2025 Southeastern Residency Conference

Background: 
Effective communication skills are essential for pharmacy students, as they directly impact patient care and counseling quality. Traditional methods such as role-playing, simulated patients, and virtual patient interactions are commonly used in pharmacy education to enhance these skills. However, these approaches have notable limitations, including increased faculty workload, the need for trained standardized patients, and the high cost and potential technical challenges of virtual simulation software. The integration of artificial intelligence (AI) presents an innovative solution to address these challenges. The purpose of this study was to assess first-year pharmacy student confidence gains in communicating with patients using an AI chatbot in a communications course. 


Methods: 
First-year pharmacy students at the University of Georgia College of Pharmacy participated in this study. ChatGPT prompts were developed to simulate patient interactions, guiding the chatbot to engage with students as if they were patients picking up a new prescription. Embedded rubrics assessed students' soft skills, accuracy of medication counseling, and use of PRIME questions. The chatbot provided real-time feedback on strengths and areas for improvement. 
Electronic surveys measured students' confidence before and after a graded standardized patient activity. Confidence was assessed across seven domains: patient introduction, patient interviewing, use of probing questions, active listening, nonverbal communication, patient-centered education, and provision of accurate medication information. Students initially registered for ChatGPT and completed a pre-survey capturing demographics and baseline counseling confidence. They then engaged in a chatbot-guided counseling session before a week-long independent practice period. A post-survey followed the first graded standardized patient session to evaluate changes in confidence. Students had the option to use the chatbot again before a second graded encounter, after which they completed the same post-survey. Descriptive statistics analyzed demographic data, and a Wilcoxon Signed Rank Test assessed changes in confidence based on pre- and post-survey results following chatbot utilization. 


Results
A total of 145 first-year pharmacy students enrolled in the Pharmacy Intercommunications course at the University of Georgia. Of these, 117 completed all components of pre- and both post-surveys. Among pre-survey respondents (n=126), 70.3% reported pharmacy work experience, with 60.7% (n=88) having experience in a community setting. Additionally, 57% (n=72) had at least one year of work experience. Prior to the study, 62.8% had used ChatGPT, while 35.9% reported feeling comfortable using it. A Wilcoxon Sign-Rank Test indicated that median post-survey ranks for confidence across all 7 confidence domains were statistically significantly higher than the pre-survey ranks. The largest changes were seen in confidence introducing oneself to the patient and stating the purpose of the interview (Z=6.82, p<0.001), interviewing and assessing patient knowledge by using PRIME questions (Z= 6.954, p<0.001), using probing questions to clarify information (Z=6.941, p<0.001), tailoring counseling to meet patient specific needs (Z= 5.457, p<0.001), and providing complete and accurate information during the counseling session (Z= 5.19, p<0.001). A Wilcoxon Sign-Rank Test comparing confidence between the first post-survey and the second post-survey indicated that median post-survey ranks for confidence were statistically significant across all domains with the exception of confidence in the ability to demonstrate active listening (Z=0.885, p=0.376) and confidence in communicating interest and confidence through body language (Z=1.825, p=0.068).  


Conclusions
Incorporating an AI chatbot as a counseling tool in the classroom resulted in a statistically significant increase in first-year pharmacy students’ confidence when counseling a graded simulated patient. These findings highlight the potential of AI as an effective educational tool to enhance student learning.

Title: Clinical Impact of GLP-1 and GIP/GLP-1 Receptor Agonist Access Issues in a Primary Care Setting

Authors: Alexandra Cochran, Laura Schalliol, Savannah Owen, Holly Lowe, and Gabriella V Rosellini

Objective: 
The primary objective is to evaluate the percent change in HbA1c for the prescribed GLP-1 or GIP/GLP-1 receptor agonist for the treatment group compared to the control group. 
The secondary objectives are to evaluate the change in weight and BMI for the prescribed GLP-1 or GIP/GLP-1 receptor agonist for the treatment group compared to the control group and to observe the medication adjustments made to maintain glycemic control in the absence of a GLP-1 and GIP/GLP-1 receptor agonist therapy.

