BACKGROUND:Determination of death by neurologic criteria (DNC) relies on clinical examination, provided no confounding conditions affect reliability. Current guidelines require patients to be free of confounders before neurologic testing but do not specify how these confounders should be assessed or managed. This lack of specificity may lead to variability in practice and uncertainty in protocol implementation. The objective of this study was to review institutional protocols for DNC determination across hospitals in the United States and evaluate how they address medication confounders and the role of ancillary testing. METHODS:To further explore variability observed in our initial national survey sent to the Neurocritical Care Society membership, we conducted a follow-up study requesting exact DNC protocol language from respondents willing to provide additional details. Participants submitted protocol excerpts related to medication confounders, ancillary testing, reversal agents, and practitioner responsibilities, which were de-identified and analyzed using artificial intelligence (AI)-assisted qualitative theme extraction with subsequent investigator review for accuracy. RESULTS:Responses were obtained from 18 of 23 U.S. institutions (78%), nearly all of which were urban centers with neurology and neurocritical care services. Analysis identified several recurring themes. Protocols consistently emphasized pharmacokinetic clearance strategies, most commonly the use of elimination half-lives, drug levels, and toxicology screening, to exclude medication confounders. Ancillary testing was generally reserved for situations in which clinical examination could not be safely performed and was often discouraged as a substitute for drug clearance. Reversal agents were infrequently addressed and, when included, were typically described as optional. Additional variability was observed in patient-specific considerations, practitioner responsibilities, and the presence of supporting drug appendices. CONCLUSION:Institutional DNC protocols demonstrate substantial variability in how medication confounders are assessed, despite most sites requiring medication review. These findings highlight the need for clearer, evidence-based protocols to ensure reliable DNC determinations in the presence of potential medication confounders.
Inpatient, acute care clinical pharmacists have contributed to many notable improvements in patient outcomes. Several studies have shown a reduction in mortality and other clinical markers when pharmacists are integrated within the care team. Economic analyses of inpatient clinical pharmacy services (CPS) generally demonstrate cost savings related to specific medication classes, prevention of adverse drug events, decreased length of stay, and decreased rehospitalization. Studies also show high satisfaction from other health care professionals, noting improvements in medication-related patient safety. Finally, studies conducted in tertiary care hospital settings report high levels of patient satisfaction with CPS. As such, the ECHO framework, based on economic, clinical, and humanistic outcomes, is used herein to organize the summary of literature associated with CPS. Given the growing body of evidence, numerous health professional and government organizations recognize the role of pharmacists as an integral part of the inpatient team. Yet implementation of CPS has not been fully realized by hospitals and health systems. This paper briefly describes inpatient CPS, highlights many benefits of and endorsements for clinical pharmacist participation on interdisciplinary teams, and provides high-level recommendations for health system administrators and the profession of pharmacy to further encourage broader integration of CPS into patient care teams. Effectively positioning inpatient clinical pharmacists as indispensable team members will require intentional work and strategic planning with a focus on high-impact value, visibility, and leadership.
BACKGROUND:Artificial intelligence (AI) tools are increasingly promoted for clinical decision support in health care. While studies have assessed general-purpose AI chatbots on the accuracy and quality of clinical or drug-related questions, direct comparison among multiple clinically-focused AI chatbots is lacking. This study compared the quality of responses to drug information (DI) questions from multiple clinically-focused AI chatbots with responses from DI pharmacists. METHODS:Thirty DI questions previously answered by DI pharmacy faculty were queried in four clinically-focused AI chatbots: OpenEvidence (OpenEvidence, Miami, FL), Clair (CaryHealth, Washington, DC), GlassHealth (GlassHealth, San Francisco, CA), and DougallGPT (Dougall Health, New York, NY). The general-purpose chatbot ChatGPT (Open AI, San Francisco, CA) was also queried. The quality of the responses was assessed independently by three pharmacy faculty members using the 25-point CLEAR scoring framework (completeness of content, lack of false information, evidence supporting the content, appropriateness, and relevance), a validated AI health information assessment tool. Mean total scores were categorized as either "poor" content (5-11 points on the CLEAR scale), "average" content (12-18 points), or "very good" content (19-25 points). Descriptive statistics of CLEAR scores were summarized, and Mann-Whitney U tests between faculty and AI-generated response scores were conducted. RESULTS:OpenEvidence had the highest mean total CLEAR score (17.82/25), followed by ChatGPT (15.72/25), both reflecting a content categorization of "average". Of the individual components of the CLEAR score, lack of false information consistently had the highest scores across AI chatbots, while evidence supporting the content had the lowest. When compared with faculty responses, all AI chatbots had statistically lower scores. CONCLUSION:While OpenEvidence had the highest overall CLEAR scores, few question responses from any chatbot were rated in the "very good" content category. Pharmacist expertise remains essential for ensuring answers to DI questions are of high quality.
