2025 Southeastern Residency Conference

Title: Impact of Virtually Based, Pharmacist Initiated Guideline Directed Medical Therapy (GDMT) for Heart Failure with Preserved Ejection Fraction (HFpEF)
 
Authors: Samantha M. Sharpe, Jon E. Folstad, Allison E. Strain, Meghan E. Mark, Anita A. Kelkar
Salisbury Veterans Affairs Health Care System
 
Background: Heart failure (HF) is a complex clinical syndrome that is linked to significant morbidity and mortality in the United States. Heart failure is classified according to left ventricular ejection fraction (LVEF). In heart failure with preserved ejection fraction (HFpEF), the main goals of therapy are to reduce HF symptoms, increase functional capacity of the patient, and reduce hospital admissions due to HF exacerbation. Two of the GDMT classes that have shown benefit in decreasing hospitalizations due to HF and potentially reduced mortality in HFpEF – mineralocorticoid receptor antagonists (MRAs) and sodium-glucose transport 2 inhibitors (SGLT2is) – are the focus of this quality improvement project due to their ease of use and relatively short follow-up. 
At the Salisbury VA Health Care System (SVAHCS), primary care clinical pharmacy practitioners (CPPs) have begun to manage low acuity heart failure patients on a more consistent basis in recent years. A quick data query through the SVAHCS Academic Detailing HF dashboard revealed over 100 patients currently receiving virtual care at the SVAHCS (Salisbury location) with a diagnosis of HFpEF who are not receiving an MRA or an SGLT2i for which they are indicated. 
Methods: This quality improvement project will utilize the SVAHCS Academic Detailing HF dashboard to identify patients diagnosed with HFpEF who are not receiving an MRA and/or an SGLT2i. Those identified who meet the inclusion/exclusion criteria will be contacted and a virtual visit will be conducted by the clinical pharmacist, including an assessment and plan for initiation of the aforementioned GDMT for HFpEF.  The clinical pharmacist will conduct a follow-up telephone visit within 1-2 weeks of initiating the medication, and a follow-up basic metabolic panel (BMP) will be obtained as well as an assessment of tolerability made by the clinical pharmacist. 
The primary objective is to evaluate the proportion of patients with HFpEF in whom GDMT is implemented by the clinical pharmacist out of those who are candidates for GDMT initiation. The secondary objective is to evaluate the tolerability of MRA and/or SGLT2i therapy in patients with HFpEF.
Results: In progress.
Conclusion: In progress.

Title: Multidisciplinary approach to caring for women with gestational diabetes: Impact of clinical pharmacy visits on glycemic control and perinatal outcomes


Authors: Teri Templin, Brianna Novak, Lindsay M. Green, Jonathan Hughes, Joel C. Marrs


Background: 
Gestational diabetes mellitus (GDM) is a complex condition that requires frequent blood sugar monitoring and tighter glycemic control compared with a nonpregnant patient with diabetes. GDM can lead to many adverse outcomes for the mother and baby if left unmanaged. Additionally, it can leave many pregnant mothers feeling overwhelmed and confused by the abrupt changes needed in their lifestyle and medical care. Ascension Medical Partners Saint Louise Family Medicine Center has clinical pharmacists integrated into direct patient care services for co-management of long term disease states. Though clinical pharmacists play a huge role in co-managing patients with type 1 and type 2 diabetes, there is little evidence to determine the impact of clinical pharmacy services on patients with gestational diabetes. The primary objective of this study is to identify if incorporating a clinical pharmacist into the antenatal care of a patient with gestational diabetes will result in improved glycemic control and, thus, decrease the risk of adverse perinatal outcomes. The secondary objective seeks to identify if clinical pharmacy co-management improves the patient’s understanding of gestational diabetes and overall satisfaction with their care. The potential impact of this study could highlight the importance of a multidisciplinary approach as standard of care in women with gestational diabetes.


Methods:
This quality improvement project evaluates the introduction of clinical pharmacists into the routine care of obstetric patients diagnosed with gestational diabetes at the Ascension Medical Partners Saint Louise Family Medicine Center. The intervention group will be recruited from our current pregnant population from October 1, 2024 to March 30, 2025. Eligible participants will be determined based on the results of the oral glucose tolerance test between 24 to 28 weeks gestation. All patients 18 years or older and diagnosed with gestational diabetes will be counseled using a standard script discussing the details of the diagnosis, instructions for dietary modifications and measuring blood glucose values, and perinatal risks associated with GDM. All participants will be instructed to measure blood glucose four times a day (fasting and 2 hours postprandial) and maintain a log of blood glucose readings to bring to each visit. We will retrospectively compare glucose control of previous gestational diabetes patients without clinical pharmacist intervention to those who are currently undergoing standard of care in addition to co-management with clinical pharmacy. This study aims to determine if involvement of clinical pharmacy improves patient and perinatal outcomes, as well as improves patient’s understanding of their condition. Primary endpoints will include the initial oral glucose intolerance test, glucose values recorded by the patient, and perinatal outcomes. Secondary endpoints will include patient surveys completed at the first and last visit to address understanding of disease state and satisfaction with care. 


Results: In Progress


Conclusion: In Progress

Title: Medication Adherence for Diabetes (MAD) Quality Measure and Correlation to A1c and Other Diabetes Measures in a Medicare Advantage Population 
Authors: Rachel Winters, Amanda Moyer, Sarah Blandy, Victoria Hetherington, and Casey Penland 
Background: The Centers for Medicare and Medicaid Services (CMS) provides financial incentives for insurance plans demonstrating high-quality care to improve patient outcomes. Medicare Advantage (MA) plan performance is assessed by nearly 40 quality measures, with diabetes care heavily represented by 5 of those measures. In accordance with ADA clinical practice guidelines, holistic care is evaluated using Diabetes Care – Eye Exams, Kidney Health Evaluation in Patients with Diabetes, and Statin Use in Persons with Diabetes. Further, Medication Adherence for Diabetes (MAD) and Diabetes Care – Blood Sugar Controlled are emphasized as triple-weighted quality measures impacting the overall star rating. The national average ratings for Medicare Advantage Prescription Drug (MA-PD) plans from 2022-2025 show a flat average pass rate of 86% four years in a row for the MAD quality measure but a steadily increasing pass rate each year (78%, 78%, 79%, 83%) for controlled blood sugar.  This leads to speculation that the MAD measure may not correlate with other positive health outcomes in diabetic patients.  
Methods: This is a retrospective cohort study including Aetna Medicare Advantage beneficiaries attributed to a Prisma Health primary care provider under contract with the inVio Health Network who indexed into the MAD and subsequent diabetes control quality measures in the 2023 measurement year. Data will be collected from January 1, 2023 to December 31, 2023. Notable exclusion criteria are those excluded from the MAD quality measure by definition (end stage renal disease, insulin use, or hospice patients). The primary endpoint is to identify the relationship between MAD performance and A1c control, comparing both the Diabetes Care – Blood Sugar Controlled quality measure and patients’ actual A1c. Secondary endpoints include the correlation between MAD and additional diabetes care quality measures including eye exams, kidney health evaluation, and statin use. Tertiary endpoints include factors affecting MAD measure performance such as low-income subsidy, dual eligibility, indexing medication class, and number of classes prescribed. 
Results: There was no statistically significant difference found between MAD pass/fail rates and the clinical definition of A1c control (<7%) (p=0.98). Statistical significance was observed between MAD and annual eye exams (EED) (p<0.05) as well as annual kidney health evaluation (KED) (p< 0.05). However, statistical significance was not observed between MAD and the HBD (p=0.31) or SUPD (p=0.30) quality measures. Most patients in this study were well-controlled on 1-2 diabetes medications with an A1c <7%.
Conclusion: In this study population, MAD performance does not impact actual A1c, the triple-weighted HBD quality measure, or the clinical definition of A1c control.

Title: Evaluating the Implementation of a Standardized Process for Nursing-Led Continuous Glucose Monitoring Patient Education for Home-Based Primary Care
 
Authors: Madison Wilson, Courtney Hines, Brittany Melville
 
Objective: Evaluate the change in nursing confidence following implementation of a standardized process for CGM education for HBPC patients
 
Self-Assessment Question: True or False? There was an increase in nursing confidence following implementation of a standardized process for initial CGM patient/caregiver education for patients in HBPC
 
Background: Continuous glucose monitoring (CGM) devices are essential tools in diabetes management. Education is critical for effective CGM use and monitoring. At the Salisbury Veterans Affairs Health Care System (SVAHCS), CGM education for Home Based Primary Care (HBPC) patients is often completed by HBPC nurses, but there is no current standardized process to guide consistent and effective CGM instruction and monitoring. This quality improvement project aims to implement a standardized process for nursing to deliver CGM education and monitoring in the home and evaluate the change in nursing confidence and documentation following this.

Methods: This quality improvement project will provide HBPC nurses education on a standardized process for CGM education, device setup, interpretation and collection of glucose data, and troubleshooting. SVAHCS HBPC patients who meet criteria for CGM implementation or those already using one, along with HBPC RNs who attend training on the standardized process for CGM education and monitoring will be included. Data collection will be completed from August 1st, 2024 and June 30th, 2025 and will include results of pre- and post-survey questionnaires, nurse documentation of initial CGM education, CGM reader results, and alert via note co-signature to Clinical Pharmacist Practitioner (CPP). The primary objective is to evaluate the change in nursing confidence following implementation of a standardized process for CGM education for HBPC patients. Secondary objectives include evaluating initial and follow-up CGM education documentation, monitoring, and CPP alerts. Descriptive statistics will be used to assess outcomes.

Results: For the primary objective, 10 RNs completed the pre-survey and 8 completed the post-survey. There was a mean increase between 0.8-2.1 in RN confidence for all 5 standardized questions. For documentation of initial CGM education, there were 2 patients with CGM education prior to RN training, 1 of which was documented and the other not being documented. Following education, there were 2 new readers started with a 100% documentation rate. There was a 14% increase in documentation of CGM reader results following education. There was a 21% increase in documentation of average BG for the past 7 days, 19% increase for the past 14 days and 39% increase for the past 30 days. For documentation of average BG based on time of day, 0% had documented this prior to the education and 25% following education. Documentation for time in target, low glucose events, sensor usage, and alert via co-signature to CPP increased post-education between 5%-44%, with sensor usage and alert of note via co-signature to CPP showing the largest increase in documentation following education.

