Primary care team member's perceptions of credentialed and privileged clinic pharmacists and impact on clinic workload in a pediatric primary care network.

BACKGROUND: Pharmacists provide increased access to care, vaccinations, and medication management for patients. Credentialing and privileging of pharmacists allows pharmacists to practice at the top of their licenses and elevate pharmacy practice. OBJECTIVE: The primary objective of this study was to assess the perception of healthcare team members of credentialed and privileged pharmacists working in a pediatric primary care network before and after implementation of pharmacist privileges. The secondary objective was to determine team members' perceptions on the amount of time spent refilling medications, resolving medication access issues, and ordering vaccines before and after implementation of pharmacist privileges. METHODS: This was a prospective pre-post study utilizing surveys to capture healthcare team members' perceptions of credentialed and privileged ambulatory care pharmacists. Surveyed participants included attending physicians, advanced practice nurses, registered nurses, licensed practical nurses, medical assistants, and patient care assistants. Summary statistics are reported as frequencies and percentages. Statistical analysis was conducted using SAS version 9.4. RESULTS: Fifty-eight pre-privileging and 56 post-privileging surveys were distributed. The return rate was 79.3% (n=46) for pre-privileging and 80.4% (n=45) for post-privileging surveys. More than 90% of respondents had a favorable perception of credentialed and privileged pharmacists in the clinic. There was a significant difference in the perception of the amount of time spent on medication access issues after pharmacist privileges were implemented (p = 0.0296). CONCLUSION: Credentialed and privileged pharmacists in a pediatric primary care network are viewed favorably by clinic team members and can have a positive impact on clinic workload.

Establishing Mental Health Friendly Pharmacies to Assist in THe Early Identification and Support of OldEr Adults at Risk of Depression: the EMPATHISE pilot study.

BACKGROUND: Late-life depression (LLD) often goes underdiagnosed and undertreated. Community pharmacists are one of the most accessible and trusted healthcare professionals (HCPs) and may play a significant role in LLD screening. OBJECTIVES: This study aimed to develop and pilot a pharmacist-delivered depression screening and referral service for older adults (≥65 years) at risk of depression, within community pharmacy. METHODS: Community pharmacists across New South Wales, Australia, were recruited to participate in a prospective pilot study. Pharmacists/pharmacy staff received specialised training before recruiting and screening patients aged ≥65 years using the Geriatric Depression Scale-15 (GDS-15). Patients scoring ≥6 were referred to another HCP, e.g., general practitioner, and followed-up by the pharmacist one-week post-screening. Patients were also followed-up by a research team member 6-weeks post-screening to explore outcomes of the screening. Semi-structured interviews with pharmacists and patients were undertaken following completion of the pilot study to explore their experiences delivering/receiving the screening service. A thematic inductive analysis approach was used to analyse interview data. RESULTS: A total of 39 community pharmacies participated in this study. In total, 113 participants attended the training sessions. Pharmacists screened 15 patients from 8 pharmacies, of which 67% were female. Two thirds of patients (67%) received a GDS-15 score of ≥6, indicating possible depression and requiring referral. Pharmacists referred 80% of patients to another HCP. One patient was diagnosed with depression and commenced antidepressant therapy. Five patients and six pharmacists participated in semi-structured interviews. Barriers to screening included lack of time and mental illness stigma. Facilitators included pharmacist-patient relationships and training. CONCLUSION: Pharmacist-delivered LLD screening was found to be acceptable by both pharmacists and patients, with pharmacists reporting training improved their comfort and confidence with depression screening. These pilot study findings may inform future work into service delivery models to support early identification and treatment of LLD.

Exploration and Practice of Introducing the Pharmaceutical Care Network Europe Classification System to Psychiatric Drugs.

