Medicine and Health Sciences Commons^™

Pharmacist Avoidance Or Reductions In Medical Costs In Critically Ill Adults: Pharm-Crit Study, Megan A. Rech, Payal K. Gurnani, William J. Peppard, Keaton S. Smetana, Megan A. Van Berkel, Drayton A. Hammond, Alexander H. Flannery

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: To comprehensively classify interventions performed by ICU clinical pharmacists and quantify cost avoidance generated through their accepted interventions.

DESIGN: A multicenter, prospective, observational study was performed between August 2018 and January 2019.

SETTING: Community hospitals and academic medical centers in the United States.

PARTICIPANTS: ICU clinical pharmacists.

INTERVENTIONS: Recommendations classified into one of 38 intervention categories (divided into six unique sections) associated with cost avoidance.

MEASUREMENTS AND MAIN RESULTS: Two-hundred fifteen ICU pharmacists at 85 centers performed 55,926 interventions during 3,148 shifts that were accepted on 27,681 adult patient days and generated $23,404,089 of cost avoidance. The quantity of …

Major Publications In The Critical Care Pharmacotherapy Literature: 2020, Brittany D. Bissell, Jeannee Campbell, Reagan Collins, Charles Cook, Dharati Desai, Jessica Dewitt, Ifeoma Mary Eche, Ijeoma Julie Eche, Pansy Elsamadisi, Janelle Juul, Soyoung Kim, Courtney T. Makowski, Ruben J Mylvaganam, Adam Smith, Jennifer Stancati, Katherine Stonesifer, Justin Tawil, Melanie Smith Condeni

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2020.

DATA SOURCES: The Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update group screened 36 journals monthly for impactful publications.

STUDY SELECTION: The group reviewed a total of 119 articles during 2020 according to relevance for practice.

DATA EXTRACTION: Articles were selected with consensus and importance to clinical practice from those included in the monthly Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. The group reviewed articles according to Grading of Recommendations, Assessment, Development, and Evaluations criteria. Articles with a 1A grade were selected.

DATA SYNTHESIS: Several trials …

Long-Term Survival Of Older Patients Hospitalized For Covid-19. Do Clinical Characteristics Upon Admission Matter?, Michał Chojnicki, Agnieszka Neumann-Podczaska, Mikołaj Seostianin, Zofia Tomczak, Hamza Tariq, Jerzy Chudek, Sławomir Tobis, Iwona Mozer-Lisewska, Aleksandra Suwalska, Andrzej Tykarski, Piotr Merks, Sylwia Kropińska, Małgorzata Sobieszczańska, Frank Romanelli, Katarzyna Wieczorowska-Tobis

Pharmacy Practice and Science Faculty Publications

Older adults are particularly susceptible to COVID-19 in terms of both disease severity and risk of death. To compare clinical differences between older COVID-19 hospitalized survivors and non-survivors, we investigated variables influencing mortality in all older adults with COVID-19 hospitalized in Poznań, Poland, through the end of June 2020 (n = 322). In-hospital, post-discharge, and overall 180-day mortality were analyzed. Functional capacity prior to COVID-19 diagnosis was also documented. The mean age of subjects was 77.5 ± 10.0 years; among them, 191 were females. Ninety-five (29.5%) died during their hospitalization and an additional 30 (9.3%) during the post-discharge period …

Using Technology To Enhance Teaching And Learning In Pharmacy Education, Clark D. Kebodeaux, Vivienne Mak

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Serum Renin And Major Adverse Kidney Events In Critically Ill Patients: A Multicenter Prospective Study, Alexander H. Flannery, Victor M. Ortiz-Soriano, Xilong Li, Fabiola G. Gianella, Robert D. Toto, Orson W. Moe, Prasad Devarajan, Stuart L. Goldstein, Javier A. Neyra

Pharmacy Practice and Science Faculty Publications

BACKGROUND: Preliminary studies have suggested that the renin-angiotensin system is activated in critical illness and associated with mortality and kidney outcomes. We sought to assess in a larger, multicenter study the relationship between serum renin and Major Adverse Kidney Events (MAKE) in intensive care unit (ICU) patients.

