Evaluating the Impact of an Innovative Integrative Health-Focused Elective in a Doctor of Pharmacy Program.

OBJECTIVE: To assess knowledge and perceptions of integrative health principles. METHODS: This was a retrospective, pre-post observational cohort study evaluating Doctor of Pharmacy students following completion of an innovative elective course that was offered between 2020-2022. This Integrated Health in Pharmacy elective was created at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in the Spring of 2020. The primary objective was to assess student knowledge of integrative health principles. The secondary objective was to assess student confidence and perceptions of integrative health principles. RESULTS: Students completed a pre-course assessment (n = 80/81) and a post-course assessment (n = 73/81). Overall, the mean (SD) performance on the assessment questions increased between the pre-post assessment groups (57.59 [12.98]% vs 65.46 [14.43]%). Survey results indicated that students' perceptions and confidence pertaining to integrative health increased after completing this elective course offering. CONCLUSION: Participation in this innovative elective course was associated with improved knowledge and perceptions of integrative health principles.

Navigating Glucagon-Like Peptide Receptor Agonist Reinitiation Amid Access Barriers: An Adverse Drug Event Case Report.

Background: The expanding roles and popularity of glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists has created access barriers to medication use. We sought to describe an adverse drug event which occurred after reinitiation of a GLP-1 receptor agonist following a prolonged lapse in therapy due to poor medication access. Case Summary: Once-weekly injectable semaglutide was prescribed to an outpatient 33-year-old male for chronic weight management. After a delayed initiation due to global shortage, semaglutide was initiated and titrated over five months before a seven week lapse in therapy due to prior authorization interruption. Despite the extended treatment gap, the patient was directed to reinitiate semaglutide at the target dose rather than starting dose, which was followed by recurrent, symptomatic nausea and vomiting requiring medical intervention. Practice Implications: A prolonged lapse in GLP-1 receptor agonist therapy, typically defined as missing three or more doses of a once-weekly injectable, warrants consideration of reinitiation at a reduced dose, personalized to the patient's prior gastrointestinal tolerability, efficacy goals, and therapy lapse duration. Therapy lapses with GLP-1 receptor agonists may be prevented by utilizing a multi-modal approach including extended dosing intervals, intermediate doses, agent interchange, efficient prior authorization communication, and cautious initiation of GLP-1 recent agonists while supply cannot meet demand.

NAPLEX Preparatory Perceptions from Recent Graduates at One College of Pharmacy.

OBJECTIVES: The current study assessed how students prepared for the North American Pharmacist Licensure Examination (NAPLEX), and examined factors associated with first-time pass rates. In addition, updated information on student perceptions of several currently available NAPLEX preparation resources was collected. METHODS: A survey was administered to 2022 graduates from 1 school, which collected data on student demographics, and NAPLEX-related items regarding when the exam was taken and how students prepared, including resources used. The association between first-time success (pass, no pass) and grade point average (GPA), timing of test date after graduation, effort toward exam, and number of hours studied was examined. In addition, student ratings of NAPLEX preparation resources in terms of usefulness, representativeness to actual examination, and monetary value were reported. RESULTS: A total of 52 individuals completed the survey. Pharmacy GPA over 3.5, taking the NAPLEX within 60 days of graduation, and exerting moderate to extensive effort to pass the NAPLEX were all associated with higher first-time pass rates. All students reported using at least 1 RxPrep resource, which students rated highly and suggested the school provide as a resource for NAPLEX preparation. CONCLUSION: This study found that taking the NAPLEX examination within 60 days of graduation, contributing moderate to extensive effort to pass the examination, as well as a cumulative GPA of 3.5 (out of 4) or above were related to success on the NAPLEX. Additionally, students reported high satisfaction with RxPrep resources.

Weight loss differences seen between glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors for treatment of type 2 diabetes.

BACKGROUND: Weight loss is an advantageous quality for diabetic medications because it can improve insulin sensitivity and glucose control and reduce cardiovascular risk factors and comorbidities. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are both preferred agents for use after metformin therapy, and both cause modest weight loss. OBJECTIVE: The aim of this study was to evaluate the difference in weight loss between GLP-1 receptor agonists and SGLT-2 inhibitors in patients with type 2 diabetes (T2D). METHODS: This was a retrospective study that was conducted at a level 3 patient-centered medical home in Buffalo, NY. The participants were adults with T2D treated with either a GLP-1 receptor agonist or an SGLT-2 inhibitor, in addition to background diabetes medications, between January 1, 2012, and September 20, 2017. The outcome measures included the median weight loss after 6 months of consecutive therapy compared between the 2 antidiabetic classes and the median differences in blood pressure, glycosylated hemoglobin (A1C) levels, and renal function markers compared between the 2 classes. RESULTS: A total of 73 patients were included in the final analysis, with 31 receiving SGLT-2 inhibitors and 42 receiving therapy with GLP-1 receptor agonists. The SGLT-2 inhibitor cohort presented a median weight loss of -2.80 kg (interquartile range [IQR] -5.40 to -1.50), and the GLP-1 receptor agonist cohort presented a median weight loss of -1.15 kg (IQR -3.38 to 0.975) (P = 0.014). There were no statistically significant differences in A1C levels, blood pressure, or renal function markers. CONCLUSION: SGLT-2 inhibitors, when used in combination with background diabetes regimens, can lead to more statistically significant weight loss than GLP-1 receptor agonists without compromising renal function.

