2024 ACCP Virtual Poster
Symposium May 21 - 22, 2024
ADR/Drug Interactions
• Electrolyte Disturbances in Patients with Breast Cancer Receiving Chemotherapy in the Ambulatory Setting.
Zahieh Abualoush, Pharm.D.1, Anoud AlSaleh, Pharm.D.2 and Lama
H. Nazer, Pharm.D, BCPS, FCCM3
(1)Department of pharmacy, King Hussein Cancer Center, Amman, **, Jordan (2)Department of pharmacy, King Hussein Cancer
Center, Amman, Jordan (3)Department of Pharmacy, King Hussien Cancer Center, Amman, Jordan
Introduction: Electrolyte disturbances are common adverse events during cancer treatment, with potentially significant clinical
implica- tions. However, there is limited data evaluating such complications Research Question or Hypothesis: What is the
incidence and nature of electrolyte disturbances in patients with breast cancer receiving chemotherapy in the ambulatory
setting?
Study Design: A 6-months retrospective study.
Methods: This study included patients with breast cancer who received chemotherapy in the infusion clinics at King Hussein
Cancer Center. Laboratory tests performed after each treatment cycle were evaluated for any deviations from the normal ranges
for sodium, potassium, magnesium, and calcium. The institutional reference ranges were used to define the normal levels and
the severity of electrolyte disturbances was classified based on the Common Terminology Cri- teria for Adverse Events. Patient
characteristics and the chemother- apy treatments received were recorded. Descriptive statistics was used to report the findings.
Results: During the study period, 3301 chemotherapy cycles for 1550
patients were evaluated. Mean age was 49±11.1(SD) years, all patients were females, and had received a median (IQR) of 3 (1-
5) treatment cycles. A total of 919 electrolyte disturbances were associ- ated with 760 (23%) chemotherapy cycles. Hyponatremia,
hypokale- mia, hypocalcemia, and hypomagnesemia were reported in 241(32%), 149(20%), 115(15%), and 208(27%) of the cycles,
respectively, while hypernatremia, hyperkalemia, hypercalcemia, and hypermagnesemia were reported in 14(2%), 18(2%), 31(4%)
and 139(18%) of the cycles,
respectively. Electrolyte disturbances were Grade 2 in 30(4%) cycles and Grade 3 in 16(2%) cycles, while the remaining were
Grade 1. Che- motherapy associated with the most electrolyte disturbances were taxane-based regimens in 371(49%) cycles.
Conclusion: Electrolyte disturbances were reported in about one-
fourth of the treatment cycles in patients with breast cancer, with hyponatremia and hypomagnesemia being the most common.
Future studies should evaluate the clinical impact of electrolyte disturbances and strategies to prevent such complications.
Adult Medicine
• Raising the Barb: Evaluating the Impact of the Updated Alcohol Withdrawal Management Order Panel on Escalation
of Care.
Kelly Kepley, Pharm.D.1, Zachary LaDuke, Pharm.D., BCPS2, Sarah Berriman, Pharm.D.2 and David Sudekum, Pharm.D., BCPS2
(1)Pharmacy, Trinity Health Ann Arbor, Ann Arbor, MI (2)Trinity Health Ann Arbor, Ann Arbor, MI
,Introduction: Alcohol withdrawal syndrome (AWS) presents a signifi- cant challenge in healthcare, contributing substantially to
emergency department visits. The 2020 American Society of Addiction Medicine (ASAM) guidelines and recent literature have
highlighted limitations in the traditional benzodiazepine-based treatment approach, necessitat- ing a reassessment of
management strategies.
Research Question or Hypothesis: Does the implementation of an
updated alcohol withdrawal order panel, in alignment with the 2020 ASAM guidelines, reduce the proportion of patients
necessitating escalation of care from general floors to the medical intensive care unit (MICU)?
Study Design: This retrospective, single-center cohort study ana- lyzed patients aged 18 and older admitted to a general floor
at Trinity Health Ann Arbor with a primary diagnosis of AWS treated with lorazepam or phenobarbital. The study compared
outcomes
before (N=551, February 2020 – August 2022) and after (N=270,
October 2022 – December 2023) implementing the updated order panel. Exclusions included direct MICU admissions, admissions
less than 24 hours, ED mechanical ventilation, epilepsy history, non- AWS MICU transfers, lorazepam or phenobarbital allergies,
and pregnancy.
Methods: Data abstraction from EPIC was performed by Michigan Data Analytics. The primary endpoint was the proportion of
patients requiring escalation of care to the MICU. Secondary endpoints included MICU and total hospital length of stay, mechanical
ventila- tion incidence, and cumulative lorazepam and phenobarbital doses.
