Clinicians continue to work toward ending the opioid‐related overdose and death epidemic in the United States. Opioid use disorder (OUD) is a chronic and relapsing disease characterized by an overpowering desire to use opioids despite serious adverse effects, impairment, or distress. Management of OUD requires team‐based care. Pharmacists are uniquely positioned to contribute to the management of OUD in all stages and have demonstrated positive outcomes. Pharmacists are the most accessible health care professionals in community settings, and they practice in all settings across the health care continuum. However, opportunities exist to bridge the disparity between the demand for treatment and its availability. Regulatory barriers limit innovation and expansion of pharmacy services. This white paper describes pharmacists' contributions to the management of OUD and identifies opportunities to leverage pharmacists within the health care landscape to improve patient outcomes.

PURPOSE:A Patient-Activated Reliever-Triggered Inhaled Corticosteroid (PARTICS) strategy of enhancing usual care with rescue short-acting beta agonist (SABA) supplemented with inhaled corticosteroid (ICS) reduces asthma exacerbations vs. usual care alone in Black and Latinx adults with moderate-severe asthma. We investigated post-trial PARTICS usage and patient perceptions of efficacy. METHODS:PREPARE trial participants randomized to the PARTICS intervention were surveyed an average of 29 months after trial exit. RESULTS:Of 600 PARTICS-assigned PREPARE trial participants, 505 consented to future research. Fifty-two percent (262/505) completed this survey. Forty-one percent (108/262) continued using PARTICS post-trial. Of these, 97% (105/108) reported that PARTICS helped to control their asthma. Thirty-four percent (37/108) switched from the trial provided QVAR® to other ICS brands due to insurance coverage or clinician issues (e.g., unwillingness to prescribe or misunderstanding of PARTICS; 65%, 24/37). Of those who stopped using PARTICS post-trial (59% [154/262]), 62% (95/154) reported using PARTICS until the PREPARE-provided ICS inhaler ran out, and 31% (47/154) reported not knowing that their asthma care clinician could prescribe it. Only 2% (5/154) of those not using PARTICS reported that it had not been helpful for asthma. CONCLUSIONS:Continued PARTICS use was common >2 years post-trial despite minimal study instruction and was perceived as helpful for asthma, suggesting that patients will likely adopt this strategy if implemented at a healthcare system level.

PURPOSE:Acute pancreatitis (AP) is a common gastrointestinal condition that carries a significant financial and physical burden for patients due to the painful presentation and frequent need for hospitalization. Treatment varies in the type and route of analgesic used. Unmanaged pain can lead to worsening health outcomes and prolonged admissions. Further research is needed to understand current practices for managing AP. METHODS:This study was a retrospective, exploratory, single-center cohort study. Patients admitted to an internal medicine unit with AP from September 1, 2020, to December 31, 2021, were included. Our primary outcome was the change in pain scores during the first 24-hours after administration of the first pain-relieving medication. Secondary outcomes included change in pain scores within the first 12-hours, time to oral tolerance, characterization of analgesic orders, comparison of median pain scores by home analgesic usage, and specific inpatient opioid use. RESULTS:One hundred sixty-nine patients were screened, and 94 were included in the study. Forty-four patients were assigned to the multimodal cohort and 50 patients to the opioid-only cohort. Changes in pain scores per unit of time, assessed by a mixed-effects model, within the first 24 hours were -0.080 (SE, 0.018) in the multimodal cohort and -0.090 (SE, 0.014) in the opioid-only cohort (P = 0.780). Morphine milligram equivalents (MME) administered in the multimodal and opioid-only cohorts were 24.50 (interquartile range [IQR], 51.75) and 52.5 (IQR, 68.5) (P = 0.001), respectively. CONCLUSION:There was no significant difference in the change in pain scores between patients receiving multimodal therapy and those receiving opioids only. Significantly fewer MME were administered in the multimodal group, suggesting that multimodal therapy can be opioid-sparing in AP.