Effect of changing COPD triple-therapy inhaler combinations on COPD symptoms.

OBJECTIVES: To determine if symptoms changed after changing chronic obstructive pulmonary disease (COPD) triple-therapy inhalers to a less expensive regimen. STUDY DESIGN: Retrospective observational case-series analysis. METHODS: A quality improvement program was instituted to reduce drug costs associated with COPD inhalers between fall 2016 and spring 2017. Patients identified as taking an inhaled corticosteroid (ICS)/long-acting ß agonist (LABA) inhaler and a long-acting muscarinic agonist (LAMA) inhaler were changed to a LAMA/LABA inhaler and an ICS inhaler. Symptoms were assessed at baseline and subsequent follow-up using the COPD Assessment Test (CAT), with lower scores representing better symptom control. Then, a retrospective observational case-series analysis of 118 patient charts was completed. The primary outcome was mean difference in CAT score. Data were analyzed using a paired t test with an α value of 0.05. RESULTS: Of 118 patients included in the quality improvement program, 19 met the inclusion and exclusion criteria. The mean (SD) CAT score prior to the change was 15.53 (5.36), and the mean (SD) CAT score after the change was 14.68 (6.98). Symptom scores improved after the change, with an average difference in postchange and prechange CAT scores of -0.84, although this difference was not statistically significant (95% CI, -3.57 to 1.89; P = .525). CONCLUSIONS: Based on the results of this observational review, changing COPD triple-therapy inhalers did not result in a significant change in patient-reported symptom scores. Patients may use triple-therapy inhalers that are most affordable without a significant change in symptom control.

Comparing Pharmacotherapy Instruction to the 2009 and 2016 ACCP Toolkit Recommendations.

Objective. To compare pharmacotherapy instruction in Doctor of Pharmacy (PharmD) programs with the 2009 and 2016 American College of Clinical Pharmacy (ACCP) pharmacotherapy toolkits. Methods. A survey was sent to representatives at US schools and colleges with PharmD programs. The survey consisted of questions pertaining to pharmacotherapy credit-hours, contact time spent for each therapeutic subject area, and pedagogical methods used. Data were analyzed using descriptive statistics. Results. Representatives from 75 of 129 PharmD programs responded (response rate 58%). A median of 23 credit-hours were devoted to required pharmacotherapy. Infectious diseases and cardiology were taught with the most number of contact hours. Lecture was the most popular principal method of instruction delivery but the incorporation of case-based learning was also common. Conclusion. Devoted curricular time to pharmacotherapy is adequate to provide coverage of tier 1 and 2 topics from the ACCP toolkit. PharmD programs should continue to review their pharmacotherapy coursework to adjust topic coverage as needed to incorporate active learning strategies whenever possible.

Student Pharmacist Perceptions of a Behind-The-Counter Class of Medications.

OBJECTIVES: To report perceptions of PharmD candidates regarding a behind-the-counter (BTC) class of medications and to identify perceived barriers to its successful implementation. METHODS: PharmD candidates in their second, third, and fourth professional years were invited to complete an online survey. Responses were used to assess perceptions of competency and willingness to participate in a BTC program and perceived preparedness of the current community pharmacy practice environment for a BTC class of medications with regard to 8 specific classes of medications. RESULTS: The survey response rate was 28%. In all, 78% of respondents agreed or strongly agreed that a BTC class of medications is a change that they would be willing to embrace, and 54% agreed or strongly agreed that their PharmD curriculum provided them with adequate training in laboratory and diagnostic test interpretation. Less than half of the respondents agreed or strongly agreed that community pharmacies are currently equipped with the resources necessary to clinically assess a patient and dispense BTC medications. CONCLUSION: PharmD candidates are prepared and willing to participate in a BTC program but believe that the current community practice environment lacks access to resources necessary to do so.

Provider Perception of Pharmacy Services in the Patient-Centered Medical Home.

