Pharmacist-Mediated Thyroid-Stimulating Hormone (TSH) Test Guideline Monitoring Program- Outcomes of a Retrospective Study In Patients On Levothyroxine.

Thirty to sixty percent of individuals taking levothyroxine were either under or overtreated, which leads to organ damage and excess mortality. This study aims to assess the gaps in the "thyroid-stimulating hormone (TSH) test guideline compliance rate" and validate the scope of ambulatory care pharmacist-mediated practice in patients on levothyroxine. At the study site, pharmacists offered patient-centered telephonic counseling to patients on levothyroxine who had been non-compliant with TSH tests for more than a year. A two-month quantitative retrospective analysis of this practice was conducted to assess its impact on TSH lab test adherence and dose modification outcomes. 415 patients met the study's inclusion criteria who received pharmacist counseling with documented intervention. Pharmacists bridged the significant gap in practice by creating new TSH lab requests with counseling in 81.2% (n = 337) of the study population who did not have TSH lab requests prior to the program. The non-compliance rate population dropped from 79.27% (n = 329) to 17.59% (n = 73) in the study population who had been non-compliant with the TSH test for 13 and 24 months. 74.5% (n = 309) were found to have performed their TSH test after the pharmacist's intervention. Among 100, 66% (n = 66) patients with abnormal TSH values consulted their physician for advice, of which 60.6% (n=40) had their levothyroxine dose adjusted (χ2=82.702, P < 0.01. The study suggests that pharmacists can significantly mediate between patients and physicians to enhance TSH test compliance and essential dose adjustment in patients prescribed levothyroxine.

Implementation of Pharmacist-led Telepsychiatry Services: Challenges and Opportunities in the Midst of COVID-19.

Over the last few decades, healthcare systems worldwide have seen many transformations, and one of the most significant transformations is the adoption of telemedicine. Its rapid and wide adoption has created an entirely different set of healthcare experiences. The healthcare field has vastly benefited from integrating technology and patient care. Johns Hopkins Aramco Healthcare (JHAH) has implemented several telehealth models as a response measure to overcome challenges in access to patient care due to the COVID-19 pandemic. This article describes the implementation of pharmacist-led telepsychiatry services utilized to provide several psychiatric services such as counseling patients, ensuring the appropriateness of medications prescribed, conducting therapeutic drug monitoring, and making clinical interventions to ensure a safe and effective therapy. By utilizing this newly integrated telepsychiatry model, pharmacists have continued to remain an integral part of improving patients' health outcomes and overall patient experience for psychiatric patients.

Safety of Tocilizumab in COVID-19 Patients and Benefit of Single-Dose: The Largest Retrospective Observational Study.

Severe acute respiratory coronavirus-2 (SARS-CoV-2) still presents a public threat and puts extra strain on healthcare facilities. Without an effective antiviral drug, all available treatment options are considered supportive. Tocilizumab as a treatment option has to date shown variable results. In this retrospective study, we aimed to assess predictors of mortality of COVID-19 patients (n = 300) on tocilizumab and the clinical effectiveness of this drug. The results showed that ICU admission OR = 64.6 (95% CI: 8.2, 507.4); age of the patient OR = 1.1 (95% CI: 1.0, 1.1); and number of tocilizumab doses administered by the patient OR(two doses) = 4.0 (95% CI: 1.5, 10.9), OR(three doses) = 1.5 (95% CI: 0.5, 5.1), and OR(four doses or more) = 7.2 (95% CI: 2.0, 25.5) presented strong correlation factors that may be linked to COVID-19 mortality. Furthermore, our study showed the beneficial effects of early administration of tocilizumab OR = 1.2 (95% CI: 1.1, 1.4) and longer hospital length of stay OR = 0.974 (95% CI: 0.9, 1.0) in reducing COVID-19 mortalities. High blood D-dimer concentration OR = 1.1 (95% CI: 1.0, 1.2) and reciprocal blood phosphate concentration OR = 0.008 (95% CI: 0.0, 1.2) were correlated to high mortality under SARS-CoV-2 infection. The short-term effect of a single dose of tocilizumab was a significant increase in blood BUN and liver enzymes (ALT, AST, and LDH) above their normal ranges. Furthermore, it significantly reduced CRP blood concentration, but not to normal levels (13.90 to 1.40 mg/dL, p < 0.001). Assessing the effect of different doses of tocilizumab (in terms of the number of doses, total mg, and total mg/kg administered by the patients) indicated that administering more than one dose may lead to increases in ICU length of stay and hospital length of stay of up to 14 and 22 days after the last dose of tocilizumab (6 to 14, p = 0.06, and 10 to 22, p < 0.001), with no improvement in 28- and 90-day mortality, as confirmed by Kaplan−Meier analysis. There were also clear correlations and trends between the number of doses of tocilizumab and increased blood CO2, MCV, RDW, and D-dimer concentrations and between number of doses of tocilizumab and decreased CRP, AST, and hemoglobin concentrations. Microbiology analysis showed a significant increase in the incidence of infection after tocilizumab administration (28 to 119, p < 0.001) with a median time of incidence within 6 days of the first dose of tocilizumab. A significant correlation was also found between the number of tocilizumab doses and the number of incidences of infections after tocilizumab administration r (298) = 0.396, p = 1.028 × 10−12. Based on these results and depending on the pharmacokinetic parameters of the drug, we recommend single-dose administration of tocilizumab as the optimal dosage for COVID-19 patients who do not have active bacterial infection or liver diseases, to be administered as soon as the patient is admitted to the hospital.

