Semaglutide Initiation in a Type 2 Diabetes Mellitus, Post-Liver Transplant Patient.

Objective To describe the process of initiation of semaglutide for complex management of type 2 diabetes mellitus (T2DM) in a patient after liver transplantation. Setting Family medicine clinic. Practice Description A family medicine clinic comprising six physicians with an ambulatory care pharmacist. The pharmacist has direct interaction with patients and providers within the clinic assisting in the management of chronic disease states under a collaborative practice agreement. Practice Innovation A 63-year-old White male with a history of liver transplantation in the context of T2DM, treated with basal-bolus insulin therapy, was referred by his family medicine provider to the ambulatory care pharmacist for diabetes management because of a hemoglobin A1c (HbA1c) level greater than 10%. Semaglutide was initiated and titrated to improve blood glucose control in combination with basal-bolus insulin adjustments taking disease states, cost, and health literacy into consideration. Results The addition of semaglutide, over an eight-month period, assisted with glycemic control to an HbA1c of less than 7%. Conclusion Semaglutide, in addition to basal-bolus insulin therapy, allowed for overall improved glycemic control; however, further studies are needed to evaluate efficacy because of the complexity of diabetes management in this patient population. Throughout the course of treatment of patients with T2DM and organ transplantation, dual monitoring of antidiabetic therapy and antirejection medications is essential to reduce the risk of organ rejection.

Assessing Self-Perceived Interprofessional Collaborative Competency on Advanced Pharmacy Practice Experiences Through Interprofessional Simulations.

Objective. To implement and assess the impact of Doctor of Pharmacy (PharmD) students participating in a required interprofessional (IP) simulation during an advanced pharmacy practice experience (APPE). Methods. Fourth-year PharmD students completing APPEs were required to participate in one of three IP simulations during the 2016-2017 academic year to improve their interprofessional teamwork and collaboration skills. Pharmacy student self-perception of IP competence was measured by the Interprofessional Collaborative Competency Attainment Survey (ICCAS), administered in a retrospective pre-/post-test design. Responses were analyzed using descriptive statistics to obtain an overview of the data. Paired t tests were used to compare the pre- and post-test results. Results. During the 2016-2017 academic year, 157 PharmD students were assigned to complete an IP simulation. Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibility, collaborative patient-centered approach, conflict management, and team functioning) were compared. Scores in all categories significantly increased after completion of the simulation. Conclusion. Following participation in an IP simulation, PharmD students felt competent to engage in IP collaboration, and this, along with their performance on APPEs, determined their practice-readiness for IP teamwork upon graduation.

Comparing patients' prescribed, self-reported, and actual intake of supplemental eicosapentaenoic acid + docosahexaenoic acid.

BACKGROUND: Dietary fish oil supplements containing the omega-3 polyunsaturated fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are frequently used for cardiovascular benefit. However, several factors may limit the intake of prescribed doses. OBJECTIVE: The objective of this study is to compare the prescribed, patient self-reported, and actual intake of supplemental EPA + DHA doses in a lipid-specialty clinic and identify common barriers and influences to therapy. METHODS: Seventy-six patients prescribed supplemental fish oil were randomly selected to participate in a 28-item cross-sectional survey for evaluating patient knowledge and intake of prescribed supplemental EPA + DHA doses. Self-reported data were collected during a follow-up clinic visit, whereas actual intake was determined when patients had access to their fish oil bottle. These data were compared with their chart-documented prescribed EPA + DHA dose. RESULTS: Many patients were well-educated and had attended the lipid-specialty clinic for approximately 2 years but only 28.9% were confident that they could accurately recall their daily EPA + DHA dose. There were statistically significant differences between the prescribed doses and patients' self-reported doses (3600 mg vs 2750 mg, P = .014), as well as between prescribed doses and actual intake (3600 mg vs 1575 mg, P < .001). Patients reported multiple barriers and influences to explain their use of fish oil products. CONCLUSION: Most patients using supplemental fish oil in a lipid-specialty clinic were not taking the prescribed amount of EPA + DHA, with many using markedly lower than prescribed doses. This is likely because of several factors including the complexities of supplemental fish oil doses and labeling, product availability, and discount sales. These findings suggest that supplemental fish oil requires continuous education and dosing guidance.

Improving care transitions: current practice and future opportunities for pharmacists.

During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to issues regarding care transitions and that students have several opportunities to practice the skills needed for effective care transitions. Moreover, reimbursement mechanisms that permit greater pharmacist involvement in providing medication assistance to patients going through care transitions should be explored. Although health information technology offers the potential for safer care transitions, pharmacists' use of information technology must be integrated into the national initiatives for pharmacists to be effectively involved in care transitions. This paper concludes with a discussion about the importance of recognizing and addressing health literacy issues to promote patient empowerment during and after care transitions.