Self Assessment Question: What are some potential strategies to mitigate the impact of GLP-1 and GIP/GLP-1 receptor agonist access issues on patient outcomes?
A. Expanding patient assistance programs
B. Utilizing SGLT2 inhibitors or insulin as alternatives
C. Implementing clinic-based sample programs
D.  All of the above

Background: Type 2 diabetes mellitus (T2DM) is a growing global health concern that requires comprehensive management to minimize complications. The complications of T2DM, including cardiovascular disease, chronic kidney disease, neuropathy, and retinopathy, can significantly impact a patient’s quality of life and overall health outcomes. Effective management of T2DM includes not only controlling blood glucose levels but also promoting weight management. However, despite significant advancements in diabetes therapies, many patients still struggle to achieve optimal control due to barriers such as medication costs, accessibility, and adherence.
The introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide, semaglutide, dulaglutide, and exenatide, revolutionized T2DM treatment by providing both glycemic control and weight reduction. The widespread use of GLP-1 receptor agonists has led to improved health outcomes, especially in patients with comorbid cardiovascular disease, and have become a cornerstone in the management of T2DM. Moreover, the recent advent of dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist, tirzepatide, has shown significant metabolic effects as well.
Despite the efficacy of these therapies, challenges in accessing GLP-1 and GIP/GLP-1 receptor agonists have emerged as a significant issue for many patients. Medication shortages, delays in prior authorization, and high out-of-pocket costs can impede timely access to these treatments, disrupting the continuity of care. Access barriers are particularly concerning, as they can lead to periods of inadequate glycemic control. Furthermore, patients who experience these disruptions may need to rely on less effective therapies

Methods: This study is a single-center, retrospective cohort analysis that utilizes medical records accessed via the electronic health record. Medical records were screened for patients prescribed any of the studied medications between January 1, 2022, and July 31, 2024. Inclusion criteria included adult patients aged eighteen years or older and having a T2DM diagnosis. Once included, patients were further divided into a treatment group and a control group. Exclusion criteria included patients who were younger than 18 years of age, with either no follow-up documentation or a medication discontinuation due to adverse effects.
 
Results: A total of 379 patients were reviewed for this study, with 247 patients meeting the inclusion criteria. Of these, 51 patients experienced an access issue with the prescribed GLP-1 or GIP/GLP-1 receptor agonists while 196 were included but did not experience any of the studied access issues. Of the 247 patients included, the average age was 59.5 years with 49% of the patient population being male.
The average change in HbA1c was -0.42% in the treatment group and -0.75% in the control group (p = 0.2128), indicating no statistically significant difference. Similarly, the average weight change was -1.91 kg in the treatment group and -2.13 kg in the control group (p = 0.7022). BMI changes followed a comparable trend, with an average reduction of -0.7 kg/m2 in the treatment group and -0.75 kg/m2 in the control group (p = 0.812).
 
Conclusion: Access issues for GLP-1 and GIP/GLP-1 receptor agonists can lead to clinically significant changes in glycemic control, weight, and BMI in patients with T2DM. This study reinforces the need for proactive management strategies and a collaborative approach among healthcare providers to mitigate the effects of access issues on patient health outcomes. Further research is needed to explore the long-term effects of medication access interruptions, including their impact on diabetes-related complications and overall patient outcomes. Additionally, studies should investigate the efficacy of alternative therapies, such as SGLT2 inhibitors or insulin regimens, in maintaining glycemic control when GLP-1 and GIP/GLP-1 receptor agonists are unavailable.

