Background Federally qualified health centers (FQHCs) provide care to vulnerable populations in rural communities. However, outpatient antimicrobial prescribing in these settings is not well described, and potential differences in prescribing patterns compared with non–FQHC facilities remain unclear. Objectives This study aimed to investigate differences in patient demographics and antimicrobial prescribing between FQHC and non–FQHC facility types in rural Western Michigan. Methods The collaboration to harmonize antimicrobial registry measures was used to conduct a retrospective analysis of electronic health record data from outpatient encounters associated with antibiotic prescriptions at 12 FQHCs and 79 non–FQHCs from January 1, 2024, to March 31, 2025. Patient demographics and antibiotic prescriptions for commonly identified diagnoses were compared. Results FQHCs more frequently served patients less than 20 years old (27.5% vs. 18.7%; P < 0.01); non–FQHCs had more patients older than 70 years (11.1% vs. 21.9%; P < 0.01). FQHC facilities also had more Medicaid-paid encounters than non–FQHCs (39.6% vs. 18.0%; P < 0.01). Compared to non–FQHCs, FQHCs preferentially prescribed azithromycin for respiratory indications (cough: 50.2% vs. 34.3%; P < 0.01; acute sinusitis: 39.7% vs. 8.0%; P < 0.01) and fluconazole for urinary tract infection -cystitis (20.5% vs. 7.3%; P < 0.01). Conclusion FQHC facilities frequently provided infectious disease care to Medicaid-dependent and younger populations. Variations in antibiotic prescribing for common indications exist compared to non–FQHCs, suggesting potential targets for antimicrobial stewardship.
Background: Chronic obstructive pulmonary disease (COPD) is currently 1 of the top 3 causes of death worldwide. A decrease in peripheral oxygen saturation (SpO2) can be a strong indicator of a COPD exacerbation. Pharmacists are well positioned to monitor SpO2 trends and changes in baseline symptoms and provide counseling on proper inhaler technique to prevent exacerbations, especially in the outpatient setting. Objectives: This pilot study aimed to (1) determine the exacerbation rate of COPD after enrollment in a pharmacist-led remote patient monitoring (RPM) program that used a Bluetooth pulse oximeter to measure SpO2 and (2) assess the impact of pharmacist-led RPM for COPD on adherence with maintenance inhaler therapy, smoking cessation, immunization uptake, and patient satisfaction. Methods: Patients completed a pre- and postintervention survey at the beginning and end of the 90-day study period. While enrolled, patients were contacted on a weekly basis to discuss SpO2 readings, changes in baseline COPD symptoms, inhaler adherence and technique, upcoming appointments, vaccine eligibility, and smoking cessation when applicable. If SpO2 was less than or equal to 92%, an effort was made to reach the patient immediately. Results: A total of 14 patients were enrolled, and 13 completed the pre- and postintervention survey. The median difference in average SpO2 change over 90 days was an increase of 0.10%. Overall, 7 patients demonstrated promising trends in average SpO2. Uptake of the influenza; tetanus, diphtheria, and pertussis; respiratory syncytial virus; and pneumococcal vaccines increased during the study period. There was also an increase in patient-reported satisfaction with COPD education and treatment. Conclusion: Enrollment in a pharmacist-led RPM program for COPD suggests an improvement in average SpO2, adherence with guideline-recommended therapy, immunization uptake, and patient satisfaction.
Background: Cirrhosis impairs the liver’s ability to synthesize vitamin K–dependent coagulation factors, contributing to coagulopathy. Elevated international normalized ratio (INR) in these patients often prompts intravenous (I.V.) vitamin K administration, despite limited evidence supporting its efficacy. Objectives: This study aimed to evaluate the impact of I.V. vitamin K administration on INR and identify factors that may predict response in patients with severe cirrhosis. Methods: This single-center, retrospective, institutional review board–approved study included adult hospitalized patients with cirrhosis who received I.V. vitamin K. The primary outcome of this study was to evaluate the change in INR. Secondary analysis included the rate of bleeding events, in-hospital venous thromboembolism (VTE), and in-hospital mortality. Subgroup analysis and linear regression analysis were conducted. Results: Among 134 patients, the median INR change from day 0 to day 3 was 0 [−0.4 to 0.2]. Bleeding events occurred in 19% of patients, in-hospital VTE in 3%, and mortality in 16%. Subgroup analysis showed a numerically greater INR reduction in patients with a baseline INR of greater than 2, but no differences based on Model for End-Stage Liver Disease scores or cirrhosis etiology. Multivariate analysis demonstrated that age older than 60 years and a decrease in INR of 0.5 from day 0 to 1 significantly predicted the overall change in INR. Conclusion: Our research provides additional data to the existing literature, showcasing a lack of impact of I.V. vitamin K on INR in patients with cirrhosis. Notably, our study adds insight into the lack of benefit even in patients with more severe cirrhosis. Standardization of clinical practice recommendations to guide I.V. vitamin K use across the spectrum of cirrhosis is needed.