BACKGROUND:National data on clinical pharmacy implementation can inform health policy, resource allocation, workforce planning, and academic development. In Chile, such data are limited, particularly for therapeutic drug monitoring (TDM). The objective of this study was to characterize the clinical pharmacy workforce in Chilean hospitals and describe the implementation of core clinical activities, with an emphasis on TDM. METHODS:A national cross-sectional survey was conducted among pharmacists performing clinical functions in Chilean hospitals, using the 2024 registry of the Clinical Pharmacy Division of the Chilean Society of Intensive Care Medicine as the sampling frame. Descriptive analyses were performed; workforce capacity was expressed as full-time equivalents (FTEs) and regional density per 10 000 inhabitants. RESULTS:Of 220 invited pharmacists, 181 responded (82.3%), representing 83 institutions across 15 of 16 administrative regions. Median age was 35 years (interquartile range [IQR] 31-39); 28.2% were registered Clinical Pharmacy Specialists, and 77.1% worked in public hospitals. The highest density was in the Metropolitan Region (0.12 FTE/10000 inhabitants), followed by Tarapacá and Antofagasta (0.09 each). Deployment was most frequent in Infectious Diseases (36.5%) and intensive care units (34.8%). Pharmacotherapy follow-up and medication therapy review were each reported by 94.5%, adverse drug reaction reporting by 87.3%, and involvement in TDM by 85.1%. Teaching and research were reported by 44.8% and 30.4%, respectively, but 95.5% reported no formally protected time. TDM was available in 81.9% of centers, most commonly for vancomycin (80.7%), valproic acid (63.9%), amikacin (60.2%), and phenytoin (57.8%); pharmacokinetic software to support dose individualization was used in 61.4% of centers. CONCLUSION:Clinical pharmacy services in Chile are broadly integrated into hospital care-particularly in infectious diseases, critical care, and TDM-while gaps persist in formal credentialing, regional workforce distribution, and institutional structures supporting academic activities.
The American College of Clinical Pharmacy (ACCP) calls for the withdrawal of direct-to-consumer (DTC) advertising of prescription drugs in the United States. Although pharmaceutical advertisements may raise disease awareness and encourage patient engagement, available evidence indicates their net impact on public health is negative. Direct-to-consumer advertising can mislead patients, distort clinical decision-making, inflate medication costs, and undermine the integrity of the patient-provider relationship. ACCP's position is that prescription drugs should not be marketed as consumer products. Instead, medication therapy decisions should be driven by scientific evidence, patient-specific considerations, and professional judgment free from the influence of commercial promotion. This statement outlines ACCP's rationale and recommendations for eliminating DTC prescription drug advertising.
BACKGROUND:Limited literature has evaluated strategies to maximize time in therapeutic range (TTR) in patients with left ventricular assist devices (LVADs) maintained on warfarin therapy. In non-LVAD populations, pharmacist-managed warfarin results in higher TTR and improved clinical outcomes. No study has evaluated the impact of pharmacist-managed outpatient warfarin exclusively in HeartMate 3 (HM3, Abbott Medical, Pleasanton, CA) LVAD patients. METHODS:This multicenter, retrospective cohort study included patients implanted with HM3 LVADs across six medical centers in the United States from January 2019 to May 2023. The study compared pharmacist-managed (RPH) warfarin therapy with usual warfarin care (UC), which was managed by any nonpharmacist clinician. The primary end point was TTR over 1 year using Rosendaal's method. RESULTS:Overall, 277 patients were included, 191 in the RPH group and 86 in the UC group. The TTR was 65.6% in the RPH group and 45.8% in the UC group (p < 0.001). This significant difference persisted after adjusting for confounding variables. There was no significant difference in thromboembolic events between groups. There was no difference in bleeding outcomes between groups when Mechanical Circulatory Support-Academic Research Consortium Type 1 bleeding was excluded (RPH 19.3% vs. UC 12.4%, p = 0.17). CONCLUSION:In patients with HM3 LVADs receiving warfarin, pharmacist-managed warfarin led to a higher TTR compared with UC.
