Background Individuals with severe mental illness (SMI) are more likely to die from cardiovascular disease (CVD) than those without SMI, yet screening for CVD risk factors is often inadequate. Comprehensive medication management (CMM) pharmacists help to address the complex healthcare needs of individuals with SMI and may enhance rates of CVD screening. Objective This study describes rates of screening for CVD risk factors among patients with SMI prescribed antipsychotic medication who received CMM pharmacist care within a large health system. Methods This retrospective study of SMI patients treated by CMM pharmacists examined screening for four common CVD risk factors at and 90-days following initial CMM visit. Health system utilization and medication therapy problems (MTPs) were compared using chi squared tests based on baseline completion of all four CVD risk factors. Results Of 1455 patients with SMI prescribed antipsychotic medication seen by CMM pharmacists, 65.1% had complete measurements for blood pressure, body mass index, blood glucose, and low-density lipoprotein cholesterol at baseline, and approximately one-third (N=186) of patients with at least one missing measurement at baseline had complete measurements within 90 days. CMM pharmacists identified 1932 MTPs at patients’ first CMM visits. Adherence problems—often due to misunderstanding instructions or forgetting to take medications—were identified (N=391, 20.2%), and nearly 90% of CMM pharmacist interventions offered to address these issues were accepted by patients and other providers. Conclusion CMM pharmacists have opportunities to address gaps in care, particularly with increasing screening rates for CVD risk factors and identifying MTPs.
Background Public-facing licensure information is intended to improve transparency and allow patients and employers to verify healthcare provider credentials. For pharmacists, the scope and format of publicly available licensure information may differ across US jurisdictions, limiting cross-jurisdictional comparisons, workforce evaluations, and policy research. Objective The objective of this study is to describe and summarize the availability, content, and transparency of pharmacist licensee data across US states, districts, and territories. Methods This cross-sectional observational study evaluated publicly accessible pharmacist license verification tools in the US, defined as jurisdiction-operated online databases, search portals, or web-based lookup systems used to verify pharmacist licensure information. Extraction included 56 US jurisdictions and occurred from May to September 2025. Using a standardized tool, 45 prespecified variables were collected and analyzed across categories, including core identifiable, contact, disciplinary, training, and practice information. Jurisdiction-level transparency was calculated as the proportion of all 45 possible variables in each jurisdiction’s tool. This proportion was refined to 29 variables after excluding fields that were rarely observed, inconsistently reported, or duplicative. Higher scores indicated increased publicly available licensure information. Results License verification tools were identifiable for 54 of 56 jurisdictions (96.4%). Across jurisdictions with tools, core verification fields were consistent: licensee name, license number, and license expiration date were present in 54 (96.4%), and license status and issue date were present in 53 (94.6%). Jurisdiction-level transparency was overall low, with jurisdictions publicly displaying, on average, approximately 41% of the 29 refined variables. Conclusion Most US jurisdictions provide pharmacist license verification tools with consistently reported core licensure fields; however, the transparency of additional licensee information varies across jurisdictions. Greater consistency in the reporting of publicly available pharmacist licensure data may enhance employer verification, policy evaluation, workforce research, and public trust.
Background Community pharmacies are widely distributed and often located in areas with limited obstetric access, positioning pharmacists to help expand reproductive health services, including pregnancy prevention, preconception, and maternal care. Objective To evaluate women's perceived access to obstetric care and their interest in receiving pharmacist-delivered reproductive health services within community pharmacies across Georgia. Methods In this cross-sectional survey, women aged 18 to 45 years were recruited at community pharmacies purposively sampled within 90 minutes of four college of pharmacy campuses to include counties with both adequate and inadequate obstetric services. A 9-page REDCap instrument assessed demographics, reproductive history, health risk factors, and interest in services from the NASPA Maternal Health Service Set. Counties were classified by obstetric service adequacy and stratified by NCHS urbanicity code. Data were collected February through May 2022. Descriptive statistics and chi-square tests were used. Results Of 103 respondents, 79 were analyzed. Although 82% resided in metropolitan counties, 37% lived in counties with inadequate obstetric services; 52% of those with inadequate access were metropolitan residents, whereas all 14 non-metropolitan participants had inadequate access. Sixty-eight percent agreed that access to women's health care is a serious problem in their community. Overall, 89% expressed interest in at least one pharmacist-delivered service. Interest was not uniform: 7 of 22 services drew interest from 70% or more of participants, led by medication review in pregnancy (77%), hypertension screening and counseling (76%), vaccinations (75%), nausea medication recommendations in pregnancy (75%), and contraception prescribing (70%). Interest was lowest for alcohol (33%) and tobacco (38%) screening. No significant differences were observed between groups stratified by obstetric access. Conclusion Women in Georgia with limited obstetric access, both in metropolitan and non-metropolitan areas, reported modifiable risk factors and interest in pharmacist-delivered reproductive health services, supporting community pharmacies as a pragmatic setting for expanding access.
