2025 Southeastern Residency Conference

Title: Impact of Educational Sources on Patient Knowledge and Confidence with Compounded Medications 
 
Author: Kayla Garris 
 
Objective: The primary objective of this study is to determine how the source of education about compounded medications influences patient confidence and knowledge in compounded medications. 
 
Self-Assessment Question: Do patients feel more confident in their compounded medications after receiving information from their healthcare provider or pharmacist? 
 
Background: Compounded medications account for 1% to 3% of all written prescriptions in the United States. For example, patients with allergies to certain dyes, diluents, binding agents or other inactive ingredients may not be able to tolerate commercially available products. For patients who are unable to take commercially available medications, compounding pharmacies across the United States have been able to fill in the gaps to help provide customized prescriptions. The decision to utilize compounded medication is not solely driven by pharmacists as physicians and patients are essential in the conversation about the use of compounds. Physicians must have a basic understanding of the risks and benefits associated with compounded medications to guide therapeutic decision making and advise their patients. While compounded medications are able to fill in gaps for medically necessary alternatives to commercially available medications, it is important to ensure that patients are knowledgeable about their compounds. The purpose of this study is to assess how the source of education about compounds influences patient confidence and knowledge in compounded medications.  
 

Title: Compounded Medications: Understanding Who Drives the Conversation in Clinical Practice 
 
Author: Katherine Moutis 
 
Practice Site: Innovation Compounding  
 
BACKGROUND: According to Alliance for Pharmacy Compounding, approximately 1-3% of all prescriptions written in the United States are compounded medications. Compounded medications are individualized preparations for patients not achieving therapeutic goals with commercially available FDA-approved medications. The process for obtaining a prescription for a compounded preparation starts in the provider’s office. If a compounded medication is deemed appropriate, the healthcare provider will write a prescription specifying the active ingredients, dose, route of administration, dosage form, and dosing interval. A licensed pharmacist then prepares the medication to these specifications. Through the use of shared decision making, the provider or the patient may initiate the conversation for considering the use of a compounded medication. There is currently no data published on who initiates this conversation. The purpose of this study was to identify if patients or providers are more likely to initiate the conversation for considering the use of a compounded medication and determine if there is a difference in perceptions of who initiates this conversation. 
 
METHODS: Surveys were emailed to providers who had prescribed compounded medications and patients who had obtained compounded medications through one of the  16 pharmacies within the Revelation Pharma network since August of 2023.  The surveys were emailed to 7,907 providers and 55,000 patients via email on October 1, 2024. The survey closed on December 1, 2024. A total of 857 (792 patients and 65 providers) responses were collected. The survey questions concerning who initiates the conversation about compounded medications were open ended. To analyze the data, all responses were examined and categorized as patient, provider, or both. Responses that did not fit into any of these categories were excluded. Responses to the survey were compared and tested using a chi-square test. P values < 0.05 were considered statistically significant. 
 
Results: For both the patient and provider surveys, 75% of responses indicated that the provider initiates the conversation about compounded medications (P = 0.951). One percent of providers and 18% of patients reported that the patient initiated the conversation about compounded medications (P = 0.003). Twenty-four percent of providers and 7% of patients reported that both the patient and the provider initiated the conversation about compounded medications (P < 0.001).  
 
Conclusions: The majority of both patients and providers reported that the providers are most commonly introducing compounded medications as a therapeutic option. This may be important when identifying audiences for education about the appropriate use of compounded medications and the availability of new compounded medications.  
 

Title: Evaluation of the Impact of Medical Billing on Documentation and Patient Outcomes in an Independent Community Pharmacy Chain


Authors: Julissa Gonzalez, Hashan Bhim, Greg Peden, Courtney E. Gamston 


Background  
Community pharmacies play a crucial role in healthcare by offering educational and clinical services in addition to the dispensing of medications. The sustainability of community pharmacies is being jeopardized with 12.8% of community pharmacies closing nationwide from 2009 to 2015. As reimbursement for dispensing medications continues to decline, pharmacies must find additional sources of revenue. As the scope of pharmacists also continues to evolve, opportunities to provide patients with more comprehensive care through clinical pharmacy services in the community setting emerge. Provision of services necessitates consistent and comprehensive documentation which is currently lacking in the community setting. The purpose of this project is to assess the impact of the introduction of medical billing on documentation of care, performed interventions, patient care outcomes and estimated cost of savings within an independent pharmacy chain. 