BACKGROUND:Stigma is a known barrier to individuals with substance use disorder (SUD) seeking care for their condition and contributes to poorer health outcomes for individuals with SUD. Despite evidence that targeted education can reduce stigmatizing attitudes among health care professionals, a paucity of research has focused on what the most effective components of anti-stigma education are and how they should be integrated into student and health care professional education. The purpose of this study was to examine students' perspectives following the completion of a first-year pharmacy seminar-style elective course, explicitly focusing on their recommendations for stigma reduction initiatives, curricular integration strategies, and their perceived preparation for future practice. METHODS:Students in a seminar-style first-year pharmacy school elective focused on stigma towards individuals with SUDs and mental health conditions were given the opportunity to share their views regarding stigma education after a semester of anti-stigma coursework. Consensual qualitative research (CQR) methodology was used to analyze the reflections of the 18 students in the course. RESULTS:Analysis of student reflections revealed six major domains, which included: Education and Curriculum, Professional Development, Stigma Reduction, Language Utilization, Community and Peer Support, and Patient-Centered Care. CONCLUSIONS:Students' reflections focused on the need for anti-stigma initiatives at all levels, including focused work with individual patients to reduce self-stigma within health care systems and through anti-stigma education with the public. A small, seminar-style course provided an ideal learning environment for engaging students in challenging conversations around substance use and mental health stigma. Guest speakers with lived personal and professional experience dealing with substance use, mental health, and harm reduction were reported by students to be the most impactful component of the course.
BACKGROUND:Large language models (LLMs) are increasingly used for clinical information retrieval and decision support, yet comparative performance on pharmacy board examination-style content across specialties remains incompletely characterized. METHODS:We evaluated 15 LLMs using 145 publicly available Board of Pharmacy Specialties (BPS) certification practice questions spanning 14 specialty domains. Questions were entered using a standardized prompt without additional prompt engineering. Model responses were scored against BPS-posted answer keys. Overall and specialty-level accuracy were summarized descriptively. Differences among LLMs were tested using Cochran's Q with Bonferroni-adjusted McNemar pairwise comparisons when appropriate, and LLMs were assessed using their default user-facing settings. RESULTS:Across all LLMs, mean accuracy was 86.2% (standard deviation [SD], 3.5%), corresponding to an average of 125/145 items answered correctly. Accuracy ranged from 79.3% (95% confidence interval [CI], 72.6%-86%) for Perplexity AI to 91.7% (95% CI, 87.2%-96.3%) for Microsoft Copilot (GPT-5). Overall performance differed significantly across LLMs (Cochran's Q = 46.262; df = 14; p < 0.001). After Bonferroni adjustment, Microsoft Copilot (GPT-5), Google Gemini 2.5 Flash, and OpenAI o3 (Reasoning) outperformed Perplexity AI (p < 0.001). Microsoft Copilot (GPT-5) also outperformed an earlier version of Microsoft Copilot (GPT-4.1) (p < 0.001). Specialty-level heterogeneity was generally limited, with significant model differences observed in Solid Organ Transplantation Pharmacy and Nuclear Pharmacy. CONCLUSIONS:LLMs demonstrated high accuracy on BPS certification practice questions, with limited variability across LLMs and select specialty domains. These findings support continued evaluation of LLMs for potential use in pharmacy practice and clinical decision support, emphasizing the need for domain-specific validation and ongoing monitoring as LLMs evolve.