Introduction Studies show that medications for opioid use disorder (MOUD) reduce illicit opioid use, emergency healthcare services, opioid-related overdose, and death. However, few studies have investigated the long-term cost-effectiveness of MOUD in office-based opioid treatment (OBOT) and opioid treatment program (OTP) settings. We aimed to estimate the cost, utility, quality-adjusted life years gained (QALYs), and incremental cost-effectiveness ratios (ICERs) of three MOUD compared to each other and counseling without medication from a US healthcare sector perspective. Methods Our study developed a Markov model to conduct a cost-effectiveness analysis of counseling and three MOUD in the OBOT and OTP settings: sublingual buprenorphine/naloxone (BUPNX), buprenorphine extended-release (XR-BUP) injection, and oral methadone. The model included five health states representing combinations of receiving or off treatment while either using or not actively using illicit opioids, and death. The cycle length was one month; the time-horizon was ten years. The study obtained model inputs from systematic reviews of published literature and public data. A 3 % annual discount rate was applied to cost and utility calculation. The primary outcomes included total costs, life-years (LYs), QALYs, and ICERs. We also conducted a scenario analysis using a hypothetical OBOT outpatient setting with methadone. Results In the base-case OBOT setting, the total costs and QALYs, respectively, were counseling $22,848, 5.60; BUPNX $29,875, 5.82; and XR-BUP $63,936, 5.87. ICERs were $32,345/QALY (BUPNX vs. counseling) and $625,858/QALY (XR-BUP vs BUPNX). In the OTP setting, the total costs of counseling, methadone, BUPNX, and XR-BUP were $20,124, $27,000, $33,500, and $75,272, respectively. QALYs of methadone were 5.86. QALYs of counseling, BUPNX, and XR-BUP remained the same as in the OBOT setting. Incremental ICERs were $26,714/QALY (methadone vs counseling) and $3,337,623/QALY (XR-BUP vs methadone). BUPNX was dominated by methadone. In the scenario analysis, BUPNX was also dominated by methadone. Conclusions Outpatient MOUD resulted in important gains in quality of life and life expectancy. In both OBOT and OTP settings, XR-BUP was not cost-effective. BUPNX was cost-effective in the OBOT setting, while it was dominated by methadone in the OTP setting. The cost-effectiveness of BUPNX and XR-BUP could be enhanced if the costs of these medications were reduced. Abbreviations: BUPNX (Buprenorphine/naloxone), CMS (Centers for Medicare and Medicaid services), CPT (Current procedural terminology), ED (Emergency department), FDA (Food and Drug Administration), ICER (Incremental cost-effectiveness ratios), LY (Life year), MOUD (Medications for opioid use disorder), MTD (Methadone), PSA (Probabilistic sensitivity analysis), OTP (Opioid treatment program), OUD (Opioid use disorder), OWSA (One-way sensitivity analysis), QALY (Quality-adjusted life years gained), SAMHSA (Substance abuse and mental health services administration), SUD (Substance use disorder), US (United States), WAC (Wholesale acquisition cost), WTP (Willingness-to-pay), XR-BUP (Extended-release buprenorphine), XR-NTX (Extended-release naltrexone)

Opioid analgesics are often overprescribed after orthopedic procedures. Several strategies have been implemented nationally to curb opioid overprescription with modest success. At an institutional level, one novel idea is to implement surgery‐specific guidelines limiting opioid quantities prescribed postoperatively.