This research aims to summarize and discuss issues related to psychiatric drugs by using the classification system of the Pharmaceutical Care Network Europe (PCNE) and to provide a reference for the development and direction of clinical pharmacists' work in the future. Psychiatric patients who were hospitalized in our hospital from Janurary 2023 to December 2023 were enrolled. Drug-related problems (DRPs) were evaluated using the PCNE classification system (version 9.0). The types, causes, intervention plans, acceptance of intervention plans, and statuses of DRPs were analyzed. A total of 362 patients were included, covering 405 DRP cases, with an average DRP of 1.12 for each patient. All 405 DRP cases underwent interventions, with a success rate of 83.46%. The main categories of related drugs were psychotropic drugs (70.37%), anti-infective drugs (8.89%), and cardiovascular system drugs (5.19%). The main DRPs were possible adverse drug events (21.24%), poor treatment effects (69.14%), and unnecessary medication treatment (9.63%). The main causes of DRPs were inappropriate drug selection (18.52%), inappropriate combinations of drugs (16.05%), and excessive drug dosage (13.58%). The PCNE classification system helps clinical pharmacists improve their ability to identify and solve DRPs faced by psychiatric departments, improve pharmaceutical care efficiency, and ensure rational drug use.

Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis.

Background: The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings. Objectives: To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings. Design: A systematic review and meta-analysis. Methods: We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs). Results: Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality. Conclusion: Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.

The impact of pharmacist activities on clinical outcomes in perioperative settings Why was the study done? The time around the surgery imposes significant risks to patient's health. While technical aspects of a procedure are important, it should be combined with the provision of optimal healthcare quality to increase the likelihood of desired clinical outcomes. Pharmacists are effective healthcare team members who have the potential to improve patient's outcomes in the perioperative settings. It is hence imperative to explore the roles and impact of clinical pharmacists in these settings. Thus far, there is no synthesis of literature regarding the pharmacist roles and effectiveness in the perioperative setting. What did the researchers do? We aimed to summarize and appraise the quality of evidence on the characteristics and impact of pharmacist activities on clinical outcomes in the perioperative settings. Three library databases were examined to identify studies eligible for inclusion. Two authors extracted data and assessed the quality of included studies. Statistical analysis was used to look at the success of the pharmacist interventions on different endpoints. What did the researchers find? A total of 25 studies were included. Most pharmacist activities consisted of multiple components (such as medication management and educating other healthcare providers) and spanned the whole perioperative journey. The analysis of included studies showed that pharmacist activities reduced the elapsed time in hospital and the number of times a patient winds up going back to a hospital after discharge. Most studies did not discuss the methods adopted to develop pharmacist activities. What do the findings mean? A number of pharmacist activity types were shown to be successful in reducing the duration of hospitalization and readmission episodes. New directions for future research should investigate the development of pharmacist-led interventions in terms of structure and processes to ensure the reproducibility of these interventions.

Influence of drug shortages on the well-being at work of pharmacists practicing in community pharmacies.

Introduction: The problem of drug shortages is not new, but it has reached unprecedented levels in recent years. In community pharmacies, pharmacists are forced to develop daily strategies to deal with such shortages and ensure patient care. These efforts result in significant constraints and adjustments to pharmacists' daily practices. The aim of this study is to explore the possible relationship between the consequences of drug shortages and the well-being of pharmacists in pharmacies. Material & method: This study adopts an exploratory qualitative approach by interviewing pharmacists working in community pharmacies in Wallonia. The data were collected between March and June 2023 through individual semi-structured interviews using a resolute guide. The interview guide was adapted as the interviews progressed and according to the pharmacists' views. 16 participants were included, including 7 owner pharmacists, 3 non-owners, and 6 non-titular pharmacists. The interviews were transcribed and then analyzed through a thematic approach. Results: An in-depth study of the day-to-day reality of pharmacies that is open to the public highlights the time-consuming nature of drug shortages, with various implications for pharmacists' relationships, finances, and workload. However, these professionals also highlight the recognition of patients when a solution is discovered, with some sources saying that shortages value the pharmacist's ability and enhance the profession. Finally, about the possibility of change in the training of pharmacists is also addressed by some pharmacists. Conclusion: Drug shortages demand changes in pharmaceutical practice and appear to affect the well-being of pharmacists in public settings. However, the impact seems complex and is amplified by the lack of personnel. With shortages continuing to rise in recent years, it would be wise to analyze the longer-term effects of this phenomenon.

An interdisciplinary intervention for detection of sexual dysfunction associated with antidepressants: A pilot study.