BACKGROUND:There is a lack of data on the impact of implementing an interprofessional approach in ambulatory clinics to de-label penicillin-allergic patients (PA) in diverse and lower-income populations. METHODS:A quality improvement (QI) interprofessional adult PA assessment/intervention protocol was implemented at two resource-limited ambulatory sites over 4 months, utilizing a post-group-only quasi-experimental study design. Pharmacists performed allergy assessments/Pen-FAST scores with nonallergic histories directly de-labeled. Nonpregnant patients with Pen-FAST scores less than 3 were offered amoxicillin direct oral challenges (DOC), and scores of 3 or greater were offered allergist referrals. Data collection included demographics, allergy information, Pen-FAST score, and outcomes. The primary outcome was the percentage of interviewed patients de-labeled. Secondary outcomes included the percentage de-labeled through different modalities, allergist referrals, and 3- and 6-month antibiotic use and relabeling. RESULTS:A total of 717 and 388 PA patients were identified at Sites 1 and 2, respectively. Interviews occurred in 228 patients, with 151 (66.2%) and 77 (33.8%) from Sites 1 and 2. The median age (interquartile range [IQR]) was 56 years (41-64), with 168 (73.7%) identified as female. A total of 130 (57%) patients had a Pen-FAST score less than 3. Successful allergy de-labeling was achieved in 74 of 228 (32.5%) patients. De-labeling occurred in 60 patients by allergy assessment and 14 patients through DOC. Allergist referrals occurred in 93 patients. Of de-labeled patients, 8 (10.8%) and 11 (14.9%) received penicillin within 3 and 6 months. Relabeling occurred in one patient within 6 months. CONCLUSION:This QI initiative was effective in de-labeling 33% of inaccurate PAs across two ambulatory care clinics with diverse populations.
BACKGROUND:Drug Information Centers (DICs) play a critical role in health care by providing accurate, evidence-based responses to drug-related inquiries. The integration of artificial intelligence (AI) into this domain offers opportunities to enhance efficiency and decision-making. This study aims to compare the accuracy and safety of drug information responses provided by drug information pharmacists and artificial intelligence (AI) technologies, including GPT-4o, Gemini, Copilot, and Medical Chat (OpenAI, San Francisco, CA, USA; Google, Mountain View, CA, USA; Microsoft, Redmond, WA, USA; Medical Chat, developer information not publicly specified). METHODS:A retrospective, real-world study was conducted over 3 months at a tertiary hospital. The end points of this study are the statistical differences in overall accuracy of responses obtained from generative AI technologies and drug information pharmacists to drug information questions' responses measured in six dimensions. RESULTS:GPT-4o and Medical Chat achieved composite scores comparable to DIC pharmacists (mean [standard deviation (SD)]: 18.3 [2.5], 17.5 [3.1], and 17.7 [3.5], respectively), while Gemini and Copilot showed lower performance (16.7 [3.5] and 16.4 [2.9]). Welch's analysis of variance (ANOVA) demonstrated a significant difference in composite scores among groups (p < 0.001), with GPT-4o outperforming Gemini and Copilot in pairwise comparisons. Differences were also observed across question categories, with routine inquiries such as administration and dosing being more common than complex categories. Inter-rater agreement was low (Fleiss' kappa = 0.015, p = 0.297), indicating variability in scoring among evaluators. CONCLUSION:Some AI tools demonstrated performance comparable with pharmacists for routine drug information questions, while others showed lower reliability, particularly for clinically nuanced responses. Variability among tools and low rater agreement highlight the need for cautious interpretation and continued pharmacist oversight when using AI in drug information practice.
Health disparities and inequities in the US health care system contribute to poor health outcomes. These issues affect all aspects of pharmacy practice, including medication use and adherence, and contribute to the suboptimal performance of the United States in global health care rankings compared with other industrialized nations. More robust efforts are needed to address the impact of cultural awareness/intelligence, social determinants of health (SDOH), health-related social needs (HRSN), and diversity, equity, inclusiveness, and accessibility (DEIA) within the pharmacy profession. Comprehensive knowledge, skills development, and assessment tools in these areas are lacking in pharmacy education. Research projects focused on health inequities and disparities are limited by their lack of statistical power, lack of inclusiveness of diverse populations, community partners, and researchers, and lack of rigorous study designs to conclusively document and resolve these problems. Addressing cultural intelligence, HRSN/SDOH, and DEIA barriers in health care and pharmacy practice, education, and research is therefore essential for improving patient outcomes and satisfaction. The American College of Clinical Pharmacy (ACCP) Public and Professional Relations Committee was charged to update ACCP's cultural competency white paper series. This white paper evaluates evidence and describes current challenges related to cultural intelligence, HRSN/SDOH, and DEIA in pharmacy practice, education, and research. Evidence tables are provided together with ranked recommendations for integrating these principles into doctor of pharmacy curricula, residency training, continuing education, clinical practice, and research. By implementing these changes, pharmacy professionals and organizations can help create a more equitable health care system and reduce disparities in patient care, health outcomes, and research.