Methods 
This was a retrospective review analyzing service records from an independent pharmacy chain in North Alabama comparing documentation of patient care activities during the six months before and after the implementation of medical billing (January 2024 through January 2025). Interventions were classified using the Pharmaceutical Care Network Europe Foundation (PCNE) classification of drug-related problems (DRP). Encounters with patients that were cancelled or never completed were excluded. T-test analyses were used to compare the number of interventions documented pre and post introduction of medical billing.


Results
In Progress.


Conclusions
In Progress. 

TITLE: Evaluating the Access Process for Patients Transitioning from Intravenous to Subcutaneous Biologic Administration for Inflammatory Bowel Disease 
 
AUTHORS: Taylor Kissel, Miranda Kozlicki, Bridget Lynch, Josh DeClercq, Autumn Zuckerman
 
OBJECTIVE: Evaluate the medication access process and outcomes for patients with IBD referred to transition to or initiate SC vedolizumab or infliximab. 
 
SELF ASSESSMENT QUESTION:  What is the most common method of approval for patients approved to start subcutaneous vedolizumab or infliximab? A. Benefits investigation only B. PA approval only C. 1^st level appeal D. 2^nd level appeal 
 
BACKGROUND: The U.S. Food and Drug Administration (FDA) recently approved vedolizumab and infliximab for subcutaneous (SC) administration, providing patients with Inflammatory Bowel Disease (IBD) [Crohn’s Disease (CD) and Ulcerative Colitis (UC)] a convenient option to administer medication at home instead of clinic-administered intravenous (IV) infusions. SC formulations are most often covered on pharmacy insurance unlike infusions which are typically covered through medical insurance. Research is needed to evaluate the uptake and challenges associated with vedolizumab and infliximab SC formulations. 
 
METHODS: A single center, ambispective study evaluated patients with IBD with a referral to start or transition to SC vedolizumab or infliximab between September 1, 2023 and December 31, 2024. Patients were excluded if they were prescribed SC vedolizumab or infliximab from a non-Vanderbilt University Medical Center provider, lost to follow-up, or were not referred to Vanderbilt Specialty Pharmacy (VSP). Patients who used a manufacturer quickstart program or whose medication access was still ongoing as of February 18, 2025, were excluded from regression analyses. The primary outcome was time to SC formulation access. Secondary outcomes included whether patients were approved for SC therapy, method of approval for SC formulation, and number of patients not starting SC maintenance therapy after referral. Time to SC formulation access was calculated from the medication access process start date to the medication approval date, either through insurance or manufacturer. Multivariable regression analyses evaluated whether patients were approved to start SC (logistic regression) and time to approval for SC formulation (proportional odds [PO] logistic regression). Covariates of interest included: referral time (from FDA approval date of SC formulation), insurance type, remission status, referral medication, and IV status. 
 
RESULTS: Of the 274 patients referred for SC vedolizumab or infliximab, 262 were included in the study.  Exclusions were for the following reasons: 1 referred by non-VUMC provider, 2 lost to follow-up, and 9 never referred to VSP. Median age was 44 years (Interquartile range [IQR] 34 – 56); approximately half (55%) were female. Most patients were White (89%) and with commercial prescription insurance (84%). Diagnoses included CD (53%) and UC (47%) with a median disease duration of 14 years (IQR 7 – 23). Most referrals were for vedolizumab (81%), and most patients were established on IV therapy (81%). There were 32 patients still in progress or who used a manufacturer quickstart program. Of the remaining 230, most patients (n = 166, 72%) referred to SC were approved, with over half of those approvals occurring via PA (56%). Of the 166 patients approved to start therapy, 21% of patients did not start therapy (n=34/166), largely due to patient decision (47%, n =16/34). The median time to access was 10.5 days (IQR 1 – 42) with a range of 0 to 340 days. Patients with commercial pharmacy insurance were 3.4 times more likely to have a longer approval time (Odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.6 - 7.3, p = 0.001). Patients in remission at baseline and those with an infliximab referral were more likely to be approved (OR: 2.3, 95% CI: 1.04 - 5.1, p=0.041 and OR: 3.3, 95% CI 1.04 - 10.2, p=0.043). Patients with commercial pharmacy insurance were 80% less likely to be approved (OR: 0.2, 95% CI: 0.1 - 0.7, p=0.012).
 
CONCLUSIONS: Strict insurance formulary requirements, particularly in patients with commercial insurance, resulted in lengthy approval times for many patients and prevented a quarter of patients from being approved. Future studies should evaluate clinical and humanistic benefit of SC formulations. 

