Pharmacy Telehealth Services: Perspectives From an Academic Medical Center.

Telehealth allows patients to receive healthcare with the aid of technology by overcoming physical barriers. The Coronavirus Disease 2019 (COVID-19) pandemic created challenges with regards to in person patient care. The use of video visits and telehealth increased in a rapid manner due to the COVID-19 pandemic. The objective of this paper is to describe telehealth services utilized by pharmacists at a large, academic medical center. Pharmacists teaching and clinical services conducted via telehealth and remote methods in the inpatient and outpatient settings are discussed. The tools and platforms utilized for patient care, staff communications, and education are described. Telehealth is likely to remain in many clinical practices even after restrictions due to COVID-19 are removed; however, as we transition, a more sustainable model that includes faculty and staff development is needed. Additionally, clinical outcomes and patient and provider satisfaction for the varying visit types should continue to be examined. Although the switch to telehealth was rapid and unprecedented, it allowed a large academic medical center to continue providing patient care and learning experiences for most clinical pharmacy services.

An interprofessional clinical toxicology advanced pharmacy practice experience.

BACKGROUND AND PURPOSE: Clinical toxicology is a blend of science, research, and patient management practices involving human poisonings from exposure to natural and synthetic toxins. The objective of this study was to describe the components of an elective advanced pharmacy practice experience (APPE) in clinical toxicology at California Poison Control System (CPCS). EDUCATIONAL ACTIVITY AND SETTING: The APPE requirements included a mix of active participation in case management and supplemental educational exercises, case presentations and consultations, and a structured self-study component consisting of readings and on-line modules. In addition, there were two active learning activities, high acuity poisoning simulation scenarios utilizing a high-fidelity mannequin, and an antidote tasting session. FINDINGS: From April 2012 to October 2017, 82 student pharmacists completed this APPE. Pharmacy students completed 85 pre-simulation surveys and 80 post-simulation surveys. Survey results showed an increase in pharmacy student beliefs that a clinical pharmacist should be involved in the differential diagnosis and management of patients (60% pre-simulation vs. 78.8% post-simulation, p = 0.009). APPE pharmacy students completed an evaluation of the preceptors(s), site, and learning experience. The average score for all areas on the preceptor and site evaluations was >4.5 on a 5-point Likert scale. Qualitative data themes included student satisfaction with opportunities, feedback, and the interprofessional and collaborative environment. SUMMARY: An APPE in the CPCS was successfully designed and implemented. The APPE provides an interprofessional collaborative learning environment that allows student pharmacists to understand the unique role of the pharmacist in this setting.

Developing a process for expansion of community pharmacy residency sites.

OBJECTIVE: The development of guidelines for community pharmacy residency site expansion is described. SUMMARY: During the past 20 years, community pharmacy residency programs have grown in number. Most community residencies were initiated and accredited through schools of pharmacy with faculty members dedicated to the oversight and growth. Because of the interest in residency expansion from sites, a systematic process was needed to determine whether a site was resident ready. This need led to the development of a site-readiness tool for community residency expansion. This tool was developed by 2 faculty members serving as residency program directors at 2 schools of pharmacy in North Carolina. The development of this tool resulted in guidance and clarification of residency expectations for potential community sites. The tool also led to improved efficiency in the assessment of readiness for residency site expansion. CONCLUSION: Development of a tool for residency site readiness increased the overall knowledge of site requirements, resulting in a more efficient process for residency program directors, and aided in the ability to increase the number of community pharmacy residency sites in North Carolina. The tool described in this article can serve as a guide to sites that have an interest in establishing new programs but are uncertain of the site's readiness and next steps.

Impact of a US Food and Drug Administration Drug Safety Communication on Zolpidem Dosing: An Observational Retrospective Cohort.