Results: Post-implementation, there was no significant reduction in the proportion of patients requiring escalation of care (5.6%
vs. 7.8%, P=0.234). However, the need for mechanical ventilation did not
increase (0.7% vs. 0.4%, P=0.538), and the cumulative lorazepam
dose decreased significantly (20.45mg vs.17mg, P=0.003). There were no significant differences in cumulative phenobarbital
dose or length
of stay.
Conclusion: While the implementation of the updated order panel did
Conclusion: In this regional hospital psychiatric outpatient clinic, patients with psychiatric disorders who received weight loss
medica- tion were not limited to those with schizophrenia, but also included those with anxiety and depression. The prescribing
behavior of physi- cians was not limited to specific weight loss medications, and they may prescribe GLP-1 and appetite
suppressants based on patient preference. While feasible in outpatient settings, long-term efficacy and side effects require
confirmation via prospective trials.
4. Full Versus Abbreviated Loading Durations of Apixaban After Initial Parenteral Anticoagulation in the Treatment of Venous
Thromboembolism in Patients with Chronic Kidney Disease.
not reduce escalation rates, it resulted in a significant decrease in lor-
azepam administration, suggesting potential benefits in optimizing medication use in AWS management.
3. Analysis of Weight-loss Medication Use in Outpatients with Mood Disorders.
Deng-Wei Yang, BS, Shen-Hua Lin, BS and Jen-Wei Liu, PhD Department of Pharmacy, Fu Jen Catholic University Hospital, Fu
Jen Catholic University, New Taipei City, Taiwan
Introduction: Psychiatric patients often require multiple medications for treatment, including antipsychotics, antidepressants,
and anxiolytics. Some of these medications can have the side effect of weight gain.
,Research Question or Hypothesis: To analyze the use of weight loss medications in patients with mood disorders attending a
psychiatric outpatient clinic.
Study Design: A retrospective electronic medical record analysis of the use of weight loss medications in a regional hospital
psychiatric outpatient clinic in Q4 2023.
Methods: Patients with mood disorders attending a psychiatric outpa- tient clinic were enrolled in the study. Evaluation criteria
included psy- chiatric diagnoses, prescribed psychotropic medications, weight loss medication category, BMI data, and changes
in weight. Descriptive statistics were used.
Results: 10 psychiatric patients met the inclusion criteria, 2 males and 8 females. The most common psychiatric diagnoses were
depression (6 patients) and anxiety (5 patients), followed by bipolar disorder and panic disorder. The most commonly used
psychotropic medications were quetiapine (Seroquel) (2 patients) and antidepressants, which were evenly distributed, including
sertraline (Zoloft) and trazodone (Mesyrel). The most commonly used anxiolytic was alprazolam (Xanax). Six patients (60%) had
a pre-treatment BMI, which was 26.58 on average, meeting the WHO criteria for overweight. The weight loss medications were
semaglutide (Ozempic) and naltrexone/bupropion (Contrave), 5 patients each. There was no significant change in body weight
at the one-month follow-up visit, and longer follow-up is needed. These patients did not complain of any side effects from the
weight loss medications.
Mykala Woods, Pharm.D. Candidate1, Jay'La Lin, Pharm.D. Candidate2, Alexandra Mihm, Pharm.D.3 and Sarah Nisly, Pharm.D.,
MEd, BCPS,
FCCP4
(1)High Point University, High Point, NC (2)Campbell University, Buies Creek, NC (3)Atrium Health Wake Forest Baptist
Medical Center, Winston-Salem, NC (4)Clinical Education Alliance, Reston, VA
Introduction: Direct oral anticoagulants (DOACs) can be used for venous thromboembolism (VTE) in patients with chronic kidney
dis- ease (CKD). In VTE treatment, loading doses (LD) are recommended prior to initiation of maintenance doses. DOACs, being
renally cleared, potentially increase the risk of bleeding in CKD patients. This study aimed to determine the safety and efficacy
of abbreviated LDs in CKD patients after initial parenteral anticoagulation.
Research Question or Hypothesis: Are abbreviated LDs safe and
effective in CKD patients with VTE after initial parenteral anticoagulation?
Study Design: Retrospective, cohort study
Methods: Eligible patients were admitted to Atrium Health Wake For- est Baptist between January 1, 2021 and December 31,
2022 with a history of CKD and radiographically confirmed pulmonary embolism (PE) and/or deep venous thrombosis (DVT).
Patients received at least 48 hours of parenteral anticoagulation before transitioning to newly prescribed DOACs. The primary
endpoint was VTE recurrence within
6 months of discharge. Secondary endpoints include major and non-major bleeding events, defined by the International Society
on Thrombosis and Haemostasis and death related to VTE or any causes. Primary and secondary endpoints were analyzed using
chi-squared (SPSS v29).