Introduction: Treatment-emergent sexual dysfunction (TESD) is a commonly reported side effect of antidepressant medications in clinical trials. Limited literature exists exploring the role of routine use of the Arizona Sexual Experience Scale (ASEX) in identification of TESD in clinical practice. Therefore, we completed a retrospective study with the primary goal of capturing the rates of sexual dysfunction associated with antidepressant use among adult patients at an outpatient encounter with a psychiatric clinical pharmacist between June 2020 and March 2022. Methods: Rates of identification of sexual dysfunction were compared pre-ASEX survey (June 2020 to June 2021) to post-ASEX survey (July 2021 to March 2022). Results: There was a significant increase in the identification of sexual dysfunction following implementation of the ASEX scale (10% in the pre-ASEX group versus 59% meeting sexual dysfunction criteria with the ASEX scale). Approximately 70% of patients in the post-ASEX group shared they would not have reported symptoms unless directly asked. Discussion: In conclusion, a validated survey (ASEX) in an ambulatory psychiatry clinic improves identification of sexual dysfunction associated with antidepressants. Use of interdisciplinary care teams in the setting of medication follow-up can assist with identifying tolerability concerns between visits with patients' prescribing clinicians.

Implementation of a practice model for inpatient psychiatric clinical pharmacist practitioners with prescriptive authority at a veterans health care facility.

Clinical pharmacists play a valuable role on collaborative health care teams, especially in the field of mental health. However, there is a need to explore innovative practice models that optimize their potential in providing comprehensive medication management in inpatient psychiatric settings. This report aims to describe the implementation of a practice model using an inpatient psychiatric clinical pharmacist practitioner performing comprehensive medication management. The implementation of a practice model using a psychiatric clinical pharmacist practitioner was a feasible way to deliver comprehensive medication management and other clinical services in an inpatient psychiatric setting amid staffing challenges. Whereas limitations such as resource constraints must be considered, the success of this model highlights the value of a versatile psychiatric clinical pharmacist practitioner. These findings might offer insight to other health care facilities considering a similar approach to provide mental health care through the use of a psychiatric clinical pharmacist practitioner.

Standardized reporting on studies of psychiatric pharmacist interventions.

Reporting interventions thoroughly and consistently in the literature allows for study reproducibility or implementation of the intervention into practice. Although there is currently no standard for describing Board-Certified Psychiatric Pharmacist (BCPP) interventions in the published literature, there are multiple checklists or guides that have been developed for reporting clinical interventions, including the template for intervention description and replication and the pharmacist patient care intervention reporting (PaCIR) checklist, that seek to improve the quality of reporting interventions in the literature. The purpose of this paper is to describe a proposed guide for reporting BCPP interventions in the literature by expanding the PaCIR checklist. Authors use a logic model developed by the American Association of Psychiatric Pharmacists to ensure all elements of the process are addressed in the expanded guide.

Impact of a community pharmacy-based medication therapy management program on clinical and humanistic outcomes in patients with uncontrolled diabetes: a randomised controlled trial.

This study was aimed to evaluate the impact of community pharmacy (CP)-based medication therapy management (MTM) program on clinical and humanistic outcomes in patients with uncontrolled diabetes. An open label, parallel-group randomised controlled trial was undertaken at a community pharmacy in Riyadh city, Kingdom of Saudi Arabia. Patients with a diagnosis of uncontrolled diabetes (HbA1c of ≥ 8%) meeting the eligibility criteria were randomised to receive either the MTM programme provided by pharmacists or standard care. The primary outcome was change in HbA1c over 6 months. Secondary outcomes included: changes in clinical parameters (blood pressure (BP), lipid profile, serum creatinine (SCr) and albumin-to- creatinine ratio (ACR)), types of drug-related problems (DRPs), health service utilization (HSU), adherence, diabetes distress and overall patient satisfaction with the service at 6-month. A sufficiently powered sample of 160 participants with a mean age was 50 years (SD ± 11.9) was recruited. The majority of the patients (68.1%) were male and had diabetes for more than eight years [IQR 3, 14]. After adjusting for baseline HbA1c, compared to the control group, the mean HbA1c level was 0.02% (p = 0.929) and 0.2% (p = 0.47) lower in the intervention arm at 3-month and 6-month respectively. However, these differences were not statistically significant. Nonetheless, within each arm, there was a significant improvement in HbA1c from baseline. Furthermore, the intervention arm demonstrated improvement in BP control (SBP lowered by 3.2 mmHg (p = 0.05) and DBP lowered by 3.8 mmHg (p = 0.008)). During the study period, none of the participants in the intervention group reported hospitalization or ER visits compared to 14 patients in the control group [OR 0.069 (95% CI 0.004, 1.3)]. Patient satisfaction as measured by Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) was significantly higher among MTM program participants compared to standard care (p = 0.00001). Patients in the MTM program were eight times more likely to be adherent compared to the patients in the standard care [OR 7.89 (95% CI 3.6, 17.4)]. MTM program metrics showed that per patient, the pharmacists spent a median of 35 [IQR 30, 44.5] minutes at the initial visit and 20 [IQR 10, 25] minutes during the 6-month visit. The number of DRPs had significantly dropped in the intervention arm at 3 and 6-month (p = 0.0001). In conclusion, CP-based MTM program can improve health outcomes and prevent hospitalisations in patients with diabetes. These findings support the implementation of CP-based MTM services for patients with diabetes in the Kingdom of Saudi Arabia.