Online patient portal-based management of medication renewal and refill pickup in ambulatory care settings: A retrospective utilization study at tertiary care hospital in Saudi Arabia.

BACKGROUND: The prescription pickup and renewal process in ambulatory care settings requires numerous steps, such as making an appointment with a physician to renew prescriptions and direct pharmacy visits to pick up medications. This process can be difficult or cumbersome for some patients; however, digital health-associated patient portals can reduce the burden on both patients and healthcare professionals. METHODS: A retrospective study was conducted in an ambulatory care setting of Johns Hopkins Aramco Healthcare. We analyzed the utilization pattern of MyChart for medication renewal and refill pickup services for ambulatory care patients of all specialties from October 1, 2018, to September 30, 2020. The data were extracted electronically from the Epic-Hyperspace EHR system, and the effects of factors such as year of access and COVID-19 on MyChart utilization were analyzed. RESULTS: A total of 125,538 patients were registered using MyChart. In the first and second year of this study, MyChart was utilized by 44,063 (8.7%) and 59,622 (13.6%) patients, respectively, for medication pickup. Additionally, in these two years, 92,997 (21.6%) and 156,020 (38.9%) medication refills were requested through MyChart (with no direct pharmacy visit) and collected from different pickup locations, respectively. In two years, there were 363,159 medications sent to physicians for renewal through Epic-MyChart, of which 347,244 (95.6%) were approved and 15,915 (4.4%) were denied. A significant increasing (p less than 0.05) trend in utilization, medication requests, and renewal requests using the MyChart were observed over a period of 24 months and during quarantine due to COVID-19. Although there was a decrease in physicians denying renewal request, these were not significantly affected by time or COVID-19. CONCLUSION: The high and consistent utilization of the patient portal MyChart indicates its broad acceptance, significantly minimizing the barriers to medication pickup and renewal processes in ambulatory care settings. The year of access and COVID-19 were significantly associated with an increasing trend in MyChart utilization. With increased utilization and higher acceptability, the internet-based patient portal MyChart continues to hold great potential for providing quality healthcare services by increasing access and making patients decision-makers in their healthcare.

Implementation of pharmacist-led tele medication management clinic in ambulatory care settings: A patient-centered care model in COVID-19 Era.

Over the past 20 years, owing to rapid advances in technological innovation, namely in telecommunication and telemedicine, healthcare institutions have integrated clinical practices with cutting-edge telecommunication technology to enhance access to patient care, improve continuity of clinical care, and ensure patient safety. Johns Hopkins Aramco Healthcare (JHAH) is a gold-certified tertiary care institution, and it is an excellent center for patient-centered care. In response to the Coronavirus 2019 (COVID-19) pandemic, it has adopted various telecommunication technologies to provide patient-care services. This article describes the integration of telecommunication technology, such as telephone and video consultation, with a pharmacist-led medication management clinic (MMC) to provide person-centered patient care services at JHAH. The JHAH pharmacy services were found to be essential in establishing face-to-face outcome-oriented pharmacist-led medication management services for patients requiring chronic ambulatory care. The established tele-MMC services enhanced patient engagement and treatment compliance, and the integration process and its challenges were assessed. Especially during this COVID-19 pandemic, the pharmacist-led tele-MMC services were beneficial to chronic disease patients and ensured the continuity of care, maintenance of up-to-date lab tests, management of polypharmacy, minimization of the use of unwanted medications and medication synchronization. Further, the pharmacist-led tele-MMC services provided comprehensive patient counseling, which included the use of visual aids. This new integrated model provides an example for other healthcare organizations to adopt and implement the program in ambulatory care settings, to better ensure the continuity of quality healthcare, especially for elderly patients and those with chronic diseases.