Results: Forty patients were included, with 22 (55%) in the abbrevi- ated group and 18 (45%) in the full group. Twenty (50%)
were male with an average age of 72 years. The average estimated creatinine clearance was 47.41 mL/min. Initial parenteral
anticoagulation was given for a mean of 137.85 hours in the abbreviated group and
78.6 hours in the full group. Between the abbreviated and full groups, there was no difference in VTE recurrence (n=1 [4.5%]
vs. n=1
[5.6%], p=0.88). There were no differences in the secondary end-
points between the abbreviated and full groups, except all-cause mor- tality (n=4 [18.2%] vs. n=0 [0], p=0.06).
Conclusion: In CKD patients receiving treatment for VTE, utilizing abbreviated LDs of apixaban after at least 48 hours of parenteral
anticoagulation is reasonable.
5. Evaluation of Apixaban and Rivaroxaban Lead-in Dose Duration in Venous Thromboembolism Treatment.
Michael Gregory, Pharm.D.5, Katharine Lawrence, Pharm.D.6 and Jalaina Brown, Pharm.D., MBA6
(1)Pharmacy Department, SALEM VA HEALTH CARE SYSTEM, Salem, VA (2)Pharmacy, Salem Veterans Affair Medical Center,
Salem, VA (3) Pharmacy, Applachian College of Pharmacy, Oakwood, VA (4)Pharmacy, Shenandoah University, Winchester, VA
(5)PHARMACY, SALEM VA HEALTH CARE SYSTEM, SALEM, VA (6)Salem VA HealthCare System,
Salem, VA
,Anna Weiland, Pharm.D. and Emmeline Tran, Pharm.D.
Medical University of South Carolina, Charleston, SC
Introduction: Statin adherence has been overall found to be poor in
Non-Caucasians and Female Veterans. Pharmacist are
well positioned
Introduction: Prescribing patterns for lead-in dosing of apixaban and rivaroxaban for venous thromboembolism (VTE) treatment
is not clearly established when parenteral anticoagulation is given initially. Further evaluation of clinical outcomes is needed to
provide insight into the optimal transition strategy.
Research Question or Hypothesis: What effect does apixaban or riv- aroxaban lead-in duration have on VTE recurrence, major
bleeding, and clinically relevant non-major bleeding (CRNMB)?
Study Design: A single-center, retrospective study evaluating patients
≥ 18 years diagnosed with acute deep venous thromboembolism (DVT) or pulmonary embolism (PE) from January 1 st, 2020 to July
31st, 2023 was conducted.
Methods: Patients were included if prescribed apixaban or rivaroxaban
for treatment. Exclusion criteria included anticoagulation prior to admis- sion, alternative indication for anticoagulation, no
follow-up within 90 days, and apixaban or rivaroxaban dosing (outside of lead-in duration) incongruent with package insert.
Primary outcomes were VTE recur- rence, major bleeding, or CRNMB within 90-days of discharge. Patients were grouped based
on duration of lead-in dosing, full or reduced. Chi- square or Fisher's exact tests were utilized to analyze nominal data.
Results: Of the 85 patients included, 42 (49%) received a reduced
lead-in duration. A majority of patients were on apixaban (91%). Patients with CKD were more likely to receive a reduced lead-
in (73%); the majority of patients diagnosed with PE received full lead- in duration (60%). Recurrent VTE occurred in 4 patients
(two in each group). No major bleeding events were identified in either group.
CRNMB occurred in 9 patients who received a full lead-in duration and in 10 patients who received a reduced lead-in duration, p
= 0.75. Conclusion: Definitive patient characteristics to help determine lead-
in therapy duration of apixaban or rivaroxaban are lacking. Further studies examining clinical outcomes in larger cohorts are
needed to determine the efficacy and safety of full or reduced lead-in durations.
Ambulatory Care
to improve statin adherence and address barriers to medication use. Research Question or Hypothesis: Can pharmacist led
population health approach improve statin adherence in Non-Caucasian or Female Veterans?
Study Design: Quality improvement project
Methods: Non-Caucasian or female veterans at a rural VA medical facility aged 18 or older were included if non-adherent to
statin ther- apy (proportion of days covered (PDC) < 80%) between February 1st, 2023, and June 30th, 2023. Patients without
primary care provider, or were deceased were excluded. Pharmacist made 2 attempts to call patients. Chart review note to
primary care provider was placed if patient did not answer. Pharmacist refilled or renewed statin prescrip- tion if clinically
appropriate. Primary outcome was to report the mean difference (MD) in statin PDC after pharmacist intervention at 90 days.
Secondary outcomes included number of patients referred for additional services (social work, Clinician, pill boxes, pharmacoge-
nomics (PGx test). Descriptive statistics were used.
