Therapy for HIV-associated cryptococcal meningitis: a case report demonstrating a new treatment approach emphasizing updated treatment guidelines.

Cryptococcal meningitis (CM) remains a significant global health burden, especially for persons living with HIV. Despite effective antiretroviral and antifungal therapy, mortality rates are still approximately 70% in low- and middle-income countries and 20-30% in high-income countries. Central nervous system symptoms range from mild to severe, depending on burden of disease, and prompt and appropriate therapy is critical to reducing mortality. Treatment consists of three phases: induction, consolidation, and maintenance. Although treatment regimens have largely remained unchanged for decades, recent clinical trials have led the World Health Organization to update guidelines to reflect best practices in resource-limited settings. We review the clinical presentation, diagnosis, and standard therapy for CM, present a case with a challenging diagnostic and treatment course complicated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and discuss the benefits of a new treatment dosing strategy highlighting potential advantages of adopting this novel dosing option in high-income countries.

Determining the accuracy of open-access databases for identifying commonly prescribed oral medications.

OBJECTIVES: To compare the accuracy of open-access medication identification databases in identifying commonly prescribed oral tablets and capsules. METHODS: We compiled a dataset from the most frequently prescribed medications in 2012 and 2013 by total prescription volume. Imprints for the medications were obtained from the Food and Drug Administration label information accessed via the National Library of Medicine's (NLM) DailyMed. The imprints were used to determine if the correct medication could be identified in the open-access medication identification databases Drugs.com, Healthline, NLM's Pillbox, RxList, and WebMD by means of the imprints alone. A general web search using the imprints as key words via Google search engine was also conducted to mimic the lay public's approach to identifying an unknown medication. RESULTS: Database accuracy of search results ranged from 26.5% to 89.27% with the NLM Pillbox having the highest accuracy when using tablet/capsule imprint information alone. The secondary web search with the use of the Google search engine yielded 75.7% accuracy in using imprints as search terms to identify websites leading to the appropriate drugs. Drugs.com was listed as the first site for the majority of Google searches and was 86.44% accurate. CONCLUSION: Open-access databases are available to help identify oral tablets and capsules and they have a relatively high success rate of identifying commonly prescribed medications. However no database is 100% accurate, which means that the risk involved with patients identifying their own medications is substantial. Patients should be highly encouraged by all health care practitioners to consult their pharmacist or primary health care provider to prevent misidentification and subsequent misadministration.

Practice Transformation Driven through Academic Partnerships.

Evidence-based interventions have been shown to improve the quality of patient care, reduce costs, and improve overall health outcomes; however, adopting new published research and knowledge into practice has historically been slow, and requires an active, systematic approach to engage clinicians and healthcare administrators in the required change. Pharmacists have been identified as important agents of change and can enhance care delivery in primary care settings through evidence-based interventions. Utilizing the Consolidated Framework for Implementation Research (CFIR) we identify, assess, and share barriers and facilitators to program development, as well as growth and expansion efforts across five discrete, university-subsidized, embedded-pharmacy practices in primary care. We identified two overarching modifiable factors that influence current and future practice delivery and highlight the role of academia as an incubator for practice change and implementation: Data collection and information sharing. Conceptual frameworks such as CFIR help establish a common vernacular that can be used to facilitate systematic practice site implementation and dissemination of information required to support practice transformation.

Community Pharmacy Enhanced Dispensing Model to Improve Medication Access for Rural Patients Living with HIV.

OBJECTIVE: To demonstrate the utility of a community pharmacy-centric workflow for improving access to medications for high-risk, rural persons living with HIV (PLWH) in partnership with a Federally Qualified Health Center (FQHC). SETTING: University-sponsored independent community pharmacy and rural FQHC providing care to PLWH. PRACTICE DESCRIPTION: Patient-centered Pharmacy Program is a service designed to improve access to HIV medications for PLWH in rural Idaho. The service is delivered in partnership with a 340B-covered entity (FQHC). PRACTICE INNOVATION: The workflow for the service in the community pharmacy is described in detail, including time assessments and descriptions of tools and forms developed for rollout. EVALUATION: Quality improvement initiatives over three years are described. RESULTS: This service ensures medication access for rural PLWH and is sustainable for the community pharmacy. Expansion of services is feasible for the future. CONCLUSION: This partnership may be one that could be implemented at other rural, independent community pharmacies seeking to have outreach to rural patients with chronic medication needs.