Title: Evaluation of the Impact of a Pharmacist-led Smoking Cessation Clinic Within a Primary Care Setting


Authors: Tiffany Gilchrist, Victoria McCarthy, Zil Tyler, Regan Wilson


Objective: To evaluate the effectiveness of a pharmacist-led smoking cessation clinic over a three-year period at the Piedmont Athens Regional Clay Community Care Clinic (CCCC)

Background: Smoking cessation plays a critical role in disease prevention and can significantly improve patient health outcomes. Pharmacists can be a great resource to assist individuals with smoking cessation due to their extensive background in pharmacotherapy and easy accessibility. This retrospective study aimed to evaluate the effectiveness of a pharmacist-led smoking cessation clinic over a three-year period at the Piedmont Athens Regional Clay Community Care Clinic (CCCC). This study hypothesized that patients who establish care with a pharmacist will demonstrate higher quit rates compared to patients who do not establish care with a pharmacist.
  
Methodology: This was a single-center, retrospective chart review of adult patients with a history of cigarette smoking referred to the CCCC pharmacist-led smoking cessation clinic from July 1, 2021 to June 30, 2024. Patients interested in smoking cessation are referred to the pharmacist-led smoking cessation clinic by their primary care provider. However, some patients do not establish care despite pharmacist outreach efforts. The primary outcome of this study is the percentage of patients who successfully quit smoking. Secondary outcomes include the percentage of patients who relapsed after quitting and the percentage of patients who successfully quit after previous unsuccessful quit attempts. Pre-specified subgroup analyses were evaluated for patients who established care with a pharmacist which included time to quit, percentage of patients who adhered to pharmacotherapy if prescribed, percentage reduction of cigarettes smoked from baseline, the percentage of patients who quit after receiving medication and behavioral counseling vs percentage of patients who quit with behavioral counseling alone, and the total number of follow-up visits completed with a pharmacist in patients who quit. Data collected included current cigarette usage at each encounter, pack-year history, pharmacological agents if prescribed, number of follow-up visits, reason for discharge, previous quit attempts, and if patients relapsed after quitting. Continuous data was analyzed using the Mann-Whitney U test and presented as an interquartile range (IQR) or medians. Categorical data was analyzed using the Chi-Square test and presented as percentages or numbers. Statistical significance was met for the primary and secondary outcomes of the study if the p < 0.05. 
  
Results: A total of 171 eligible patient referrals were reviewed, with 150 patients meeting the inclusion criteria. Baseline characteristics were similar between groups, with an average age of 53.5 years and 51.5% male patients. Among the 75 patients who did not establish care with a pharmacist, 67 (89%) did not receive smoking cessation pharmacotherapy. In the intervention group, the most commonly utilized pharmacotherapy was nicotine replacement therapy, prescribed in 54.6% of cases. The primary outcome—patients who quit smoking—was achieved in 14.7% of patients managed through the pharmacist-led smoking cessation clinic, compared to 1.3% of patients who did not establish care (p = 0.003). For secondary endpoints, there was a significant difference in patients who quit smoking after previous unsuccessful quit attempts (13.3% vs. 0%, p = 0.02). No significant difference in patients who relapsed after quitting was found between both groups (5.3% vs. 0%, p = 0.46).
  
Conclusions: In conclusion, patients who established care with a pharmacist had a statistically significant improvement in successful smoking cessation. 

Title: Evaluation of a Pharmacist-Led Cardiovascular-Kidney-Metabolic (CKM) Initiative 


Objective: To evaluate the impact of a pharmacist-led cardiovascular-kidney-metabolic (CKM) initiative to assist in early detection in management of CKD to slow disease progression and prevent cardiovascular disease. 