Title: Pharmacist-Led Interventions to Improve Medication Access to Rifaximin in the Treatment of Hepatic Encephalopathy
Author: Jenny Hollingsworth
Objective: The primary outcome will be the identification of optimal processes specialty pharmacy can utilize for the improvement of workflow to impact the time to rifaximin medication acquisition for patients. Secondary outcomes include patient barriers to starting therapy and the number of patients requiring assistance through manufacturer patient assistance programs.
Self-Assessment Question: What is one method specialty pharmacists can utilize to benefit medication acquisition to patients?
Background: The current standard of practice for monitoring adherence of rifaximin in the treatment of Hepatic Encephalopathy (HE) is lacking. This study’s purpose is to evaluate the effectiveness of community-based specialty pharmacist interventions in enhancing medication adherence and improving patient access. This study aims to identify best practices that pharmacists can employ to optimize therapeutic outcomes and support patient management of rifaximin therapy in a specialty pharmacy setting. 
Methods: Data is anonymous and does not contain patient-specific data points. This is a prospective study utilizing patients who will fill their prescription at a community-based specialty pharmacy located within a health system. Inclusion criteria for patients include those with a confirmed diagnosis of HE, a valid prescription of rifaximin as a new start, and are 18 years of age or older. Exclusion criteria for patients include contraindications to rifaximin or taking rifaximin for treatment other than HE or patients refilling rifaximin. Pharmacist-Led interventions in this study will include coordinated efforts with prescribers to aide in the prior authorization process and utilize patient assistance and copay cards for patients unable to afford rifaximin.
Data collection of these interventions will be conducted over a period of six months from March 1st to April 1st with sample size of 69 patients. Quantitative items in the data will include the number of insurance approval rates, the number of patient applications and approvals or denials for assistance, prescription refills, and the time from prescription receipt to receiving their first fill. The data will be analyzed using descriptive statistics to assess adherence rates with interventions.
Results: The number of prescriptions received throughout the data collection time period was 69. Of the 69, 62 needed prior authorizations which were completed. All 62 prior authorizations received approval with 10 of them needing patient assistance program support. The total number of patients with insurance through Medicare was 27. The total number of patients with insurance through commercial plans was 34. The total numbers of patients with insurance through Medicaid was 7. The total number of uninsured patients was 1. Regarding patient assistance program applications, 16 total applications were submitted and utilized for Medicare patients exclusively. No patient assistance programs were utilized for commercial plan patients.
Regarding time to medication acquisition, the average time from receipt of prescription to medication delivered to patient was 13.7 days. The lowest time was 0 days as represented by receipt of prescription and bedside delivery to patient within the same day upon discharge from the hospital. The longest time was 80 days. The time frame which appeared the most throughout the data collection process was 3 days.
Conclusions: By utilizing the steps outlined in the implemented process of rifaximin acquisition, a quicker medication acquisition time has been demonstrated for patients to begin optimal therapy for treatment with hepatic encephalopathy with a value of 12.5 days, thus demonstrating an improvement in workflow processes. It furthermore displays the avenues in which patients can receive medication by utilizing guided pharmacist support in prior authorizations and patient assistance programs. This study illustrates the importance of pharmacist-led interventions in the community space and showcases pharmacists’ impact on positive patient outcomes in optimization of therapy with rifaximin. 