Results: A total of 668 charts were reviewed to determine appropri-
ateness for pharmacist outreach of whom 10 patient were excluded. Of the 658 patients with average age of 64 years and
majority male 89.2%), 371 (56.4%) answered the phone call. Overall, 481 (73.1%) patients had their statin refilled or renewed
either by the pharmacist or provider upon alerts. In Non-Caucasian veterans, PDC increased from 67.95% to 79.00% (MD of
11.05%). In female veterans, PDC increased from 68.45% to 85.40% (MD 16.95%). Number of patients with referrals to higher
level of care included: referral for tobacco or alcohol use (6), primary care pharmacist (19), social work (5), PGx test ordered
(43) and pillbox ordered (47).
Conclusion: Pharmacist-led outreach can reduce statin adherence dis- parity in non-Caucasian or female Veterans by increasing
access to care and addressing barriers to medication adherence.
7. The prevalence of continuous glucose monitoring devices prescribed in patients with diabetes on intensive insulin therapy in
primary care with and without pharmacy support.
,6. Evaluating the impact of Pharmacist Led Quality
Improvement
Initiative on Statin Adherence in Non-Caucasian or Female Veterans with Diabetes or Cardiovascular Disease.
Sydney Sadkin, Pharm.D.1, Jacqueline Lucey, Pharm.D., BCPS, BCACP2, Brittany Nolton, Pharm.D., BCACP2, Rachael
Moustaader, Pharm.D.,
BCPS, TTS2 and Jennifer Karabinos, Pharm.D., TTS2
Tanvi Patil, Pharm.D., BCPS1, Alamdeep Kaur, Pharm D, BCPS2, Logan Surface, Pharm.D. Candidate3, Sidney Rorrer, Pharm.D.
Candidate4,
(1)Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA (2)Allegheny Health Network, Pittsburgh, PA
Introduction: Intensive insulin therapy requires close monitoring and frequent dose adjustments to improve the safety and
efficacy of dia- betes management. Determining the prescribing practices of continu- ous glucose monitors (CGM) will allow for
us to identify ways to increase utilization of these devices and pharmacy support within the organization's primary care practices.
Research Question or Hypothesis: What is the percentage of patients with a diagnosis of diabetes and treated with intensive
insulin therapy prescribed a CGM device in a primary care practice with clinical phar- macy support compared to a primary care
practice without clinical pharmacy support within Allegheny Health Network?
Study Design: This study was a multi-center, retrospective, cohort chart review of patients who followed with the identified
embedded pharmacist and non-embedded pharmacist primary care practices from June 2022 through June 2023.
Methods: Adults with a diagnosis of type 1 diabetes, type 2 diabetes or latent autoimmune diabetes in adults prescribed intensive
insulin therapy were included. Descriptive statistics were used for data analysis.
Results: Forty-eight patients were included in the study. Of those, 27 patients were included from the embedded pharmacist
clinic and 21 patients were included from the non-embedded pharmacist clinic. In the embedded pharmacist clinic, 21 patients
(77%) were initiated on a CGM and in the non-embedded pharmacist clinic, 7 patients (33%) were initiated on a CGM. Within the
embedded pharmacist clinic, 21 patients (78%) were referred to the clinical pharmacist. Of the patients referred, 20 patients
(95%) were initiated on a CGM. Of the patients not referred to the clinical pharmacist, 1 patient (17%) was started on a CGM
device.
Conclusion: Prescribing practices of CGMs in patients on intensive
insulin therapy improved when there was direct pharmacy support with an embedded pharmacist versus usual care, confirming
the
Study Design: This is a retrospective analysis of CP interventions at an ambulatory HF clinic in a single-centre adult quaternary-
referral hospital in Australia
Methods: Ambulatory HF patients reviewed by the CP between January 2023 and May 2023 were included. Interventions were
extracted from CP consultation notes in the electronic medical record. The number and type of medication-related interventions
made by the CP and the proportion accepted by the treating physicians were evaluated
Results: Of the 100 patients included, the CP performed 194 medica- tion-related interventions. The most common medication-
related interventions documented were therapy optimisation (medication
addition or discontinuation [40%, n=78], dose change [15%, n=30]),
adverse effects monitoring (10%, n=19), and laboratory recommenda- tions (8%, n=15). Of the 194 interventions, 81% (n=157)
were accepted by the physician. Reasons for non-acceptance include 1)
Vital signs and renal impairment limiting medication up-titration; 2) Patient deemed stable; up-titration not required; 3) Patient
not ame- nable to medication changes; 4) Medical consult recommendations not followed in the community setting. The
availability of vital signs and laboratory results is limited during CP consultations, which may impact the appropriateness of
recommendations.
Conclusion: CP in ambulatory HF clinics supports optimising medica-
tion therapy regimens and improves patient care. There is a high rate of acceptance of their therapeutic recommendations by
physicians. This study highlights the importance of a multidisciplinary approach to HF management
,9. Comparison of Prescribing Rates for SGLT2 Inhibitors and GLP-1 Receptor Agonists Among Primary Care Clinics With and
Without Embedded Pharmacists.
importance of integrating pharmacists into the primary care
setting.