Conclusion: Nursing confidence increased for all survey questions following implementation of a standardized process for initial CGM patient/caregiver education for patients in HBPC and RNs utilized template for CGM initial education documentation. Additionally, documentation of CGM reader results in all data points showing an increase following education. Surprisingly, there was an overall low documentation rate for low glucose events. Education session provided was effective in increasing nursing confidence for initial CGM patient/caregiver education for patients in HBPC and educational intervention increased the documentation of CGM reader results by HBPC RNs.

Title: Risk Factors related to Time in Therapeutic Range for Warfarin Patients in an Outpatient Cardiology Clinic


Authors: Anna Cooke, Ben Tabor, Marina Carter, Adam Pizzuti, Lauren Schultz


Objective: Determine which individual patient factors are associated with highter or lower time in therapeutic range related to warfarin therapy


Self-Assessment Question: Which individual patient factors correlate with a lower time in therapeutic range while on warfarin?


Background: Despite the emergence of new oral anticoagulants, warfarin remains a regularly utilized option for the prevention and treatment of venous thrombosis and thromboembolic events. While warfarin, a vitamin K antagonist, is an effective anticoagulant, it has several limitations due to its narrow therapeutic range, dose response variability, and numerous drug-drug and drug-food interactions. Therefore, to ensure optimal anticoagulation with warfarin, a patient’s international normalized ratio (INR) must be frequently monitored. Time in therapeutic range (TTR) is used to assess the percentage of time a patient on warfarin is within their target INR range, allowing clinicians to estimate a patient’s quality of anticoagulation. Certain patient characteristics exist that may lead to a higher or lower TTR while on warfarin for anticoagulation. The purpose of this study is to identify these individual risk factors in our patient population at Prisma Health to better warfarin management and help to identify those at greater risk for complications. 


Methods: This retrospective cohort study included patients aged 18 years and older on warfarin therapy for at least 30 days who were being managed by the Coumadin Clinic at Prisma Health Cardiology. To be included, patients had to have an INR goal range of 2.0-3.0 or 2.5-3.5 and have at least 3 INR values reported between November 1, 2023 and April 30, 2024 with INR values no greater than 60 days apart. The primary objective was to identify variables associated with lower or higher TTR related to warfarin therapy, such as race, warfarin indication, weight (kg), or history of thromboembolic events. The secondary objective was to determine the safety of warfarin therapy in patients with different TTR ranges. Statistical analysis will involve multivariate logistic regression and descriptive statistics.


Results: In progress


Conclusion: In progress

Title: Blood Pressure Reduction in GLP-1 RA Users in a Family Medicine Clinic  
Authors: David Mercer, PharmD; Julia Mesawich, PharmD; Tiffaney Threatt, PharmD, CDCES, BC-ADM, FADCES
Practice Site: Prisma Health-Upstate

Background:
The prevalence of hypertension has surged, with the 2017-2018 NHANES survey indicating that 45.4% of US adults over the age of 18 years old have hypertension. Hypertension is a common complication of type 2 diabetes mellitus (T2DM), and approximately 70% of those with T2DM have hypertension. Therefore, a therapy that simultaneously lowers blood pressure and blood glucose could be an ideal treatment option for patients who require comprehensive management of these conditions. Incretin-based therapy is an emerging treatment for T2DM and obesity that can stimulate insulin secretion, improve insulin resistance, and reduce body weight. While some meta-analyses have shown that patients on GLP-1 RAs experience modest blood pressure lowering, there have not been any studies that look at this as a primary endpoint. The primary objective was to determine the blood pressure lowering effect of GLP-1 RAs on systolic and diastolic blood pressure in adults within 1 year of starting a GLP-1 RA.
Methods:
This study was an observational, retrospective pre-post study of approximately 100 patients completed at Travelers Rest Family Medicine in South Carolina. Patients were identified for inclusion if they were prescribed a GLP-1 RA between 12/01/2020 and 06/01/2021, with this date range chosen to give sufficient sample size and to minimize gaps in therapy due to medication shortages.

GLP-1 RA use was defined as at least two prescriptions sent for the same GLP-1 RA, authorized on different dates, as reported within the electronic medical record. Participants were excluded if they did not have enough refills of the GLP-1 RA to last a 12-month period. Participants were also excluded if they were started on a GLP-1 RA and a blood pressure lowering medication at the same visit, if they underwent bariatric surgery during the timeframe, or became pregnant during the timeframe.
 
Clinic-measured systolic and diastolic blood pressures from baseline to one year after the initiation of GLP-1 RA therapy were collected to assess the primary endpoint. The secondary analysis includes an evaluation of the change in systolic and diastolic blood pressure from baseline to month 9-12 within the population with a diagnosis of hypertension, change in systolic and diastolic blood pressure stratified by GLP-1 RA use, and an evaluation of the change in weight from baseline to month 9-12 after GLP-1 RA initiation.  
 
Results:  
A total of 77 participants were evaluated for change in blood pressure from baseline to month 9-12 after GLP-1 RA initiation. In looking at baseline characteristics, 100% of the participants had a diagnosis of type 2 diabetes, and 80.52% had a diagnosis of hypertension. Most participants started on semaglutide injection (33.77%) or dulaglutide injection (36.36%). For the primary outcome, there was a statistically significant change in SBP from baseline to 9-12 months after GLP-1 RA initiation with a p value of <0.001. There was no statistically significant change in diastolic blood pressure within the study timeframe.  
 
Within specific GLP-1 RA medications, the only medication that had a statistically significant change in blood pressure from baseline to month 9-12 was dulaglutide injection. The lack of statistical significance within other groups may have been due to the small sample sizes. There was not a statistically significant change in weight from baseline to month 9-12 within the population. This may have been due to many not reaching maximum doses of GLP-1 RA agent.  
 
Conclusions:
From baseline to month 9-12, GLP-1 receptor agonists lowered blood pressure with statistical significance. When looking at the individual GLP-1 RAs, only dulaglutide injection had statistically significant blood pressure lowering effects. In conclusion, in someone with hypertension and another compelling indication, GLP-1 RAs may be a good option for comprehensive management of comorbidities.  
 
Contact: julia.mesawich@prismahealth.org 

Title: 
Evaluation of Insulin Requirements After Initiation of GLP-1 Receptor Agonists Versus GLP-1/GIP Receptor Agonist


Authors:

• Omar Mouna, PharmD
• Kate O’Connor, PharmD, BCACP, BC-ADM

Objective:
Determine the impact of initiating GLP-1 Receptor Agonists compared to GLP-1/GIP Receptor Agonists on total daily insulin requirements in adults with Type 2 Diabetes Mellitus after 6 months. 


Self Assessment Question:
 Does initiation of GLP-1/GIP receptor agonist therapy show statitistical significance in reducing insulin requirements at 6 months compared to initiation of GLP-1 receptor agonist therapy?


Background (168 words)
Incretin-based therapies, including GLP-1 receptor agonists (GLP-1 RAs) and the dual GLP-1/GIP receptor agonist (GLP-1/GIP RA), tirzepatide, are increasingly utilized in the management of type 2 diabetes mellitus (T2DM). These agents improve glycemic control and offer additional benefits, such as weight reduction and cardiovascular risk mitigation. For patients requiring insulin therapy, the initiation of GLP-1 RAs has demonstrated potential in reducing daily insulin requirements by enhancing endogenous insulin secretion and suppressing glucagon release. The recent introduction of tirzepatide, a dual incretin receptor agonist, has shown even greater efficacy in glycemic control and weight loss compared to traditional GLP-1 RAs in clinical trials. However, limited real-world data exist on the comparative impact of these therapies on insulin dose adjustments in patients already on insulin. Understanding the different impact of GLP-1 RAs versus GLP-1/GIP RAs on insulin requirements may guide therapy selection, optimize insulin regimens, and minimize dose-related side effects. This study aims to evaluate the impact of initiating these incretin-based therapies on daily insulin requirements in patients with T2DM.
 
 
Methods (182 words)
This was a single-center, IRB-approved, retrospective medical record review, conducted at Wellstar MCG Health’s outpatient clinics, and included adult patients 18 years and older who were initiated on incretin-based therapy while concurrently being on insulin therapy between the dates of July 1, 2022 and December 31, 2023. Patients were excluded if they had type 1 diabetes, had insulin added to their regimen after initiating incretin-based therapy, were administering sliding scale prandial insulin, or began an oral GLP-1 RA. The primary outcome assessed was percent change in total daily insulin requirement from baseline in individuals who initiated GLP-1 RAs versus GLP-1/GIP RAs after 6 months of agent initiation. Secondary outcomes evaluated changes in hemoglobin A1c (HgbA1c) between the two groups from baseline to 6 months, requirement of additional antidiabetic medications after initiation of incretin-therapy at 6 months, and percentage of patients requiring insulin discontinuation after initiation of incretin therapy at 6 months. Continuous variables were analyzed using paired T-tests while categorical variables were assessed with chi-square. Multivariable regression was used to adjust for potential confounders. Statistical significance was set at P < 0.05. 
 
Results (132 words)
A total of 130 patients were included, with 65 in each treatment group. Baseline characteristics, including age, baseline HgbA1c, weight, and total daily insulin dose, were similar between groups. At six months, individuals initiating GLP-1/GIP RA therapy experienced a significantly greater reduction in total daily insulin requirements compared to those initiating GLP-1 RA therapy (35.6% vs. 28.9%, p = 0.018). Insulin therapy was fully discontinued at 6 months in 24.6% of patients in the GLP-1/GIP RA therapy group versus 16.9% of patients in the GLP-1 RA therapy group. Five patients who initiated GLP-1/GIP RA therapy required additional antihyperglycemic agents while 7 patients in the GLP-1 RA therapy group required additional agents at 6 months. No significant difference in HgbA1c at 6 months was observed between groups (-0.81% vs. -0.84%, p = 0.91). 
 