Background: In 2023, the American Heart Association (AHA) published a presidential advisory on Cardiovascular- Kidney-Metabolic (CKM) Health, which defines CKM syndrome as a health disorder attributable to connections among obesity, diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD), including heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral artery disease. The AHA recommends that patients be screened across their life span with the main aim to reduce the risk of CKD progression and prevent associated cardiovascular outcomes. This wholistic approach includes patient-centered pharmacologic and nonpharmacologic therapy which may include treatment of obesity, diabetes, hypertension, hyperlipidemia, and CKD to reduce cardiovascular disease risk factors. In order to slow progression and prevent associated adverse outcomes of CKM, it requires an interdisciplinary team of nephrology, cardiology, endocrinology, and primary care. However, there are barriers to this wholistic approach which include provider difficulty managing risk factors, provider concerns about adverse drug reactions , patient acceptance, affordability of treatment, and lack of comprehensive integrated clinical information systems. The inclusion of a clinical pharmacist in this multidisciplinary team can help address these barriers to increase the number of patients on guideline-directed therapy with the ultimate goal to reduce CKD and CVD risk in CKM. Pharmacists at our institution have implemented a CKM initiative to assist in early detection in management of CKD to slow disease progression and prevent cardiovascular disease. 


Methods: A single-center retrospective chart review was conducted at Piedmont Columbus Regional Midtown Family Medicine Center and Piedmont Community Health Clinic to evaluate the impact of the pharmacist-led CKM initiative conducted between October 1, 2024, through February 28, 2025. The study included patients screened by clinical pharmacists at Piedmont Columbus Community Health and Piedmont Columbus Family Medicine and excluded patients on renal replacement therapies and renal transplant patients. The primary outcome was the percent of patients receiving CKM screening with an actionable recommendation by the pharmacist [obtainment of a laboratory assessment, addition of guideline directed therapy, adjustment in guideline directed therapy doses, or referral to the pharmacist managed clinic for chronic disease state management (DM, HTN, HLD, CKD, obesity management, smoking cessation)]. Secondary outcomes included percent of patients on guideline-recommended therapies for CKM pre- and post-intervention, percent of patients diagnosed with CKD through screenings, percent of patients with a positive clinical outcome, and number of medications obtained through patient assistance programs. Descriptive statistics were used to analyze the primary objective and both chi-square and descriptive statistics were used to analyze the secondary outcomes.  


Results: In progress


Conclusion: In progress

Title: Implementing a Pharmacist Driven Proton Pump Inhibitor (PPI) Deprescribing Intervention in a Veteran Patient Population
Authors: Kristin Allen, Marisa Strychalski, Kye Grooms

Background: 
Proton pump inhibitors (PPIs) are among the most commonly prescribed medications in the VA to treat acid-related stomach disorders. The American College of Gastroenterology (ACG) recommends up to an 8-week course of a PPI for symptomatic relief of gastroesophageal reflux disease (GERD). The PPI should then be tapered off and discontinued or switched to a histamine 2 receptor antagonist (H2RA) for maintenance therapy. The long-term use of PPIs can potentially lead to adverse events such as osteoporosis and bone fractures. Due to these potential long-term risk, they are also included on the American Geriatric Society (AGS) Beers Criteria for potentially inappropriate medication use in older adults. Furthermore, Veterans on long-term PPIs with a low BMI (defined as a BMI of 19 kg/m2 and lower) are at even higher risk of osteoporosis and bone fractures, as low BMI is an independent risk factor in and of itself. The purpose of this study was to limit the potentially inappropriate continuation of formulary PPIs in a geriatric Veteran patient population most vulnerable to developing or worsening osteoporosis by reducing the PPI dose, stopping the PPI, and/or switching to a formulary preferred H2RA.

Methods:  
A data query identified geriatric Veterans (>75 years old) who have an active prescription for omeprazole or pantoprazole for at least 2 years and had at least one of the following: a low BMI, a diagnosis of osteoporosis, or were on osteoporosis prevention/treatment in the last 2 years. Veterans who were deemed appropriate for intervention based on chart review were contacted by phone. Through shared decision-making, the Veteran either continued the PPI at their current dose, reduced the dose, discontinued the PPI, and/or switched to an H2RA and were then scheduled for telephone follow-up for any interventions made. The primary endpoint was the percent difference in PPI utilization following pharmacist intervention. The secondary endpoint was the difference in the total daily dose of the PPI and H2RA for all patients on therapy following pharmacist intervention. The tertiary endpoint was to determine if the results of the DEXA scans performed show new/clinically relevant findings and require intervention. Data collected also included baseline characteristics such as age, weight (in kilograms), body mass index, serum creatinine, sex, and if the patient had a DEXA scan on file with the VA. 

