OBJECTIVE:To assess the validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures in patients with chronic nonbacterial osteomyelitis (CNO). METHODS:Within the longitudinal patient registry of CNO, English-speaking patients aged 8 years and older self-reported PROMIS Pediatric measures of fatigue, pain interference (PI), pain behavior (PB), mobility, upper extremity (UE), physical activity (PA), and strength impact (SI), and external validation measures. Log-transformed linear mixed-effects models with random patient intercepts were used to assess PROMIS T-score changes. Wilcoxon signed-rank test was performed to determine the PROMIS T-score changes among the improved, worsened, and unchanged groups. Spearman rank correlation test determined the relationship of PROMIS T-scores with disease status reported by patients/families. RESULTS:More than 1,000 clinical visits from 184 patients included PROMIS Pediatric measures entries. All PROMIS T-scores correlated significantly (P < 0.01) with patient-reported variables and physician global assessment (PHGA). The correlation between function and mobility, PB, and PI was good (r = 0.4-0.6). The correlation of patient-reported disease status was strong with PHGA (r = 0.75); moderate with mobility, PB, and PI; and weak with fatigue, SI, UE, and PA. The changes of PROMIS T-scores over time for mobility, PB, PA, and PI compared with the self-reported status change were significant (P < 0.05). After effective treatment, when clinical disease activity score improved by at least three points (n = 18), the change of PROMIS T-scores for mobility, PB, PI, and UE were significant (P < 0.05). CONCLUSION:This study provided evidence supporting the use of PROMIS Pediatric mobility, PB, and PI measures for CNO clinical disease monitoring.
OBJECTIVE:To evaluate the impact of a centralized pharmacist-led telehealth model utilizing home blood pressure monitoring (HBPM) readings on hypertension quality measure pass rates and blood pressure reduction at 3 and 6 months. STUDY DESIGN:Retrospective observational cohort study. METHODS:Adults with uncontrolled hypertension (≥ 140/90 mm Hg) were identified through a centralized outreach model. Patients who completed a visit with a pharmacist comprised the intervention group; those who were not reached or who declined were included in the usual care group. Pharmacists met with patients via telehealth appointments and sent recommendations to their providers. RESULTS:A total of 1776 patients were included: 179 patients in the intervention group and 1597 patients in usual care. The mean age was 56 years (95% CI, 55.7-57.0 years), with approximately half identifying as female (47.6%-53.1%). The intervention group had a higher proportion of Black patients (53.1% vs 37.3%; P = .0002) and a higher mean Elixhauser Comorbidity Index score (2.93 vs 2.54; P = .0016). Patients in the pharmacist intervention group were more likely to pass the Healthcare Effectiveness Data and Information Set Controlling Blood Pressure measure (2022: OR, 1.78; P = .014; 2023: OR, 1.75; P = .014). Greater systolic blood pressure reductions in the intervention group vs usual care were observed at both 3 months (-12.69 vs -5.69 mm Hg; P < .0001) and 6 months (-13.87 vs -9.05 mm Hg; P = .001). CONCLUSIONS:Participating in telehealth visits integrating HBPM readings with a pharmacist between primary care visits significantly improves blood pressure control. Pharmacists play a critical role in actively engaging patients and optimizing medication therapy in team-based care for chronic hypertension management.
BACKGROUND:Overweight and obesity are major contributors to cardiovascular-kidney-metabolic (CKM) disease. Tirzepatide (TZP-MJ), originally approved for type 2 diabetes (T2D), has shown significant weight loss beyond glycemic improvement. Despite these benefits, real-world medication access barriers may lead to abrupt therapy discontinuation. Currently, there is a lack of real-world data regarding TZP-MJ discontinuation in outpatient settings. OBJECTIVES:To assess the real-world impact of TZP-MJ discontinuation on body weight in patients with overweight or obesity managed in an endocrinology and weight management clinic with clinical pharmacist support. METHODS:A 12-month, single-center retrospective study of adult patients with obesity or overweight with a weight-related comorbidity and an active prescription for TZP-MJ from 5/13/2022-6/30/2023 for ≥ 3 months before discontinuation. The primary outcome was percent change in body weight 12 months following TZP-MJ discontinuation. Secondary outcomes included rates of transitioning to alternate obesity medications (OMs). RESULTS:Eighty-three patients met inclusion criteria and had remained on TZP-MJ for a mean of 11 months, achieving a mean body weight reduction of 6.7%. The most common reason for TZP-MJ discontinuation was because of medication access related to cost (80.7%). At 12 months following TZP-MJ discontinuation, mean body weight change was not statistically significant (+1.9%, p = 0.11). Most patients transitioned to alternative OMs (n = 68; 81.9%). CONCLUSION:Although TZP-MJ is associated with meaningful weight loss, medication cost is a barrier to therapy continuation. In real-world practice, weight loss achieved on TZP-MJ may be sustained by transitioning to alternate OMs to mitigate potential rebound weight gain following discontinuation, showing a critical role for clinical pharmacists.