Conclusion (97 words)
Initiation of GLP-1/GIP RA therapy resulted in a significantly greater reduction in total daily insulin requirements compared to GLP-1 RA therapy after 6 months. Additionally, a higher percentage of patients in the GLP-1/GIP RA group were able to fully discontinue insulin, while the addition of other antihyperglycemic agents was similar between groups. Despite these differences, glycemic control, as measured by HgbA1c reduction, was comparable. These findings suggest that GLP-1/GIP RA therapy may be a more effective option for reducing insulin dependence in individuals with T2DM, potentially minimizing the burden of insulin therapy and the risk of hypoglycemia. 

Title: 
Evaluation of a Medication Synchronization Program as a Tool for Identifying Patients at Increased Risk for Type 2 Diabetes  
Authors: 
Catie Tuori
Lena McDowell
Courtney E. Gamston
Kimberly Braxton Lloyd
Background:
The Centers for Disease Control and Prevention estimates that 8.7 million adults have undiagnosed diabetes, and 87.8 million adults have undiagnosed prediabetes. Delayed identification is associated with increased risk for poor outcomes, making routine screening for these conditions vital. Due to the accessibility of community pharmacists, there exists the opportunity to improve identification of undiagnosed diabetes and pre-diabetes through screening services. 
Objective: 
The purpose of this study is to assess the implementation of a community pharmacy-based diabetes risk evaluation quality improvement initiative.   
Methods: 
During a regularly scheduled medication synchronization call, patients 35 years or older without diabetes and not taking any diabetes medications were screened for diabetes risk using the American Diabetes Association “Type 2 Diabetes Risk Test.” Individuals identified at increased risk were invited to have their A1c checked during medication pickup at the pharmacy. Patients with A1c at diabetes (≥ 6.5%) or prediabetes (5.7-6.4%) levels were referred to their primary care provider for follow up or to a Diabetes Prevention Program, respectively. Patients with an A1c value within the normal range (<5.7%) were counseled on healthy lifestyle measures. The RE-AIM framework was utilized to evaluate service implementation. Reach was measured as the number of patients eligible for inclusion in the service, successfully screened, and the number and percentage that consented to A1c testing. Effectiveness outcomes include the number of patients identified at increased risk and the percentage identified at increased risk with a prediabetes- or diabetes-level A1c. Adoption was measured as the number of pharmacy staff members involved in A1c screening and qualitative evaluation of staff feedback. Implementation was measured as the percentage of eligible medication synchronization encounters that included screening and the number of staff-reported deviations from the planned implementation process. All outcomes were reported as descriptive statistics.   
Results: In Progress 

Title: Implementation and Impact Assessment of a Pharmacy Led Geriatrics Clinic


Authors: Emily Corbett, Krishna Rana, Kelly Krieger


Background: A geriatrics pharmacy clinic will be implemented as an expansion of pharmacy services to address geriatric related concerns such as dementia related medication titrations, polypharmacy, and deprescribing potentially inappropriate medications as identified by the American Geriatrics Society (AGS). The purpose of this project is to describe the interventions made and evaluate the impact of a pharmacist- led geriatrics clinic on reducing the drug burden index and increasing access to care among Veterans   ≥ 65 years old with dementia related treatment and/or polypharmacy within a Veterans Affairs (VA) Health Care System.


Methods: A pharmacist-led geriatrics telephone clinic will be implemented to assist with the medication management of dementia related medications, reduce polypharmacy, and increase access to care among Veterans enrolled in the geriatrics psychiatric clinic. Patients will be referred to the clinic by geriatric psychologists for the titration and/or monitoring of acetylcholinesterase inhibitors, N-methyl-D-aspartate receptor inhibitor, selective serotonin reuptake inhibitors, and anti-amyloid therapy. Patients will also referred by the Acute Care for the Elders inpatient pharmacist for outpatient follow up after deprescribing is initiated at hospital discharge. Additionally, patients will be referred internally for polypharmacy assessment, prior authorization drug request consults and cost saving drug conversions.


A retrospective chart review will be conducted to include all patients referred to the pharmacy geriatrics clinic  with at least one visit within a 6-month period. The primary objective is to describe the pharmacist interventions associated with implementation of the service expansion clinic. The secondary objective is to evaluate the change in a patients drug burden index score from the initial to last pharmacist visit for patients referred for polypharmacy. Lastly, the number of interim pharmacist-led visits will be used to estimate the geriatric psychologist time saved. Descriptive statistics will be utilized to describe the primary objective. Student t-test will be utilized for parametric data, while chi-square will be utilized for non-parametric data.


Results: There were a total of 31 patients enrolled in the pharmacist-led geriatrics clinic from August 12, 2024 to March 2, 2025. A total of 107 interventions were made among 80 unique visits. Patients that were referred for polypharmacy had an average of 1.85 visits per patient. Those referred from Geri-psych required an average of 2.43 visits per patient. A total of 57 medications were deprescribed. The most commonly prescribed medications were proton pump inhibitors and benzodiazepines. The average index DBI score was 2.28 and average post DBI 2.00 (-0.28, P = 0.02). The average time to first pharmacist visit from time of Geri-psych referral was 2.9 weeks with an average of 1.58 pharmacist visits between Geri-psych follow ups. 


Conclusion: The majority of referrals came from Geri-psych providers for assistance with monitoring and titrating dementia related medications. Patients referred from Geri-psych often required more visits than those referred for polypharmacy likely due to the complexity and frequently changing needs of both patients and caregivers. This project showed that pharmacists can effectively assist with deprescribing to decrease a patients drug burden index.

Title: Reducing the Risk of Hypoglycemic Events through Targeted Interventions Focused on Veterans at High Risk 


Authors:  Jessica Richardson, Blair Andreassi, Tiffany Jagel, Katrina White


Objective: Identify Veterans at high risk for hypoglycemia and evaluate the diabetes medications prescribed, focusing on medications with high hypoglycemic risk. 


Background: Hypoglycemia is a significant risk for older adults with diabetes, particularly those receiving insulin or sulfonylureas. Current guidelines from the American Diabetes Association (ADA), American Geriatrics Society (AGS), and Endocrine Society emphasize individualized glycemic targets, recommending an A1C goal of 7-8% (or higher in frail individuals) rather than intensive glucose control. Studies, including the ACCORD, ADVANCE, and VADT trials, have demonstrated that stringent glycemic control in older adults does not significantly reduce macrovascular complications but increases the risk of hypoglycemia-related harm, such as falls. The 2014 Choosing Wisely Hypoglycemic Safety Initiative (CW-HSI), which was used to identify high risk Veterans, was created to reduce the risk of hypoglycemia and to ensure Veterans have a personalized plan for blood sugar control based on their unique health goals.


Methods:This was a multi-center, prospective quality improvement project conducted within the Gulf Coast Veterans Health Care System. The CW-HSI dashboard was used to identify Veterans 65 years and older within the Gulf Coast Veterans Health Care System with a diagnosis of type 2 diabetes, a glycated hemoglobin of <6%, and prescribed a sulfonylurea and/or insulin. Veterans with type 1 diabetes and/or those who had not been seen by Veterans Affairs primary care within the past 3 years were excluded. After identification of Veteran from the dashboard, the Veteran was contacted by the pharmacist to discuss findings. During the appointment, the pharmacist focus was placed on diabetes management including medication adherence, blood glucose readings, recent hypoglycemic events, and education on the treatment of hypoglycemic events. After collection of information from the Veteran, medication modifications such as discontinuation or dose reduction was implemented. After initial appointment with pharmacist, if Veteran was deemed as needing further interventions Veteran was followed up by clinical pharmacist practitioner.  Otherwise, Veteran was followed up by their provider care clinician. Documentation of medication interventions, such as dosing modification, discontinuation, and prescribing of medications for treatment of hypoglycemic events were tracked via excel sheet to evaluate the impact of this project. The primary endpoint of the project was the frequency of medication interventions. Secondary endpoint was the number of hypoglycemic prevention medications prescribed.  All data was analyzed using descriptive statistics.


Results: A total of 112 patients meeting the inclusion criteria were identified from the CW-HSI dashboard. Of these, 41 patients were excluded due to ongoing medication modifications and elevated A1C levels, 14 patients were deceased prior to contact, and 2 patients could not be reached after multiple attempts, resulting in 55 patients being contacted. Among those contacted, 95% (52 patients) agreed to implement medication modifications. The primary interventions were the discontinuation of sulfonylureas in 22 patients (42%) and a reduction in the insulin regimen in 20 patients (38%). Additional modifications included a dose reduction of sulfonylureas in 9 patients (17%) and complete discontinuation of insulin in 1 patient (5%). Furthermore, 16 patients were prescribed a hypoglycemic treatment agent.


Conclusion: Pharmacist-led deprescribing was effective in reducing the number of Veterans on diabetes medications that are high risk hypoglycemic events, thus reducing risk hypoglycemic events.

Title: Comparing the Impact of Pharmacist Driven Care When Patients are Enrolled in a Medical Student Telehealth Clinic 


Authors: Emily Strickland, Kate O’Connor 


Objective: To determine the impact on clinical outcomes following the addition of medical student telehealth clinic encounters to patients who are followed by the internal medicine clinical pharmacist.


Self Assessment Question: True/False: Patients enrolled in the medical student telehealth clinic had a better outcome in their diabetes management than patients who were not enrolled in the medical student telehealth clinic.
 
Background: The involvement of clinical pharmacists in patient care within primary care clinics has been shown to significantly enhance clinical outcomes. Patients receiving care from clinical pharmacists often experience improved management of their chronic conditions. Similarly, medical students have demonstrated positive contributions to patient care, particularly in the management of chronic diseases. In recent years, the Medical College of Georgia (MCG) has established a student-run telehealth clinic that offers free services to eligible patients. These encounters focus on chronic disease management, fostering a hands-on learning environment for the students. Notably, some patients enrolled in this telehealth clinic are also under the care of an internal medicine (IM) clinical pharmacist. However, there is currently limited evidence examining the effects of incorporating medical students into the care of patients already managed by a clinical pharmacist. This study aims to explore the clinical impact on patient outcomes resulting from the addition of medical students to the care teams of patients who are already being followed by an IM clinical pharmacist. By investigating this collaborative approach, we hope to identify potential benefits, enhance chronic disease management strategies, and guide the future direction of the telehealth clinic at MCG and other institutions.   