Results:
25 patients were contacted and 72% of patients agreed to the deprescribing intervention. The utilization of low dose PPIs and high dose PPIs decreased by 8% and 24% and the utilization of as needed famotidine and non-pharmacologic strategies increased by 24% and 8% following pharmacist intervention. In total, 20% of Veterans were able to de-escalate PPI therapy and 32% were able to successfully discontinue the PPI and switch to as needed famotidine or non-pharmacologic strategies only. The total daily dose of PPIs decreased by 370 mg and the famotidine dose increased by 120 mg in total across 25 patients. One patient was started on a non-formulary PPI due to uncontrolled GERD symptoms on the formulary agents. Three out of four DEXA scans showed osteopenia/osteoporosis and two patients were started on treatment while one was referred to Endocrinology for further management.

Conclusion:
The pharmacist driven deprescribing intervention was able to de-escalate and discontinue PPI therapy, reduce the total daily dose of PPIs, increase the total daily dose of famotidine, and initiate osteopenia/osteoporosis treatment in those with new/clinically relevant DEXA scan results which illustrates the important role pharmacist play in reducing the risk of adverse drug events and pill burden as well as improving the overall health of the geriatric Veteran patient population.

Title: Implementation of the Pharmacogenomic Testing for Veterans (PHASER) Program among High Suicide-Risk Veterans: A quality improvement project


Authors: Adirika Obiako, Christina Laird, Shari Brown, Tiffany Jagel


Objective: The primary objective of this quality improvement project is to increase testing and evaluate the impact of implementing PHASER in patients that are at a high risk of suicide who are on a mental health medication impacted by the PHASER panel.


Background: PHASER is an initiative designed to provide patients and providers access to high quality, evidence-based pharmacogenomic laboratory testing and recommendations that help optimize medication efficacy and reduce trial and error prescribing. The PHASER panel tests 15 different genes and multiple alleles that impact drug metabolism of over 73 commonly prescribed medications.


Methods: Patients flagged for a high risk for suicide have been identified from the High-Risk Flag Patient Tracking Report. Once these patients were identified, patients’ mental health medication regimen was reviewed to see if they were taking any mental health medications that were impacted by the PHASER testing panel. Patients on the high suicide risk dashboard were contacted and offered testing. Testing was ordered and scheduled for patients that were agreeable. Patients completed a one-time blood draw which was sent to a third-party testing facility where the test was performed and analyzed. Results were uploaded to patient medical records. The results highlight the type of metabolizer for each of the 15 genes and which of the 73 medications may require dose modification. Medications impacted were listed. When required, evidence-based dose adjustments were advised to prescribers based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. 


Results: 19.7% of candidates completed testing and their appointment with the pharmacogenomics pharmacist to review results for potential medication changes. Variants for cytochrome enzymes involved in pharmacogenomics influenced major depressive disorder medication metabolism were common. CYP2B6 and CYP2C19 had 53.6% variance present. CPY2D6 had 54% variance present. All of the patients included in the project had 1 of 3 cytochrome enzymes impacted and 51.3% who had 2 or more impacted. An average of 4.6 of the panel's 16 pharmacogenomic influenced major depressive disorder medications were impacted. 33.3% of patients had an actionable variant for a currently prescribed major depressive disorder medication and 20% required a pharmacogenomic guided dosage adjustment due to patient reported adverse drug event. These patients had been on their major depressive disorder medication for less than 3 months. 46.3% had been on major depressive disorder therapy for 3 months or more with no issues reported with adverse drug events or efficacy.