The relationship between psychological burden and providing assistance with taking medication among caregivers of patients with dementia: a cross-sectional study.

OBJECTIVES: Previous studies have examined the psychological burden of caregivers of patients with dementia. However, although many caregivers struggle to assist patients with dementia with medication management, the relationship between assisting such patients with taking their medicines and the caregiver psychological burden is understudied. Therefore, this study identified the association between caregivers' psychological burden and assisting patients with dementia with taking medication. METHODS: A cross-sectional survey was conducted among caregivers of patients with dementia in Japan. The survey questionnaire included questions that assessed the symptoms of patients with dementia, their status of taking medication through medication assistance from caregivers, and caregivers' psychological burden using the Kessler Psychological Distress Scale and the Japanese version of the Perceived Stress Scale. KEY FINDINGS: A total of 57 caregivers participated in the study. Higher Kessler Psychological Distress Scale scores were significantly associated with unsuccessful assistance with taking regular medication (ß = 0.35, 95% confidence interval [CI]: 2.23-12.0, P < .05), depressive symptoms (ß = 0.26, 95% CI: 0.10-8.53, P < .05), and irritability (ß = 0.38, 95% CI: 2.71-11.5, P < .05). Likewise, higher scores on the Japanese version of the Perceived Stress Scale were significantly associated with irritability (ß = 0.37, 95% CI: 1.87-12.5, P < .05) among patients with dementia. CONCLUSION: The findings suggest that caregiver psychological burden is associated with unsuccessful assistance with taking regular medication for patients with dementia.

Treatment patterns and factors associated with adherence in pulmonary arterial hypertension.

OBJECTIVE: Improving understanding of actual pulmonary hypertension (PH) treatment adherence patterns is crucial to properly treating these patients. We aimed to primarily assess adherence to treatments used for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) specific therapies, identify potential factors related to it and secondly describe its treatment patterns. METHODS: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC ≥80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. P < 0.05 indicated statistical significance. RESULTS: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of Macitentan + Tadalafil and Ambrisentan + Tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%). CONCLUSIONS: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.

Quality of work life (QWL) of community pharmacists and its association with subjective evaluations of pharmaceutical services.

Background: In Japan, pharmacists' role has drastically changed in recent years. However, previous studies have not performed internal marketing analysis for Japanese community pharmacists so that they improve the quality of work life (QWL) and be satisfied with it. Further, few studies are conducted on Japanese community pharmacists' QWL and its effect on the quality of pharmaceutical services. Objectives: This study aimed to reveal associations between community pharmacists' QWL and their subjective evaluations of pharmaceutical service. Methods: A questionnaire survey was conducted among 2027 pharmacists, with the cooperation of 20 corporations that run pharmacies. The collected data were subjected to multiple regression analysis, using SPSS 29. Results: Standard multiple regression shows that 27.4% of variance in pharmacists' subjective evaluations of their service was explained by QWL and other control variables, such as age, gender, and employee status (p < .001, R2 = 0.274). This analysis showed that factors behind pharmacists' QWL, "meaning of existence in the workplace" and "pride in work," explained pharmacists' subjective evaluations of pharmaceutical service (ß = 0.307, p < .001, ß = 0.277; p < .001, respectively). Conclusion: This study shows that improving QWL, especially "mental and physical effects on work" and "pride in work," might contribute to improving community pharmacists' services.