Dave Dixon, Pharm.D.1, Amanda Robinson, MS2,
Teresa M. Salgado, MPharm, PhD1, Salvatore
Carbone, PhD2, Tyler Wagner, Pharm.D.,
8. Evaluation of clinical pharmacist interventions in ambulatory heart failure patients
PhD2, Haroon Hyder, MD3, Bryan Kirschner, Pharm.D.3, Kerri Musselman, Pharm.D.4, Tonya Buffington, Pharm.D.3 and Roy
Sabo, PhD2
Beryl Lai, MClinPharm, BPharm, Alexander Caird, BPharm and Alice Hann, BPharm
Department of Pharmacy, Royal Melbourne Hospital, Parkville, VIC, Australia
Introduction: International guidelines recommend a multidisciplinary
(1)Department of Pharmacotherapy & Outcomes Science and Center for Pharmacy Practice Innovation, Virginia
Commonwealth University School of Pharmacy, Richmond, VA (2)Virginia Commonwealth University, Richmond, VA (3)Bon
Secours Mercy Health, Richmond, VA (4) PopHealthCare & Emcara Health, Pharmacy Care Solutions,
Richmond, VA
approach to heart failure (HF) management, including a
pharmacist,
for improved patient outcomes. Given the complex disease state and medication burden, our institution recently implemented
a telehealth clinical pharmacist (CP) consult service as part of the established ambulatory HF team to enhance the transition of
care management of patients with HF
Research Question or Hypothesis: This study aims to evaluate inter- ventions made by the CP in ambulatory HF patients and their
uptake by physicians
Introduction: SGLT2i and GLP-1 RA are cardio- and kidney- protective, yet their uptake in clinical practice has been poor. The
effect of pharmacists embedded within primary care clinics on SGLT2i and GLP-1RA prescribing rates is unknown.
Research Question or Hypothesis: Primary care clinics with embed- ded pharmacists will have higher SGLT2i and GLP-1 RA
prescribing rates among patients with diabetes and ASCVD, HF, or CKD com- pared to clinics without pharmacists.
Study Design: Cross-sectional study using EHR data from Bon Secours Mercy Health primary care clinics across Virginia from 2019-
2021.
Methods: Patients were ≥18 years of age with T2DM and ASCVD, HF, or CKD, and ≥1 outpatient visit. Adults with T1DM, ESRD,
pregnancy, or on hospice/palliative care were excluded. Patient/spe- cialty-level prescribing rates were compared between the
8 clinics with embedded pharmacists versus 5 matched clinics without using generalized linear mixed modeling with a random
practice-level effect. A positive prescription was considered a prescription for either medi- cation for the overall analysis and a
prescription of the preferred drug class according to comorbidities for each subgroup.
Results: The 6,377 included patients had a mean age of 68.6 years,
49.8% female, 36.8% Black, and 73.2% were Medicare beneficiaries. The overall raw prescription rate was higher at clinics with
embedded pharmacists (16.2%) compared to those without (13.8%), and for patients with ASCVD or CKD, but not HF, though this
difference did not reach statistical significance when adjusting only for the pharmacist
group (P=0.7610) or after adjusting for age, sex, race, and insurance
,75 years, with 45% of patients being former or current smokers. Over 75% of patients had more than one chronic disease. The
median LDL cholesterol level at enrollment was 81 mg/dL, with 67.7% of patients managed on statin therapy. After incorporating
pharmacy services, the median follow-up was 48 days, and seventeen patients (54.8%) reached their lipid goal. At the end of
the study, the median LDL cho- lesterol level was 47 mg/dL, with a median percentage reduction of 42%. The most common
medication interventions made by the phar- macy service were the addition/modification of ezetimibe (32%), statin (29%), and
evolocumab (9.6%) therapy.
Conclusion: Pharmacy-led lipid therapy management of high-risk
patients with PAD resulted in improved LDL cholesterol levels. This pilot study demonstrates the potential benefits of pharmacy
services in managing PAD patients' LDL cholesterol levels to prevent future cardiovascular complications.
11. Evaluating the impact of pharmacist led intervention on SGLT2i utilization in non-Caucasian or rural veterans.
coverage (P=0.4916). Factors associated with higher prescription
rates
included being male, Black, and being commercially insured. Conclusion: Prescription rates for SGLT2i and GLP-1 RA were higher
in primary care clinics with embedded pharmacists than those without but this effect was attenuated in the adjusted model.
10. Impact of a vascular surgery and pharmacist collaborative initiative on achieving lipid goals in patients with peripheral artery
disease: a prospective chart review.