INTRODUCTION/BACKGROUND: Zolpidem is a sedative-hypnotic widely prescribed in the United States. Recently, the US Food and Drug Administration (FDA) issued a drug safety communication regarding its dosing in women. OBJECTIVE: To compare compliance with FDA-approved dosing for zolpidem in women before and after a drug safety communication, and to evaluate compliance based on pharmacy location and prescriber type. METHOD: This was a retrospective, observational cohort study. New prescriptions for Ambien, Ambien CR, Edluar, or Zolpimist or their respective generics dispensed from Kerr Drug pharmacies in North Carolina to women 18-64 years of age between April and September of 2012 ("before" cohort) or April and September of 2013 ("after" cohort) were included. χ(2) tests were conducted to assess overall compliance, as well as compliance based on location (urban or rural) and prescriber type (physician or midlevel), with FDA-approved dosing for zolpidem. Trends in total prescription volume and total zolpidem prescription volume for all Kerr Drug pharmacies over the study period were also described. RESULTS: A total of 14,156 prescriptions for zolpidem were included in the primary analysis. Sixteen percent of prescriptions dispensed were in compliance with FDA recommendations following the FDA alert. A statistically significant increase was observed in compliance with FDA-approved dosing for zolpidem (odds ratio = 1.49; 95% CI, 1.35-1.65; P < .0001) postdrug safety communication. Significant increases in compliance were also observed in the post-FDA communication subgroups based on location and prescriber type, though no subgroup was found to be significantly more compliant than another. CONCLUSIONS: The release of a drug safety communication by the FDA resulted in a statistically significant increase in proper dosing of zolpidem in women. Further research is needed in order to determine the impact of FDA alerts on prescribing patterns and the reasons for therapeutic substitution after such alerts.

Natural products for the management of type 2 diabetes mellitus and comorbid conditions.

OBJECTIVE: To provide pharmacists with practical information to guide consumers in their choices of herbal products and dietary supplements for the management of type 2 diabetes mellitus (T2DM) and its comorbid disease states. SUMMARY: The herbal and dietary supplement market has grown exponentially over the past decade as Americans increasingly use such agents for generalized health and the prevention and treatment of chronic disease states.1 Pharmacist advice is often requested on the use of these agents for the management of T2DM; however, this is an area that has insufficient evidence to support confident recommendations. Many published studies involving herbal agents and dietary supplements are small and poorly designed, with heterogeneous results. Pharmacists should be aware of the safety and efficacy data available for these agents, recognize potential drug interactions, and identify acceptable manufactured products. CONCLUSION: The strongest scientific evidence for blood glucose lowering effect is associated with alpha-lipoic acid and fenugreek. There is also good evidence supporting the use of ivy gourd, gymnema, and vitamin E for management of hyperglycemia; however, caution should be used when recommending vitamin E. Pharmacists should advise consumers to disclose use of any of these products to all of their health care providers.

Ospemifene for the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women.

Vulvovaginal atrophy (VVA) and dyspareunia are common problems experienced by postmenopausal women, although few seek treatment. Symptom-based therapies include nonhormonal vaginal lubricants, vaginal moisturizers, low-dose vaginal estrogen, and systemic estrogen. The 2013 United States Food and Drug Administration approval of ospemifene, an estrogen agonist/antagonist for the treatment of moderate-to-severe dyspareunia associated with VVA, increased options available to women. Several studies have evaluated the effects of ospemifene on VVA and dyspareunia and indicate an improvement in subjective findings. Objective findings such as a decrease in pH and recovery of a premenopausal vaginal maturation index have been reported. Beneficial effects have also been demonstrated in bone. Evaluations of breast health support the safety of ospemifene, although data are limited to 1 year. Short-term risks appear to be limited and include the development of hot flushes. Until additional comparative studies of ospemifene and estrogens have been performed, ospemifene should be recommended for women with symptoms of VVA and dyspareunia who are unable to tolerate or unwilling to take local or systemic estrogens. In this review, current evidence for the safety and efficacy of ospemifene in the treatment of moderate-to-severe VVA and dyspareunia are evaluated.

Medication nonadherence secondary to drug-induced memory loss.

Overactive bladder (OAB) is a common condition in the elderly. Treatments for OAB include nonpharmacological or behavioral therapy, pharmacological therapy, and surgical therapy. Antimuscarinic agents are the current pharmacological treatment for OAB and are known to cause memory impairment. A 66-year-old female presented with memory loss secondary to the administration of oxybutynin, which resulted in medication nonadherence. Upon review of her medications, the pharmacist recommended discontinuing the oxybutynin because of the anticholinergic effects on cognition. At a three-week follow-up visit, the patient reported an improvement in memory and medication adherence. Pharmacists can play a vital role in recognizing drug-induced side effects and educating patients in an effort to improve medication adherence.