Title: Evaluating the Impact of a Community Pharmacist-Led Blood Pressure Service to Improve Hypertension Control
Authors: Tolulope Olajide, Allyson Marsh, Megan Boothby, Catie Harper, Nicole Aldaz, Claire O’Conner
Background: 
Uncontrolled hypertension is associated with increased prevalence of major adverse cardiac events. This health disparity is thought to be largely driven by disparities in Social Drivers of Health (SDOH) in this population. In 2023 Cone Health identified a systemwide disparity between the proportion of patients identifying as Black or African American with hypertension control compared to that of the general population (69.9% vs. 74.8%). A previous cohort study in our health system found pharmacy student-led patient interactions, either in person within a community pharmacy or telephonic, were associated with a significant improvement in hypertension control. As community pharmacists are one of the most accessible healthcare professionals, pharmacist-led blood pressure screenings have the potential to positively impact blood pressure control on a broader scale. The purpose of this study is to assess the impact of community pharmacist-led blood pressure screening and education on hypertension control.
Methods:
This was a single system, multi-site, IRB-exempt, retrospective cohort study. Adults diagnosed with hypertension were included if they had a recent blood pressure reading ≥ 140/90 mmHg recorded in an ambulatory care setting. Patients were outreached via telephone or approached at their Cone Health community pharmacy. Patients that underwent telephonic outreach were recruited from an electronic medical record report that listed recent patient ambulatory blood pressure reading data taken at a Cone Health clinic. A community pharmacist, pharmacy resident, or pharmacy student under the supervision of a pharmacist led the blood pressure monitoring encounter. The pharmacist or pharmacy student led the visit by asking questions related to medication adherence, adverse effects, and at-home blood pressure monitoring. Patients were counseled on the importance of blood pressure control in preventing cardiovascular events, non-pharmacological methods of blood pressure control, and how to properly monitor their blood pressure at home. The primary outcome was a mean change in systolic and diastolic blood pressure in the overall study population. Secondary objectives included percent of African Americans and general population with BP at goal (< 140/90 mmHg), adherence to blood pressure medications (assessed by proportion of days covered), and the number of social drivers of health at risk at time of outreach.
Results: 
Between August 1 and December 31, 2024, 70 patients were included in the study. Of this cohort, 59 patients (84.3%) had a post-encounter blood pressure (BP) reading recorded. Eight patients approached the pharmacy counter for BP screenings but only 2 patients were included in the study. The mean BP was 156/92 mmHg pre-encounter and 142/84 mmHg post-encounter, with a mean within-subject change in systolic blood pressure (SBP) of -12 .4 mmHg (95% CI –19.4 to –5.5; P< 0.001) and diastolic blood pressure (DBP) of –7.4 mmHg (95% CI –11.5 to –3.4; P < 0.001). Overall, achievement of target BP goal of < 140/90 mmHg occurred in 54.2% of patients post-intervention (OR 7.8; 95% CI 2.7-30.2; p<0.001). In a subgroup analysis, BP goal was achieved post-intervention in 26 of the 52 patients identifying as Black or African American and 6 of the 7 Non-Black patients; however, this difference did not reach statistical significance (P=0.11) at this sample size.  Similarly, a trend toward greater mean within-subject reductions was observed in Non-Black compared to Black or African American participants for both SBP (-17.9 vs -11.7; P=0.57 and DBP -8.6 vs 7.3; P =0.84), but these subgroup differences were not statistically significant.
Conclusion: 
Community pharmacist-led blood pressure monitoring encounters resulted in a decrease in average blood pressure. The disparity in achievement of controlled blood pressure persisted in our study, although this difference was not found to be statistically significant. This could be due to limited time and resources to address patients’ social determinants of health.

Title: Utilization of Pharmacist Instructors in Didactic Curricula Across Graduate Healthcare Education Programs


Authors: River Medlin, Carrie Baker, Riley Bowers


Background: Pharmacology and pharmacotherapy courses are part of curricula across health science programs with a variety of strategies utilized to deliver this material including the use of pharmacists. Previous literature has examined the use of pharmacists within physician assistant (PA) programs, but is limited concerning use across graduate healthcare education programs. The purpose of this research was to describe the current utilization of pharmacists in didactic instruction among graduate healthcare education programs along with barriers to utilization.


Methods: This was a cross-sectional, descriptive survey electronically distributed to graduate healthcare education programs within the United States between October 30, 2024 and February 3, 2025. Eligible programs included accredited physician (MD, DO), physician assistant (PA), physical therapy (PT), and occupational therapy (OT) programs. The primary outcome was to compare the utilization of pharmacists as instructors within didactic curricula between accredited health profession education programs. 


Results: Contact information was collected for 903 eligible programs with emails successfully deployed to 823 programs. Of those programs, 129 (15.7%) responded.  Overall responses indicated that 74 (57.4%) programs utilized pharmacists as instructors within their curriculum. When examined by individual program type, 13/18 (72.2%) of MD/DO, 44/51 (86.3%) of PA, and 17/60 (28.3%) of PT/OT programs utilized pharmacists. The most common barrier across all disciplines was availability of qualified pharmacists, and the most influential factor in determining utilization was qualifications of pharmacists.


Conclusion: Current utilization of pharmacist instructors varies across disciplines and regions within the United States. The most influential factors for programs who utilized pharmacists and those who did not was the qualifications of pharmacists and availability of pharmacists with adequate qualifications. This emphasis on qualifications identifies an opportunity for pharmacists to better promote their expertise and capabilities as instructors as the number of pharmacists with post-graduate training, specialization, and board certifications continues to increase.

Title:
Chlamydia return rates in the ED in a community-based health system following treatment with doxycycline or azithromycin
 
Authors: 
Witney Butler
Devon Burhoe
Erica Merritt
Joseph Crosby


Background:
Sexually transmitted infections (STIs) are a major public health concern, with 1.6 million Chlamydia cases reported in 2022. Emergency Departments (EDs) play a key role in treatment, yet many patients still receive azithromycin despite CDC guidelines favoring doxycycline. Studies show doxycycline is more effective due to its sustained drug levels, while a single dose of azithromycin may be less effective in high bacterial loads or resistance. Comparing return rates between treatments, considering demographics and pharmacist follow-up, could inform hospital protocols. Logistic regression analysis may provide insights to optimize Chlamydia management and reduce ED return visits.