Sarra Adam, Pharm.D.1, Maranda Switzer, Pharm.D. Candidate2, Tanvi Patil, Pharm.D., BCPS, DPLA3, Alamdeep Kaur, Pharm D,
BCPS4, Sarah Hood, Pharm.D., BCPS2, Jennifer Bowyer, Pharm.D.5, Ebenezer Boakye, Pharm.D., BCPS5, John Minchak,
Pharm.D., MBA, BCPS, BCGP6, Robert Karim, Pharm.D.2, Rebecca McCorkle, Pharm.D., BCGP2 and Hima Bindu Yalamanchili,
MD2
(1)SVAMC Pharmacy Department, Salem VA Health Care System, Salem, VA (2)Salem VA Health Care System, Salem, VA
(3)Salem Veterans Affairs Health Care System, Salem, VA (4)Pharmacy, Salem Veterans
Affair Medical Center, Salem, VA (5)SALEM VA HEALTH
CARE SYSTEM,
Jiaqi Cai, Pharm.D.1, Raymond Lamore III, Pharm.D., BCCCP1, Domenica Ricciuti, Pharm.D.2, Boluwatife Familusi, Pharm.D.1 and
Kassidy Baum, Pharm.D.1
(1)Department of Pharmacy, Penn Presbyterian Medical Center,
Philadelphia, PA (2)Mount Sinai Health System, New York City, NY
SALEM, VA (6)Salem Veterans Affairs Medical Center, Salem, VA
Introduction: SGLT2i use has shown to reduce chronic kidney disease(CKD) progression and cardiovascular risk, but racial
disparities and barriers to its utilization exists. Overall, 60.5% of veterans with
CKD and type 2 diabetes(T2DM) were identified as
potentially eligible
Introduction: Peripheral artery disease (PAD) is a condition character- ized by atherosclerosis affecting the peripheral blood
vessels. Lipid- lowering therapy has been shown to reduce limb-related events and the need for revascularization. Despite
available treatment, PAD patients often do not achieve lipid goals.
Research Question or Hypothesis: Does a pharmacy-led lipid therapy
service improve outcomes for patients with PAD who are at high risk? Study Design: Single-center, prospective chart review
study Methods: The patient population was identified by vascular providers and inpatient clinical pharmacist. Adult patients
diagnosed with PAD who have a low-density lipoprotein (LDL) cholesterol level above goal within 6 months of the referral to
pharmacy services were included in the study. The primary objective is to evaluate interventions made by the pharmacy
service, and the secondary objective is to assess the percentage of patient meeting LDL-C goal at the end of the study.
Results: A total of 31 patients were enrolled in the study between June 21, 2023, and December 18, 2023. The median age was
, for SGLT2i therapy based on National Academic Diabetes Dashboard at Salem VA Health Care System.
Research Question or Hypothesis: To assess whether pharmacist-led intervention can increase SGLT2i use
Study Design: Prospective quality improvement study
Methods: Ambulatory patients with CKD and T2DM were identi- fied conducted from October 2023 and April 2024 using national
dashboard and reviewed for eligibility via chart review. Patients with eGFR <20 ml/min, type 1 diabetes, on dialysis, or with
perti- nent medical history were excluded. Eligible patients received phar- macist outreach calls. If the patient answered,
SGLT2i education was provided, socioeconomic barriers assessed, and empagliflozin was initiated as appropriate. Referral to
higher level of care (social work or the primary care mental health integration pharmacist . When a patient could not be
reached, a chart-review note was placed and provider was alerted. The primary outcome was propor- tion of patients initiated
on empagliflozin 90 days after
intervention. Secondary outcomes included describing socioeco- nomic barriers and proportion of patients referred to higher
level of care. Descriptive statistics were used for analyses.
Results: Of 824 patients, 357 were included. Patients were primar-
ily White(48.46%) or Black(40.90%) males(100%) aged 77(SD 7.67) living in rural settings (81.79%). A total of 106 patients (29.69%)
were initiated on empagliflozin within 90 days. Barriers to medica- tion use included: 21(5.88%) AUD; 15(4.20%) TUD; 4(1.12%)
homelessness and food insecurity. For patients with barriers to health, 16(4.48%) were referred to social work or PCMHI and
71(19.89%) received a pill splitter and medication organizer to improve compliance.
Conclusion: Our study supports implementing pharmacist-led inter-
vention to improve uptake of guideline directed medical therapy such as SGLT2i in CKD patients.
• Impact of a Pharmacist run Statin Clinic.
insurance, primary language, or race (P=0.55, P = 0.36, P=0.21, P=0.11).
Conclusion: Pharmacist intervention in a telehealth clinic did not increase statin use when compared to usual care. Alternative
initia- tives should be considered to improve statin use amongst eligible patients, improve patient care, and determine best
utilization of resources.
• Pharmacist-Physician Collaborative Model in Diabetes Care: A Longitudinal Study of Outcomes in Primary Care.