Methods: A single-center retrospective chart review was conducted at Wellstar MCG Health of patients who were 18 years or older with a diagnosis of diabetes and were followed by the IM clinical pharmacist between January 1, 2023 and December 31, 2023. This study was divided into two arms, a control arm consisting of patients who followed with the IM clinical pharmacist and the intervention arm consisting of patients who were both enrolled in the telehealth clinic and followed by the IM clinical pharmacist, and were required to have at least 1 telehealth encounter between January 1, 2023 and December 31, 2023.  Patients were excluded if they were referred to the IM clinical pharmacist after enrollment in the telehealth clinic or if their HbA1c was <7% at the time of enrollment in the telehealth clinic. The primary outcome was the percent change in HbA1c from baseline to post intervention. Secondary outcomes included percent of patients with blood pressure at goal, appropriate statin use following intervention, and documentation of annual eye exam and collection of eGFR and UACR.  Statistical analysis was performed using descriptive statistics.


Results: We identified 13 unique patients who met inclusion criteria in the intervention arm and included an identical number of patients in the control arm for comparison, which resulted in analysis of 26 patients. For the primary outcome of change in HbA1c from baseline to follow up the results were a -3.2 percent change for the control arm compared to-1.8 percent change in the intervention arm. Results of the secondary outcomes included 6 patients with blood pressure at goal in the control arm compared to 9 patients in the intervention arm, which showed improvement from baseline. In both groups, all patients were on a statin or intolerance at follow up.


Conclusion: Based on the results the incorporation of medical students to care teams of patients followed by the IM clinical pharmacist provides additional benefit for chronic disease state management. The positive findings from this study support MCG's efforts to continue providing medical students with telehealth-based learning opportunities, enhance clinic functions, and improve patient outcomes. We hope the results of this can be utilized by other intuitions to grow and establish learning opportunities for medical students and improve clinical outcomes for patients.

Title:
Reducing Disparities in Blood Pressure Control Among Female Veterans with Type II Diabetes Mellitus 


Authors:
Victoria Clark, Schylar Hathaway, Marci Swanson, Deborah Hobbs
 
Objective:
Highlight the improvement in equity in hypertension control among female Veterans with diabetes via medication management.
 
Self-Assessment Question:
True/False – Per the ACC/AHA guidelines, the recommended BP target for patients with DM is less than 130/80 mmHg.
 
Background:
A majority of patients with diabetes will have a comorbidity of hypertension which increases risk of cardiovascular disease (CVD), the leading cause of death in women in the U.S. The use of antihypertensives is strongly recommended for both primary and secondary prevention of CVD. Research suggests mixed results on presence of a disparity in blood pressure control among men and women, but reveals older women are less likely to have controlled blood pressure than their male counterparts. This project aims to reduce disparities for female veterans with diabetes mellitus and uncontrolled hypertension via medication management. 


Methods:
This performance improvement project was approved by the P&T Committee. The primary objective aims to improve blood pressure control in female veterans with type II diabetes. The secondary objectives are to increase percentage of female veterans on angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, if clinically appropriate. The Primary Care Equity Dashboard (PCED) was utilized to identify disparities in blood pressure control. This dashboard was created by using electronic quality measure (eQM) data and provides VISN (Veterans Integrated Services Network) and facility level performance via a disparity matrix. A Clinical Pharmacist Practitioner (CPP) will identify veterans using the following inclusion criteria: females aged 18 to 75, presence of type II diabetes, and blood pressure greater than or equal to 140/90 mmHg at most recent outpatient encounter. The CPP will exclude those with type I diabetes, actively followed by cardiology, no history of primary care provider follow-up within 2 years, receiving hospice/palliative care services, or relocated to outside care. The Computerized Patient Record System (CPRS) was used to review veterans’ charts and determine appropriate antihypertensive therapy for blood pressure control per the 2018 ACC/AHA guidelines.


Results: In Progress


Conclusion: In Progress

Title: Evaluation of Pharmacists’ Impact on Diabetes Care Using Cloud-based Continuous Glucose Monitoring
Author’s names: William L. Kendrick, J. Lindsey Pitt, Shauntá M. Chamberlin, R Eric Heidel, Jeffrey A. Lewis, Kaitlyn P. North
Objective: Describe the effect of pharmacist-led diabetes management for patients using CGM devices linked to a cloud-based service versus those who use CGM devices incompatible to cloud services.
Self Assessment Question: True or False: there was a noticeable difference seen in the management of diabetes using cloud-based CGM devices.
Purpose: When patients share their data over cloud-based software, continuous glucose monitors allow pharmacists to assess glycemic control and make real-time therapy changes for patients participating in virtual or telehealth visits. It is hypothesized that the ability to make these changes in between primary care visits allows for faster glycemic control when compared to patients who utilize readers which are not compatible with cloud-based uploading. However, limited data is published in regard to pharmacist-led diabetes management using continuous glucose monitoring devices utilizing cloud-based services.
Methods: This retrospective cohort study assesses patients from an internal medicine residency clinic and a family medicine clinic at a tertiary academic medical center, where pharmacists have collaborative practice to manage diabetes. Patients were included if they were 18 years or older, had a diagnosis of type 1 or type 2 diabetes, and were current patients of their respective clinic. Patients were excluded if they were pregnant or lactating, if their diabetes was managed by an outside endocrinologist, or if they had not been followed by pharmacist for at least 3 months allowing for a follow-up A1C. Data collected from retrospective chart review included patient age, gender, type of diabetes, associated diabetic comorbidities, date of first and last pharmacist intervention utilizing CGM data, initial A1c, first follow-up A1c, most recent A1c since last pharmacist intervention, type of continuous glucose monitor, and ability for cloud-based monitoring. The two primary outcomes being assessed were the change from baseline A1c to first follow-up A1c, and the change from baseline A1c to most recent A1c since last pharmacist intervention. Consultation with a biostatistician revealed that the study would require at least 79 patients in each arm to achieve 80% power with an alpha of 0.05. Data was analyzed using mixed-effects ANOVA. 
Results: Between the two primary care clinics, 121 patients were reviewed for eligibility, and 49 patients were included in the study. Of the patients enrolled, median age was 55 (IQR 46-65), 20 were female (41%), 20 were enrolled in cloud-based sharing (41%), and seven had type 2 diabetes (14%). The median days between first pharmacist consult and first follow-up A1c was 107 (IQR 66-160), and the median days between first pharmacist consult and most recent A1c was 347 (IQR 206-407). Average baseline A1c for the cloud and non-cloud groups were 9.86% vs 9.92% (p=0.88) respectively, average first follow-up A1c was 8.48 vs 8.56 (p=0.85), and average A1c at most recent follow-up was 8.53 vs 8.58 (p=0.90). The most common type of pharmacist intervention performed for each patient was medication titration (100%) followed by initiating new therapies (49%) and discontinuing therapy (10%).
Conclusion: While the retrospective study did not identify enough patients to meet the pre-specified power, there was no difference in A1c reduction between the cloud-based group and the non-cloud-based group found in the limited number of patients analyzed. Average A1c reduction of -1.4% at first follow-up A1c and -1.3% at most recent A1c for both pharmacist-managed groups. Limitations include variability in pharmacist coverage between the two clinics, poor social determinants of health in the patient population, and lack of timely cloud enrollment. Benefit incurred with cloud-based CGM utilization may come in the form of increased workflow productivity instead of directly from improved patient glycemic control.

Title: Pillars of Care: Impact of a Heart Failure Pharmacist on Optimization of Guideline Directed Medical Therapy


Authors: Christopher J. Rogers, Lindsey Pitt, Laura Bullock, Muddassir Mehmood 


Objective: Evaluate the impact clinical pharmacists have on titrating guideline directed medical therapy and their benefits to health systems.


Self Assessment Question: True of False: Heart failure pharmacists have a stastistically significant impact on up-titrating guideline directed medical therapy. 


Background: Heart failure currently impacts 6.2 million adults in the United States. The national 30-day and 90-day composite heart failure hospitalizations and emergency department visits rates are 18.2% and 31.2% respectively. Studies such as CHAMP-HF, EVOLUTION-HF, and GUIDE-IT trials have highlighted barriers in up-titrating and fulling implementing heart failure guideline directed medical therapy (GDMT). These barriers include bradycardia, hypotension, and declining renal function. A simple GDMT score was created to account for medication titration and additional factors that affect fully implementing heart failure guideline directed medical therapy. The purpose of this study was to determine and assess the impact of a heart failure clinical pharmacist on guideline directed medical therapy. 


Methods: This study was a single-center, retrospective, cohort, chart review that enrolled patients from January 2023 through August 2024. Patients were included in this study at least 18 years of age or older with a diagnosis of heart failure with reduced ejection fraction and completed at least one pharmacist-led titration visit within the study time frame. Patients were excluded if they were less than 18 years old or if they passed within the study time frame. The primary outcome was the change in the baseline GDMT score by at least one point 90-days after the first pharmacist-led GDMT titration visit. Secondary Endpoints included the change in the patient’s baseline GDMT score 120-days after the titration visit, combined 30-day and 90-day heart failure related hospitalizations and emergency department visits, and the revenue generated for the health system by pharmacist billing. The primary outcome was analyzed via the Chi-Square Goodness-of Fit analysis. All secondary outcomes were analyzed using descriptive statistics.  


Results: A total of n=100 patients were included in this study. The average patient was a Caucasian, male, with Medicare insurance, and NYHA class II symptoms at the time of the pharmacist-led titration visit. Common comorbid disease states included atrial fibrillation (43%), cardiomyopathy (60%), coronary artery disease (46%), and hypertension (55%). For the primary endpoint, 10 patients were expected to have a GDMT score increase, and 90 patients were expected to not have a GDMT score increase. 45 patients were observed to have a GDMT score increase while 55 patients were observed to not have a GDMT score increase (Chi-Square 136.11 p<0.001). At 120-days post titration visit, 7% patient’s scores increased, 71%patient’s scores remained the same, 3% of patients declined titrations, 11% of patients were lost to follow-up, and 7% of patients had scores decrease. 10% of patients were readmitted to the hospital or visited an emergency department for heart failure related causes within 30-days of the pharmacist-led titration visit. 11% of patients were hospitalized for heart failure and 14% of patients visited an emergency department within 90-days of the pharmacist-led titration visit. The total revenue generated for the health system by billing 99211 was $893.88.