Background: More than 50 million Americans experience a behavioral health illness. Adherence to prescribed medication is important for those with mental illness. Pharmacists are widely used health care providers, especially in rural areas with a limited number of mental health professionals. Owing to pharmacists’ increased duties, certified pharmacy technicians (CPhTs) can assume broader roles in patient care. Cape Fear Clinic serves rural counties wherein most patients experience a mental health illness. A CPhT intervention was implemented to assess the impact of ongoing care management after the initiation of a behavioral health medication. Objective: The primary objective was to assess changes in Short Form Health Survey 12 (SF-12) scores after participation in a CPhT-led care management program. The secondary objectives were to assess behavioral health medication proportion of days covered (PDC) and suicidal/homicidal ideation at baseline and 12 weeks after the intervention. Methods: Patients aged 18 years and older receiving a first-time prescription for a behavioral health medication or dose change were included. CPhTs contacted patients telephonically at enrollment and at 2, 4, 8, and 12 weeks after enrollment. Data collected at each touchpoint included SF-12 score, suicidal or homicidal ideation, and PDC. Results were analyzed using descriptive statistics. Results: A total of 34 patients were enrolled; 9 patients (24%) completed the 12-week program. The average change in the SF-12 mental component score was +12.7 (baseline, 38.8; final, 51.5) and the SF-12 physical component score was −1.3 (baseline, 47.1; final, 45.8). Average PDC values were 71% (n = 1), 83% (n = 1), 87% (n = 1), and 100% (n = 6). Suicidal or homicidal ideation was positively reported in 7% of appointments (n = 6 of 86); 100% of positive findings (n = 6 of 6) were reported to the care team. There were 0 positive suicidal or homicidal ideation reports (0%) at program completion. Conclusion: This CPhT-led care management service contributed to improved mental health, measured through SF-12 scores, and decreased positive suicidal ideation or homicidal ideation findings.
Background: Respiratory syncytial virus (RSV) is a common respiratory infection in infants that can result in serious complications and hospitalization. In July 2023, the Food and Drug Administration approved nirsevimab for RSV prevention in infants, and the Centers for Disease Control and Prevention (CDC) began tracking coverage rates through the RSV vaccination dashboard. Although pharmacists have been shown to improve vaccination rates in adults and children, the impact of pharmacist immunization authority (PIA) on infant RSV immunoprophylaxis rates has not been studied. Objective: This study aimed to assess the impact of PIA on nirsevimab immunoprophylaxis rates in infants aged 0-7 months across U.S. jurisdictions during the 2024-2025 RSV season. Methods: Publicly available data from the CDC RSV vaccination dashboard were analyzed to compare nirsevimab prophylaxis rates among infants across 28 jurisdictions from September 2024 to January 2025, categorized by PIA (independent, dependent, or none). Statistical analyses, including analysis of variance, post hoc t tests, and a Pearson chi-square test, were used to assess the relationship between PIA and immunoprophylaxis rates. Results: Of the 28 jurisdictions included in the study, 9 had independent PIA, 8 had dependent authority, and 11 had no authority. The mean rate across all jurisdictions was 35% (SD 7%), with notable variability within each category of PIA. Statistical analyses showed no statistically significant difference in immunoprophylaxis rates by PIA category. Conclusion: Although this study did not identify a statistically significant relationship between PIA and infant RSV immunoprophylaxis rates, jurisdictions requiring a patient-specific prescription had lower uptake than those with independent or no authority. This suggests that additional prescribing steps may limit timely access and highlights the need for strong pharmacist–physician collaboration. Although pharmacists did not shift rates during this early period, their involvement expands access points and may support improved uptake as implementation and authority become more consistent.