Poorva Birari, BPharm1, Tyler D. Wagner, Pharm.D., PhD2, Dave Dixon, Pharm.D.3, Kerri Musselman, Pharm.D.4, Tonya
Buffington, Pharm.D.5, Haroon Hyder, MD5, Bryan Kirschner, Pharm.D.5, Yongyun Shin, PhD6, Resa M. Jones, MPH, PhD7 and
Teresa M. Salgado,
MPharm, PhD3
(1)Department of Pharmacotherapy & Outcomes Science, Virginia
Commonwealth University School of Pharmacy,
Richmond, VA (2)
Katie Shupp, Pharm.D.1, Emily Doycich, Pharm.D.1, Benjamin King, Pharm.D., BCACP2, Kelly Makino, MD1 and Antoinette Abou
Haidar, MD1
(1)MetroHealth, Cleveland, OH (2)The MetroHealth System, Cleveland, OH
Introduction: Statins are first line treatment for hyperlipidemia and decrease risks of atherosclerotic cardiovascular disease
(ASCVD), stroke and mortality. Previous studies have proven pharmacists
National Pharmaceutical Council, Washington DC, DC (3)Department of Pharmacotherapy & Outcomes Science and Center for
Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond, VA (4)PopHealthCare &
Emcara Health, Pharmacy Care Solutions, Richmond, VA (5)Bon Secours Mercy Health, Richmond, VA (6) Department of
Biostatistics, Virginia Commonwealth University School of Population Health, Richmond, VA (7)Department of Epidemiology
,and Biostatistics and Fox Chase Cancer Center, Temple University Health
System, Temple University, Philadelphia, PA
involvement in statin management has increased the proportion
of
patients prescribed a statin, leading to overall improved health out- comes for patients and lower costs to health systems.
However, stud- ies to this point have primarily involved in office visits. With the surge in telehealth care post COVID-19, telephonic
based clinics have pro- vided another avenue for pharmacists to provide care, but this has not yet been largely studied.
Research Question or Hypothesis: A telephonic pharmacist-run statin
clinic would increase the percentage of eligible patients on statin ther- apy when compared to usual care.
Study Design: Retrospective multisite evaluation of electronic medical record data.
Methods: Data was analyzed from October 2021 to October 2023 comparing patients who received pharmacist intervention
(n=161) and patients who did not (n=100). Statin prescription data and fill his- tory were obtained via the electronic medical
record. The Chi-Square
Test of Independence was used to assess associations between nomi- nal data and groups. A Type 1 Error Rate of alpha < 0.05 was
consid- ered statistically significant.
Results: Both groups were similar in demographics of sex, primary lan- guage, and race (P=0.16, P=0.82, P=0.15). Primary
insurance type differed significantly between groups (P < 0.005). In the control group,
39% were prescribed a statin during the study period. In the treat- ment group, 24% were prescribed a statin (P = 0.012). Statin
use showed no significant difference across patients of differing sex,
Introduction: Cross-sectional studies described the positive impact of pharmacist-physician collaborative care (PPCC) on
diabetes manage- ment. This study aimed to evaluate the longitudinal impact of PPCC on diabetes control.
Research Question or Hypothesis: What is the effect of PPCC on improving glycemic control [glycated hemoglobin A1c (HbA1c)
<7%] compared to standard of care (SC)?
Study Design: This retrospective, longitudinal, observational study analyzed electronic health record data from Bon Secours
Mercy Health primary care clinics in Virginia. Mean reductions in HbA1c at 4-, 8-, and 12-months from baseline were compared
between patients receiving PPCC and SC.
Methods: Patients with uncontrolled diabetes (HbA1c ≥7%) seen at
primary care clinics with and without embedded pharmacists were included. Propensity score matching (1:2) was employed to
create a comparator group. Data collected included HbA1c recorded at every visit and baseline sociodemographic characteristics
and comorbidities. Means and standard deviations (SD) were obtained for continuous variables. A generalized linear mixed
model assessed the effects of PPCC on HbA1c at 4-, 8- and 12-months, controlling for other covari- ates and including a patient-
specific random effect.
Results: The mean (SD) baseline HbA1c was 9.93% (0.094) for PPCC
(n=431) and 9.72% (0.075 (n=862) for SC. Significant HbA1c reduc- tion from baseline was observed for PPCC and SC (all p-
values
<0.0001) at 4- (PPCC -2.01, SC -1.41), 8- (PPCC -1.51, SC -0.93) and
12-months (PPCC -1.45, SC -1.37). Compared to SC, patients in the
15. Implementation and Impact of a Pharmacist-led Post-discharge Clinic.
PPCC group had significantly lower HbA1c at 4- (-
0.87,
p-value = 0.0001) and 8-months (-0.85, p-value = 0.0069), but not at 12-months (-0.35, p-value = 0.366).