Conclusion: Pharmacist-led GDMT titration visits had a statistically significant impact on increasing patient’s heart failure GDMT scores within our institution. This study also saw lower 30-day and 90-day rates for hospitalizations and emergency department visits for heart failure. While unable to completely justify a full pharmacist’s salary in the outpatient setting, our study demonstrated the ability for pharmacists to generate revenue for our health system.

Title: Correlation of Mid-Upper Arm Circumference in Malnutrition Assessment for Pediatrics in Southern Rural Malawi
 
Authors: Christian Brown
 
Objective: To assess the correlation between mid-upper arm circumference (MUAC) z-scores and World Health Organization (WHO) weight-for-height z-scores; to assess the correlation between MUAC z-scores and various disease states.
 
Self-Assessment Question: Which of the following disease states is associated with malnutrition measured by MUAC z-score?
 
Background: Moderate to severe malnutrition is a modifiable risk factor for poor outcomes such as death, increased susceptibility to infectious disease, and poor cognitive function in young children. Screening for nutritional status should be conducted in both inpatient and outpatient/community settings, with common methods being WHO weight-for-height z-score (WHZ), Subjective Global Assessment, and MUAC z-score. MUAC z-scores can be measured using a standardized paper tape, a tool more portable and affordable than tools for measuring height for weight, that is a scale and stadiometer. This assessment compares nutrition status measured via MUAC z-score and WHZ while determining the association between MUAC z-score and prevalence of anemia, malaria, HIV, typhoid, dermatologic infections, and helminth infestations.
 
Methods: Patient data were collected from multiple community outreach clinics conducted in southern, rural Malawi during May 2024 and provided to the researchers in a de-identified database (therefore, this study was determined to be non-human subjects research by the East Tennessee State University Institutional Review Board). Although healthcare was provided to all presenting patients, only children 2 months to 18 years of age were included in the analysis. Data were excluded if no MUAC risk category was available or if the values recorded appeared incongruent with life. SAS version 9.4 (SAS Institute Inc., Cary, NC, USA) software was used to assess statistical correlations. Spearman coefficient was used to determine the association between MUAC z-score and WHZ, while multinomial regression and Chi-square tests were used to determine the association between MUAC z-score and various disease states.
 
Results: In progress.
 
Conclusion: In progress.

Title: Evaluation of Ambulatory Pharmacist Interventions in Patients with Type 2 Diabetes and Medicaid Managed Care Contracts
Authors: Layna Fox, Kaleigh Mikolichek, Julie Pruitt, Catie Harper
Objective: At the conclusion of this presentation, the participant will be able to describe a population health intervention to address care gaps in patients with Medicaid Managed Care plans.
Self Assessment Question: According to this data, where do you feel pharmacists can contribute value to this population of patients? A) Improving adherence, B) Encouraging use of guideline-directed therapy, C) Providing telehealth follow-up for high-risk patients, D) All of the above
Background: North Carolina launched Medicaid Managed Care plans in July 2021, and expanded Medicaid access to adults earning up to 138% of the federal poverty limit on December 1, 2023. Medicaid Managed Care contracts involve value-based care quality measures for disease state control for chronic conditions, including diabetes and hypertension, which influence health system reimbursement. Despite having insurance, patients with Medicaid face substantial barriers to accessing healthcare including financial limitations and transportation. The purpose of this study was to evaluate the impact of proactive pharmacist intervention on quality measures and access to care among patients with type 2 diabetes (T2D) that were newly eligible for Medicaid Managed Care plans. 
Methods: This was a single-center, prospective, pre-post matched, IRB-reviewed and exempt cohort analysis that included patients with T2D with initiation of a Medicaid Managed Care plan December 1, 2023 through August 30, 2024 that were engaged by an embedded pharmacist at a Cone Health Primary Care clinic. Eligible patients were identified through a monthly report and scheduled with the appropriate clinic-based pharmacist, who then worked with the patient and their primary care provider to manage T2D and associated disease states. Demographics, medications, and clinical data at baseline prior to pharmacy engagement and at most recent follow-up, through December 31, 2024, were collected via chart review. The primary outcome was percent of patients meeting Medicaid quality metrics for diabetes (A1c < 9%) and hypertension (BP <140/90 mmHg) after pharmacist intervention compared to baseline. The primary outcome was assessed using a McNemar’s Chi-Square test. Baseline characteristics and secondary outcomes were reported with descriptive statistics. 
Results: There were 63 patients engaged over 184 pharmacy appointments during the study period. Pharmacists utilized telehealth during the initial encounter for 45 (71.4%) patients. There were 31 (49.2%) female patients and 30 (47.6%) patients who identify as Black or African American. The mean age was 51.7 years and mean baseline A1c was 9.9%. Most patients reported a social determinant of health barrier. At baseline, 21 (33.3%) patients were achieving the primary composite outcome of A1c < 9% and BP < 140/90 mmHg, which increased to 39 (61.9%) patients at the end of the study period (difference 28.6%, 95% confidence interval 11.5%-45.7%, p = 0.001).  The median time between first pharmacist engagement and last follow-up through December 2024 was 202 days (IQR 158 days). The most common medication therapy problem identified by pharmacists was adherence in 82.5% of patients, and the most common drug therapy interventions were medication counseling, adjusting pharmacotherapy, and assisting in access to care. 
Conclusion: Proactive pharmacist intervention in patients with Medicaid Managed Care contracts positively contributed to patients’ access to care, disease state management, and health system performance on Medicaid quality measures for diabetes and hypertension control.

Title: Standardization of Inpatient Dashboard Procedure To Impact Quantitative Documentation of Pharmacist Interventions on Bacteremia
Author: Brooke Jordan-Brown, Sara Lucas, Landon Johnson

Background:
The Ralph H. Johnson VA Healthcare System (RHJ VAHS) utilizes a decentralized pharmacy practice model. Time constraints limit documentation of pharmacist interventions, which ultimately results in undocumented interventions. An inpatient dashboard was recently created to identify interventions and increase documentation.  However, there is no standardized process to incorporate this new tool into pharmacist workflow. Despite recognized benefits of clinical pharmacists, the lack of standardized documentation process limits the visible impact and value that clinical pharmacists contribute to patients. This quality improvement project aims to standardize documentation of pharmacist interventions for bacteremia within the RHJ VAHS.

Methods:
A standardized procedure was developed for utilizing the inpatient dashboard, focusing on antimicrobial stewardship flags. Focus was placed on bacteremia given the significant impact clinical pharmacists can have on optimizing antimicrobials. Interventions were documented through an antibiotic timeout note. Pharmacists were educated on this standardization process in October 2024. The new procedure took effect November 2024. Education emphasized the importance of documenting all antibiotic related interventions. Data was collected on all patients admitted for bacteremia from July 1st, 2024 to February 28th, 2025, with a pre-intervention period from July to October and post intervention period from November to February. The primary endpoint was the change in the quantity of pharmacist interventions for bacteremia following education and implementation of the standardized dashboard procedure. The secondary endpoint assessed the frequency of dashboard use by pharmacists after implementation. Data on hospitalizations for bacteremia (identified by positive blood cultures), bacteremia interventions (identified by bacteremia data points in the EHR) , and dashboard interaction metrics were collected for analysis.

Results:
In the pre-intervention period there was a total of 41 hospitalizations for bacteremia with 18 bacteremia interventions (43.9%).  In the post-intervention period there was a total of 52 hospitalizations for bacteremia with 32 bacteremia interventions (61.5%). The change in quantity of pharmacist interventions was not statistically significant (p=0.0903). In the post-intervention period, 90.6% of the bacteremia interventions were through the antibiotic timeout note, while the remaining 9.6% were from the previous methods of documentation. For the secondary endpoint, in the pre-intervention time period, the dashboard view history was 7,575 and in the post-intervention period, the dashboard view history was 5,904, (p=  <0.00001). For flag touches with removing/snoozing/resolving, in the pre-intervention period, the total flag touches was 3,540 (31%/17%/52% respectively) and in the post-intervention period, the total flag touches was 2,762 (34%/16%/50% respectively) (p=0.1167).

Conclusion:
Overall, there was no statistically significant increase in quantitative documentation of bacteremia interventions after implementing the standardized dashboard procedure. However, there is a strong signal towards an increase in the number of bacteremia interventions in the post-intervention period, demonstrating that the sample size was likely too small to show statistical significance. In contrast there was a statistically significant decrease in view history of the dashboard, indicating a disconnect in the number of bacteremia interventions and dashboard use. Based off these results, the antibiotic timeout note is likely an efficient method to document bacteremia interventions. The inpatient dashboard is a tool that can assist pharmacists in making interventions, however methods of documentation may impact the number of interventions more so than utilization of the dashboard.