Background: The scope of practice and clinical responsibilities of community pharmacists have expanded over time but are not widely used. This cross-sectional study provides a quantitative assessment of how widely known clinical services provided at community pharmacies are to students of health care professions with prescriptive authority. Objective: To determine health professional students’ awareness of and support for the clinical services that community pharmacists are permitted to perform under the Illinois Pharmacy Practice Act. Methods: An online survey was conducted with students at accredited Illinois programs for physicians, nurse practitioners, and physician assistants. Participants answered questions regarding their awareness of available community pharmacist–provided clinical services and their support for patients using these services. Results: Less than 40% of respondents reported having some awareness of services beyond vaccinations. Mean and median scores for support for services were above the positive response level, with maximum median scores in most subgroups. Except for the administration of long-acting medications, more than 80% of respondents reported that they support or strongly support patients using services from a community pharmacist. Most comparisons of differences between subgroups were not statistically significant. Conclusion: Health care professional students are largely unaware of community pharmacist–provided clinical services but strongly support patients using them, suggesting trust and a willingness to delegate responsibilities to them. There are opportunities for educating students on the evolving capabilities of community pharmacists and potentially shifting how community pharmacists provide patient care. Future improvements to interprofessional education and experiental learning should address potential concerns about patient safety and outcomes.
Background: Metabolic dysfunction–associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease, affects up to 30% of adults in the United States and is associated with an increased risk of cardiovascular disease, cancer, and end-stage liver disease. The University Medical Center (UMC) of El Paso consists of 6 community health clinics along the United States–Mexico border in El Paso, TX, serving a unique population addressing multiple conditions including MASLD. Objective: This study aimed to investigate the efficacy of a pharmacist-led weight management service in patients with MASLD at an outpatient clinic on the United States–Mexico border. Methods: Clinical pharmacists at UMC conducted a cohort study to assess the impact of pharmacist-led weight management on patients with MASLD. The primary outcomes were the improvement of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and FibroScan controlled attenuation parameter (CAP) scores. The secondary outcomes of this study were the decrease in weight, body mass index, and hemoglobin A1C. Results: Of 669 chart reviews, 86 participants met the inclusion criteria. There was a statistically significant overall decrease in AST levels over a 7-month study period (P < 0.001). However, both primary care providers (PCPs) and clinical pharmacist health care teams experienced similar reductions in AST, with a mean decrease of 13 units/liter and 8 units/liter, respectively (PCP vs. clinical pharmacist, P = 0.382). ALT levels also decreased significantly over the 7-month period (P < 0.001), with a significant reduction observed in the clinical pharmacists compared with PCPs (13 vs. 6 units/liter, P = 0.023). Owing to incomplete data, analysis of FibroScan CAP scores was not performed. The results demonstrate that pharmacist involvement in MASLD care is associated with potential improvements in metabolic and hepatic parameters. Conclusion: Both AST and ALT levels showed statistically significant reductions over a 7-month period. The significant decline in AST (P < 0.001) across both groups suggests general hepatic improvement.