Conclusion: The PPCC was more effective than SC at improving gly- cemic control at 4- and 8-months, but not at 12-months. One
possible reason is that patients receiving SC achieve optimal HbA1c levels at about 12 months, thus resulting in no significant
differences between groups.
, 14. Percentage of patients prescribed an SGLT2 inhibitor with a diagnosis of type 2 diabetes and Stage 3 chronic kidney disease
who are followed by a specialist care team.
Sydney Cravener, Pharm.D., Jacqueline Lucey, Pharm.D., BCPS, BCACP, Jennifer Karabinos, Pharm.D., TTS and Rachael
Moustaader, Pharm.D., BCPS, TTS
Allegheny Health Network, Pittsburgh, PA
Introduction: The prescribing practices of sodium glucose cotranspor- ter 2 (SGLT2) inhibitors by specialist providers is not known.
Current guidelines recommend the use of an SGLT2 inhibitor in patients with type 2 diabetes and chronic kidney disease (CKD),
with conflicting recommendations regarding the urine albumin creatinine ratio (UACR). The purpose of this project is to assess
if patients who are eli- gible for treatment with an SGLT2 inhibitor due to the presence of type 2 diabetes and Stage 3 CKD are
being initiated on therapy. We specifically looked at endocrinologists, nephrologists, and cardiologists to review how prescribing
practices align with the guideline recommendations.
Research Question or Hypothesis: SGLT2 inhibitors are being under
prescribed in patients with a history of type 2 diabetes and Stage 3 CKD.
Study Design: Retrospective chart review
Methods: Included for analysis were adult patients with a diagnosis of type 2 diabetes, Stage 3 CKD, and an office visit with a
specialist care team in an academic medical center between the dates of 01/01/2022 through 12/31/2022.
Results: A total of 203 patients were included in the study. Thirty- one patients had a diagnosis of type 2 diabetes, an eGFR of
30-59 mL/min and a UACR >200 mg/g collected during the study time frame. Of those 31 patients, 5 (16%) were prescribed an
SGLT2 inhibitor. A total of 172 patients had a diagnosis of type 2 diabetes, an eGFR of 30-59 mL/min and a UACR < 200 mg/g or
did not have a UACR collected. Of those 172 patients, 17 (9.9%) were prescribed an SGLT2 inhibitor.
Hanie Barakat, Pharm.D., BCPS1, Cristina Plemmons, Pharm.D., BCPS2 and Marisa Strychalski, Pharm.D., BCPS, BCACP3
(1)Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC (2)Ralph H. Johnson VAMC, Charleston, SC
(3)Ralph
H. Johnson VA Medical Center, Savannah, GA
Introduction: Hospital readmissions are often accompanied with unfavorable patient outcomes and high institutional financial
costs. Transitions of care must be prioritized to provide adequate patient education, complete medication reconciliations and
care coordination as patients transfer from the inpatient to outpatient settings.
Research Question or Hypothesis: The pharmacy post-discharge clinic (PDC) was established at the Ralph H. Johnson VA Medical
Cen- ter (RHJVAMC) to answer the project question; “What impact does a Clinical Pharmacy Practitioner have on improving
transitions of care by identifying and managing ambulatory care sensitive conditions (ACSCs) in referred and identified
Veterans?”
Study Design: This prospective quality improvement project was con- ducted at RHJVAMC from July 11, 2022 to June 30, 2023.
Methods: Patients were enrolled into PDC if they were a high-utilizer of unplanned healthcare services (at least 3 inpatient
admissions at RHJVAMC in the past year). Other patients included were ones who had a readmission within 30 days of the index
admission or others who warranted a close follow-up within 1-2 weeks post-discharge to address ACSCs. Patients were excluded
if they were discharged to a skilled-nursing facility (SNF), assisted living facility (ALF), or to hospice care.
Results: A total of 99 patients were contacted for a visit in PDC
acutely post-discharge with an average number of visits of 1.4 per patient. The average time to follow up with patients was
approxi- mately 8 days following discharge with an average of a 8.1 pharmacy interventions per visit. The most prevalent disease
states with phar- macist interventions included diabetes, hypertension, and heart fail- ure. Other pertinent interventions were
related to adherence, prevention of adverse drug reactions, and care coordination with other members of the healthcare team.
Conclusion: A pharmacist-run post-discharge clinic effectively
increased access to care for patients recently discharged from the hospital and improved patient outcomes. Clinical Pharmacy
Practi- tioners can optimize ACSCs and coordinate care to help reduce pre- ventable hospital readmissions.
16. Comparison of Dulaglutide and Semaglutide on Body Mass Index and Glycemic Control.
Conclusion: SGLT2 inhibitors are being underutilized in patients eli-
gible for therapy. Most patients prescribed therapy had a UACR
<200 mg/g or no lab was collected, showing that providers are not consistently utilizing a UACR value to determine eligibility for
therapy.