ABSTRACT Background Intensive lipid‐lowering therapy (LLT) to achieve low‐density lipoprotein cholesterol (LDL‐C) levels < 70 mg/dL is recommended to lower the risk of atherosclerotic cardiovascular disease (ASCVD) events following revascularization. However, LDL‐C remains elevated in most patients and LLT intensification is infrequent. To evaluate post‐revascularization management of LLT in patients with various forms of ASCVD. Methods This retrospective cohort study evaluated LLT intensification in adults with ASCVD after coronary, cerebrovascular, or peripheral revascularization between July 2021 and July 2022. Patients were identified from procedure lists. Exclusion criteria included no baseline LDL‐C, baseline LDL‐C < 70 mg/dL, triglycerides > 500 mg/dL, end‐stage renal disease, and no documented follow‐up care. The last documented LDL‐C, LLT prescribing patterns, and all follow‐up visits with primary care providers and ASCVD specialists were evaluated during post‐revascularization follow‐up (15 months). We compared patient characteristics and LLT practice patterns between patients achieving LDL‐C < 70 mg/dL (goal) and those with LDL‐C ≥ 70 mg/dL (not‐at‐goal) during a 15‐month follow‐up period. Results 119 patients were included. Within 15 months, 57 (47.9%) patients had a follow‐up lipid panel for evaluation, 27 (47.7%) of whom were at goal. Only 23 (19.3% of the entire cohort) patients had LLT intensified. Patient characteristics were similar between those at goal and not‐at‐goal except for race (fewer non‐White patients, p < 0.01) and revascularization type (more coronary revascularization, p < 0.05) in those at goal. Patients with follow‐up lipid panel(s) had significantly more ambulatory care visits (6 [4–10] vs. 3 [1–6], p < 0.001) and had higher rates of LLT intensification (28.1% vs. 11.3%, p < 0.001) than those without. Among patients without follow‐up lipid panels, there were 269 missed opportunities to reassess lipids and/or intensify LLT. Conclusion In this study, most revascularized ASCVD patients did not have follow‐up lipid panels, LLT intensification, and did not achieve an LDL‐C < 70 mg/dL, suggesting numerous opportunities for improvement.
BACKGROUND:Pharmacy education and workforce development are undergoing significant disruption. While national forecasts outline key directions, they lack granularity and stakeholder validation. This study aimed to develop a stakeholder-informed, data-driven forecast of pharmacy strategic priorities through 2035. Objectives were: (1) identify key themes shaping pharmacy's future, (2) align these themes with national priorities, and (3) forecast their trajectory and readiness to inform strategic planning. METHODS:A mixed-methods design integrated qualitative analysis of 27 stakeholder focus groups and eight interviews with trend modeling and policy triangulation. Participants (n = 148) represented students, faculty, preceptors, administrators, professional organizations, payors, interprofessional educators, and transformation leaders. Transcripts were coded using grounded theory and analyzed for themes. Identified themes were aligned with the 2024 American Association of Colleges of Pharmacy and 2024 American Society of Health-System Pharmacy Forecast reports. Historical emphasis scores (2015-2024) were modeled using linear regression to project thematic growth through 2035. Each theme was rated for system readiness based on stakeholder insight and national preparedness indicators. RESULTS:Ten core themes emerged: Workforce Shortages/Accessibility, Digital Health/Technology, Competency-Based Education (CBE), Public Health/Prevention, Medication Safety/Optimization, Interprofessional Collaboration, Patient-Centered Care, Leadership/Advocacy, Professional Identity/Perception, and Business/Financial Acumen. Convergent themes like Workforce Shortages, Public Health, and Medication Safety were validated by national forecasts and reflected high stakeholder urgency. Digital Health and CBE showed the steepest forecasted growth slopes but were marked by low readiness. A strategic prioritization matrix was developed to guide policy and curricular responses based on urgency, growth, and readiness. CONCLUSIONS:This study offers a novel, future-facing framework to guide the transformation of pharmacy education and workforce strategy. High-priority, low-readiness themes require urgent investment. Strategic scaffolds such as leadership, identity, and business acumen, though underemphasized, are critical to sustaining innovation. Pharmacy must reimagine itself as a lifelong, adaptable profession, equipped not only to respond to change but to lead it.