Title: Optimization of Pharmacist Interventions for a Health Equity Initiative to Improve Hypertension Control in African American Patients
Authors: Katie Sfirlea, Rachel Shelley, Luke Van Ausdall, Madison Yates
Objective: Describe the optimization of pharmacist interventions for a health equity initiative to improve hypertension control in African American patients
Self Assessment Question: What outcomes occurred as a result of the optimization of pharmacist interventions for African American hypertension control?
Background: The disparity between hypertension control in African American patients compared to White patients is a major health equity concern in the United States. At Cone Health, baseline data indicated a 6% gap in hypertension control between African American and White patients. From October 2022 to September 2023, implementation of a systemwide health equity goal resulted in improvement in African American hypertension control for patients seen by Cone Health primary care providers. To remain committed to health equity, beginning in October 2023 a new systemwide goal was created to obtain hypertension control for 71.4% of African American patients seen by any Cone Health provider. A previous project utilized a pharmacist-led initiative where all African American patients with uncontrolled hypertension at Cone Health Community Health and Wellness Center (CHWC), an internal medicine clinic, were referred to the embedded Clinical Pharmacist Practitioner (CPP) for medication management. In 45% of the CPP visits no medication changes were made due to the patient’s non-adherence to antihypertensives prior to the visit or being out of refills. A nurse blood pressure (BP) visit referral was added to the protocol to allow the CPP to focus on patients requiring more complex medication management. The purpose of this project is to assess hypertension control in African American patients prior to implementation of the new systemwide health equity goal (pre-intervention) as compared to post-intervention.
Methods: This single center, retrospective, IRB-reviewed and exempt, cohort study included African American patients initially seen by the CPP at CHWC for hypertension from October 1, 2023, to August 31, 2024, with follow up visits until September 30, 2024. Exclusion criteria included end-stage renal disease, dialysis, renal transplant, pregnancy, hospice, or palliative care. The primary outcome was the proportion of African American patients seen at CHWC with hypertension control pre-intervention as compared to post-intervention. Hypertension control was defined as BP <140/90 mm Hg at the last ambulatory visit during the study period. Secondary outcomes include patients seen by the CPP with hypertension control (baseline, last CPP visit, and end of study), average change in blood pressure, number of nurse and CPP visits, adherence to CPP referral protocol, and type of medication adjustments made by the CPP. Chi-square and descriptive statistics were used to analyze the data as appropriate.
Results: During this study, 72.1% (n=881) of African American patients seen at CHWC for hypertension achieved hypertension control post-intervention as compared to 62.3% (n=716) pre-intervention for a risk ratio 1.16, 95% CI (1.09-1.23), p<0.001. Of the 119 patients seen by the CPP, 73.1% achieved hypertension control by their last CPP visit. Patients seen by the CPP had an average decrease of 17 mm Hg in systolic blood pressure and 7 mm Hg in diastolic blood pressure. The referral protocol was followed for 70.5% of patients with only 17 patients having a nurse BP visit. The average number of CPP visits per patient overall was 1.76 and 1.57 for patients with controlled hypertension. During the study, 10.1% (n=12) of patients were lost to follow up.
Conclusions: African American hypertension control at CHWC was significantly improved post-intervention as compared to pre-intervention despite low utilization of nurse BP check visits. These results are consistent with a previous pharmacy resident project at CHWC that demonstrated significant improvements in African American hypertension control amongst patients managed by the CPP. Based on these results we will continue to optimize implementation of the nurse BP visit referral protocol and evaluate the feasibility of continued targeted hypertension follow up after hypertension control is achieved.

Title: The Impact of a Rural Health Scholars Program on Pharmacy Students' Attitudes Toward Rural Healthcare Delivery at Graduation


Authors: Anna Hale, PharmD; Amanda Savage, PharmD; Stephanie Kiser, RPh


Objective: Assessing the impact of a Rural Pharmacy Health Certificate on pharmacy students' outlook on practicing healthcare in rural settings and their attitudes toward rural health. 


Self-assessment question: Why is providing pharmacy students with exposure to rural healthcare important for the population health of North Carolina residents? 


Background: Approximately 20% of the U.S. population lives in rural areas, where residents face higher rates of chronic conditions like COPD, obesity, and heart disease, as well as limited access to healthcare and higher poverty levels. As of September 2024, 66.33% of Primary Care Health Professional Shortage Areas were in rural regions. Integrating pharmacists into team-based care can help address this shortage, as they are well-equipped to manage chronic illnesses and provide comprehensive medication management. Since 2014, the Rural Pharmacy Health Certificate program at UNC Eshelman School of Pharmacy has provided rural health seminars, population health projects, experiential education in rural communities, service and leadership activities, and interprofessional education. Certificate faculty wanted to assess rural certificate participants prior to their graduation as it relates to students’ attitudes towards rural health and their desire to practice in rural areas.


Methods: The participants were final-year pharmacy students at the University of North Carolina Eshelman School of Pharmacy and completing a graduate certificate in Rural Pharmacy Health.  All students who participated in the program were invited to complete a survey in the Spring semester prior to graduation. A total of 12 students, across the classes of 2022, 2023, 2024, and 2025 completed the survey. Students’ rural health attitudes data was collected using a Likert scale. Descriptive statistics were used to analyze students’ responses and determine the overall patterns of agreement or disagreement for each question. In addition, thematic analysis was conducted on open-ended questions exploring participants' background in rural health, their current knowledge and confidence from working in rural communities, and their future intentions to practice in rural settings.


Results: Pharmacy students enrolled in a Rural Pharmacy Health Certificate program had a high level of agreement in regard to social determinants of health that they found things they enjoy in a rural environment, living in rural environments provided an enjoyable lifestyle and that rural workplace settings are friendly environments. When exploring a sense of community there was a high level of agreement with people in rural communities being friendly, there is a great sense of belonging. There was a high level of disagreement that working in a rural area isolated the students from their family. When examining professional goals there was a high level of agreement that working in a rural area provided more opportunity to practice a variety of skills, staff are often more supportive in a rural environment and that they found greater opportunity for autonomy in rural practice. Students strongly agreed that rural seminars and rural rotations increased student confidence, knowledge of health disparities and barriers and increased understanding of the role of the pharmacist. After graduation 85% of students said they were likely or very likely to practice in a rural setting, compared to reporting 54% prior to pharmacy school being likely or very likely to practice in a rural setting. 

Conclusion: Overall pharmacy students in a Rural Pharmacy Health Certificate Program had a high level of agreement that living in a rural area would be enjoyable, that sense of community and friendliness was prominent in rural communities and that there were opportunities for professional development in rural communities. Pharmacy students indicated that prior to pharmacy school compared to after completion of the Rural Pharmacy Health Certificate Program they had a higher likelihood of wanting to practice in a rural area.

TITLE: Impact of clinical pharmacy team intervention on naloxone fills in patients on chronic opioid therapy 
AUTHORS: Rosy S. Sijapati, Erin R. Himes, Stephanie Hale
BACKGROUND: Opioids are highly effective for pain management but carry risks of addiction, overdose, and life-threatening respiratory depression. Naloxone, an opioid antagonist, can quickly reverse opioid overdoses by blocking opioid receptors in the brain. Despite its effectiveness, naloxone remains underutilized due to barriers such as stigma, lack of awareness, and access issues. Kaiser Permanente created the Interregional Pharmacy Opioid Use Improvement (OUI) Group to support safe opioid prescribing and increase appropriate naloxone prescribing. The purpose of this study was to evaluate the impact of clinical pharmacy team interventions on naloxone fills in patients on chronic opioid therapy of ≥ 50 morphine milligram equivalents (MME)/day.
METHODS: This was a retrospective, observational, IRB-exempt cohort study conducted within an integrated healthcare delivery system. Inclusion criteria included Kaiser Permanente Georgia (KPGA) members who are 18 years and older and filling chronic opioid therapy of ≥ 50 MME averaged over the last 90 days. Exclusion criteria included patients with a cancer diagnosis or enrolled in hospice care. The primary objective was to compare the number of patients meeting inclusion criteria who filled a naloxone prescription within the last 24 months as of March 31, 2023 versus as of December 31, 2023. The secondary outcome was to compare the naloxone fill rates based on intervention type. Data reported by the OUI Group from April 1, 2023, to September 30, 2023 was used. Descriptive statistics was used to determine the similarities in patient characteristics and the Chi-squared test was used to determine the statistical significance of categorial variables.
RESULTS: A total of 496 patients were included in this study. The mean patient age was 60 years, and the majority were Caucasian female (55%). As of March 31, 2023, 399 patients were eligible for a naloxone prescription compared to 356 patients eligible as of December 31, 2023. There were 122 naloxone prescriptions (30.6%) filled as of March 31, 2023 and 241 naloxone prescriptions (67.7%) filled as of December 31, 2023. This represents an absolute increase of 119 naloxone prescriptions (37.1%) between the pre- and post-intervention time periods (P < 0.0001). Clinical Pharmacy Specialists (CPSs) contacted 31 patients via telephone outreach, all of whom (100%) filled their naloxone prescriptions. Pharmacy technicians contacted 106 patients via telephone outreach, resulting in 75 naloxone prescriptions filled (70.8%). An additional 56 patients received outreach via secure message only, with 42 naloxone prescriptions filled (75%). Among patients not directly reached, 37 received voicemails, and 15 of those (40.5%) filled their naloxone prescriptions. Additionally, 100 patients were successfully reached and spoken to directly, and 91 naloxone prescriptions were filled (91%).
CONCLUSION: The rate of naloxone prescription fills increased significantly when the clinical pharmacy team intervened. The findings of this study suggest that direct telephone contact, especially by clinical pharmacists, had the highest success rate for encouraging patients to fill their naloxone prescriptions. Voicemails had a significantly lower fill rate, highlighting the importance of direct interaction in improving patient outcomes.

Title: Assessing Provider Awareness and Confidence in Prescribing Connected Insulin Pens for Diabetes Management 
Authors: Caroline McKenna, PharmD & Casey Wells, PharmD, BCACP, CPP 
Objective: Determine provider readiness and confidence in prescribing connected insulin pens, caps, or buttons and comfortability in assessing generated reports. 
Self-Assessment Question: What is one benefit to using connected insulin pens (CIPs) for diabetes management? 
Background: 
Although there have been significant technological advancements around insulin delivery for the management of diabetes, some devices are underutilized due to lack of provider awareness. Connected insulin pens (CIPs) and pen caps offer an additional method for diabetes management in outpatient clinics. Various products, like the Abbott Bigfoot Pen, Lilly Tempo Button, Medtronic InPen, and NovoEcho Pens allow tracking of basal and/or bolus dosing, calculations for doses, and timing of insulin on board via Bluetooth and iOS/Android Smartphone applications. This study sought to assess provider readiness and confidence in prescribing connected insulin pens, caps, or buttons and comfortability in assessing generated reports.  
Methods: 
Baseline CIP prescribing levels were assessed through an internal dashboard for the four CIPs mentioned above. A survey was then distributed to 50 prescribers to investigate awareness of CIP products, who may qualify for use, comfortability in prescribing, and confidence in evaluating CIP-generated reports to adjust settings. Answers were provided via a Likert Scale (ex: 1 = Very Low Confidence and 5 = Very High Confidence). The final question from the survey asked how respondents would like to best learn about CIPs between a variety of modalities.  
Results: 
This abstract describes baseline prescribing trends and results from prescribers' readiness and confidence survey. Only 24 CIPs were prescribed by providers at baseline, with 95.8% being prescribed in the Internal Medicine and Endocrinology Clinic. Based on the initial survey results, 66% of responders had not heard of CIP technology. Of those who did have knowledge of CIP products, more than 75% had less than medium confidence in identifying patients who may qualify CIPs, with mixed opinions for patients who may qualify. The preferred learning methods for education about CIPs included live presentation by a pharmacist and a comparison sheet of available products.  
Conclusions: 
More education around connected insulin pens and pen caps is needed for prescribing providers caring for patients with diabetes. Educational sessions have been scheduled and comparison table compiled with intent to re-survey post-session and present at future conferences. 

