Analysis of Pharmacist Interventions Used to Resolve Safety Target of Polypharmacy (STOP) Drug Interactions.

BACKGROUND: Statin drug interactions commonly increase the risk of muscle-related toxicities. The medical literature supports consultative pharmacist interventions to resolve drug interactions, but studies demonstrating autonomous pharmacist interventions are lacking. OBJECTIVE: To evaluate the complementary impact of using pharmacist-led protocols and pharmacists with prescriptive authority to resolve statin drug interactions. METHODS: Pharmacist-led protocols were developed to address gemfibrozil-statin and niacin-statin interactions. Pharmacists discontinued gemfibrozil and niacin by protocol or referred patients to the Patient Aligned Care Team (PACT) Pharmacy Clinic for individualized management. After all drug interactions were addressed, a retrospective quality improvement analysis was conducted. The primary outcome was to evaluate the impact of gemfibrozil and niacin discontinuation by protocol on patients' triglyceride (TG) laboratory results. The coprimary endpoints were the change in TGs and the percentage of patients with TGs ≥ 500 mg/dL, following pharmacist discontinuation by protocol. Secondary outcomes included the time required to resolve the interactions and a description of the PACT Clinical Pharmacy Specialists' (CPS) pharmacologic interventions. RESULTS: The gemfibrozil and niacin protocols addressed 397 drug interactions. Seventy-six patients underwent gemfibrozil discontinuation by protocol and had TG laboratory results available. TG levels decreased or increased by < 100 mg/dL for 62 patients (82%), and 1 patient (1.3%) experienced TG elevation above the threshold of 500 mg/dL. Thirty-six patients had niacin discontinued by protocol and available laboratory results. The TG levels decreased or increased by < 100 mg/dL for 33 patients (91.7%), and no patients had TG levels increase above the threshold of 500 mg/dL. The mean time required to resolve both gemfibrozil and niacin drug interactions was 15.5 minutes per patient. A total of 129 patients were referred to the PACT Pharmacy Clinic to manage gemfibrozil and niacin drug interactions. TG laboratory results were available for 80 gemfibrozil patients (74.8%) and 16 niacin patients (72.7%). The PACT CPS made 171 pharmacologic interventions to address drug interactions and the median of 2 encounters per patient. CONCLUSIONS: This single-site quality improvement analysis supports the complementary use of protocols and pharmacists with prescriptive authority to resolve statin drug interactions. These data support expanded roles for pharmacists, across settings, to mitigate select drug interactions.

Evaluation of a Newly Established Layered Learning Model in an Ambulatory Care Practice Setting.

BACKGROUND AND PURPOSE: Given the need to accommodate overlapping longitudinal Introductory Pharmacy Practice Experience (IPPE) students and Advanced Pharmacy Practice Experience (APPE) students at regular intervals while meeting clinical demands, the opportunity to establish a layered learning model (LLM) became evident at University of Missouri - Kansas City School of Pharmacy. The purpose of this project was to establish an LLM at an ambulatory care site, observe the teaching-learning interactions between IPPE and APPE students, and evaluate student perceptions of the experience. EDUCATIONAL ACTIVITY AND SETTING: The LLM was implemented over the course of three traditional semesters during Spring 2016 through Spring 2017. Clinical services were offered 2.5 days per week. Overlapping student instructional time was established in conjunction with the provision of clinical pharmacy services and the structure of each rotation type. Third-year (P3) IPPE and fourth-year (P4) APPE students, who participated in the LLM at this site, completed a course evaluation pertaining to their experiences. The evaluation focused on APPE and practice readiness, as well as strengths and limitations of the LLM. FINDINGS: All 16 students completed the evaluation (100% response rate). All IPPE students indicated the LLM prepared them for APPEs in either an excellent (n=3, 37.5%) or above average (n=5, 62.5%) manner. Of the APPE students, most indicated the LLM prepared IPPE students for APPEs in an excellent (n=3, 37.5%) or above average (n=4, 50%) manner. Similarly, the majority of APPE students indicated the LLM prepared APPE students for practice in an excellent (n=3, 37.5%) or above average (n=5, 62.5%) manner. In addition, the following common themes developed, which highlight the benefits of the experience: reinforcement of knowledge through instruction, enhanced understanding of APPE expectations, exposure to multiple teaching styles, and creation of a comfortable learning environment. Students suggested the LLM include increased time for interaction with other learners. SUMMARY: An LLM involving P3 IPPE and P4 APPE pharmacy students, in an ambulatory care practice setting, was associated with positive student perceptions. Student feedback was best utilized to generate the hypothesis that this LLM may increase both APPE and practice readiness. However, further study is needed to confirm direct cause and effect.

Efficacy of Patient Aligned Care Team Pharmacist Services in Reaching Diabetes and Hyperlipidemia Treatment Goals.

The services provided by clinical pharmacy specialists can improve low-density lipoprotein cholesterol and hemoglobin A1c levels in the veterans enrolled in a disease management clinic.