Background Interdisciplinary collaboration is a core component of residency training. At the University of Illinois Hospital & Health Sciences System (UI Health), a 24-h in-hospital Doctor of Pharmacy (Pharm.D.) resident on-call program provides real-time clinical support to health care teams. Although primarily patient care-directed, these interactions offer a platform for interprofessional learning. The educational value of pharmacy resident involvement in training physician residents remains underexplored.Methods A prospective cross-sectional survey was conducted in March 2025, targeting UI Health inpatient physician residents across specialties. Eligible residents received email invitations to complete an anonymous Qualtrics survey of their perceptions about the Pharm.D. resident on-call program. Quantitative data were analyzed using descriptive statistics; qualitative feedback underwent thematic analysis. The primary outcome was the percentage of residents reporting a positive impact on their training. Secondary outcomes included satisfaction by specialty, areas of clinical knowledge growth, perceived accessibility, self-reported confidence, and reasons for lack of interaction with the Pharm.D. on-call.Results Of 557 residents, 97 responded (17% response rate). Among the 87 who interacted with a pharmacy resident, 93.0% reported a positive training impact. These interactions were associated with improved pharmaceutical knowledge (89.7%), particularly in dosing adjustments, anticoagulation management, drug interactions, and contraindications. Residents reported that Pharm.D. on-call collaboration enhanced their confidence in patient care (92.0%) and contributed to feeling more prepared for independent practice (70.1%). Qualitative responses highlighted physician residents' appreciation for the on-call program's contributions to medication safety, with conveyed interest in expanding the program's availability and educational opportunities. Responding physician residents also emphasized the need for increased awareness of the program across underutilizing specialties.Conclusion The Pharm.D. resident on-call program was well-received and perceived to enhance physician resident education. Future efforts should focus on increasing program visibility, targeted specialty outreach, and enhancing pharmacists' responsibility and integration in physician residency training and education.
Interactions between clinical pharmacists and industry partners continue to evolve as health care increases in complexity and technology assumes a more dominant role. To address the corresponding ethical challenges, the 2025 Industry Relations Committee of the American College of Clinical Pharmacy (ACCP) was charged with updating the 2008 ACCP position statement, Pharmacists and Industry: Guidelines for Ethical Interactions. This update expands its perspective, reflecting the broader and more influential roles pharmacists play across the health care ecosystem. All clinical pharmacist-industry interactions should be grounded in improving patient care. Through this lens, six recommendations are provided: (1) Pharmacists should not engage in industry partnerships or collaborations that might unduly influence objectivity, independence, or fairness in clinical and professional judgments; (2) Pharmacists should disclose and mitigate financial, consulting, or other relationships that constitute potential conflicts of interest and should not participate in activities where an existing conflict cannot be resolved; (3) Pharmacists who participate in industry-sponsored research should follow accepted ethical, regulatory, and scientific standards; (4) Pharmacists providing continuing education programs or developing drug information materials should maintain control of content; ensure their content is fair, balanced, and free from bias; and disclose and mitigate any conflicts; (5) Formal instruction on ethical interactions with industry professionals should begin early and continue through all stages of pharmacist education, training, and professional development; (6) Pharmacists should maintain the confidentiality and privacy of patients and other health care professionals when working with industry partners. Questions to guide personal industry interactions are provided. This paper does not detail every emerging area (e.g., artificial intelligence, social media), but recommendations are applicable wherever clinical pharmacists leverage their professional expertise. By maintaining a critical, discerning, and ethical approach to industry collaborations, clinical pharmacists can uphold professional obligations while contributing to the advancement of evidence-based practice, ultimately prioritizing patient welfare.