Authors: Michaelyn Moretz, PharmD; Carrington Royals, PharmD; Sara Messier, PA-C; Reagan K. Barfield, PharmD, BCPS; P. Brandon Bookstaver, PharmD, FCCP, FISDA, BCPS; Robert Bailey


Objective: The purpose of this study is to assess whether pharmacist impact in mental health services will provide increased access to services and improved patient outcomes at a medically underserved Federally Qualified Health Center (FQHC) as compared to clinician interventions. 


Self-Assessment Question: Which of the following areas of behavioral health are pharmacists able to make an impact in? Select all that apply. 
A. Prescribing and monitoring psychiatric pharmacotherapy- Correct
B. Billing for services
C. Diagnosing patients with mental health disorders
D. Optimizing current patient medication regimens - Correct


Background: As the number of mental health clinicians continues to decrease, there is a disproportional demand for adequate provider access. Pharmacist-driven medication therapy adjustments improve access opportunities in this population with the goal of improving quality of life and outcomes for adults with various mental health disorders. Though the use of psychiatric medications is becoming more accepted by the public, there is an indwelling lack of confidence in continued care by providers due to the disease complexity, as well as schedule limitations and the overwhelming need for increased providers in rural areas. Pharmacists are becoming a proposed solution in performing these beneficial services. 


Methods: Established patients of a medically underserved FQHC enrolled in current mental health services eligible for a pharmacotherapy consult within the 6-month study period were included. The primary endpoint for the study was the change in measurable outcomes via mental health screening scores. The secondary endpoints were the potential revenue generation based on pharmacist visits overall and overall impact. Cost-savings and financial benefits were measured by revenue generated over the 6-month study period overall and the conversions of patients to the FQHC pharmacy. Impact was measured by patient satisfaction, disease improvements, adequate lab monitoring, medications reconciled, patient assistance provided through programs, and no-show rates.


Results: In progress


Conclusion: In progress

Title: 
Evaluating the Impact of “On the Spot”– a Remote Pharmacy Hypertension Consult Service 


Authors:
Briana Bethune; Jamie Coates; Naomi Yates


Background:   
Nearly half of adults in the United States have hypertension, although only 22.5% are considered controlled. Studies have shown that pharmacist intervention can improve management of hypertension through scheduled pharmacy appointments. However, no studies appear to examine pharmacist impact on blood pressure during nurse visit appointments where clinical pharmacy is not physically present. The purpose of this study was to determine whether immediate remote blood pressure consultation by clinical pharmacy specialists reduces time to blood pressure goal in patients diagnosed with hypertension.  


Methods:  
This IRB-exempt, observational, retrospective cohort study was conducted within an integrated healthcare delivery system. This study included adult patients diagnosed with hypertension who had a blood pressure reading between 140-179/90-109 mmHg after repeat check at a nurse visit from November 2023 to August 2024. Patients were excluded from the study if they were pregnant, receiving hospice/palliative care, or had a GFR < 30 mL/min/1.73 m². Patients in the treatment group received an immediate consultation from a remote, on-call pharmacist for medication review and optimization as needed.  Patients in the control group received usual care where the “Doctor of the Day” was consulted for recommendation(s) as their schedule permitted.  The primary outcome of this study was to assess time to blood pressure goal (defined as ≤ 140/90 mmHg) for patients managed by the “On the Spot” pharmacy hypertension consult service compared to patients who received usual care. The secondary objectives were to evaluate medication optimization, change in blood pressure from baseline, and the percentage of patients who achieved blood pressure goal compared to usual care. The tertiary objective was to compare the percentage of patients enrolled in remote blood pressure monitoring (RBPM) where “On the Spot” was utilized versus usual care. Results were assessed at 4 months post intervention and data was analyzed using descriptive statistics.  


Results:
The study included 1,726 participants with 1466 patients in the control group and 260 patients in the intervention group. The average time to achieve blood pressure control was 31.93 ± 27.43 days in the control group and 31.21 ± 25.85 days in the intervention group, showing no statistically significant difference (p=0.72). Patients that received medication changes on the day of the nurse visit at a higher rate in the intervention group (62.31%) compared with the control group (35.54%, p<0.0001). The percentage of patients who achieved the blood pressure goal of ≤ 140/90 mmHg was similar between both groups with 87.08% in the control group and 88.21% in the intervention group (p= 0.51).  Similarly, changes in systolic and diastolic blood pressure from baseline were comparable in the control and intervention groups (systolic: -24.91 vs. -23.06 mmHg, p = 0.13; diastolic: -8.27 vs. -9.76 mmHg, p = 0.09, respectively). The percentage of patients enrolled in RBPM was significantly higher in the intervention group at 63.08% versus 6.55% in the control group (p<.0001). 


Conclusion:
The "On the Spot" remote pharmacy hypertension consult service demonstrated a significant impact on process measures, including higher rates of medication optimization and enrollment in RBPM compared to usual care. While the time to blood pressure control and overall blood pressure control rates were similar between groups, the higher medication intervention rates and RBPM enrollment suggest that integrating remote pharmacist consults into nurse visits enhances hypertension management workflow efficiency. Benefits include reducing delays in care, clearing physician and nurse schedules, and increasing rate of follow up. These findings highlight the value of immediate remote pharmacist intervention and underscore the potential for integrated remote pharmacy services to enhance hypertension management in healthcare systems.

Title: Tripping on Serotonin and Norepinephrine Reuptake Inhibitors: Evaluating the Fall Risk in Older Adults using Claims Data 


Authors: Lakedra White, Chelsea Keedy, Kristen Pierce, Jianing Xu, Jinae Lee, Hanna Kim, Daniel Hall, Ashlee Greene, Jessica Osborn, Joshua Caballero


Background: Major depressive disorder is a common mental health issue in older adults, often treated with antidepressants. However, their use can increase the risk of falls and fractures which can significantly contribute to morbidity and mortality in this population. Most research has focused on selective serotonin reuptake inhibitors, despite the widespread use of serotonin and norepinephrine reuptake inhibitors in older adults. Overall, limited data exist on the comparative fall risk among serotonin and norepinephrine reuptake inhibitors. As a result, this study aims to assess differences in fall risk associated with serotonin and norepinephrine reuptake inhibitors in an older population.


Methods: A retrospective cohort study was completed using the MarketScan® Medicare Supplemental claims from 2015 to 2021. The study included adults aged 65 and older with a prescription claim for a serotonin and norepinephrine reuptake inhibitor (i.e., duloxetine, venlafaxine, desvenlafaxine, milnacipran, and levomilnacipran). Individuals were followed for 30 days after their prescription claim to identify falls, defined using International Classification of Diseases, 9^th Revision codes E8800- E8889 and International Classification of Diseases, 10^th Revision codes W00-W19 and V00141. The primary outcome was the percentage of patients who experienced a fall within 30 days of the medication claim. Descriptive statistics were used for analysis. A larger study will similarly compare fall risk and related injury in older adults newly started on these agents. The date of their first prescription claim will be defined as the index date. Individuals will be excluded if they are prescribed serotonin and norepinephrine reuptake inhibitors or selective serotonin reuptake inhibitors within the preceding two months. Individuals will also be excluded if they have a history of fall or related injury within the preceding six months.


Results: There were 194,821 individuals with a prescription claim for a serotonin and norepinephrine reuptake inhibitor from 2015 to 2021. The average age was 72.5 (+/-8.1) years and 70% were female. Within 30 days of the prescription claim, 2,171 (1.1%) patients experienced a fall. The serotonin and norepinephrine reuptake inhibitor approximate prescribing rate included duloxetine (65%), venlafaxine (30%), desvenlafaxine (4%), milnacipran (0.8%), and levomilnacipran (0.4%). The serotonin and norepinephrine reuptake inhibitor fall rate included duloxetine (1.22%), venlafaxine (0.96%), milnacipran (0.76%), desvenlafaxine (0.70%), and levomilnacipran (0.54%).


Conclusion: Preliminary findings suggest a fall rate of approximately 1% within the first 30 days for most serotonin and norepinephrine reuptake inhibitors. While duloxetine appears to have the highest fall rate, further comparisons between serotonin and norepinephrine reuptake inhibitors are needed to determine statistical and clinical significance. Additionally, it is unknown if specific doses may be associated with an increased risk of falls and fractures which needs to be further elucidated. These findings can assist providers in carefully selecting the safest serotonin and norepinephrine reuptake inhibitor and dose for older patients.

Title: Improving Compliance with Gout Management Guidelines: Implementing a Standardized Order Menu for HLA-B*58:01 Testing in Veterans

Authors: Roslyn Mays; Mary Kalyn Pounders

Background/Purpose: 
Gout is a common and significant health issue among veterans, particularly in those with comorbid conditions like chronic kidney disease and cardiovascular disease. Allopurinol, the first-line recommended treatment for gout, carries the rare risk of a severe adverse hypersensitivity reaction, allopurinol hypersensitivity syndrome (AHS). The risk of AHS is higher in those with the HLA-B*58:01 allele, which is most prevalent in African American and Asian populations. The American College of Rheumatology (ACR) 2020 Gout Management Guidelines recommend routine genetic testing for HLA-B*58:01 in these higher-risk ethnicity groups before initiation of allopurinol. As of July 2024, preliminary data from the Atlanta VA revealed significant noncompliance with these guideline recommendations. This project aimed to improve compliance with the ACR allele testing recommendations by implementing a standardized order menu with prompts for allele testing in recommended patient groups, thus in hopes of reducing the risk of AHS in at-risk veterans.