Patterns of infections and antimicrobial drugs' prescribing among pregnant women in Saudi Arabia: a cross sectional study.

BACKGROUND: Antimicrobial agents are among the most commonly prescribed drugs in pregnancy due to the increased susceptibility to infections during pregnancy. Antimicrobials can contribute to different maternal complications. Therefore, it is important to study their patterns in prescription and utilization. The data regarding this issue is scarce in Saudi Arabia. Therefore, the aim of this study is to generate data on the antimicrobial agents that are most commonly prescribed during pregnancy as well as their indications and safety. METHODS: This is a retrospective study focusing on pregnant women with a known antimicrobial use at Johns Hopkins Aramco Healthcare (JHAH). The sample included 344 pregnant women with a total of 688 antimicrobial agents prescribed. Data was collected on the proportion of pregnant women who received antimicrobial agents and on the drug safety during pregnancy using the risk categorization system of the U.S. Food and Drug Administration (FDA). RESULTS: The results showed that urinary tract infections (UTIs) were the most reported (59%) infectious diseases. Around 48% of pregnant women received antimicrobial medications at some point during pregnancy. The top two antimicrobial agents based on prescription frequency were B-lactams (44.6%) and azole anti-fungals (30%). The prescribed drugs in the study were found to be from classes B, C and D under the FDA risk classification system. CONCLUSION: The study revealed a high proportion of antimicrobials prescribed during pregnancy that might pose risks to mothers and their fetuses. Future multicenter studies are warranted to evaluate the rational prescription of antimicrobial medications during pregnancy.

Structural and operational redesigning of patient-centered ambulatory care pharmacy services and its effectiveness during the COVID-19 pandemic.

BACKGROUND: The newly emerged coronavirus pandemic (COVID-19) has collapsed the entire global health care system. Due to these settings, a lot of strategic changes are adopted by healthcare facilities to ensure continuity in patient-centered services. OBJECTIVE: This study aims to evaluate the effectiveness of structural and operational changes made in ambulatory care pharmacy services during the COVID-19 pandemic. METHODS: A retrospective comparative study was conducted to evaluate the impact and effectiveness of patient-centered interventions and consequent access to medication management care within Johns Hopkins Aramco Health Care ambulatory care pharmacy services during the COVID-19 pandemic by comparing patient-centered key performance indicators before and during COVID-19 pandemic for a total of 4 months. RESULTS: As a result of the structural and operational changes made in patient-centered ambulatory care pharmacy services during the COVID-19 pandemic, a 48% prescriptions requests and 90% prescriptions fills are increased through online health portal application. A three-fold increase in the pharmacy call center utilization resulted in around 10% abandoned calls. In the number of physical visits to ambulatory care pharmacies, a 37% reduction was also noted. The decrease in staff schedule efficiency and an increase in average prescription waiting time were also noticed. The prescription collection through remote area pick up locations, and medication home delivery services were successful during COVID-19 pandemic as supported by statistical data. CONCLUSION: The access to ambulatory care pharmacy services during COVID-19 pandemic has been successfully maintained via medication home delivery, remote area pickup locations, pharmacy call-center consultations and refill requests, online health portal application services, and other measures, while reducing the number of physical visits to the JHAH hospital/clinic to ensure compliance with infection control and prevention measures.

COVID-19 pandemic: Response plan by the Johns Hopkins Aramco Healthcare inpatient pharmacy department.

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic having caused a major health care crises across the globe. Pharmacy professionals are considered vital in preparation for optimal response to the COVID-19 pandemic. Therefore, in response to the estimated potential impact of COVID-19 on Johns Hopkins Aramco Healthcare (joint venture between Saudi Aramco and Johns Hopkins Medicine International), several initiatives were taken by the hospital's inpatient pharmacy department with focus on infection control, staffing, meeting clinical operational challenges, ethics, increased utilization of automation, and maintenance of employee wellness to prepare for this challenge. The plan implemented by the inpatient pharmacy department was prepared while incorporating information and recommendations from leading pharmacy organizations, ministry of health, institute's experience in battling another similar coronavirus (the Middle East respiratory syndrome-coronavirus) previously, and updated scientific research. The key focus areas include development of an institutionalized COVID-19 protocol, measures to improve infection control when handling and dispensing medications, modified staffing plan, system changes in peri-operative areas, keeping pharmacy professionals updated about new and scientific researches, increased utilization of automation, clinical interventions by pharmacist ensuring appropriate utilization of medications while monitoring for drug-drug interactions, adverse drug event prevention, and preparing for handling drug shortages. By implementing a robust plan, pharmacy professionals continue to show that they are an integral member of inter-professional health care teams.