Methods:
This was a retrospective, observational cohort chart review that evaluated adult patients who tested positive and were treated for Chlamydia within a community-based health system and returned within 30 days after their initial visit. Patients were excluded if pregnant or tested negative for Chlamydia. A computer-generated list identified patients with a positive Chlamydia test from December 1, 2021, to August 31, 2024. Subjects were reviewed for study inclusion or exclusion based on the criteria.  Information was gathered from the subjects' electronic health records, including the prescribed antibiotic and whether they returned to the ED within 30 days for a STI complaint. If the patient was seen multiple times within the study period, there must have been at least 6 months between visits to be counted as a new study entry in the data. Patients were evaluated based on demographic characteristics including gender, sexual orientation, age, race, co-infections, insurance type, and if there was follow up by a pharmacist with a documented note in the patient’s chart. Pharmacists only contacted the patient if the test was positive and the patient was not treated correctly for Chlamydia. 


Results:
Of the 1,664 ED encounters with a positive Chlamydia test, 33 patient encounters met inclusion criteria by returning to the ED within 30 days. For comparison, a control group of 33 patients who did not return within 30 days was randomly selected. Logistic regression analysis indicated that antibiotic choice does not significantly impact 30-day return rates for patients treated for Chlamydia (p = 0.067). Logistic regression analysis also showed that ages 18-45 years old, male sex, and African American race were associated with higher odds of 30-day ED return, while having insurance reduced the odds by 46%. Compared to no antibiotics, doxycycline and azithromycin significantly reduced return odds by 76% and 61%, respectively. Co-infection with gonorrhea was also associated with lower return rates which reduced the odds by 44%.

Conclusion: 
Antibiotic selection does not appear to significantly impact 30-day ED return rates for patients with Chlamydia, suggesting it may not be a primary factor in patient return visits. More data in a larger, prospective trial is needed to determine if there is a true relationship between initial antibiotic choice and return visit to the ED. Further research should also explore adherence monitoring strategies or microbiological data to refine STI management protocols in community-based health systems.

Resident follow-up email:
butlerwi@sjchs.org

Impact of Pharmacist-Led Intervention on Maintenance Inhaler Appropriateness in COPD Exacerbations  
Kaysey Gilchrist, Emily Cooley, Taylor Wells, Danielle McGlynn, Michael Pitt
Background: Chronic Obstructive Pulmonary Disease (COPD) exacerbations are associated with worsening outcomes, including repeat hospital admissions. The Centers for Medicare and Medicaid created a Hospital Readmissions Reductions Program, which financially penalizes hospitals for excessive 30-day readmission rates of certain conditions, including COPD. Previous literature has indicated that pharmacists are uniquely positioned to identify interventions for COPD therapy optimization based on knowledge of clinical guidelines and insurance formularies. However, this study did not describe the implementation of pharmacist led transitions of care initiatives for patients with COPD. The purpose of this study was to identify the impact of pharmacist-led interventions in COPD patients prior to discharge on 30-day hospital readmission rates for COPD by evaluating appropriate maintenance inhaler therapy.
Methods: In July 2024, a new transitions of care service was implemented at Cape Fear Valley Medical Center (CFVMC) which enabled pharmacists to review patients admitted for a COPD exacerbation and send recommendations to the attending provider for optimization of maintenance inhaler regimens before discharge. Adult patients admitted to CFVMC between March 1, 2024 – June 30, 2024 (pre-intervention) and October 1, 2024 – January 31, 2025 (post-intervention) with a primary diagnosis of COPD exacerbation identified by ICD 10 and DRG diagnosis codes were retrospectively reviewed in this single-center study. The primary endpoint was to compare the percentage of patients admitted for COPD exacerbation who are discharged on appropriate maintenance inhaler therapy regimens pre- and post-pharmacist-led intervention. 
Results: A total of 146 hospital encounters were included in the study with 59 hospital encounters in the pre-intervention group and 87 hospital encounters in the post-intervention group. Of the 146 hospital encounters included in the study, 32 regimens (54%) were appropriate at discharged in the pre-intervention phase compared to 67 (77%) in the post-intervention phase (P=0.004). The rate of 30-day hospital readmissions was lower in the post-intervention group compared to the pre-intervention group (19.5% vs 37.3%; P = 0.02).
Conclusions reached to date: This study provides further evidence to confirm the positive impact of pharmacist-led interventions on the provision of guideline-directed maintenance inhaler therapy in patients with COPD prior to discharge from a community teaching hospital.