Defining the Roles of Inflammatory Bowel Disease Clinical Pharmacists in the United States: A Systematic Review and National RAND/UCLA Consensus.

BACKGROUND: Given the complexity of inflammatory bowel disease (IBD) care, utilization of multidisciplinary teams is recommended to optimize outcomes. There is a growing recognition that clinical pharmacists should be an integral part of this care model. We sought to define the roles of IBD clinical pharmacists in the United States. METHODS: A national multidisciplinary expert panel of 12 gastroenterologists and clinical pharmacists practicing in IBD clinics was assembled. We used the RAND/University of California, Los Angeles appropriateness method, with a total of 281 statements generated based on a systematic literature review and expert opinion. Each statement was anonymously rated as appropriate, uncertain, or inappropriate in 2 rounds of voting. RESULTS: The number of publications evaluating the clinical pharmacists' roles in IBD is limited, primarily focusing on thiopurine initiation and monitoring, medication adherence, and switching to biosimilars. Medication education; medication initiation and monitoring; therapeutic drug monitoring; biosimilar management; health maintenance review; and transitions of care were deemed by the panel to be appropriate roles for IBD clinical pharmacists. In considering real-world settings, IBD clinical pharmacists should practice clinically under a predefined scope and primarily focus on complex treatments (eg, immunomodulators, biologics, and small molecules). Clinical pharmacists should also be included in practice settings with IBD specialized physicians. Additionally, clinical pharmacists caring for patients with IBD should be residency trained and board certified. CONCLUSIONS: This consensus defines IBD clinical pharmacists' roles and provides a framework for embedded clinical pharmacists in IBD care.

Discharge prescription optimization by emergency medicine pharmacists in an academic emergency department in the United States.

Background Emergency medicine (EM) pharmacists may be uniquely positioned to optimize discharge prescriptions for emergency department (ED) patients but the clinical significance of interventions and association with patient outcomes are not well-described. Objective To evaluate the clinical significance of EM pharmacist interventions completed during review of ED discharge prescriptions. Setting This study was conducted in an academic medical center ED. Methods: This was a retrospective observational study of patients discharged with prescriptions from the ED over two months. EM pharmacists reviewed discharge prescriptions and provided drug therapy recommendations. Two independent reviewers rated the clinical significance of interventions. High risk criteria were proposed a priori and included in a multivariable logistic regression analysis to identify variables independently associated with pharmacist intervention. Main Outcome Measure The primary outcome measure was the rate, type, and clinical significance of interventions associated with EM pharmacist review of discharge prescriptions. Results A total of 3107 prescriptions for 1648 patients were reviewed. Interventions occurred for 7.3% of patients with 29% of interventions rated as significant. The intervention rate was higher in patients with at least 1 high risk criteria versus those without (9.6% vs. 3.7%, p < 0.0001). An incremental increase in the number of discharge prescriptions was independently associated with pharmacist intervention. The 30 day readmission rates did not differ between patients with and without pharmacist review (27.4% vs. 26.2%, p = 0.38). Conclusion: Pharmacist review of discharge prescriptions resulted in clinically significant interventions but did not impact readmission rates. An incremental increase in the number of discharge prescriptions was associated with pharmacist intervention.

Effect of Pharmacy-Driven Bedside Discharge Medication Delivery Program on Day 30 Hospital Readmission.

BACKGROUND: Previous studies demonstrated that transitions of care bundles, which include bedside discharge medication delivery (BDMD), may be helpful in decreasing hospital readmissions. OBJECTIVE: To evaluate the effects of BDMD alone on day 30 readmission rates. METHODS: Retrospective, cohort study comparing those who received pharmacy-driven BDMD to usual discharge. Primary outcome was day 30 readmission rates. Multivariable logistic regression was used to account for baseline differences between groups. RESULTS: A total of 30916 patients met inclusion and exclusion criteria. Of those, 2253 (7%) received BDMD and 28663 (93%) received usual care. Significant differences in age, distance from hospital, race, marital status, insurance type, previous hospitalizations, admission source, baseline comorbidities, and medication counts were observed between groups. Patients who received BDMD were less likely to have day 30 readmissions (10.6% vs 12.8%, P = .002). However, after adjusting for baseline characteristics, BDMD was not an independent predictor of day 30 readmission (adjusted odds ratio = 0.91, 95% confidence interval = 0.79-1.04, P = .17). BDMD was associated with decreased day 14 readmissions in an unadjusted analysis. CONCLUSIONS: BDMD was not independently associated with a reduction in day 30 readmissions. Future studies should focus on targeting patients who are most likely to benefit from this service.

Predictors of Medication Nonadherence From Outpatient Pharmacy Data Within a Large, Academic Health System.

BACKGROUND: Medication nonadherence is a worldwide issue that can lead to poor clinical outcomes and increased health-care costs. OBJECTIVE: To determine the predictors of medication nonadherence. METHODS: A retrospective chart review was conducted for patients who received prescription medications from Cleveland Clinic outpatient pharmacies. Prediction variables consisted of demographics, socioeconomic status, number of medications, and number of daily administrations. These variables were analyzed using a logistic regression to determine independent predictors of medication adherence. RESULTS: Between January and September 2015, over 300 000 eligible prescriptions were filled, corresponding with over 70 000 unique patients. Of these, 29 134 patients were included. After multivariable regression, increasing age (odds ratio [OR]: 1.01), household income (OR: 1.03), and medication count (OR: 1.05) were found to be associated with adherence. Male gender (OR: 0.88), African American (OR: 0.45), Hispanic (OR: 0.62), or other race (OR: 0.87), being single (OR: 0.92), and increasing frequency of administrations per day (OR: 0.76) were associated with nonadherence. CONCLUSION: Medication nonadherence was associated with nonwhite race, single status, male gender, low socioeconomic status, and increasing frequency of medication administration. Based on these results, a risk prediction tool could be created to determine which patients are at the highest risk of medication nonadherence.

Clinical pharmacy services in the emergency department.

The emergency department (ED) is a fast-paced, high-risk, and often overburdened work environment. Formal policy statements from several notable organizations, including the American College of Emergency Physicians (ACEP) and the American Society of Health-System Pharmacists (ASHP), have recognized the importance of clinical pharmacists in the emergency medicine (EM) setting. EM clinical pharmacists work alongside emergency physicians and nurses at the bedside to optimize pharmacotherapy, improve patient safety, increase efficiency and cost-effectiveness of care, facilitate antibiotic stewardship, educate patients and clinicians, and contribute to scholarly efforts. This paper examines the history of EM clinical pharmacists and associated training programs, the diverse responsibilities and roles of EM clinical pharmacists, their impact on clinical and financial outcomes, and proposes a conceptual model for EM clinical pharmacist integration into ED patient care. Finally, barriers to implementing EM clinical pharmacy programs and limitations are considered.