BACKGROUND: Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile. OBJECTIVE: To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation. METHODS: A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group. RESULTS: The survey response rate was 78%. Top-tier clinical services were identified as medication counseling, reconciliation, adherence assessment, polypharmacy assessment, and drug information. Formulary review was the only top-tier cost- or access-related service. Top-tier educational services included new black-boxed warnings, drug market withdrawals, and new drug reviews. Ninety-one percent of providers were comfortable referring to a pharmacist for diabetes medication selection and dose titration, but no other disease state eclipsed 75%. More than twice as many providers found the pharmacy service to be very or extremely valuable when the pharmacist is physically located in the office versus virtual interactions (70% vs 34%). CONCLUSION: Top-tier clinical, cost/access, and educational services considered worthwhile by providers in a PCMH have been identified. In addition to these services, when developing or evaluating a pharmacy service, special attention should be paid to provider preference for physical location in the office and perceived barriers to the pharmacist availability, concern over complex disease management competency and patient confusion as to the role of the pharmacist.

Introduction and Assessment of a Blended-Learning Model to Teach Patient Assessment in a Doctor of Pharmacy Program.

Objective. To integrate a blended-learning model into a two-course patient assessment sequence in a doctor of pharmacy (PharmD) program and to assess the academic performance and perceptions of enrolled students. Design. A blended-learning model consisting of a flipped classroom format was integrated into a patient assessment (PA) course sequence. Course grades of students in the blended-learning (intervention) and traditional-classroom (control) groups were compared. A survey was administered to assess student perceptions. Assessment. The mean numeric grades of students in the intervention group were higher than those of students in the traditional group (PA1 course: 92.2±3.1 vs 90.0±4.3; and PA2 course: 90.3±4.9 vs 85.8±4.2). Eighty-six percent of the students in the intervention group agreed that the instructional methodologies used in this course facilitated understanding of the material. Conclusion. The blended-learning model was associated with improved academic performance and was well-received by students.

Scope of contemporary pharmacy practice: roles, responsibilities, and functions of pharmacists and pharmacy technicians.

OBJECTIVE: To provide an overview of the current context and scope of pharmacy practice, the range of professional services offered by pharmacists, and the supporting role of pharmacy technicians. DATA SYNTHESIS: A synopsis of the current state of pharmacy practice as it relates to the spectrum of professional roles and responsibilities, the diversity of patient populations served, the complexities of patient services provided, and various aspects of emerging pharmacy practice is provided. The current work focuses on patient care services provided by pharmacists; it does not address all possible activities of pharmacists, such as administration and general management. This is a descriptive analysis. It does not take a position regarding future changes but is intended to serve as a foundation for understanding the relationship and alignment between the profession's various mandatory and voluntary credentials and the scope of practice continuum. The key educational and credentialing standards for pharmacists and pharmacy technicians are summarized and referenced. CONCLUSION: The evolutions in health care and pharmacy practice are presenting many new opportunities for pharmacists to perform functions and provide services not considered as traditional roles. The profession of pharmacy is working to achieve a pervasive model and standard of care determined only by the needs of patients and populations. The Council on Credentialing in Pharmacy hopes that the material presented herein, including the framework for credentialing in pharmacy practice, will allow audiences to gain a better understanding of where pharmacy is today and what future pharmacy practice will look like.

Clinical and economic impact of a diabetes clinical pharmacy service program in a university and primary care-based collaboration model.

OBJECTIVE: To provide program methodology and outcomes data identifying the impact of clinical pharmacy services (CPSs) in patients with type 2 diabetes. DESIGN: Longitudinal pre-post cohort study. SETTING: Regional primary care group in Buffalo, NY, during 2006-2007. PATIENTS: Patients with type 2 diabetes identified by their primary care providers were referred to the MedSense program; a pharmacist-led, patient-centered pharmacotherapy management program developed through university collaboration with a regional primary care physician group. INTERVENTIONS: Education, clinical assessments, provider recommendations, and longitudinal follow-up of treatment goals provided by MedSense pharmacists. MAIN OUTCOME MEASURES: Clinical outcomes were followed for 1 year from the index date for primary diabetes endpoints (glycosylated hemoglobin and fasting plasma glucose) and accompanying metabolic parameters (body mass index, blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides). Economic endpoints from the payer perspective were also followed for 1 year from the index date for medical and prescription-related costs. RESULTS: Primary diabetes endpoints were significantly reduced versus baseline at the 6-month (-1.1%; P < 0.0001, -39 mg/dL; P = 0.003) and 12-month (-1.1%; P < 0.0001, -35 mg/dL; P = 0.005) assessments. Improvement rates were observed for all accompanying metabolic parameters at each assessment (range 40-64%). Geometric mean costs tended to decrease versus baseline at 6-month (-$84; P = 0.785) and 12-month (-$216; P = 0.414) assessments, despite nominal increases in diabetes and total medication costs. CONCLUSION: In this CPS model, there were initial and sustained reductions in the primary diabetes endpoints and a high rate of improvement for accompanying metabolic parameters. Concurrent with clinical improvements, total direct medical costs were reduced despite an increase in antidiabetic medication and total medication costs.