Building a Hospital Pharmacist Workforce by a Diversified and Position-Oriented Learning System.

Background: The role of hospital pharmacists has shifted from primarily ensuring drug supply to providing comprehensive pharmaceutical care. To accommodate this shift, new positions are needed. The traditional training model for hospital pharmacists is no longer sufficient for the evolving demands of pharmaceutical care and these new roles. This study aimed to describe the development of a position-oriented learning system explicitly tailored for hospital pharmacists and to assess its impact on workforce development and pharmacy service. Methods: The position-oriented learning system for hospital pharmacists, aimed at enhancing training and workforce development, was evaluated based on two critical criteria: the completion rate of learning modules and the subsequent improvement in pharmaceutical care at the hospital. The completion rate assessed the engagement and effectiveness of the training content. At the same time, the improvement in pharmaceutical care evaluated practical outcomes such as percentages of patients who received pharmaceutical care and percentages of inappropriate medication orders intercepted. Results: In 2021, 218 employees participated in the learning system. The pharmacy department has identified 22 pharmacists for various positions through this system. The quantity and quality of pharmaceutical care have improved significantly. Conclusion: The position-oriented diversified learning system achieves the perfect combination of department development direction and individual career planning of employees. The learning system can significantly improve the learning efficiency of pharmacists, enhance the quality of various pharmaceutical care, and promote the development of disciplines.

A Web-Based Survey of Patients Dispensed Viagra Connect® Behind the Counter in UK: An Evaluation of Effectiveness of Additional Risk Minimization Measures.

Purpose: A national additional risk minimization measures (aRMMs) program was implemented to train pharmacists for safe supply of non-prescription Viagra Connect® (VC) to erectile dysfunction (ED) patients in United Kingdom (UK). A survey aimed to evaluate the effectiveness of aRMMs. Methods: A cross-sectional, web-based survey enrolled ED patients who purchased at least 1 supply of VC in UK, using a structured self-administered questionnaire. Patients were assessed for the suitability of VC and received appropriate advice from pharmacists. Descriptive statistics were used. Results: The final sample had 297 patients, who reported that pharmacists inquired about blood pressure and heart comorbidities (91.9%), relevant illnesses (87.9%), medications (86.5%), ED diagnosis (82.2%), and were advised to consult their doctor regarding ED (51.2%). Furthermore, 85.5% of patients were advised on how to take VC correctly, 82.2% on possible side effects for which they might have to discontinue taking VC and consult their doctor, 80.1% on being informed that ED could be caused by underlying conditions. About 65.0% reported that they had visited (19.2%) or planned to visit (45.8%) their doctor. A majority (68.7%) also indicated that they had received advice on lifestyle modifications to manage their ED-related health risks. Conclusion: This survey provided a reasonable confirmation of the effectiveness of the VC aRMMs program and assurance that ED patients, when requesting and purchasing VC in UK pharmacies, are assessed appropriately for suitability of VC and receive the appropriate advice from pharmacists.

A national additional risk minimization measures (aRMMs) program was implemented to train pharmacists for safe supply of non-prescription VC to erectile dysfunction (ED) patients in United Kingdom (UK). A cross-sectional, web-based survey enrolled ED patients who purchased at least 1 supply of VC in UK, using a structured self-administered questionnaire. Patients were assessed for the suitability of VC and received appropriate advice from pharmacists. The final sample had 297 patients, who reported that pharmacists inquired about blood pressure and heart comorbidities, relevant illnesses, medications, ED diagnosis, and were advised to consult their doctor regarding ED. Additionally, most of the patients had consulted or planned to consult their doctors, on how to take VC correctly, on possible side effects for which they might have to discontinue taking VC and consult their doctor, on being informed that ED could be caused by underlying conditions, and on lifestyle modifications. A majority also indicated that they had received advice on lifestyle modifications to manage their ED-related health risks. This survey provided a reasonable confirmation of the effectiveness of the VC aRMMs program and assurance that ED patients, when requesting and purchasing VC in UK pharmacies, are assessed appropriately for suitability of VC and receive the appropriate advice from pharmacists.

