention participants, compared with a control group. SETTING: Grandma's Marathon Medical Tent in Duluth, MN, June 2016. PARTICIPANTS: Runners in the 2016 Grandma's Marathon who never previously ran a marathon (n = 2943), randomized into control (n = 1482) and intervention (n = 1461) groups. Intervention participants opened the EAC prevention video (n = 590). INTERVENTIONS: Online EAC education included an introductory webpage and 5-minute professional video describing EAC and prevention. MAIN OUTCOME MEASURES: Medical tent visit with EAC diagnosis. RESULTS: Intervention participants had no decreased likelihood of EAC, compared with controls [odds ratio (OR), 0.88, 95% confidence interval (CI), 0.46-1.69]. Exercise-associated collapse occurred less frequently in those with longer race times (OR, 0.58, 95% CI, 0.43-0.79). Intervention participation was associated with longer race times (OR, 1.12, 95% CI, 1.10-1.23). CONCLUSIONS: Those opening the EAC prevention video and controls had similar EAC rates. Slower running speed was associated with lower EAC rates. Video viewing was a predictor of slower running pace.

Mathematical Analysis of Melanocyte Patterns on Danio rerio.

The study of zebrafish skin pattern development could lead to a better understanding of how these patterns are generated and how they evolved. To compare and contrast wild-type (WT) striped and leopardt1 mutant spotted patterns, photographs were taken of the developing fish. Initial observations led to the hypothesis that the black melanocyte spots in leopardt1 mutants were not randomly distributed, but rather were located in "dashed" stripes. To test this, melanocyte-spot-sized transparent grids were overlaid onto photographs and the location of melanocyte clusters was recorded. The grid maps were used to identify whether a black, melanocyte positive, grid area was present adjacent to each melanocyte cluster in each cardinal and intercardinal direction. In addition, Python-based computer programs were used to analyze the photographs at the pixel level. When analyzed using analysis of variance and logistic regression models, the striped and spotted patterns expressed more similarities than expected. In the leopardt1 zebrafish, the spots were organized into dashed stripes that had similar locations to the WT stripes. This research suggests that spotted and striped patterns are related. Further, the leopardt1 spots were farther apart along the dorsal-ventral axis than in the anterior-posterior direction, suggesting that different mechanisms control spacing along these two axes.

Alcohol Use at the Time of Traumatic Brain Injury: Screening and Brief Intervention in a Community Hospital.

The use of screening and brief interventions (SBI) has been proposed to reduce future alcohol misuse and injury in traumatic brain injury (TBI) patients. As a result a SBI protocol for TBI patients was introduced with nursing training at a community hospital. In the 2 years following the implementation of a SBI protocol and nursing training, the number of patients with positive alcohol results decreased. The number of brief interventions increased to 83 (40.1%, 95% confidence limit [CL] = 33.4, 46.8), and CAGE questionnaire screenings decreased to 88 (42.5%, 95% CL = 35.8, 49.2), with 31 (35.2%) having positive results. These results highlight the need to assess processes and training in the emergency department to ensure that SBIs occur.

Enhancing Risk Assessment in Patients Receiving Chronic Opioid Analgesic Therapy Using Natural Language Processing.

OBJECTIVES: Clinical guidelines for the use of opioids in chronic noncancer pain recommend assessing risk for aberrant drug-related behaviors prior to initiating opioid therapy. Despite recent dramatic increases in prescription opioid misuse and abuse, use of screening tools by clinicians continues to be underutilized. This research evaluated natural language processing (NLP) together with other data extraction techniques for risk assessment of patients considered for opioid therapy as a means of predicting opioid abuse. DESIGN: Using a retrospective cohort of 3,668 chronic noncancer pain patients with at least one opioid agreement between January 1, 2007, and December 31, 2012, we examined the availability of electronic health record structured and unstructured data to populate the Opioid Risk Tool (ORT) and other selected outcomes. Clinician-documented opioid agreement violations in the clinical notes were determined using NLP techniques followed by manual review of the notes. RESULTS: Confirmed through manual review, the NLP algorithm had 96.1% sensitivity, 92.8% specificity, and 92.6% positive predictive value in identifying opioid agreement violation. At the time of most recent opioid agreement, automated ORT identified 42.8% of patients as at low risk, 28.2% as at moderate risk, and 29.0% as at high risk for opioid abuse. During a year following the agreement, 22.5% of patients had opioid agreement violations. Patients classified as high risk were three times more likely to violate opioid agreements compared with those with low/moderate risk. CONCLUSION: Our findings suggest that NLP techniques have potential utility to support clinicians in screening chronic noncancer pain patients considered for long-term opioid therapy.