Background: In Virginia, pharmacists are authorized to test and treat for influenza, group A streptococcus, coronavirus disease 2019, and urinary tract infections per statewide protocols. Objectives: This study aimed to assess patients’ willingness to receive influenza test and treat services in a community-based pharmacy setting versus other health care settings, evaluate patients’ willingness to pay, identify barriers preventing use, and understand which patient demographic is best to target for marketing strategies. Methods: A 6-month prospective convenience sample-based study was conducted using a 49-question needs assessment survey, distributed via quick response code or text link at an independent pharmacy and 3 off-site influenza vaccine clinics. The survey assessed patient perceptions of health care settings, health care access, payment preferences, and demographics. Data were analyzed using SPSS version 26. Descriptive statistics were reported, and Wilcoxon signed-rank tests were used to assess differences in patients’ likelihood of using community-based pharmacy test and treat services compared with alternative health care settings. Results: More than 300 surveys were offered, and 25 surveys were completed. Most patients were female (76%), were Caucasian (88%), were aged 31-50 years (40%), held a graduate degree (48%), and were employed full time (56%). A statistically significant difference was observed in patients’ willingness to receive influenza test and treat services at community-based pharmacies compared with at hospitals, specialist offices, nurse practitioner–led clinics, or free clinics. Convenience was the most cited reason for choosing both pharmacies and other health care settings, followed by cost, trust, and wait times; perceived quality and urgency also influenced care decisions. A lack of awareness was the most noted barrier, followed by distance, limited weekend hours, and preference for primary providers; 96% of patients were willing to use insurance and preferred out-of-pocket costs from $0 to $25. Those most likely to use pharmacist-led test services were aged 31-50 years, retired or full-time employed, Caucasian, and female and held graduate degrees. Conclusion: There is strong patient willingness to use test and treat services in community-based pharmacies; however, a lack of awareness needs to be addressed to increase patient engagement.
Background: “Food-is-medicine” (FIM) is an emerging health care model that integrates nutrition into chronic disease management. The accessibility of community pharmacists makes them well positioned to identify and refer eligible patients to dietitian services, yet these collaborations and associated patient perceptions remain underexplored in current practice. Objective: This study aimed to explore the feasibility of community pharmacist-facilitated dietitian appointments. Methods: A large pharmacy chain piloted an initiative allowing pharmacists in 1 regional division to directly schedule patients for virtual appointments with their nutrition team. A pharmacist contacted English-speaking adult patients with diabetes or hypertension by telephone between December 2024 and April 2025 and offered to schedule them with a dietitian. Patients who accepted direct scheduling were invited to complete a voluntary survey on their experience. Results: The pharmacist reached 172 of 336 eligible patients (51.2%) across 110 pharmacy sites. After speaking with the pharmacist, 26 patients (15.1%) expressed interest in dietitian services and 8 (4.7%) were directly scheduled. Reasons for declining an appointment included not having insurance information readily available, requesting contact at a later time, or scheduling conflicts. Among patients who were directly scheduled, 50% attended their appointment. The most common reason for nonattendance was scheduling conflicts. Survey responses indicated overall favorable impressions of both the scheduling process and the dietitian service, including observed minor health improvements such as weight loss. Respondents recognized both pharmacists and dietitians as playing an important role in supporting the management of their chronic conditions. Conclusion: The results of this pilot study support the hypothesis that community pharmacists can facilitate access to nutrition-focused care and highlight an actionable opportunity to integrate community pharmacists into FIM initiatives. Future research should focus on optimizing referral workflows and addressing patient barriers to increase engagement with dietitian services and develop sustainable and scalable models for broader implementation.
Background Surgical site infections (SSIs) are a leading complication in pediatric surgery, and antimicrobial prophylaxis is essential for prevention. Patients with penicillin allergies often receive alternative perioperative agents, such as clindamycin. These agents have been associated with adverse outcomes. Objective This study evaluates antibiotic selection in pediatric surgical patients before and after an educational intervention following a national clindamycin shortage. Methods This quasi-experimental study included pediatric patients with a penicillin allergy who underwent a surgical procedure and received perioperative antibiotics from January 1, 2020, to July 31, 2024. The educational intervention took place in September 2022 during the clindamycin shortage. The primary outcome of this study was to compare the rate of cefazolin use in pediatric surgical patients with a documented penicillin allergy before and after the intervention. Secondary outcomes included rate of allergic reactions to perioperative cefazolin, rates of SSIs and accuracy of antibiotic administration in patients who received cefazolin versus alternative antibiotics, including vancomycin and clindamycin. Results A total of 276 patients were included, with 138 patients in each group. The median age was 5.5 years. The majority had a low-risk allergy (85%), and rash was the most common reaction documented (47%). There were significantly more patients in the post-group that received cefazolin compared to the pre-group (27% vs. 79%, P < 0.001). No patients had a documented allergic reaction to cefazolin. Significantly more patients had perioperative antibiotics completed appropriately before the incision in the post-group (59% vs. 84%, P < 0.001). No patient in either group had a documented SSI within 30 days of operation. Conclusions There was a statistically significant increase in cefazolin perioperative use in patients with a penicillin allergy in the post-group. This increase was linked to improved rates of appropriate perioperative antibiotic administration and was not associated with safety concerns, such as allergic reactions or an increased rate of SSIs.