Antibiotic stewardship in the emergency department setting: Focus on oral antibiotic selection for adults with skin and soft tissue infections.

PURPOSE: An advisory panel of experts was convened by the ASHP Foundation as a part of its Medication-Use Evaluation Resources initiative to provide commentary on an approach to antibiotic stewardship in the treatment of skin and soft tissue infections (SSTIs), with a focus on oral antibiotics in the emergency department (ED) setting for patients who will be treated as outpatients. Considerations include a need to update existing guidelines to reflect new antibiotics and susceptibility patterns, patient-specific criteria impacting antibiotic selection, and logistics unique to the ED setting. SUMMARY: While national guidelines serve as the gold standard on which to base SSTI treatment decisions, our advisory panel stressed that institutional guidelines must be regularly updated and grounded in local antimicrobial resistance patterns, patient-specific factors, and logistical considerations. Convening a team of experts locally to establish institution-specific guidelines as part of a comprehensive antibiotic stewardship program can ensure patients receive the most appropriate oral therapy for the outpatient treatment of SSTIs in patients visiting the ED. CONCLUSION: SSTI treatment considerations for antibiotic selection in the ED supported by current, evidence-based guidelines, including guidance on optimal oral antibiotic selection for patients discharged for outpatient treatment, are a useful tool to improve the quality and efficiency of care, enhance patient-centric outcomes and satisfaction, decrease healthcare costs, and reduce overuse of antibiotics.

Effect on Diabetes Control in a Resident Clinic Following the Integration of a Clinic Pharmacist.

The impact of a pharmacist has been evaluated within the primary care setting but not within a resident-managed internal medicine clinic. This retrospective study found that the integration of a clinical pharmacist within a resident clinic improved the mean HbA1c of a high-risk patient group by 3% in 3 months and 2.6% in 6 months. None of the residents surveyed reported that the presence of a clinical pharmacist hindered their learning experience. The study also found the residents perceived the clinical pharmacist to be helpful with co-management of diabetes. This data supports the addition of a clinical pharmacist into a resident clinic and continues to support the benefits in the primary care setting.

Clinical Pharmacy Initiatives Contribute to the Excellent Efficacy of the Dabrafenib/Trametinib Combination for Iodine-Refractory Thyroid Carcinoma: A Case Report.

A 76-year-old female patient presented with an iodine-refractory papillary thyroid carcinoma (PTC), diagnosed eight years earlier, with several lymph node recurrences requiring successive surgeries. Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging revealed a new unresectable loco-regional recurrence. The patient was diagnosed with a somatic BRAF V600E mutation. Therefore, dabrafenib and trametinib combination therapy was introduced and closely monitored by a dedicated multidisciplinary team, involving pharmaceutical consultations. As early as six weeks after treatment initiation, the patient reported multiple adverse events (AEs) to the clinical pharmacy team, who provided advice on resolving AEs or improving tolerance. Close interprofessional collaboration among healthcare workers involved in the care pathway allowed for the identification of the most opportune times for temporary suspension of treatment (four suspensions over seven months) or dose reduction (two reductions over 3.5 months). This resulted in a total treatment duration (one year) longer than the average times reported in the literature. The patient showed a rapid and excellent response to treatment immediately after initiation, culminating in a complete metabolic response assessed by [18F]FDG PET/CT imaging at nine months. Twenty-five months after treatment discontinuation, the disease remained controlled. Overall, dabrafenib and trametinib combination could offer excellent outcomes in selected patients with refractory BRAF-mutated PTC, with additional clinical pharmacy initiatives allowing for the optimized management of AEs and prolonged treatment periods.

Association of Pharmacist Interventions With Adverse Drug Events and Potential Adverse Drug Events.