Neuromuscular Training Availability and Efficacy in Preventing Anterior Cruciate Ligament Injury in High School Sports: A Retrospective Cohort Study.

OBJECTIVE: To document neuromuscular training (NMT) availability and its relationship to anterior cruciate ligament (ACL) injuries in 4 major high school sports by gender, sport, and rural/urban geography, with the hypothesis that increased exposure to NMT would be associated with fewer ACL injuries. DESIGN: A retrospective cohort study. SETTING: All Minnesota high schools identified in the Minnesota State High School League (MSHSL) database for fall 2014 boys' football and soccer, and girls' volleyball and soccer. PARTICIPANTS: All high school athletic directors were surveyed to report their school's fall 2014 experience; 53.5% returned the survey reporting experience with one or more of the sports. INTERVENTION: Athletic directors documented each sport's preseason and in-season exposure to NMT (plyometric exercises, proximal/core muscle strengthening, education and feedback regarding proper body mechanics, and aerobics) and licensed athletic trainers. MAIN OUTCOMES: Reported ACL injuries by sport, gender and rural/urban. RESULTS: More than two-thirds of teams incorporated facets of NMT into their sport. Among male athletes, soccer players exposed to licensed athletic trainers experienced significantly fewer ACL injuries (P < 0.005), and NMT was associated with significantly fewer ACL injuries in football (P < 0.05) and soccer (P < 0.05). Female athletes did not demonstrate similar associated improvements, with volleyball injuries associated with increased NMT (P < 0.001), and soccer injuries not associated with NMT. However, girl soccer players in rural settings reported fewer ACL injures compared with urban teams (P < 0.001). CONCLUSIONS: Most fall high school sports teams were exposed to NMT, which was associated with fewer ACL injuries for male, but not for female athletes. Improved gender- and sport-specific preventive training programs are indicated.

Predictors of Hospital Length of Stay and Readmissions in Ischemic Stroke Patients and the Impact of Inpatient Medication Management.

OBJECTIVE: This study was designed to evaluate predictors of hospital length of stay (LOS) and readmissions among nonsurgical ischemic stroke patient, and the impact of inpatient medication management. METHODS: This retrospective cohort study includes adult patients (≥18 years) hospitalized with a diagnosis of nonsurgical ischemic stroke from November 2007 to March 2013. In November 2011, an inpatient medication management model was implemented in the stroke unit. At the end of the study period, patients were matched before and after implementation of the inpatient medication management model (non-PHC [pharmacist-hospitalist collaborative] and PHC, respectively) to evaluate change in outcomes. The primary outcome of the study is an evaluation of predictive factors affecting LOS and readmissions. Additionally, changes in LOS and all-cause readmission at 30, 60, and 90 days when compared between PHC and non-PHC were evaluated. FINDINGS: A total of 151 PHC patients were matched to 248 non-PHC patients. There was no difference in LOS between the PHC and non-PHC patients (mean adjusted difference -.14; P = .66). Similar finding was observed for readmissions (P > .05). Insurance type was a significant predictor of LOS, with Medicare patients having an extended LOS compared to patients with private insurance (mean difference -1.00; P = .005). Patients taking statins and patients aged less than 80 years had a lower 30-day readmission rate compared to nonstatin users and patients aged 80 years or older, respectively (P < .05). CONCLUSIONS: Insurance type and severity of illness are important predictors of LOS, whereas readmissions are mostly influenced by age and statin use.

Comparison of a pharmacist-hospitalist collaborative model of inpatient care with multidisciplinary rounds in achieving quality measures.