BACKGROUND:Research experience in pharmacy school is beneficial to all students seeking post-graduate training and there is a need to diversify the clinical pharmacy workforce. The objective of this study was to identify barriers and facilitators to Black Doctor of Pharmacy (Pharm.D.) student participation in research activities. METHODS:A qualitative study employing focus groups was conducted at three colleges of pharmacy within large, public, Carnegie R1, predominantly White institutions (PWIs) and two Historically Black Colleges and Universities (HBCUs) in the southern United States. Students self-identifying as Black were recruited via email invitation. Student champions were identified at each institution and received training in focus group best practices. One student-led focus group was conducted at each collaborating institution. Focus group recordings were professionally transcribed and data were analyzed with a phenomenological approach. RESULTS:Of the 29 participants, there were 3 fourth-year (10.3%), 16 third-year (55.1%), 6 second-year (20.6%), and 4 first-year (13.7%) students. The median age of participants was 25 years and 74.1% of participants were female. In addition to concerns for time commitment and limited awareness of opportunities, the students identified misconceptions, intimidation, limited representation of Black faculty in research roles, and lack of established mentoring relationships as barriers to research participation. Facilitators such as racial/cultural concordance with faculty, improved communication regarding available opportunities, and opportunities for research to directly impact minority communities were also described. CONCLUSIONS:The findings of this study may be used by pharmacy schools to increase Black Pharm.D. student research participation. This study provides insight into and context for experiences that are unique to Black Pharm.D. students at colleges of pharmacy. As this was not designed as a comparator study, further research into differences in barriers and facilitators for Pharm.D. research activities at PWIs and HBCUs is warranted.
BACKGROUND:Alcohol use disorder (AUD) remains undertreated in the United States despite the availability of effective pharmacotherapies. Pharmacist-led education and clinical decision support embedded in the electronic medical record (EMR) was provided to primary care providers (PCPs) to address barriers to prescribing medications for AUD. This study evaluated the impact of the pharmacist-led intervention on pharmacologic treatment rates for patients with AUD managed by PCPs. METHODS:This was a retrospective, fixed cohort, pre-post study conducted across a network of 10 clinics within a single health system. The study included patients 18 years and older with an AUD diagnosis managed by a PCP within the institution. The cohort of patients was utilized to evaluate PCP prescribing rates for pharmacologic treatment of AUD. The pre-intervention period was from July 2021 to July 2022, and the post-intervention period was from August 2023 to August 2024. Pharmacists created and delivered educational tools and EMR enhancements to PCPs. The primary outcome was the pharmacologic treatment rate of AUD. Secondary outcomes included clinic-level pharmacologic treatment rates and associations between patient factors and treatment. Statistical analyses were conducted utilizing descriptive statistics, McNemar's test, and a logistic regression model. RESULTS:Of the 800 patients screened, 441 met inclusion criteria. The baseline pharmacologic treatment rate for patients with AUD was 7%. After the intervention, the pharmacologic treatment rate increased to 18% (p < 0.001). Treatment rates increased in eight out of 10 clinics. Concurrent benzodiazepine use was associated with an increased treatment rate (p = 0.0062) while no associations were found with concurrent opioid use, tobacco use, methamphetamine use, chronic kidney disease, or cirrhosis. CONCLUSION:The pharmacist-led intervention more than doubled the pharmacologic treatment rate for AUD in primary care.
BACKGROUND:Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use in intensive care units (ICUs), where high antimicrobial consumption, antimicrobial resistance, and complex pharmacokinetics complicate therapy. METHODS:This prospective, observational, pre-post study was conducted in the ICU of a tertiary hospital in Türkiye over 6 months (October 2024-April 2025), comprising a 3-month pre-ASP observation period and a 3-month ASP period. During the ASP period, a clinical pharmacist integrated within a interprofessional team, including infectious disease physicians, conducted prospective audit and feedback in collaboration with the ICU team. Antimicrobial appropriateness was evaluated as the primary objective, while antimicrobial consumption (days of therapy [DOT] and length of therapy [LOT]), intervention characteristics, acceptance rates, and 30-day mortality were assessed as secondary objectives. RESULTS:A total of 160 patients and 466 antimicrobial treatments (235 pre-ASP; 231 post-ASP) were evaluated. Consistent with the primary outcome, antimicrobial appropriateness improved significantly following ASP implementation, with the inappropriateness rate decreasing from 81.7% to 8.7% (p < 0.001), corresponding to an 89.6% reduction in antimicrobial-related problems. Regarding secondary outcomes, overall antimicrobial exposure declined, with total DOT and LOT decreasing by 8.5% and 19.5%, respectively, although median DOT and LOT per patient-day did not differ significantly between periods. The most frequent pharmacist interventions were dose adjustment (38.3%), initial dose selection (35.2%), and infusion duration modification (15.4%), with a 98.1% acceptance rate. Thirty-day mortality decreased from 56.0% to 38.8% (relative risk [RR] 0.699, 95% confidence interval [CI] 0.505-0.968; p = 0.027). In adjusted patient-level analyses, pharmacist intervention was independently associated with lower mortality (adjusted odds ratio [OR] 0.331, 95% CI 0.148-0.743; p = 0.007). CONCLUSION:Integration of a clinical pharmacist into a interprofessional audit and feedback process significantly improved antimicrobial appropriateness and reduced antimicrobial-related problems. An associated reduction in 30-day mortality was observed after adjustment for illness severity; however, this finding warrants confirmation in larger prospective studies.
