Journal of the American Pharmacists Association : JAPhA

BACKGROUND: Inappropriate ADC overrides pose a significant risk to patient safety. Bypassing pharmacist review during these overrides removes a vital safety check, leaving nurses to review complex medication orders alone. This can lead to overlooking incorrect orders and significantly increasing the potential for medication errors. While ISMP guidelines promote profiled ADCs and safe override practices, there is no national standard for acceptable override rates. OBJECTIVES: Assessing the appropriateness of ADC overrides of profiled ADCs at a tertiary hospital in Saudi Arabia in accordance with ISMP guidelines (3rd core safety process)...

BACKGROUND: The Veterans Affairs San Diego Healthcare System converted its pharmacist-run Diabetes Intense Medical Management (DIMM) Clinic to telehealth during the COVID-19 pandemic. Previous studies suggested that in-person DIMM visits improved glycemic control, medication adherence, and patient satisfaction. To explore if these benefits apply to telehealth, we compared glycemic control in veterans with post-COVID-19 telehealth DIMM visits and pre-pandemic in-person DIMM visits. OBJECTIVE: The primary study objective was to evaluate the mean hemoglobin (A1c) change from baseline in cohorts who received telehealth visits, traditional visits, or a combination of both after 12 months of intervention...

BACKGROUND: ChatGPT is a conversational artificial intelligence (AI) technology that has shown application in various facets of healthcare. With the increased use of AI, it is imperative to assess the accuracy and comprehensibility of AI platforms. OBJECTIVE: This pilot project aimed to assess the understandability, readability, and accuracy of ChatGPT as a source of medication-related patient education as compared with an evidence-based medicine tertiary reference resource, LexiComp®...

BACKGROUND: North Carolina immunizing pharmacists are authorized to provide oral and transdermal hormonal contraception to eligible patients. In March 2022, implementation of this enhanced patient care service began statewide, following approval of standing orders and published training from the North Carolina Association of Pharmacists. Two pharmacy locations on a college campus began offering pharmacist-provided hormonal contraception shortly after approval. OBJECTIVE: The objective of this study was to assess the willingness of students to seek pharmacist-provided hormonal contraception and the willingness of students to pay for this service...

BACKGROUND: Colorectal cancer (CRC) is the third most common diagnosed cancer in the United States. Kentucky pharmacists can be instrumental in the CRC early detection process through board authorized protocols (BAP): a regulatory approach managed by the Kentucky Board of Pharmacy that allows pharmacists to increase access to care while saving lives through early detection screening. Determining the barriers and successes of implementing CRC screening can improve access to education and care for patients...

BACKGROUND: The American Public Health Association defines a Community Health Worker (CHW) as "a trusted member of and/or has an unusually close understanding of the community served." Both CHWs and pharmacists have shown they are well-equipped to produce positive outcomes in chronic disease management, but there is still a gap in the literature regarding the CHW-pharmacist relationship. OBJECTIVE: The objective of this study was to assess and describe pharmacist perceptions and experiences with CHWs...

BACKGROUND: Research shows that one-time doses of intravenous (IV) antibiotics do not improve resolution of infection. Providers, however, continue to use them - especially in the emergency department. Very few studies have aimed to quantify the cost of this practice. OBJECTIVES: The primary objective was to evaluate the difference in average total cost of emergency department (ED) stay between patients who received a one-time dose of intravenous antibiotics in the ED before discharging on oral antibiotics and patients who were just discharged on oral antibiotics...

BACKGROUND: Tricyclic antidepressants (TCAs) are a treatment option for diabetic peripheral neuropathy (DPN). Existing evidence demonstrates the prolonged use of TCA therapy increases the risk of cognitive decline and dementia, likely due to the anticholinergic effects of these medications. The anticholinergic activity is thought to contribute significantly to the observed increase in cognitive decline and dementia risks associated with long-term TCA use. There is little information available to describe the usage patterns of TCAs in DPN, particularly within underserved populations who receive care at Federally Qualified Health Centers (FQHCs)...

Peer review is an essential step in scientific progress and clinical improvement, providing opportunity for research to be critically evaluated and improved by one's colleagues. Pharmacists from all job settings are called to serve as peer reviewers in the ever-growing publication landscape of the profession. Despite challenges to engagement such as time and compensation, peer review provides considerable professional development for both authors and reviewers alike. This article will serve as a practical guide for peer reviewers, discussing best practices as well as the handling of different situations that may arise during the process...