Conclusion: Definitive conclusions cannot be draw outside of the objective data reported, but some interesting parallels with what has been reported in the literature were noted. The literature reports Veterans carry at least 1 pharmacogenomic variant that can impact therapy decisions. We found these patients averaged 6 variants that impacted an average of 16 medications on the 73-medication panel. 1.6 of those variants were for a cytochrome enzyme involved in processing of pharmacogenomic influenced medications for major depressive disorder. Literature reports patients fail an average of 2-3 medications before finding symptom relief with depression. For 80% of the patients that completed testing this was true. These patients failed an average of 2.5 trials and this included pharmacogenomic influenced major depressive disorder medication trials only, it did not include trials for major depressive disorder medications that are not influenced by pharmacogenomics.

Title: A Dose of Change: Advancing Buprenorphine Induction Practices in the ED
Authors: Samantha Keen, Rebecca Maloney
Objective:  Final pending
Self Assessment Question: Final pending
Background: 
Opioid use disorder (OUD) continues to be one of the most pressing public health crises in the United States, claiming thousands of lives each year through overdose and contributing to a wide range of social, health, and economic burdens. Emergency departments (EDs) often serve as critical initial points of care for veterans in acute opioid-related crises, yet many leave without access to evidence-based treatment. This initiative aims to improve care quality by implementing standardized buprenorphine induction protocols in the ED, focusing on reducing barriers to treatment initiation and facilitating transitions to outpatient care. Despite the strong evidence and growing support for buprenorphine induction in the ED, our facility does not currently offer this service to veterans presenting with OUD. This gap in care is significant, as veterans who come to the ED for issues related to opioid use often leave without being connected to ongoing treatment, leading to continued cycles of misuse and repeated ED visits. Implementing standard buprenorphine induction protocols in the ED would help bridge this gap, providing veterans with immediate access to life-saving treatment and significantly improving their chances of long-term recovery.  By addressing logistical challenges, enhancing care coordination, and fostering staff engagement, the project seeks to improve patient outcomes, reduce ED recidivism, and promote continuity of care for veterans with OUD.
Methods: 
This prospective interventional cohort study will be conducted in the emergency department at the James H Quillen VA Medical Center.  The study will consist of two phases: a baseline period (pre-implementation) and an intervention period (post-implementation).  During the baseline period, data will be collected retrospectively on patients presenting with OUD to the ED and treated with standard care.  During the intervention period, a buprenorphine induction protocol with an order set will be implemented.  Education on appropriate use of the protocol will be provided to the ED mental health providers.  This intervention will be implemented as part of standard of care treatment for this quality improvement project.  Following implementation and education, this intervention will be considered standard of care for management of OUD in the ED.  Data collection for both phases will include the number of patients screened, buprenorphine inductions performed, and rates of successful outpatient referrals.   Following evaluation of the data collected, continuous monitoring of outcomes and quality metrics will occur.   Outcomes measured will be the number of patients who receive a buprenorphine prescription through the ED and referrals the SUD clinic.  
Results: In progress
Conclusions: In progress

Title: 
Pharmacist-Led Deprescribing of Inappropriately Prescribed Inhaled Corticosteroids in Veterans with Chronic Obstructive Pulmonary Disease


 Authors:
Jessica Parks, Amber Jefferson, Lauren Howard, Cassandra Warsaw


Introduction:
Chronic obstructive pulmonary disease (COPD) management consists of bronchodilators and inhaled corticosteroid (ICS). ICS use is recommended with a history of COPD hospitalizations, two or more moderate COPD exacerbation within the last two years, eosinophil (EOS) count of 300 cells/µL or higher, or if the patient is diagnosed with concomitant asthma. ICS should be considered as a last-line option due to increased risk for oral candidiasis, hoarse voice, and pneumonia. Previous studies have shown benefits of pharmacist-led clinics for the management of chronic disease states. The purpose of this quality improvement initiative was to investigate the impact of pharmacist-led deprescribing of inappropriately prescribed inhaled corticosteroids in Veterans with COPD, regardless of initial ICS-containing regimens.