Movement from one care setting to another is a critical junction that makes patients vulnerable to suboptimal medication-related outcomes. Medication optimization after hospital discharge is an essential component of an ideal care transition. When medication information is not communicated effectively, errors can occur. Further, medication-related problems can be mitigated if identified early and addressed. Dedicated efforts for improving transitions of care (TOC), including attention to medications, have been trending for years. Pharmacists are key health professionals to help identify and prevent medication-related problems, reduce readmissions, and improve patient satisfaction during care transitions. Anytime medications are involved, patients undergoing a TOC should have a pharmacist's expertise to assist with medication optimization. Clinical pharmacy draws upon unique knowledge, experience, and perspective to optimize medication-use outcomes through a patientcentered lens. Pharmacists, in any setting where direct patient care is provided, must practice clinical pharmacy, improve patient medication outcomes, and help reduce error and risk. Attention to medication use during TOC is a ubiquitous consideration in all patient care settings. Although pharmacists are ideal for providing these TOC services, it is not feasible everywhere. Competing job responsibilities, a lack of direct compensation, limitations communicating within and in between health care settings, and challenges developing clear interprofessional collaborations are just some of the barriers for pharmacy service integration for TOC. Who then can help the profession further demonstrate our role in TOC? Pharmacy trainees, such as pharmacy students or residents, help pharmacists accomplish their job duties by performing specific, supervised tasks while utilizing a clinical opportunity to learn. Pharmacistdirected discharge education services, like the one reported by Gonzalez and colleagues in this issue of JACCP, show that pharmacy trainee extenders can help deliver vital education services, leveraging a pharmacist's capabilities for medication optimization. The discharge education provided by students helped patients identify medication errors that could lead to problems while maintaining high levels of patient satisfaction with neither a compromise in 30-day readmission rates nor additional costs to the hospital or department. Further, it fits within an interprofessional system involving nurse-directed discharge counseling and a clinic-based follow-up education by a pharmacist to help form a safe bridge for the patient to transition from inpatient to outpatient care. Programs that leverage pharmacy trainee extenders such as these may find it more feasible for pharmacists to maintain a clinical service on their own and free up the pharmacist's time to develop other services. In addition, pharmacist trainee-driven TOC program can provide practice experience aligned with their clinical pharmacy education objectives. Entrustable professional activities (EPAs) are descriptors of the work of a profession and can be used in the workplace to assess learner's ability to perform the tasks of that profession and practice readiness. An EPA framework also provides a road map for their progression in practice. While the American Association of Colleges of Pharmacy list of core EPAs for pharmacy graduates does not explicitly denote TOC as an entrustable task, critical components of effective medication optimization in TOC are defined and support the need for preparing future pharmacists to offer TOC services in multiple pharmacy settings. Specifically, transition components of collaborating with interprofessional team members, maximizing appropriate medication use, and educating patients are core pharmacy EPAs, among others, supporting TOC in pharmacy practice. For pharmacy residents, who should be performing these EPAs at a higher level of competence, TOC provides a unique opportunity for layered learning and practice, where the resident can supervise a pharmacy student. Deliberate, hands-on experiences through clinical rotation or extracurricular experiences can improve a trainee's confidence and competence, help achieve practice readiness, and engrain TOC into their view of what a pharmacist does within pharmacy practice. Clinical pharmacists using trainee extenders must provide training and ensure service excellence and consistency as the revolving door of students and residents constantly spin. Pharmacists planning to start new TOC services should coordinate with current programs, incorporate trainees into them for more continuous service provision, ensure consistent messaging, and avoid inundating patients/ caregivers with visitors, calls, and appointments. Pharmacists should also consult previously successful examples and consider measuring valuable outcomes. Building TOC programs around pharmacy trainees may not be feasible in all practice locations due to scarcity or competing duties. Pharmacists may consider pharmacy technicians as pharmacy extenders in settings where there is limited pharmacy trainee availability or to increase continuity across learners. Health information technology (HIT) can also be considered as an extender since it can help pharmacists improve TOC without the need for direct involvement or minimal additional time. Electronic health records assist with communication between care team members, with patients/caregivers, and between settings including ones that do not typically have access to medical records such as community pharmacies or long-term care facilities. Electronic communication through Received: 14 November 2021 Accepted: 18 November 2021