Background Pharmacogenomics (PGx) is a clinical tool that has focused on adult patient populations, although there may be clinical applicability in the pediatric and adolescent population. Objectives Develop a multisite expert group to assist in the implementation of and enhancement to pharmacogenomic (PGx) programs at institutions serving pediatric patients. Methods Pediatric pharmacy and PGx experts created a workgroup within a multisite pediatric genomic medicine consortium, to further develop PGx programs focused on the pediatric and adolescent patient population. Institutions used an implementation framework model to deploy and augment clinical pediatric PGx services. A survey was deployed as the PGx implementation workgroup to establish the current state of PGx programmatic endeavors across the consortium. After 4 years of workgroup effort, the survey was repeated and evaluated for progress. Results PGx programs throughout the multisite consortium reported considerable progress in multiple aspects of their programs, including implementation, result reporting, and clinical decision support development. Conclusion Collaborative efforts within an interinstitutional pharmacogenomic workgroup developed a structured methodology that leveraged shared expertise to overcome key implementation barriers. This approach enabled the successful launch and expansion of clinical PGx programs across multiple institutions that participated in a unified pediatric genomic consortium.
Background Dupilumab is an effective biologic therapy for moderate-to-severe atopic dermatitis (AD) with a favorable safety profile. However, ocular symptoms and head and neck dermatitis are frequently reported, particularly among Asian populations, necessitating closer initial monitoring. With the rising prevalence of AD, increasing dupilumab use, and limited specialist resources, this creates opportunities for a Pharmacist Eczema Clinic (PEC) to review patients 2 to 4 weeks after dupilumab initiation, replacing a dermatologist-led review. Objectives The primary objective was to compare the clinical outcomes of patients newly initiated on dupilumab who were reviewed by the PEC versus those reviewed by a dermatologist. Secondary objectives included evaluating patient satisfaction and cost savings in consultation fees. Methods A retrospective chart review was conducted at a single site (National Skin Centre, Singapore) for patients initiated on dupilumab between September 1, 2018, and January 4, 2023. The clinical outcomes and consultation fees of patients reviewed by the PEC were compared with those reviewed by dermatologists. Results A total of 72 patients were included, with 36 patients in each group. Both groups demonstrated comparable mean improvements in the Scoring Atopic Dermatitis (SCORAD) score (dermatologist, 19.54; PEC, 26.27; P = 0.43) and body surface area involvement (dermatologist, 12.9; PEC, 13.2; P = 0.67). The proportions of patients with improvement in SCORAD (dermatologist, 90.0%; PEC, 100.0%; P = 1.00) and body surface area (dermatologist, 77.8%; PEC, 76.5%; P = 1.00) were similar in both groups. The total numbers of medication therapy problems addressed (dermatologist, 10; PEC, 18; P = 0.09) and unplanned returns (dermatologist, 1; PEC, 0; P = 1.00) were comparable between the groups. Among the 23 PEC respondents, 96.5% rated overall care as very good or excellent. The PEC patients had a relative cost saving of 42.8% in consultation fees compared with those reviewed by dermatologists. Conclusion A PEC-led review can provide clinical outcomes comparable to those of a dermatologist-led review in the short term for patients initiated on dupilumab, with high patient satisfaction and reduced consultation fees.