PURPOSE: Results of a study of hospitalization outcomes with the use of a pharmacist-hospitalist collaborative (PHC) model of care as an alternative to multidisciplinary rounds (MDR) are reported. METHODS: In a retrospective matched-cohort study, data on more than 2000 adults discharged from two medical units of a community teaching hospital were analyzed to compare selected outcomes before and after the units augmented traditional hospitalist care (usual care) with either MDR or a PHC care model emphasizing pharmacist involvement in case review and medication management. The study cohorts were matched for primary diagnosis, severity of illness, and other variables. The outcomes were mean length of stay (LOS) and rates of all-cause readmission during designated preintervention and intervention periods. RESULTS: Among patients admitted to the unit that implemented the PHC care model, those admitted during the preintervention period had a longer mean LOS than matched intervention-phase patients: 5.5 days (95% confidence interval [CI], 5.0-6.0 days) versus 4.7 days (95% CI, 4.2-5.3 days); p = 0.002. Patients admitted to the MDR unit during the preintervention period also had a significantly longer mean LOS than those in the matched intervention-phase cohort. There were no significant between-group differences in all-cause readmissions. CONCLUSION: Systematic implementation of either the PHC or the MDR model of care was associated with a decreased mean hospital LOS relative to LOS values with usual care only. No significant differences in readmissions at 30, 60, and 90 days were attributable to implementation of the PHC or the MDR model.

Effects of Statins on Hospital Length of Stay and All-Cause Readmissions Among Hospitalized Patients With a Primary Diagnosis of Sepsis.

BACKGROUND: There is little information on the impact of statins on hospital length of stay (LOS) or readmission among patients with sepsis. OBJECTIVE: The objective of this study is to evaluate the association between statin use and LOS and all-cause readmissions among sepsis patients hospitalized in the medical unit. METHODS: The design was a retrospective propensity score-matched study of adult patients with a primary diagnosis of sepsis from 2007 to 2013. Information was extracted from the electronic health record. Sepsis patients were identified using ICD-9CM codes. Propensity scores estimated the probability that a patient would be on statins, and patients who were on statins were then matched with those who were not, within ±0.05. Additional greedy matching criteria were organ dysfunction (yes/no) and all patient refined diagnosis-related group (APR-DRG) medical/surgical. The primary outcome was LOS, and the secondary outcomes were all-cause readmission at 30, 60, and 90 days, adjusted for age, sex, modified Deyo-Charlson comorbidity index, APR-DRG severity of illness (SOI), and APR-DRG medical/surgical, as appropriate. RESULTS: Patients taking statins had a shorter LOS than patients not taking statins, 8.7 ± 3.7 and 10.3 ± 2.7 days, respectively (P value = 0.018). There was no significant difference (P> 0.05) in all cause readmissions between statin and nonstatin patients. Presence of comorbidities and SOI were significant factors for 60- and 90-day readmissions. CONCLUSIONS: The use of statins among patients admitted with primary sepsis in the medical unit was associated with shorter length of hospital stay. However, it did not affect frequency of readmissions.

Animal-related activities as risk factors for injuries among youth on agricultural operations.

Working with animals on agricultural operations is hazardous for youths. This study evaluated the associations between activities and injuries related to specific animal types. A case-control study within the Regional Rural Injury Study II included 425 youths (less than 20 years of age) with injuries related to their operation and 1,886 controls (randomly selected youths). Exposures of interest were collected for the months prior to injury events for cases and randomly selected months for controls, based on an injury incidence algorithm. Multivariate logistic regression characterized associations between specific animal-related activities and injury outcomes among youths who reported working with the same animals. Large proportions of cases and controls, respectively, worked with beef cattle (47%, 28%), followed by horses (28%, 14%), and dairy cattle (22%, 12%). Feeding was the primary activity associated with animals; over 80% of cases and controls were involved in this activity during relevant exposure months, followed by milking (63%, 44%) among those working with dairy cows and herding (81%, 61%) among beef cattle workers. Elevated risk of dairy cattle-related injury was associated with milking (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.0-6.6) whereas beef cattle-related injuries were associated with calving (OR: 4.2; 95% CI: 2.1-8.6) and footwork (OR: 2.2; 95% CI: 1.0-4.9). Among youths working with animals, explicit activities can be identified that are associated with animal-specific injuries. The identification of relevant hazardous tasks is necessary for the development of effective prevention measures.

Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis.