METHODS: Prospective, multicenter study at two institutions of patients with and without acute kidney injury (AKI). Blood samples were collected for renin measurement a median of 2 days into the index ICU admission and 5-7 days later. The primary outcome was MAKE at hospital discharge, a composite of mortality, kidney replacement therapy, or …

An Investigation Of New Medications Initiation During Ambulatory Care Visits In Patients With Dementia, Alexandra Wallem, Ashley I. Martinez, Lauren Vickers, Michael Singleton, Daniela C. Moga

Pharmacy Practice and Science Faculty Publications

Background
There is currently insufficient data describing how new medications are provided to older adult ambulatory patients with dementia in the United States (US).

Objectives
To describe characteristics of ambulatory care visits for adults ≥ 65 years old and investigate differences in prescribing of new medications between patients with and without dementia.

Methods
We conducted a population-based cross-sectional study using the 2016 National Ambulatory Medical Care Survey (NAMCS) in the US. Non-perioperative ambulatory care visits of patients ≥ 65 years old with sampling weights were used to provide national estimates of visits. Baseline characteristics were compared between visits for patients …

Rabies Postexposure Prophylaxis In The United States: Opportunities To Improve Access, Coordination, And Delivery, Gavin T. Howington, Huy-Binh Nguyen, P. Brandon Bookstaver, Peter Akpunonu, Joshua T. Swan

Pharmacy Practice and Science Faculty Publications

No abstract provided.

Pharmacotherapy In Coronavirus Disease 2019 And Risk Of Secondary Infections: A Single-Center Case Series And Narrative Review, Michael Behal, Brooke Barlow, Breanne Mefford, Melissa L. Thompson Bastin, J. Chris Donaldson, Melanie Laine, Brittany D. Bissell

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: Since the onset of the coronavirus disease 2019 pandemic, immune modulators have been considered front-line candidates for the management of patients presenting with clinical symptoms secondary to severe acute respiratory syndrome coronavirus 2 infection. Although heavy emphasis has been placed on early clinical efficacy, we sought to evaluate the impact of pharmacologic approach to coronavirus disease 2019 within the ICU on secondary infections and clinical outcomes.

DATA SOURCES: PubMed (inception to March 2021) database search and manual selection of bibliographies from selected articles.

STUDY SELECTION AND DATA EXTRACTION: Articles relevant to coronavirus disease 2019, management of severe acute respiratory …

Pharmacist Avoidance Or Reductions In Medical Costs In Patients Presenting The Emergency Department: Pharm-Em Study, Megan A. Rech, William Adams, Keaton S. Smetana, Payal K. Gurnani, Megan A. Van Berkel Patel, William J. Peppard, Drayton A. Hammond, Alexander H. Flannery, Pharm-Em Investigators On Behalf Of The Society Of Critical Care Medicine Clinical Pharmacy And Pharmacology Section And Endorsed By The Discovery Network

Pharmacy Practice and Science Faculty Publications

Objectives:
To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions.

Design:
A multicenter, prospective, observational study was performed between August 2018 and January 2019.

Setting:
Community and academic hospitals in the United States.

Participants:
Emergency medicine clinical pharmacists.

Interventions:
Recommendations classified into one of 38 intervention categories associated with cost avoidance.

Measurements and Main Results:
Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in …

Case Report: The Complexities Of Managing Medications And The Importance Of Deprescribing Anticholinergics In Older Adults, Taylor Elliott, Lynne Eckmann, Daniela C. Moga

Pharmacy Practice and Science Faculty Publications

Potentially inappropriate anticholinergic medications (including over-the-counter products), polypharmacy, and the existence of communication barriers among members of the interprofessional team frequently contribute to clinical complexity in older adults. We present the case of a frail 86-year old female from the perspective of a community pharmacist managing outpatient medications and transitions of care. CD’s past medical history is significant for dementia, multiple falls, recurrent urinary tract infections, depression, cardiac arrhythmia, macular degeneration, chronic pain, depression, and cerebrovascular disease.

An Experimental Education Project For Consultations Of Older Adults During The Pandemic And Healthcare Lockdown, Agnieszka Neumann-Podczaska, Mikołaj Seostianin, Konrad Madejczyk, Piotr Merks, Urszula Religioni, Zofia Tomczak, Sławomir Tobis, Daniela C. Moga, Melody Ryan, Katarzyna Wieczorowska-Tobis

Pharmacy Practice and Science Faculty Publications

Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering …

Efficacy And Safety Of Vancomycin Loading Doses In Critically Ill Patients With Methicillin-Resistant Staphylococcus Aureus Infection, Alexander H. Flannery, Katie L. Wallace, Christian N. Rhudy, Allison S. Olmsted, Rachel C. Minrath, Stuart M. Pope, Aaron M. Cook, David S. Burgess, Peter E. Morris

Pharmacy Practice and Science Faculty Publications

Background: While vancomycin loading doses may facilitate earlier pharmacokinetic–pharmacodynamic target attainment, the impact of loading doses on clinical outcomes remains understudied. Critically ill patients are at highest risk of morbidity and mortality from methicillin resistant Staphylococcus aureus (MRSA) infection and hypothesized to most likely benefit from a loading dose. We sought to determine the association between receipt of a vancomycin loading dose and clinical outcomes in a cohort of critically ill adults.