Background Heavy alcohol use is linked to numerous negative health outcomes. Regular assessment of high-risk drinking, along with timely psychotherapy, pharmacotherapy, and specialty care, is essential for preventing or managing alcohol-related conditions such as liver disease. The fibrosis-4 (FIB-4) score is a useful tool for identifying patients who may be at increased risk for advanced liver fibrosis. Objectives The objective of this project was to incorporate pharmacist-led FIB-4 screening into care and to then provide targeted recommendations based on fibrosis risk to improve access to health care resources, such as GI referral and treatment engagement, among veterans with self-reported heavy alcohol use. Methods This quality improvement project identified veterans at a single Veterans Affairs Health Care System with documented heavy alcohol consumption, defined as an AUDIT-C score ≥ 8, for potential clinical pharmacist intervention. Veterans were excluded if they were already receiving pharmacologic treatment to reduce alcohol intake, were currently engaged in psychotherapy, or had previously been evaluated by gastroenterology (GI) for high-risk alcohol use. For eligible veterans, clinical pharmacists calculated the FIB-4 score. Veterans with a FIB-4 score ≥ 3 were classified as high risk of liver fibrosis and had pharmacist recommendations made to the primary care provider (PCP) for immediate referral to GI specialty care. Those with a FIB-4 score < 3 were classified as low risk of liver fibrosis and had pharmacist recommendations made to the PCP for treatment options such as pharmacotherapy to support reduced alcohol use or psychotherapy. Results Twenty-six veterans met criteria for clinical pharmacist intervention. Four veterans (15.4%) had a FIB-4 score of score ≥ 3 and received recommendations for urgent GI referral for further evaluation. The remaining 22 veterans, all with FIB-4 scores < 3, had their primary care providers alerted to their AUDIT-C and FIB-4 scores with suggested treatment options, including pharmacotherapy and psychotherapy. Following pharmacist recommendations, 22 out of 26 (76.9%) veterans had action taken by the PCP, including nine veterans (35%) being offered pharmacotherapy. Conclusion Utilization of the FIB-4 score as a screening tool by clinical pharmacists may lead to increased access to health care resources, such as GI referral and pharmacotherapy, for veterans with high-risk alcohol consumption.
Background: Pharmacist-led counseling is an important service that has been associated with improved clinical outcomes, increased quality of life, drug knowledge, and patient satisfaction.2 Effective patient education that produces patient understanding of medication-induced adverse effects has shown to improve medication adherence.8 To date, there are no studies regarding factors influencing community pharmacists’ intention to counsel on medication-induced genitourinary adverse effects (GAEs). Objectives: The objectives of this study were to determine psychosocial and workflow factors that may influence a community pharmacist’s intention to counsel patients on medication-induced genitourinary adverse effects. Methods: This study was an anonymous, online survey distributed to community pharmacists focusing on their intention to counsel patients on medication-induced GAEs. Inclusion criteria were licensed community pharmacists employed at Albertsons community pharmacies, primarily working with patients, aged 18 years or older, and able to read and write English. Survey items used the Theory of Planned Behavior (TPB) framework to assess factors such as attitudes, subjective norms, and perceived behavioral control and included demographic questions and ranking of workflow influences. Descriptive statistics were used to summarize survey data. Results: Out of 276 survey respondents, 242 individuals provided usable responses. The majority of respondents agreed that both patients and providers expect them to provide counseling on GAEs (∼55%), although fewer respondents (∼48%) felt that patients are comfortable discussing these issues. Pharmacists who counseled more frequently reported significantly greater comfort discussing GAEs across age and gender differences. Conclusion: Most Albertsons pharmacists were willing and comfortable discussing medication-induced GAEs with patients. Additional training may support consistent counseling in the presence of external workflow challenges.
Background Artificial intelligence (AI) tools, including large language models (LLMs) such as ChatGPT, Gemini, and Claude, are increasingly explored in healthcare. While AI may enhance efficiency and accuracy, there are concerns regarding reliability, privacy, and liability. Limited data exist on pharmacists’ perceptions of AI in specialty and inpatient settings within large U.S. health systems. Objectives To assess pharmacist familiarity, use, and perceptions of AI tools across Vivo Health Pharmacies and Northwell inpatient hospital pharmacies, and to evaluate perceived benefits, concerns, and overall willingness to adopt. Methods A cross-sectional, electronic survey was distributed to pharmacists and pharmacy residents between August and September 2025. The 13-item survey collected demographics, familiarity, usage, benefits, concerns, trust, and willingness to adopt. Responses were summarized descriptively overall and stratified by gender and age. Results A total of 122 pharmacists and residents responded, representing specialty, outpatient, and inpatient settings across clinical, non-clinical, and administrator roles. Most respondents reported at least moderate familiarity with AI (61%), though use was concentrated in non-clinical tasks such as proofreading (50%) and literature summarization (44%), 3% used AI for clinical decision support, and 27% reported no use. Nearly half agreed that AI could improve accuracy, but concerns included information accuracy (82%), lack of human judgment (79%), and privacy risks (61%). Trust was limited, with most reporting somewhat or neutral trust. While 89% supported AI education, 77% expressed willingness to adopt AI if institutionally validated. Gender and age differences were observed, with males and mid-career pharmacists reporting higher familiarity. Conclusion Pharmacists in specialty and inpatient settings expressed cautious optimism toward AI, recognizing potential benefits, while citing major concerns about accuracy, privacy, and judgment. These findings underscore the need for structured education, clear governance, and phased implementation strategies to ensure safe adoption of AI in pharmacy practice.