Efforts to reduce the disproportionate asthma morbidity in African American/Black (AA/B) and Hispanic/Latinx (H/L) patients have been mostly unsuccessful. In a pragmatic, randomized study, we tested a Patient-Activated Reliever-Triggered Inhaled Corticosteroid (ICS) Strategy (PARTICS) in 1201 AA/B and H/L patients with moderate-to-severe asthma. PREPARE compared the addition of PARTICS [concomitant use of study-provided ICS (beclomethasone dipropionate 80 mcg) with reliever] to usual care (UC) (PARTICS+UC) with UC in 603 AA/B and 598 H/L adults (18–75 years old) who had an Asthma Control Test (ACT) <20 or an exacerbation in the past year (NCT02995733). UC continued at physician discretion. The primary endpoint was verified severe asthma exacerbations. Patients had one instructional visit followed by 15 monthly questionnaires. PARTICS+UC reduced severe asthma exacerbations by 15.4% (p=0.048) which corresponded to a reduction of 13 exacerbations/100 patient-years. PARTICS+UC improved ACT scores by 3.37 vs. 2.53 points from baseline (p<0.0001). ACT scores improved by ≥3 points from baseline during 11.8% more study months for patients assigned to PARTICS+UC versus UC (p=0.006). Asthma Symptom Utility Index (ASUI) scores improved by 0.12 versus 0.08 points (p<0.0001). The annualized rate of days missed of work/school/usual activities was reduced by 3.33 days/year (p=0.013). The total additional ICS use in PARTICS+UC was 1.3 refills/year. A patient-centered, one-time instruction in PARTICS, resulting in minimal additional ICS use, substantially reduces asthma exacerbations and improves asthma control and quality of life in AA/B and H/L adults with poorly controlled asthma.

BACKGROUND Black and Latinx patients bear a disproportionate burden of asthma. Efforts to reduce the disproportionate morbidity have been mostly unsuccessful, and guideline recommendations have not been based on studies in these populations. METHODS In this pragmatic, open-label trial, we randomly assigned Black and Latinx adults with moderate-to-severe asthma to use a patient-activated, reliever-triggered inhaled glucocorticoid strategy (beclomethasone dipropionate, 80 μg) plus usual care (intervention) or to continue usual care. Participants had one instructional visit followed by 15 monthly questionnaires. The primary end point was the annualized rate of severe asthma exacerbations. Secondary end points included monthly asthma control as measured with the Asthma Control Test (ACT; range, 5 [poor] to 25 [complete control]), quality of life as measured with the Asthma Symptom Utility Index (ASUI; range, 0 to 1, with lower scores indicating greater impairment), and participant-reported missed days of work, school, or usual activities. Safety was also assessed. RESULTS Of 1201 adults (603 Black and 598 Latinx), 600 were assigned to the intervention group and 601 to the usual-care group. The annualized rate of severe asthma exacerbations was 0.69 (95% confidence interval [CI], 0.61 to 0.78) in the intervention group and 0.82 (95% CI 0.73 to 0.92) in the usual-care group (hazard ratio, 0.85; 95% CI, 0.72 to 0.999; P = 0.048). ACT scores increased by 3.4 points (95% CI 3.1 to 3.6) in the intervention group and by 2.5 points (95% CI, 2.3 to 2.8) in the usual-care group (difference, 0.9; 95% CI, 0.5 to 1.2); ASUI scores increased by 0.12 points (95% CI, 0.11 to 0.13) and 0.08 points (95% CI, 0.07 to 0.09), respectively (difference, 0.04; 95% CI, 0.02 to 0.05). The annualized rate of missed days was 13.4 in the intervention group and 16.8 in the usual-care group (rate ratio, 0.80; 95% CI, 0.67 to 0.95). Serious adverse events occurred in 12.2% of the participants, with an even distribution between the groups. CONCLUSIONS Among Black and Latinx adults with moderate-to-severe asthma, provision of an inhaled glucocorticoid and one-time instruction on its use, added to usual care, led to a lower rate of severe asthma exacerbations. (Funded by the Patient-Centered Outcomes Research Institute and others; PREPARE ClinicalTrials.gov number, NCT02995733.).

Patients moving between health care settings or providers are at increased risk of complications, including unplanned hospital readmissions and medication errors. Several actions must occur in concert with members of the health care team and across settings to ensure coordinated and continuous care for patients undergoing these transitions of care (TOC). Clinical pharmacists support patients during care transitions by providing interventions and services designed to improve medication outcomes. Clinical pharmacists and team members who support clinical pharmacist activities (eg, pharmacy students, technicians, and residents) are located throughout the care continuum, from acute care to care in the community, with each contributing to improved TOC outcomes. This article provides information on evidence of high‐impact clinical pharmacist TOC practices to serve as a practical guide for practitioners interested in starting or improving TOC activities. This article also addresses current and emerging best practices and offers suggestions for improving clinical pharmacist involvement in care transition activities.