BACKGROUND:Patient-reported outcomes (PROs) are used to assess a variety of patient experiences including medication nonadherence. Community pharmacists are well-positioned to address medication adherence. OBJECTIVES:The objectives of this study were to 1) determine the adoption, acceptability, feasibility, fidelity, appropriateness, and costs of piloting PatientToc, adapted to collect medication adherence PROs in community pharmacies, 2) pilot an initial implementation strategy for PatientToc including a resource toolkit and external facilitation plan, and 3) identify adaptations to consider for scaling PatientToc to pharmacies beyond this pilot. METHODS:Qualitative and quantitative data were collected, with data sources varying by outcome. Adoption, acceptability, fidelity and feasibility were evaluated with both quantitative (i.e., PatientToc administrative data and/or researcher records) and qualitative data (i.e., interviews and observations.) Appropriateness was evaluated with qualitative data. Costs were evaluated with quantitative data. Quantitative data were analyzed using descriptive statistics. Qualitative interview data were deductively coded. Intra- and inter-site summaries were created to synthesize quantitative and qualitative data to identify potential adaptations to make to PatientToc and/or the implementation plan. RESULTS:Three pharmacies implemented PatientToc for two to three months. Adoption by staff was lower than what had been requested by the study team, resulting in pharmacies using PatientToc with an average (standard deviation, SD) of 27 (14) patients. Moreover, pharmacies demonstrated varying fidelity in using PatientToc as pharmacists completed documentation in 21-100% of patient encounters. Implementation costs included a per-site average of $1280 for equipment, advertisement, and supplies, $290 per month in pharmacy staff time and $630 per month in research support staff time. Community pharmacy teams and patients overall found the use of PatientToc appropriate, acceptable, and feasible but six potential adaptations were identified. CONCLUSION:Implementing an electronic application for collecting and using PROs in community pharmacies was possible but challenging and staff adoption was lower than expected.
BACKGROUND:Integration of pharmacogenomics (PGx) into clinical care has primarily occurred within academic medical centers. Clinical decision support (CDS) is vital to the incorporation of PGx into clinical care, however, efforts have not capitalized on the integration within community pharmacy settings. OBJECTIVE:To describe the implementation efforts for community pharmacy CDS alerts and assess effectiveness. METHODS:A retrospective manual chart review was conducted to evaluate the effectiveness of deploying PGx alerts across 14 community pharmacies within a single health system. A report was created to capture all PGx CDS alerts generated during the eight-month study period (October 2024-May 2025). Alerts were categorized as actionable when documentation was sparse for medication adjustments based on PGx results from the prescribing clinician upon transmission of the prescription to the community pharmacy. RESULTS:A total of 74 alerts were generated, of which 36 were unique alerts. Thirty-eight alerts were excluded as duplicates when the pharmacist re-entered the dispensing function. Clinicians adjusted 17 chemotherapy prescriptions prior to order transmission. Additionally, five alerts for chemotherapy medications were considered not actionable as the patient had previously tolerated therapy. The remaining 13 alerts comprised of 11 for clopidogrel and 2 for tramadol. Pharmacists intervened in 8 of the 11 clopidogrel orders which resulted in 3 medication modifications. The overall alert acceptance was 23%. CONCLUSION:This study describes one of the first institutions to deploy PGx alerts through the community pharmacy module across a health system's electronic health record. PGx alerts in the medication dispensing module provide an additional safeguard for precision medicine, enabling pharmacists to make targeted interventions and provide patient education. Continuous evaluation of PGx alerts affords opportunities for alert refinement and further optimizing patient care.
BACKGROUND:Treatment resistant hypertension (TRH) represents a major public health challenge in the United States, substantially increasing risks of major cardiovascular events. The racial and ethnic differences in prescribing patterns and outcomes of treatment resistant hypertension are not well characterized. OBJECTIVES:This study exams racial differences in TRH epidemiology, treatment and outcomes in a national sample of hypertensive adults. METHODS:We analyzed US adults (≥18 years) with hypertension from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 (N=4,174). Apparent treatment resistant hypertension (aTRH) was defined as uncontrolled blood pressure (systolic blood pressure, SBP≥130 mmHg or diastolic blood pressure, DBP≥80 mmHg) despite concurrent use of ≥3 antihypertensive classes including a diuretic or use of ≥4 medications regardless of blood pressure. Estimates were weighted to represent the US population. RESULTS:Among adults with hypertension, the overall prevalence of aTRH was 6.61 [CI: 5.58, 7.65]. Prevalence was the highest among non-Hispanic Blacks (9.57%), followed by non- Hispanic Whites (6.81%) and Hispanics (3.49%). Despite more antihypertensive medications (average number of antihypertensive medications: 3.87, 3.66 and 3.58 among Black, Whites and Hispanic participants, respectively; p <0.001), blood pressure levels were the highest among Black participants. Black participants had the lowest rate of BP control (10.5%) compared to Whites (23.8%) and Hispanics (14.4%) (Pdiff<0.01). CONCLUSIONS:Non-Hispanic Blacks bear disproportionate burden in aTRH while Hispanics are likely undertreated, although small sample size in the former group limits conclusive findings. Further research is needed to disentangle the interrelationship between TRH, race and ethnicity and mediating factors.