Methods:
Retrospective chart reviews were completed for the initiative. A total of 123 Veterans, identified using the COPD Dashboard, were included in the review. Descriptive statistics were used for data analysis. Veterans were included if assigned to the designated primary care clinic, diagnosed with COPD, and had an active ICS prescription. A total of 54 Veterans met inclusion criteria. Charts were reviewed for an appropriate indication for ICS use. Updated pulmonary function tests (PFTs) and complete blood cell counts (CBC) were scheduled with consent. If the ICS was deemed inappropriate, then the pharmacist contacted the Veteran via telephone to provide education and utilized Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines to determine appropriate therapy. Veterans were contacted via telephone to conduct a COPD management appointment, and based on patient-specific factors, the pharmacist recommended to either discontinue or continue the ICS-containing inhaler. If an ICS was discontinued, a long-acting muscarinic antagonist (LAMA) or LAMA/long-acting bronchodilator agonist (LABA) was prescribed as alternative therapy. Interventions were documented in the electronic health record using a specified note template. Data collection occurred between July and November 2024. The project was approved by the Pharmacy and Therapeutics committee as a quality improvement initiative, which is exempt from IRB approval.


Results:
Upon examination of charts, it was noted that PFT results and CBC lab work were outdated in accordance to GOLD guidelines for COPD therapeutic management. A total of 21 Veterans obtained updated PFTs and 9 Veterans obtained updated CBC labs. There were a total of 54 Veterans that met inclusion criteria and there were a total of 33 Veterans deemed appropriate for ICS deprescribing. Overall, 76% (N=25) of Veterans agreed to ICS de-escalation.


Conclusions:
The data collected further supports the necessity of pharmacist-led clinics to ensure appropriate medications are prescribed and monitoring parameters are upheld. Additionally, pharmacist-led deprescribing of inappropriate ICS inhalers reduces the risk of adverse effects and enables pharmacists to identify patients requiring updated COPD monitoring.

Title: Impact of a Remote Continuous Glucose Monitoring Service in an Ambulatory Care Setting
Authors: Alexa Williams, Matthew Holt, Ryan Cromer, TJ Henderson, Aayush Patel
Background: Continuous glucose monitoring (CGM) offers an alternative to the traditional self- monitoring blood glucose methods. Traditional methods, which may negatively impact patient satisfaction, cannot account for glycemic excursions and hypoglycemic unawareness. CGM provides more data points to assess glycemic variation and generates an ambulatory glucose profile (AGP) which provides calculated percentages of time in range (TIR), time below range (TBR), and time above range (TAR) for glucose levels in a measured time period as well as hourly. The reported glycemic trends can be used by providers to better understand the time and frequency glucose levels are out of the recommended range and customize diabetes regimens appropriately. At the Piedmont Columbus Family Medicine Center, many patients have begun using CGMs to share data with their providers. Based on glycemic trend data, providers can make informed decisions on customizing patient-specific regimens and continue to monitor their patient’s blood glucose levels closely. The purpose of this retrospective chart review was to compare the mean difference in A1c improvement between patients managed with remote CGM and those managed without this service in a multidisciplinary family medicine practice. 
Methods: A retrospective chart review was completed of patients with diabetes at Piedmont Columbus Family Medicine Center with a baseline A1c ≥7, comparing those utilizing CGMs with those not utilizing CGMs. Improvement in A1c was determined from the baseline A1c at the beginning of the study to the final A1c level recorded for each patient. The mean difference in A1c was determined from all patients within each group and the overall improvement in A1c between the control group and the treatment group was compared. The LibreView® and Dexcom Clarity® systems were used to store patient’s blood glucose levels from their CGM to determine TIR, TBR, and TAR within various date ranges. Baseline TIR, TBR, and TAR were determined at the beginning of the study time period and then again around the time of each A1c measured for each patient. Improvement in TIR, TBR, and TAR were determined from baseline to the final values measured at the end of the study. Data was collected from patients beginning on January 1, 2024 until February 28, 2025.
Results: There was a total of 78 patients included in the study, 39 patients that utilized CGM and 39 patients that did not utilize CGM. Baseline characteristics were similar between groups, with the largest difference seen in race and diabetes type. For the primary objective of mean difference in A1c, the CGM patients had a baseline A1c of 9.3% and a final A1c of 8.1% with an average reduction of 1.2% and the non-CGM patients had a baseline A1c of 8.0% and a final A1c of 6.7% with an average reduction of 1.3%. The mean difference in A1c was not statistically significant between groups. For secondary objectives, the CGM patients had a total baseline TIR of 53.8% and a final TIR of 57.2% with an average increase of 3.3%, a total baseline TBR of 0.5% and a final TBR of 0.6% with an average increase of 0.1%, and a total baseline TAR of 45.7% and a final TAR of 42.2% with an average reduction of 3.5%. These secondary objectives were not statistically significant. There was a total of 189 pharmacy interventions, 172 in the CGM group and 17 in the non-CGM group.
Conclusion: Continuous glucose monitoring offers an alternative to traditional finger stick monitoring, providing glucose trends and reports such as the ambulatory glucose profile including detailed analysis of time in, above, and below range. The impact of A1c was similar between groups, however the duration of patient inclusion for non-CGM patients was higher, offering more time for patients to better control their diabetes. While there was not a statistically significant difference seen between groups, average A1c was improved when utilizing a CGM, which may provide a good option for patients with uncontrolled diabetes.
Contact: alexa.williams@piedmont.org