BACKGROUND: Adverse drug events (ADEs) are a frequent cause of injury in patients. Our aim was to assess whether pharmacist interventions compared with no pharmacist intervention results in reduced ADEs and potential adverse drug events (PADEs). METHODS: We searched MEDLINE, Embase, and two other databases through September 19, 2022 for any RCT assessing the effect of a pharmacist intervention compared with no pharmacist intervention and reporting on ADEs or PADEs. The risk of bias was assessed using the Cochrane tool for RCTs. A random-effects model was used to pool summary results from individual RCTs. RESULTS: Fifteen RCTs met the inclusion criteria. The pooled results showed a statistically significant reduction in ADE associated with pharmacist intervention compared with no pharmacist intervention (RR = 0.86; [95% CI 0.80-0.94]; p = 0.0005) but not for PADEs (RR = 0.79; [95% CI 0.47-1.32]; p = 0.37). The heterogeneity was insignificant (I2 = 0%) for ADEs and substantial (I2 = 77%) for PADEs. Patients receiving a pharmacist intervention were 14% less likely for ADE than those who did not receive a pharmacist intervention. The estimated number of patients needed to prevent one ADE across all patient locations was 33. CONCLUSIONS: To our knowledge, this is the first systematic review and meta-analysis of RCTs seeking to understand the association of pharmacist interventions with ADEs and PADEs. The risk of having an ADE is reduced by a seventh for patients receiving a pharmacist care intervention versus no such intervention. The estimated number of patients needed to be followed across all patient locations to prevent one preventable ADE across all patient locations is 33.

Residents Preferences for Pharmacist-Managed Clinic in China: A Discrete Choice Experiment.

Purpose: This study aimed to survey and analyze the preferences for pharmacist-managed clinic among urban residents in China. Materials and Methods: A discrete choice experiment was conducted in Nanjing, China. A D-efficient fractional factorial design was used to generate the questionnaire. Three models were used to investigate each patient's strength of preference and preference heterogeneity. The relative importance for each treatment attribute was also determined. Results: 156 usable questionnaires (of 228 questionnaires sent out) were received. Respondents preferred pharmacist-managed clinics with the following characteristics: good pharmacists' knowledge and clinical medication practice competency, lower consultation fees, a dedicated consultation room, physician-pharmacist joint clinic, with pharmacists' knowledge competency receiving the highest priority. Latent class analysis revealed three classes (Experiential Type, Content Type and Economic Type) were identified based on respondents' preferences for pharmacist-managed clinics. Conclusion: The respondents were willing to choose a PMC relative to the current situation. When deciding on a pharmacist-managed clinic, residents are driven by pharmacists' competency, consultation fee, availability of consultation rooms and collaborative care or independent pharmacist service. Differences in patients' preferences identified in the study provide information on pharmacist-managed clinics that meet residents' expectations.

Thiazide Discontinuation in Chronic Kidney Disease Hypertension Management: A Retrospective Chart Review.

INTRODUCTION: Thiazides are utilized in general hypertension management, however, their role in chronic kidney disease (CKD) hypertension management remains unclear. Although data support thiazide efficacy in advanced CKD, the adverse effect profile (including estimated glomerular filtration rate [eGFR] decline and electrolyte abnormalities) may lead to thiazide discontinuation. The authors assessed the thiazide discontinuation rate in Kaiser Permanente Southern California members with moderate-to-severe CKD and hypertension. METHODS: This study was a multicenter retrospective analysis evaluating Kaiser Permanente Southern California members with hypertension and CKD 3B or 4 who filled a thiazide prescription in 2021, with follow-up through 2022. The outcomes were thiazide discontinuation rate, reason for thiazide discontinuation, time to thiazide discontinuation, and discontinuing practitioner specialty. Mean changes in blood pressure and eGFR from baseline were also evaluated. RESULTS: Of the 401 patients followed for 1 year after thiazide initiation, 65 patients discontinued a thiazide (discontinuation rate: 16.2%, mean time to discontinuation: 7.5 months). Of the 201 patients followed for 2 years after thiazide initiation, 57 patients discontinued a thiazide (discontinuation rate: 28.4%, mean time to discontinuation: 15.5 months). The most commonly documented thiazide discontinuation reason was increased serum creatinine (30% of total reasons at 1 year and 39% of total reasons at 2 years). CONCLUSION: Most patients with hypertension and CKD 3B or 4 continued on a thiazide with favorable blood pressure lowering effects and modest eGFR decline. Thiazides may be considered viable antihypertensive options with close renal function monitoring for patients with moderate-to-severe CKD.