Evaluation of Tobacco Cessation Rates Among Veterans in a Pharmacist-Run Smoking Cessation Clinic.

Objective: To determine if there was a significant increase in cessation rates over a 6-month time frame with a pharmacist-managed smoking cessation clinic.Methods: This single-center, prospective study recruited veterans via ICD-10 diagnosis codes for nicotine/tobacco dependence to participate in a clinical pharmacy practitioner (CPP)-run smoking cessation clinic. To aid cessation efforts, participants were offered pharmacotherapy, behavioral modifications, and frequent follow-up appointments. Once a participant demonstrated tobacco-free success for 6 months, the veteran was eligible for discharge from the clinic. Patient visits were conducted between December 2020 and October 2021. Data were analyzed using intention-to-treat principle.Results: A total of 54 participants were screened, of which 29 met the inclusion criteria. Eleven participants withdrew from the study, as they were no longer willing to quit smoking. Thirty-eight percent (n = 11) of the enrolled participants achieved complete tobacco cessation by the end of the study, with 31% (n = 9) achieving the primary endpoint of tobacco cessation for 6 months. Seventeen percent (n = 5) of participants maintained ≥ 50% reduction in tobacco use. One participant increased the amount of tobacco used since the initial visit.Conclusions: Providing pharmacotherapy, behavioral counseling, and frequent follow-up visits may result in higher numbers of tobacco-free patients. Expanding pharmacist-run smoking cessation clinics may result in an increase in cessation rates in the veteran population.

Application of a Risk Score to Identify Older Adults with Community-Onset Pneumonia Most Likely to Benefit From Empiric Pseudomonas Therapy.

STUDY OBJECTIVE: To assess the impact of empiric Pseudomonas pharmacotherapy on 30-day mortality in hospitalized patients with community-onset pneumonia stratified according to their risk (low, medium, or high) of drug-resistant pathogens. DESIGN: Retrospective cohort study. DATA SOURCE: Veterans Health Administration database. PATIENTS: A total of 50,119 patients who were at least 65 years of age, hospitalized with pneumonia, and received antibiotics within 48 hours of admission between fiscal years 2002 and 2007. Patients were stratified into empiric Pseudomonas therapy (31,027 patients) and no Pseudomonas therapy (19,092 patients) groups based on antibiotics received during their first 48 hours of admission. MEASUREMENTS AND MAIN RESULTS: A clinical prediction scoring system developed in 2014 that stratifies patients with community-onset pneumonia according to their risk of drug-resistant pathogens was used to identify patients who were likely to benefit from empiric Pseudomonas therapy as well as those in whom antipseudomonal therapy could be spared; patients were classified into low-risk (68%), medium-risk (21%), and high-risk (11%) groups. Of the 50,119 patients, 62% received Pseudomonas therapy. All-cause 30-day mortality was the primary outcome. Empiric Pseudomonas therapy (adjusted odds ratio 0.72, 95% confidence interval 0.62-0.84) was associated with lower 30-day mortality in the high-risk group but not the low- or medium-risk groups. CONCLUSION: Application of a risk score for patients with drug-resistant pathogens can identify patients likely to benefit from empiric Pseudomonas therapy. Widespread use of this score could reduce overuse of anti-Pseudomonas antibiotics in low- to medium-risk patients and improve survival in high-risk patients.