Background Pharmacy technicians have traditionally assisted pharmacists with administrative medication dispensing tasks, but many are now being trained to serve in advanced roles supporting clinical services. However, the specific advanced tasks they perform and the benefits or barriers associated with these roles remain unclear. Objective To identify the roles and training methods offered by outpatient community-based pharmacies to pharmacy technicians and to identify perceived benefits and barriers for pharmacy technicians serving in advanced roles. Methods A cross-sectional, online survey was distributed to outpatient community-based pharmacists and pharmacy technicians in North Carolina whose sites employed at least one pharmacy technician. A 19-item investigator-developed survey explored technician roles, practice site encouraged or supported training, and perceived benefits and barriers to pharmacy technicians in advanced roles. The survey was open for 30 days. Responses were analyzed using descriptive statistics and thematic analysis. Results Of 42,800 surveys distributed, 2,663 were returned, and 1,257 were included (pharmacists: n=459; pharmacy technicians: n=798). Commonly reported tasks performed were refill reminders (n=1,237, 98%), data entry (n=1,213, 96%), inventory management (n=1,203, 96%), and patient intake (n=975, 78%). Encouraged or supported trainings at the practice site were continuing education (n=1,080, 86%), vaccine administration certificate training programs (n=986, 78%), and cardiopulmonary resuscitation training (n=874, 70%). Reported benefits were increased workflow efficiency (n=645, 51%), increased personal or career satisfaction (n=599, 48%), and increased workplace engagement (n=555, 44%). Reported barriers were hiring shortages or high turnover (n=591, 47%), lack of interest, engagement, or capacity (n=574, 46%), and lack of incentive (n=561, 45%). Conclusion North Carolina pharmacy technicians support pharmacists in tasks beyond medication dispensing, aided by practice site-supported training or education aligned with regulatory requirements. Findings suggest the need for solutions to address hiring shortages, a lack of interest, engagement, or capacity, and to incentivize those fulfilling advanced roles.
Background Chronic wounds are associated with morbidity, reduced quality of life, and high healthcare costs. Topical antibiotics offer localized therapy, and community pharmacists can support patients through individualized therapy, education, and antimicrobial stewardship. Objectives To evaluate patient-reported outcomes on effectiveness, safety, and satisfaction with a pharmacist-led wound care service providing topical antibiotic therapy. Methods This cross-sectional survey study included adults who received pharmacist-recommended topical therapy within the previous 90 days. Participants completed an anonymous Likert-scale survey assessing perceived therapy effectiveness, safety, and satisfaction using positively worded statements. Responses were recorded on a 5-point scale (1 = strongly agree to 5 = strongly disagree). Descriptive statistics summarized demographics and survey responses. Because satisfaction and effectiveness were assessed using Likert-scale items treated as continuous interval data, one-sample t-tests compared mean scores to the neutral midpoint (3) to determine whether patient perceptions differed significantly from neutrality. Chi-square goodness-of-fit tests evaluated categorical safety outcomes by comparing observed response distributions to an expected equal distribution across response categories. Internal consistency of the patient survey was assessed using Cronbach’s alpha. Results Of the 231patients who were administered the survey, 94 met eligibility criteria and completed the survey to termination (40.69% response). Patients reported high perceived effectiveness in wound healing (mean = 1.69), smell (mean = 1.79), size (mean = 1.84), drainage (mean = 1.98), and pain (mean = 2.07) (all p < 0.001). Safety data showed 17.02% (p < 0.001) experienced application-site pain; 58.51% (p < 0.005) had prior systemic antibiotics. Satisfaction was high across communication (mean = 1.44), verbal (mean = 1.51) and written instructions (mean = 1.56), application (mean = 1.67), and affordability (mean = 1.82) (all p < 0.001). Conclusion Pharmacist-recommended topical therapy for chronic, treatment-resistant wounds was associated with high satisfaction and perceived effectiveness, with few adverse events.