Title: A Retrospective Evaluation of an Electronic Medical Record Alert to Pharmacists on the Incidence of Inappropriate Medication Administration in Patients with Feeding Tubes 

Authors: Devin O'Brien, Rosemary Garbowski, Matthew Lane, Saumil Vaghela

Background: Medication administration is an important part of the foundation for medication safety and efficacy. Various studies have demonstrated the frequency of inappropriate administration of medications through a feeding tube. Many of these studies have shown that pharmacist interventions can positively impact the percentage of medications administered appropriately in patients with feeding tubes. Few studies have evaluated the effectiveness of a pharmacist-directed alert on the appropriate administration of medications. The purpose of this study was to evaluate the effectiveness of an electronic medical record alert to pharmacists on the incidence of inappropriate medication administration in patients with feeding tubes.  

Methods: A retrospective chart review was conducted using the electronic medical record (EMR) at an acute care community hospital. Chart reviews were conducted on patients with tube feeding (TF) orders who were admitted prior to and following implementation of the EMR alert. The pre-implementation period was between June 1, 2024 and August 31, 2024. The post-implementation period was between October 1, 2024 and December 31, 2024. A wash-out period was designated between September 1, 2024 and September 30, 2024 to ensure that all patients with a TF order triggered the alert to pharmacists in the EMR. Patients were included if they had a TF order placed and had at least one scheduled medication ordered to be administered enterally. Patients were excluded if they were covered by a service that participated in daily multidisciplinary team rounding, as the medications for these patients were individually evaluated regardless of the pharmacist-directed alert. The primary outcome for this study was the composite incidence of inappropriate medication administration and medication administration omissions in patients with feeding tubes (for example: crushed medications that should not be crushed per the package insert or a liquid administered through the feeding tube that has potential for binding to the feeding tube). The secondary outcome for this study was inappropriate administration of high risk medications. All data points collected for each patient were compiled in an electronic spreadsheet. 

Results: A total of 52 patients were included in the study, 29 in the pre-implementation group and 23 in the post-implementation group. For the primary endpoint of composite incidence of inappropriate medication administration and medication administration omissions,122 errors were found in the pre-implementation group and 71 in the post-implementation group. For the secondary outcome of inappropriate administration of high risk medications, there were zero patients in both groups. 

Conclusion: An EMR alert to pharmacists to evaluate medications in patients with feeding tubes may help to decrease the number of inappropriate medication administrations