BACKGROUND:Hypomagnesemia is common after Roux-en-Y gastric bypass (RYGB) due to reduced gastrointestinal absorption; however, management becomes particularly challenging when renal magnesium wasting coexists. OBJECTIVES:This report describes refractory hypomagnesemia in a post-RYGB patient with confirmed renal magnesium wasting and evaluates the role of magnesium glycinate as an alternative oral replacement strategy to oral magnesium oxide and intravenous magnesium sulfate. CASE SUMMARY:A 56-year-old female with a history of RYGB and chronic malnutrition presented with bilateral lower-extremity weakness and neuropathic symptoms. Despite high-dose intravenous magnesium sulfate administered via total parenteral nutrition and intravenous supplementation, as well as oral magnesium oxide, serum magnesium levels remained persistently low (1.1-1.9 mg/dL) with only transient correction. A markedly elevated random urine magnesium level confirmed renal magnesium wasting as a contributing factor. Oral therapy was transitioned to magnesium glycinate, a chelated formulation with alternative absorption pathways. Following this change, serum magnesium improved to 2.0-2.1 mg/dL without further need for intravenous supplementation, and episodes of severe hypomagnesemia decreased. PRACTICE IMPLICATIONS:This case highlights the importance of evaluating both gastrointestinal malabsorption and renal losses when hypomagnesemia remains refractory to standard therapy in post-bariatric surgery patients. Magnesium glycinate may represent an effective long-term oral replacement option in patients with combined malabsorption and renal magnesium wasting. Further research is needed to guide formulation selection in this population.
BACKGROUND:Marijuana is a schedule I controlled substance under federal law, but the Drug Enforcement Administration has published a proposed rule to reschedule it to schedule III at the federal level. This may create an even more complex regulatory landscape for the drug, with potentially ongoing conflicts between federal and state law. OBJECTIVE:To evaluate the current scheduling of marijuana in the United States. METHODS:In January 2026, two researchers independently conducted a 50-state survey to identify the schedule of marijuana in all 50 states and D.C. Westlaw, a legal database, was used to conduct searches in each state using the following search terms: "marijuana, "controlled substance," "schedule," "cannabis," and "marihuana." RESULTS:Most states listed marijuana as a schedule I controlled substance (n=33; 65%), which is the most restrictive schedule and consistent with current federal law. A total of nine (18%) states did not schedule marijuana. A total of nine (18%) states included marijuana in another schedule or classification system, with two (4%) states having already adopted schedule III. CONCLUSIONS:This review of state laws highlights implications of potentially rescheduling marijuana to schedule III, including three post-change scenarios: (1) state law is stricter than federal, (2) federal law remains stricter, and (3) automatic change in schedule when state law defers to federal. This will likely create more regulatory complexity immediately post-change, and pharmacists must be mindful of their state's laws in practice to ensure compliance, particularly for states that become the stricter law on the topic.
BACKGROUND:Population aging in Asia heightens the demand for effective medication management, with rational drug use literacy (RDUL) being crucial for safe and appropriate medication use. However, evidence on socio-demographic determinants of RDUL remains limited. OBJECTIVE:To examine socio-demographic factors associated with RDUL among aging populations. METHODS:A systematic review and meta-analysis of observational studies was conducted through comprehensive searches of seven electronic databases, supplemented by grey literature and organizational library sources, covering publications up to May 2026. Eligible studies were selected based on inclusion criteria, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled associations between socio-demographic factors and RDUL were estimated using random-effects models with restricted maximum likelihood (REML) and Hartung-Knapp-Sidik-Jonkman (HKSJ)confidence intervals. REML with Wald-type (WT) confidence intervals and fixed-effect models were used for sensitivity analyses. The protocol was registered in PROSPERO (CRD42025635989). RESULTS:Of the 21,702 records screened, nine studies were eligible. Seven were identified through database searches and two through hand searching. All were assessed as moderate to high quality. Education level was the only socio-demographic factor significantly associated with RDUL, whereby individuals with a higher education were 2.61 times more likely to achieve adequate RDUL compared with those with a lower education (95% CI: 1.75-3.89; p <0.001; I2 = 88.7%). Collective socio-demographic factors (age, sex, education, employment, marital, and living status) were significantly associated with RDUL (OR = 1.41; 95% CI: 1.19-1.68; p < 0.001; I2 = 94.6%). Of these, only education was significantly associated with RDUL, whereas the remaining factors showed no significant or robust associations. CONCLUSION:Education level was a key determinant of RDUL, with significance observed only for collective socio-demographic factors. However, evidence remains limited due to low robustness, few studies, and a lack of specific assessment tools.