Competency standards in pharmacy education and training have been formulated by different organizations to focus on various stages in the development of students, residents, and clinical pharmacists. This commentary advocates a deliberate alignment of educational outcomes, goals, and competencies across the developmental continuum of students, residents, and pharmacy practitioners. Consistent use of terminology and appropriate sequencing of expectations will help develop pharmacists who can meet the demands of the profession in the changing health care landscape. Progressive development is needed for the pharmacist's abilities, from student to resident to new practitioner to experienced professional. Consistency will ensure that educational and training programs optimally prepare individuals for board certification and professional roles. Specific recommendations include developing a common taxonomy that aligns within the pharmacy profession and across health care professions.

ObjectiveTo identify the proportion of viral acute upper respiratory tract infections (AURTI) inappropriately treated with antibiotics before and after the implementation of a multimodal outpatient antibiotic stewardship initiative in a real-world setting. DesignPre-post, quasi-experimental study. PatientsAdult patients with a diagnosis of either acute bronchitis, influenza, unspecified viral infection, or unspecified AURTI who visited internal medicine (IM) or family medicine (FM) ambulatory care clinics at an urban, academic health system in 2016 and 2017. InterventionsProvider education including the dissemination of an institutional guideline and algorithm for the treatment of AURTI occurred in FM and IM clinics. In the FM clinics, a roundtable discussion with clinicians promoting safe and appropriate antibiotic prescribing was conducted, and patient-facing educational posters were placed in exam rooms and clinic waiting areas describing the FM teams' commitment to using antibiotics only when necessary. ResultsA total of 2817 patient encounters met study inclusion criteria. In total, inappropriate antibiotic prescribing had a relative decrease of 24% after implementation of the interventions (17.2% [235/1362] preintervention vs 13.1% [191/1455] postintervention; P = .02). During the preintervention period, 25.4% (143/563) of the encounters in the IM clinics were associated with inappropriate antibiotic prescribing compared with 19% (108/568) in the postintervention period (P < .01). Relative to the IM clinics, the FM clinics had a lower proportion of encounters associated with inappropriate antibiotic prescribing at baseline. In FM clinics, 11.5% (92/799) of encounters were associated with inappropriate antibiotic prescribing during the preintervention period compared with 9.4% (83/887) during the postintervention period (P = .15). ConclusionsSimple educational interventions may decrease inappropriate antibiotic prescribing for AURTIs in outpatient settings. In addition, the incremental benefit of patient-facing education may be limited outside of randomized studies or in settings with low baseline antibiotic prescribing rates for AURTIs. Therefore, additional studies outside of randomized trials are needed.

BACKGROUND:Asthma prevalence, morbidity, and mortality disproportionately impact African American/Black (AA/B) and Hispanic/Latinx (H/L) communities. Adherence to daily inhaled corticosteroid (ICS), recommended by asthma guidelines in all but the mildest cases of asthma, is generally poor. As-needed ICS has shown promise as a patient-empowering asthma management strategy, but it has not been rigorously studied in AA/B or H/L patients or in a real-world setting. Design and Aim The PeRson EmPowered Asthma RElief (PREPARE) Study is a randomized, open-label, pragmatic study which aims to assess whether a patient-guided, reliever-triggered ICS strategy called PARTICS (Patient-Activated Reliever-Triggered Inhaled CorticoSteroid) can improve asthma outcomes in AA/B and H/L adult patient populations. In designing and implementing the study, the PREPARE research team has relied heavily on advice from AA/B and H/L Patient Partners and other stakeholders. Methods PREPARE is enrolling 1200 adult participants (600 AA/Bs, 600H/Ls) with asthma. Participants are randomized to PARTICS + Usual Care (intervention) versus Usual Care (control). Following a single in-person enrollment visit, participants complete monthly questionnaires for 15 months. The primary endpoint is annualized asthma exacerbation rate. Secondary endpoints include asthma control; preference-based quality of life; and days lost from work, school, or usual activities. Discussion The PREPARE study features a pragmatic design allowing for the real-world assessment of a patient-centered, reliever-triggered ICS strategy in AA/B and H/L patients. Outcomes of this study have the potential to offer powerful evidence supporting PARTICS as an effective asthma management strategy in patient populations that suffer disproportionately from asthma morbidity and mortality.