Background Professional society guidelines provide discordant recommendations regarding the inpatient use of sodium–glucose cotransporter 2 inhibitors (SGLT2i) for glycemic management in non-critically ill patients with type 2 diabetes mellitus (T2DM). While the American Diabetes Association supports continuation or initiation of SGLT2i in select hospitalized patients with heart failure, the Endocrine Society recommends against routine inpatient use. Objective This study evaluated real-world safety and glycemic outcomes associated with SGLT2i use in non-critically ill hospitalized patients with T2DM. Methods This single-center, observational, retrospective cohort study included adults with established T2DM admitted to a large tertiary care hospital between August 1 and December 7, 2024. Patients receiving an SGLT2i in combination with insulin therapy were compared with patients receiving insulin therapy alone. The primary outcome was median inpatient point-of-care blood glucose. Secondary outcomes included percentage of glucose readings within target range (100–180 mg/dL), total daily insulin, 90-day all-cause readmissions, length of stay, inpatient mortality, acute kidney injury, hypoglycemia, and ketoacidosis. Results A total of 150 patients were included (75 per group). Median inpatient blood glucose was lower in the SGLT2i group compared with insulin alone (165 vs 180 mg/dL; p<0.001). There was no difference in percentage of glucose readings within target range. Patients receiving SGLT2i required a slightly lower median total daily insulin dose (15 vs 16 units; p=0.006) and had fewer 90-day all-cause readmissions (28% vs 48%; p=0.005). Rates of hypoglycemia, acute kidney injury, ketoacidosis, length of stay, and inpatient mortality were similar between groups. Conclusions In this real-world cohort of non-critically ill hospitalized patients with T2DM, SGLT2i use in combination with insulin was associated with comparable glycemic control and no increase in adverse safety outcomes. These findings support cautious continuation of SGLT2i during hospitalization in appropriately selected patients and underscore the need for prospective studies to better define inpatient use.
Background Practice guidelines recommend individualized dosing strategy approach for erythropoiesis-stimulating agent (ESA) therapy due to the narrow therapeutic range of target hemoglobin (Hb). Data on optimal dosing of ESA in acutely hospitalized patients with chronic kidney disease (CKD) is not well established. Objectives The study aimed to evaluate the impact of pharmacist-driven dosing standardization of ESA on efficacy, safety, and associated costs in acutely hospitalized non-dialysis and dialysis-dependent patients with CKD anemia. Methods The study was a single-center, retrospective cohort evaluating the impact of pharmacist-driven initial ESA dose optimization intervention compared to standard of care. Outcomes evaluated included: ESA dosing characterization, clinical safety, and efficacy. Results The study included a total of 254 patients. Baseline characteristics were equally balanced for the majority. Intervention group favored a reduction in the primary outcome of median ESA dose: 100 units/kg/dose compared to 137 units/kg/dose (p <0.001). Intervention group was associated with reduced ESA dosing characteristics: total dose of ESA per patient (30,000 units versus 40,000 units, p=0.047); total dose of ESA (5,659,000 units versus 6,733,000 units, p=0.047); and the total weekly dose of ESA used per patient (15,000 units versus 20,000 units, p <0.001). The intervention group yielded total estimated drug-related savings of $19,267.56. There were no differences in clinical outcomes: the last known Hb (p=0.096), relative change of Hb (p=0.768), absolute change of Hb (p=0.809), packed red blood cell transfusion (p=0.167), hospitalization within 90 days due to thrombotic events (p=0.271), proportion of patients experiencing hypertensive crisis (p=0.132) and inpatient survival (p=0.725). The intervention group was associated with longer length of stay (15 days vs. 11 days, p=0.009), a finding likely associated with confounders. Conclusion Pharmacist-driven dosing standardization protocol limited to initial ESA dose adjustment was associated with reduced ESA utilization in acutely hospitalized patients with CKD.