Methods: Four hundred and forty-nine critically ill patients with MRSA cultures isolated from blood or respiratory specimens were eligible for the study. Cohorts were established by receipt of …

Variations In Schedule Iii Prescription Patterns In A Medicaid Population Pre- And Post-Policy, Radhakrishnan Nagarajan, Jeffery C. Talbert, Craig S. Miller, Jeffrey Ebersole

Pharmacy Practice and Science Faculty Publications

The present study investigated variations in patient movement patterns between prescribers before and after House Bill 1 (HB1) implementation in Kentucky using network abstractions (PPN: prescriber-prescriber networks) from a one-month cross-sectional Schedule III prescription data in a Medicaid population. Network characteristics such as degree centrality distribution of PPN was positively skewed and revealed Dental Practitioners to be the highly connected specialty with opioid analgesic hydrocodone-acetaminophen to be the most commonly prescribed drug. Taxonomy enrichment of the prescriber specialties in PPN using chi-square test revealed a reduction in the enriched taxonomies Post-HB1 compared to Pre-HB1 with Dental practitioners being constitutively enriched …

How Well Can We Assess The Validity Of Non-Randomised Studies Of Medications? A Systematic Review Of Assessment Tools, Elvira D'Andrea, Lydia Vinals, Elisabetta Patorno, Jessica M. Franklin, Dimitri Bennett, Joan A. Largent, Daniela C. Moga, Hongbo Yuan, Xuerong Wen, Andrew R. Zullo, Thomas P. A. Debray, Grammati Sarri

Pharmacy Practice and Science Faculty Publications

OBJECTIVE: To determine whether assessment tools for non-randomised studies (NRS) address critical elements that influence the validity of NRS findings for comparative safety and effectiveness of medications.

DESIGN: Systematic review and Delphi survey.

DATA SOURCES: We searched PubMed, Embase, Google, bibliographies of reviews and websites of influential organisations from inception to November 2019. In parallel, we conducted a Delphi survey among the International Society for Pharmacoepidemiology Comparative Effectiveness Research Special Interest Group to identify key methodological challenges for NRS of medications. We created a framework consisting of the reported methodological challenges to evaluate the selected NRS tools.

STUDY SELECTION: Checklists …

Pace Yourself: Impact Of Covid-19 On Patient-Centered Care Experience, Kristen Wilhite, Mikael D. Jones, Clark D. Kebodeaux

Pharmacy Practice and Science Faculty Publications

(1) Background: The outbreak of the novel coronavirus, COVID-19, forced colleges of pharmacy to implement new online learning methodologies to ensure that students could complete required courses. This transition was especially acute for laboratory simulation courses that require students to practice professional skills. This study aims to compare student assessment performance within a simulation-based laboratory course for students who completed the module prior to and after the online transition. (2) Methods: This study was a retrospective cohort comparison of student outcome performance with two distinct content delivery methods. Students were organized into two tracks at the beginning of the semester …

Obstetrician-Gynecologist Perceptions And Utilization Of Prescription Drug Monitoring Programs: A Survey Study, Amie Goodin, Jungjun Bae, Chris Delcher, Joshua Brown, Dikea Roussos-Ross

Pharmacy Practice and Science Faculty Publications

Query of Prescription Drug Monitoring Programs (PDMPs) is recommended before prescribing opioids by the US Centers for Disease Control and Prevention, to inform clinical practice and aid diversion prevention. Many states mandate prescriber PDMP use; however, little is known about PDMP perception of utility and use among Obstetricians-Gynecologists (OB/GYN), who are the primary provider for most women during pregnancy.

This study examined OB/GYN perceptions and utilization of their state PDMP.

Survey items were developed by expert consensus. A voluntary anonymous survey was emailed to a random sample of 5000 OB/GYNs (adjusted participants n = 1470, minus unread/refusals). Responses were stratified …