The opioid crisis represents one of the largest failures of our current health care system as it continues to claim lives at an unprecedented rate and has caused a devastating range of preventable morbidity. Although the availability of highly potent synthetic opioids has amplified the urgency of the crisis for patients and communities, this problem has evolved over several decades. Pharmacists are in a position to offer many potential solutions due to their widespread accessibility, extensive drug knowledge, and integration into various health care settings. This opinion paper challenges the status quo by calling on all pharmacists to embrace evidence‐based opioid stewardship and harm reduction practices, contribute to the medical management of opioid use disorder, and address the misconceptions and prejudices that serve as barriers to effective, compassionate patient care. Regardless of practice setting or available resources, pharmacists can take deliberate and impactful steps to address the opioid crisis. Some pharmacists may be positioned to implement innovative and far‐reaching pharmacist‐led clinical services, while others may simply begin with careful consideration of the language they use when speaking to and about patients with substance use disorders. To optimize patient outcomes, the ineffective laws, regulations, and policies that negatively impact pain and addiction care must be addressed so that evidence‐based solutions can be widely disseminated. Pharmacists must aggressively advocate for the removal of barriers preventing high‐level clinical practice or policies that perpetuate patient harm and abandonment. Finally, there must be support for continued research on pain and opioid use disorder treatments and services, as well as the impacts of harm reduction practices and pharmacist‐led clinical services, so that resources can be allocated effectively.

Overactive bladder (OAB) affects adults of all ages. The risk for medication-related adverse events (AEs) may differ between age groups, given age-related changes in pharmacokinetics and pharmacodynamics. No previous study has differentiated the risk of AEs between older and non-older adults with OAB. Our objective was to assess the risk of AEs and treatment discontinuations between older and non-older adults with OAB initiated on an antimuscarinic. We searched MEDLINE (PubMed interface), Embase, SCOPUS, and Cochrane Central Register for Controlled Trials in a previous analysis in February 2015 and repeated the search in August 2018, with no additional studies identified. Studies that delineated AEs or treatment discontinuations between the older and non-older (age <65 years) subjects were included. Six studies that made nine comparisons between older and non-older subjects met the inclusion criteria. The AEs of dry mouth (46.7%), constipation (10.3%), and headache (7.7%) were most frequently reported. Older subjects were more likely to experience dry mouth (relative risk [RR] 1.09; 95% confidence interval [CI] 1.00–1.19), constipation (RR 1.92; 95% CI 1.52–2.43), dizziness (RR 2.37; 95% CI 1.21–4.62), and urinary retention (RR 4.17; 95% CI 1.76–9.89) than were non-older subjects. Headache was less likely to occur in older subjects (RR 0.58; 95% CI 0.40–0.86). Treatment discontinuations due to AEs were more likely to occur in the older subjects (RR 1.59; 95% CI 1.20–2.11). Treatment of OAB with antimuscarinics in the older population resulted in significantly higher rates of AEs, barring headache, when compared with non-older subjects.