Objective. To evaluate the effectiveness of a whole-foods, plant-based diet (WFPB) to reduce symptoms of osteoarthritis. Methods. Six-week, prospective randomized open-label study of patients aged 19-70 with osteoarthritis. Participants were randomized to a WFPB (intervention) or continuing current diet (control). Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores, weekly Patient Global Impression of Change (PGIC) scales, and mean weekly Visual Analog Scale (VAS) pain assessment. Mixed models analysis also evaluated pre-post change from baseline level for standard clinical measures: weight, BMI, body temperature, pulse, and blood pressure. Results. Forty participants were randomized. Thirty-seven of them, 18 control and 19 intervention, completed the study. The intervention group reported a significantly greater improvement than the control group in SF-36v2 energy/vitality, physical functioning, role physical, and the physical component summary scale. The differences between the intervention and control PGIC scales were statistically significant over time. Intervention group improvement in VAS weekly mean was also significantly greater than that of the control group from week 2 onward. Conclusion. Study results suggest that a whole-foods, plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients.

Evaluation of the influence of a pharmacist-led patient-centered medication therapy management and reconciliation service in collaboration with emergency department physicians.

BACKGROUND: The implementation of the Patient Protection and Affordable Care Act is anticipated to increase the frequency of emergency department (ED) visits. Therefore, there is a critical need to improve the quality of care transitions among ED patients from ED to outpatient services.  OBJECTIVE: To evaluate the effect of systematic implementation of a pharmacist-led patient-centered approach to medication therapy management and reconciliation service (MRS) in the ED on patient utilization of available health care services. METHODS: A single institution prospective randomized cohort study with 90-day postvisit observation randomized patients into 2 groups: (1) medication therapy management reconciliation service following a patient-centered approach (MRS) or (2) usual care provided by the institution (non-MRS). To align patient enrollment with availability of other primary care services, subjects were enrolled during weekday daytime hours. Data for the 90 days before and after the index ED visit were matched in all analyses. Generalized estimating equations evaluated any primary care (PC), urgent care (UC), and ED visits during the 90 days post-index ED visit, adjusted by age and sex and weighted by survival time. Generalized linear models evaluated the average number of ED visits during that period, adjusted by age and sex and weighted by survival time. Data were analyzed for all adult patients (ADLTS), aged ≥ 18 years, and the subpopulation taking 1 or more prescribed daily medication at the time of the index ED visit (ADLTS1+)-the patients expected to receive greatest benefit from an MRS program. RESULTS: ADLTS MRS patients were 1.9 more likely than non-MRS patients to visit their PC providers (mean difference 0.15, P less than 0.001). Similarly, ADLTS1+ MRS patients were 1.5 times more likely to visit their PC providers (mean difference 0.10, P = 0.026). Although ADLT MRS patients were less likely to visit the UC, this was not significant. However, ADLTS1+ MRS patients were significantly less likely than non-MRS patients (OR = 0.5, 95% CI = 0.3-0.9) to visit the UC. No significant difference was seen in ED visits. CONCLUSIONS: The implementation of a patient-centered approach to medication therapy management and reconciliation improved the odds of patients visiting their PC providers, a positive first step in transitioning patients toward an appropriate use of PC services.

Evaluation of the impact of comprehensive medication management services delivered posthospitalization on readmissions and emergency department visits.

BACKGROUND: The impact of providing cognitive pharmacy services following hospital discharge has been studied with various results. This study is specifically focused on comprehensive medication management services delivered postdischarge in an interprofessional team environment to patients aged >65 years. OBJECTIVE: To determine if delivery of comprehensive medication management services postdischarge will prevent hospital readmissions or emergency department visits within 6 months following discharge in patients aged >65 years. Secondary endpoints included 30-day and 60-day postdischarge events. METHODS: This was a prospective group matched-controlled study of patients aged >65 years with selected diagnoses identified as high risk for readmission. The intervention group received comprehensive medication management that was provided face-to-face in the patient's primary care clinic within 2 weeks of discharge. RESULTS: No statistically significant difference was found between intervention and control groups in hospital readmissions or emergency department visits at 30 days, 60 days, or 6 months after discharge. No statistically significant difference was seen in mortality between groups. CONCLUSIONS: Provision of comprehensive medication management services did not reduce emergency department visits or readmissions in this study. This study was limited by multiple other changes occurring in the health system during the time of this study that potentially confounded results. In addition, the study may have been too small to detect a difference.