Anaerobic antibiotics may be associated with worse patient outcomes in some populations. This has not been studied in burn patients who often receive early antibiotics and are at risk for hospital acquired and multidrug resistant infections. Figure 1 Flowchart of Burn Intensive Care Unit Cohort Table 1 Baseline demographics by level of exposure to anaerobic antibiotics in week 1 of hospital stay We performed a retrospective cohort study of adult burn patients admitted to the UNC burn intensive care unit between January 1, 2016, and August 31, 2023. Patients discharged or deceased before hospital day 8 were excluded. Antibiotic exposure was defined as receiving any antibiotic during the first 7-days of hospitalization. A novel Anaerobic Activity Index was created, scoring antibiotics 0-24 based on published in vitro susceptibilities, and multiplied by days on therapy and summed to create a composite anaerobic antibiotic exposure score for week 1 of admission. Anaerobic antibiotic exposure was defined based on quartiles. The primary outcome was a composite 90-day outcome including positive culture for multidrug resistant organisms, healthcare-associated infection, and/or death. Multivariable logistic regression was used to estimate the odds ratio of having the outcome on or after hospital day 8. Two models were generated, adjusting for admission Baux score and Charlson Comorbidity Index. Table 2 Clinical outcomes by level of exposure to anaerobic antibiotics in week 1 of hospital stay Table 3 Unadjusted and adjusted logistic regression models of (a) receiving 1 or more doses of any antibiotic in the first 7-days of hospital admission or (b) anaerobic antibiotic exposure as measured by the AAI and the odds of having 1 or more positive culture for MDR bacteria and/or 1 HAI event and/or death after the first week of admission and within 90-days. In the first week of admission, 67% patients (350/522) received ≥ 1 antibiotic and had 1.87 times the odds of a composite poor outcome compared with those who received no antibiotics in adjusted analyses (95% CI: 1.17, 2.97). The 7-day Anaerobic Activity Index ranged from 0 to 391 with a median of 52 [Q1 Q3: 0, 104]. Patients with level 3 or 4 anaerobic antibiotic exposure had higher baseline severity of illness (Baux score) than those who received less or no anaerobic antibiotics (p < 0.001). Compared to an Anaerobic Activity Index of 0, exposures at levels 3 or 4 were associated with increased odds of worse outcomes (OR [95% CI] 1.99 [1.15, 3.46] and 1.89 [1.05, 3.37], respectively) in adjusted models. An Anaerobic Activity Index may be used to measure antibiotic exposure over a certain period. In this cohort of critically ill burn patients, early antibiotic exposure was associated with worse outcomes, and increased odds of worse outcomes were seen with higher exposure to antibiotics with activity against anaerobes. David J. Weber, MD, MPH, CareFusion/BD: Advisor/Consultant|GAMA: Advisor/Consultant|Germitec: Advisor/Consultant|GSK: Advisor/Consultant|Pfizer, Inc.: Advisor/Consultant David van Duin, MD, PhD, AbbVie Inc: Advisor/Consultant|Merck & Co., Inc.: Advisor/Consultant|Merck & Co., Inc.: Grant/Research Support|Parexel International: DSMB|Pfizer, Inc.: Advisor/Consultant|Pfizer, Inc.: Honoraria|Roche Pharmaceuticals: Advisor/Consultant|TEVA: Advisor/Consultant