Acute upper respiratory tract infections (URI) result in significant outpatient antimicrobial prescriptions and are targets for antimicrobial stewardship efforts given they are often of viral origin. Our objective was to evaluate the impact of educational antimicrobial stewardship initiatives on the proportion of URI treated with antibiotics in a large, ambulatory setting that included Internal Medicine and Family Medicine clinics. This quasi-experimental pre–post intervention study evaluated antibiotic prescribing for URI from January 1, 2016 to December 31, 2017. The calendar year 2016 was considered the preintervention time period. The stewardship interventions were implemented in December 2016 and included practitioner education on URI treatment guidelines (education) and commitment to safe antibiotic use posters displayed in patient rooms and clinic waiting areas (poster). Education was provided in both clinics whereas posters were displayed only in the family medicine clinic. ICD-10 codes were used to identify cases, excluding patients with COPD. The primary endpoint was the proportion of patient visits for URI where antibiotics were prescribed for the treatment of acute bronchitis, influenza, and unspecified viral infection collectively. There were 1,533 encounters preintervention and 1,479 postintervention. In the internal medicine clinic (education only), the rate of antibiotics prescribed for all URI diagnoses preintervention was 24.5% vs. 19.0% post (P = 0.022). In the family medicine clinic (education + poster), the antibiotic prescribing rate for all URI diagnoses preintervention was 11.0% vs. 9.4% post (P = 0.242). The overall rate of antibiotics prescribed for all clinics was 16.6% preintervention vs. 13.0% postintervention (P = 0.009). The educational and antimicrobial stewardship initiatives implemented in these outpatient clinics may have contributed to a significantly reduced rate of inappropriately prescribed antibiotics for URI in the internal medicine clinic and both clinics overall. The addition of the poster was not associated with a significant change in practice. However, these results demonstrate the potential utility of the educational initiative, and that stewardship strategies may have a different impact by clinic setting. All authors: No reported disclosures.

Acute respiratory tract infections (RTI), such as sinusitis, pharyngitis, and bronchitis, generate a significant number of outpatient prescriptions and are targets for antibiotic stewardship efforts because they are typically of viral origin and self-limited. The objective of this study is to identify current antibiotic prescribing practices for RTI in a large, outpatient, ambulatory care setting. This retrospective, single-center, cohort study was designed to identify the proportion of antibiotics prescribed for the treatment of RTI, during ambulatory care visits for patients >18 years in an urban, public, academic medical center from 11/1/2014 to 7/31/2016. ICD-9/-10 codes were used to identify cases. The primary endpoint was the proportion of antibiotics prescribed for the treatment of acute sinusitis, pharyngitis, and bronchitis. Secondary endpoints included: antibiotic agent classes and Clostridium difficile infection (CDI) within 90 days post-antibiotic prescription. Additional data regarding patient demographics, medical history, allergies, antibiotic dosing and course, and prescriber information were collected. For acute bronchitis, 142/345 (41%) encounters were associated with an antibiotic, mostly azithromycin (84.5%). For acute sinusitis, 511/988 (52%) encounters were associated with an antibiotic, mostly amoxicillin-clavulanate (52%). For acute pharyngitis, 271/1038 (26%) encounters were associated with an antibiotic, mostly penicillin VK (45%). Seasonality in prescribing rates were observed. There were three cases of CDI within 90 days of an antibiotic prescription, one following azithromycin use for bronchitis and two following amoxicillin-clavulanate use for sinusitis. A significant number of visits for RTI could benefit from antibiotic stewardship interventions. Antibiotic prescribing for acute bronchitis is never clinically appropriate. Furthermore, prescribing rates for acute sinusitis and pharyngitis were much higher than the expected appropriate rate based on national epidemiologic data. These local prescribing data can be used to direct patient and provider education and to provide a baseline to measure the effect of stewardship interventions. Acute Respiratory Tract Infections Prescribing Rates. All authors: No reported disclosures.

Introduction: Perspectives from faculty regarding team-based learning (TBL) are not well understood. Previous studies describe faculty preference for TBL due to increased student interaction despite requiring increased time for design. The perception of changes in faculty workload over multiple semesters has not been measured. This research evaluates faculty workload and perceived student engagement after implementing TBL in a required non-prescription medication course over multiple semesters. Methods: TBL was implemented in the non-prescription medication course and continued for three consecutive semesters. Faculty members' perception of TBL was captured using an anonymous survey. The survey was an 11 item questionnaire with five Likert-type response options to identify changes in workload, training, and student interaction using TBL. Results: Twenty-eight total responses were collected from 10 faculty members who taught in at least one of the four semesters. Results were aggregated based on the number of semesters faculty continually taught in the course. More respondents agreed than disagreed that participation from and interactions with students increased with the TBL course compared to traditional lectures. However, more respondents believed the TBL course approach was more difficult and reported increased workload in the initial semester taught. Enjoyment of teaching increased for a majority of respondents. Discussion and conclusions: This is the first study to explore the impact of TBL implementation over multiple semesters. These data can be used to help implement TBL in pharmacy school curricula.