BACKGROUND: The potential uses of artificial intelligence have extended into the fields of healthcare delivery and education. However, challenges are associated with introducing innovative technologies into healthcare, particularly with respect to information quality. OBJECTIVE: To evaluate the accuracy of answers provided by a chatbot in response to questions that patients should ask before taking a new medication. METHODS: Twelve questions obtained from the Agency for Healthcare Research and Quality were asked to a chatbot for the top 20 drugs...

BACKGROUND: Even though pharmacists are fully capable of dispensing naloxone under protocols, there are barriers perceived by pharmacists, such as determining which patients are at high risk. OBJECTIVE(S): The study objectives were to 1) determine the impact of pharmacist-led identification of patients at a high risk of opioid-related harm and pharmacist intervention by providing naloxone counseling; and 2) identify patient-reported barriers for receiving naloxone recommended by pharmacists under the Missouri Standing Protocol...

BACKGROUND: Community-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a Health Information Exchange (HIE) on pharmacist recommendations during a medication management encounter. OBJECTIVE: The objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE...

BACKGROUND: Medication synchronization involves coordinating a patient's medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared to automatic refill-processing programs. Patients are two to six times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service...

BACKGROUND: Diabetes is the eighth leading cause of death and has a substantial impact on the United States (U.S.) health care system. Recent changes to major insurance formularies allow for increased access to continuous glucose monitors (CGM). Community pharmacists routinely assist and educate patients about diabetes care, including usage of CGM. OBJECTIVES: The purpose of this study was to evaluate the clinical impact of a community pharmacist remote CGM monitoring service on patients' glycemic metrics...

BACKGROUND: Low health literacy and numeracy are associated with poor health outcomes and lower self-efficacy. Continuous glucose monitors (CGMs) can improve diabetes management, but their benefits may be limited by health literacy levels. OBJECTIVES: Our objective was to characterize health literacy levels of ambulatory care patients using CGMs to manage their diabetes in one urban health system. Secondary aims were to identify specific knowledge deficits related to CGM education and determine predictors of self-rated comfort with and understanding of CGM use...

BACKGROUND: Food insecurity (FI) is a disturbance of eating patterns due to lack of resources, preventing consistent access to healthy foods. FI negatively impacts health outcomes and increases care cost. OBJECTIVES: The primary objective was to (a) explore patient willingness to screen with the two-question Hunger Vital SignTM tool and (b) accept education regarding food assistance programs (FAP) at their community pharmacy. The secondary objective was to gauge pharmacy personnel's comfort with utilizing the screener and providing education...

BACKGROUND: Tobacco use remains a leading cause of death in the U.S. Varenicline is a preferred medication for tobacco cessation, and a prior report in the literature showed its use fell dramatically after the voluntary recall of Chantix (name-brand varenicline) in July 2021. OBJECTIVES: Working with data on prescriptions for varenicline and nicotine-replacement therapy (NRT), we studied use from 2018 to 2023 to determine if varenicline use had recovered or if there had been a compensatory increase in NRT use...

BACKGROUND: The current state of the mental health crisis has been a topic of discussion around the nation, with those in rural communities being at a particularly higher risk. Community pharmacists are uniquely positioned to screen patients for mental health disorders as well as provide education and patient monitoring following medication changes by prescribers. OBJECTIVE: The objective of this study is to assess mental health screening outcomes provided by rural community pharmacists...

BACKGROUND: The influence of adverse factors on social determinants of health (SDOH) and their impact on patient outcomes is widely recognized. Pharmacists, as accessible healthcare professionals, can play a pivotal role in identifying and addressing SDOH concerns. Health system specialty pharmacies have consistently assisted patients in accessing expensive specialty medications and ensuring adherence to therapy. As such, they are uniquely positioned to address SDOH concerns of patients...

BACKGROUND: Approximately 50-70% of patients have at least one medication discrepancy in their initial medication history. These discrepancies can lead to errors on admission and discharge orders and have the potential to cause patient harm and incur added costs associated with increased length of stay and readmission rates. Several studies have demonstrated improved medication history accuracy with pharmacy-conducted services, but variations in practice exist due to challenges with workflow and resources...