BACKGROUND:Antimicrobial Stewardship (AS) is crucial for delivering high-quality care to patients, minimizing adverse effects and outcomes, mitigating antimicrobial resistance, and generating cost savings for the healthcare system and patients. Successful AS programs are often multi-disciplinary, with infectious diseases and antimicrobial stewardship pharmacists (ID/ASP) playing a key role in the implementation and coordination of care. This study evaluated the documentation of stewardship interventions following the implementation of an ID/ASP-led stewardship program in a large Midwestern academic medical center. METHODS:This quasi-experimental study evaluated the impact of hiring an ID/ASP with subsequent AS education and feedback and updated documentation methods. It was conducted from January 2023 to September 2023 (pre-intervention) and October 2023 to December 2024 (post-intervention), and compared the impact of an ID/ASP pharmacist on the documentation of key AS interventions by non-ID pharmacists. The number and type of interventions and drugs used in interventions were assessed for adult and pediatric patients before and after the ID/ASP pharmacist was hired. The primary outcome was the average number of interventions documented by non-ID pharmacists per month in the pre-intervention period compared to the post-intervention period. A p-value < 0.05 was considered statistically significant. RESULTS:A total of 5606 non-ID pharmacist interventions occurred throughout the study. There was a statistically significant increase in average monthly documented interventions by non-ID pharmacists after the intervention compared to before (283 ± 102 vs. 152 ± 49, respectively; p = 0.002). Furthermore, the ID/ASP pharmacist contributed an additional average of 104 interventions per month and was able to perform high-impact AS interventions. CONCLUSION:This study demonstrated a positive impact of an ID/ASP pharmacist-led AS program in a large academic medical center. The number of documented AS interventions significantly increased in the post-intervention period. These data underscore the importance of ID/ASP in advancing the shared goal of antimicrobial stewardship.
BACKGROUND:Little is known about the familiarity and implementation of anticoagulation (AC) stewardship on a global scale. Therefore, we aimed to identify current AC stewardship patterns globally. METHODS:An international survey was electronically distributed to individuals involved with AC as a practitioner, researcher, or administrator between June and September 2024. RESULTS:A total of 985 responses (790 United States [U.S.]/195 non-U.S.) representing 65 countries/regions and 50 U.S. states. Most respondents were physicians (51.9%) or pharmacists (24.2%). 93.7% felt AC safety was a serious concern in their country; 90.5% were at least moderately familiar with the term AC stewardship. Only 52.1% have an AC stewardship program for hospitalized, ambulatory, or both patient populations. Most (73.4%) felt their organization does a good job implementing clinical guidelines/protocols for AC stewardship, most commonly for direct oral anticoagulants (DOACs) (37.0%), low molecular weight heparin (LMWH) (36.5%), intravenous unfractionated heparin (IV UFH) (35.9%), and warfarin (34.3%). Most commonly tracked quality measures were AC reversal (38.5%), rates of major bleeding (33.1%), number of international normalized ratios (INRs) > 5 (32.8%), and warfarin time in therapeutic range (31.4%). 82.2% felt their organization's leadership supports AC stewardship with dedicated resources, including dedicated time to complete AC stewardship (51.1%), dedicated AC stewardship positions (56.5%), and financial support for training (36.3%). CONCLUSION:Respondents were familiar with the term AC stewardship, and many organizations have a supportive leadership structure in place for AC stewardship activities, but only half of the respondents felt they have an AC stewardship program in place. Many organizations have not implemented systematic care that includes the use of common clinical guidelines or protocols, and they are not tracking common quality measures. Opportunities exist for further development of AC stewardship services worldwide.