Methods: 
This was a single-site, retrospective quality improvement project designed to evaluate the impact of a standardized HLA-B*58:01 allele order menu on compliance with the ACR 2020 gout management guideline recommendations. Eligible participants included veterans aged 18 or older prescribed allopurinol for non-hematologic or oncologic indications within the timeframe both prior to and following the implementation of the order menu in July 2024. Eligible patients were identified using the VA National Quality Enhancement Research Initiative (QUERI) Gout Safety Dashboard. Patients prescribed allopurinol for conditions other than gout, such as tumor lysis syndrome, were excluded using prescriber data. Baseline data was collected on key variables such as race/ethnicity, urate-lowering therapy (ULT) status, HLA-B*5801 allele testing results, and the type of prescribing provider (primary care physician or rheumatologist). The primary endpoint was the percentage of new ULT users prescribed allopurinol who received guideline-recommended HLA-B*58:01 testing before and after introducing the standardized order menu. Statistical analysis was used to compare testing compliance rates before and after the intervention. Upon data review, the impact of the order menu on allele testing was assessed to identify specific areas needing improvement, allowing for future targeted interventions in areas of continued non-compliance.

Results:
Upon review, after the implementation of the order menu, the percentage of new ULT users with guideline recommended HLA-B*58:01 test results increased by 5.2%. The total number of patients with an HLA-B*58:01 test result increased from 3.6% to 5.1%. The percentage of African American (AA) patients tested for the allele rose by 2.2%, while Asian patients demonstrated a 3.9% increase. While these changes are encouraging with a new ULT non-compliance rate decrease from 96.7% to 91.6%, more than 90% of at-risk patients remained untested, indicating that more targeted interventions may be necessary to achieve substantial improvements.

Conclusion:
The introduction of a standardized HLA-B*58:01 allele testing order menu resulted in a modest increase in testing compliance for new ULT users. While this increase is a positive step, the continued rate of non-compliance suggests the need for further refinements in the intervention. Potential future directions for this project include enhancing provider education, incorporating automated reminders, and exploring other interventions or tools to further enhance facility compliance. Continued monitoring and refinement of this intervention will be essential to achieving better compliance rates to the ACR 2020 gout guideline recommendations, and thus, a further reduction in risk for AHS development in at-risk veteran groups.

Title: Impact Assessment of Food Deserts and Food Insecurity on Diabetes Mellitus


Authors: 
Allison Eppenauer


Background: 
The worldwide epidemic and challenges of managing diabetes mellitus (DM) is partially driven by the intake of nutrient-poor and highly processed foods, however access to nutrient dense foods can be limited by financial restrictions and proximity to supermarkets. Areas of low access have been identified by the United States Department of Agriculture (USDA) Economic Research Service (ERS) Food Access Research Atlas as ‘food deserts’. As negative health outcomes of residing in food deserts or experiencing food insecurity have been previously demonstrated in other studies, this study aims to evaluate if these factors are an area that requires additional focus within the current population of patients with DM at the Ralph H. Johnson Veterans Affairs Healthcare System (RHJVAHS). Identification or focus on patients residing in food deserts or experiencing insecurity may allow clinicians to streamline preventative interventions during diabetes management to improve outcomes.


Methods: 
This project is a retrospective observational longitudinal cohort study for quality improvement comparing DM outcomes in veterans residing in a food desert/experiencing food insecurity and those not residing in a food desert/experiencing food insecurity. Eligible patients in the study included all patients enrolled within the RHJVAHS catchment area who had an active ICD 9/10 code diagnosis of DM or A1c > 6.5% between January 1, 2016 and December 31, 2018 with at least one annual visit with a VA provider in a primary location. Patients were then targeted over a follow up period to include lab values, hospitalizations, and deaths during the follow up period. 

The primary endpoint for this project was to determine if there is a significant difference in the frequency of uncontrolled A1c or urine albumin-creatinine ratio (UACR) based on a composite status of residing in a food desert or experiencing food insecurity and food insecurity alone. The secondary endpoint analyzed the difference in the frequency of all-cause hospitalizations, DM-related hospitalizations and mortality based on a composite status of residing in a food desert or experiencing food insecurity and food insecurity alone.


Results: Of the 4,209 veterans included in this study, 2054 (49%) patients were found to be residing in a food desert. 18 (0.004%) of patients screened positive for food insecurity. The primary outcome of uncontrolled A1c and UACR did not differ significantly between between the composite group of non-food desert/non-food insecurity (NFD/NFI) vs food-desert/food insecurity (FD/FI).  A1c >7% occurred in 45.7% of NFD/NFI vs. 44.2% FD/FI; p = 0.338.) A1c >8% occurred in 16.8% of NFD/NFI vs. 15.1% FD/FI; p = 0.133.) UACR >30 occurred in 39.1% of NFD/NFI vs. 39.5% FD/FI; p = 0.791. UACR >300 occurred in 4.2% of NFD/NFI vs. 5.4% FD/FI; p = 0.167. 

The primary outcome did not differ in patients with food insecurity alone with overall similar findings to the composite group. Although not statistically significant, patients with food insecurity had higher UACR >30 (63.6% in those experiencing food insecurity vs. 39.2% in those without, p = 0.098.)

The secondary outcome of all-cause hospitalization rate, DM-related hospitalizations, and mortality did not differ between NFD/NFI vs. FD/FI - about 20% of patients were hospitalized for any reason, 4% hospitalized due to complications of DM, and~20% of patients passed away. In food insecurity alone, all-cause hospitalizations was higher in those experiencing food insecurity vs. those not (44.4% vs 20.8%, respectively, OR 3.0 (1.2 - 7.7); p = 0.014.) DM-related hospitalizations did not differ between groups (3.7% in food insecurity vs. 5.6% in non-food insecurity; p = 0.864.) Mortality was also higher in patients with food insecurity (44.4% vs 20.2%, respectively, p = 0.018)

Additionally, patients with food insecurity had higher odds of missing a UACR lab value within the reporting period (19.7% vs 38.9%; OR 2.6 (1.0 - 6.7) ; p = 0.042.)


Conclusion: 
In summary, there was no difference in DM outcomes (UACR, A1c, hospitalizations, or mortality) between patients residing in a food desert/experiencing food insecurity versus those who are not. Patients with food insecurity were less likely to be evaluated for UACR despite the fact their UACR >30 trended higher than patients without food insecurity. Additionally, patients with food insecurity were more likely to be hospitalized for any reason or have higher mortality rate than those without food insecurity. The project was limited by the small patient population included in the food insecurity group which likely contributed to underreported findings. Data was not collected from other facilities, limiting the information available for patients seen at other medical centers which is an especially important consideration for patients residing in rural areas that may not seek care at the VA facility a significant distance away. Patients were also excluded if their address changed during the follow-up period. 

PURPOSE:
Recognizing that veterans have a higher prevalence of cardiovascular disease (CVD) and CVD-related mortality than the general population, there is a need to manage risk factors, including blood pressure. Over 70% of patients within the Veterans Affairs healthcare system have hypertension (HTN), but less than 33% have controlled blood pressure. To address the issue of uncontrolled blood pressure and reduce CVD risk, a remote, population health-based, pharmacist-managed quality improvement HTN management service was implemented at a rural Veterans Affairs clinic. This project aims to evaluate the implementation of the service.
 
METHODS:
This retrospective study evaluated the implementation of the pharmacist-managed HTN clinic using the RE-AIM implementation science framework, a five-domain model designed to assess the impact and implementation of health interventions. The domains of reach, effectiveness, and implementation were evaluated. Reach outcomes included the demographics of veterans who participated in the clinic. Effectiveness outcomes were collected at three months and the most recent visit. Outcomes included changes in baseline blood pressure and home monitoring, the percentage of veterans whose blood pressure was controlled,  and the number and types of interventions completed. Implementation outcomes include the average number of patient visits, percentage of eligible patients completing at least one visit, average number of completed visits, number of unsuccessful visit attempts, percentage of calls successfully completed, and number and types of barriers to blood pressure management.
 
RESULTS:
In progress
 
CONCLUSION:
In progress

Title: Proper Sodium-Glucose Transport Protein 2 Inhibitor use in New York Heart Association class II-IV heart failure patients
Authors:
Primary: Mary Sizer
Secondary: Melissa Johnson, Joseph Crosby, Akshaya Arunkumar, Ashlee Greene
Objective: To determine if HF patients are being prescribed SGLT2 inhibitors more often in collaborative care of a physician and pharmacist versus a physician alone in the primary care setting.
Self-Assessment Question: To be presented with slides
Background:
Sodium-Glucose Transport Protein 2 (SGLT2) inhibitors were recently added to the heart failure guidelines in 2022 and can help prevent heart failure hospitalizations by up to 30%. Being a Class I recommendation for heart failure with reduced ejection fraction and a Class 2a recommendation for preserved ejection fraction, it is crucial that these medications are used correctly in the outpatient setting. Pharmacists are not consulted on all heart failure patients in primary care offices at our health system. Identifying these potential gaps in care would ultimately improve outcomes for patients and help advocate for further pharmacy involvement within primary care offices.
 
Methods:
This was a multi-center, retrospective study identifying SGLT2 inhibitor use in outpatient heart failure New York Heart Association (NYHA) class II-IV patients at St. Joseph’s/Candler primary care clinics from August 1, 2023, to August 1, 2024. Patients were identified through a report capturing heart failure ICD10 codes and reviewed for eligibility. Patients considered for inclusion were at least 18 years old with a diagnosis of heart failure that followed at participating St. Joseph’s/Candler affiliated offices. Patients that were on dialysis, had a reported allergy or contraindication for use, or were pregnant/lactating were excluded. Eligible patients were stratified into physician/pharmacist cohort or a physician-only cohort. Medication data was obtained and patients were classified into groups SGLT2 inhibitor use and no use. The primary objective was to determine if heart failure patients are being prescribed SGLT2 inhibitors more often in collaborative care of a physician and pharmacist versus a physician alone in the primary care setting. Secondary objectives included determining if patients were prescribed appropriate heart failure doses, determining if appropriate outpatient use correlates with less hospital admissions, and comparing rates of use in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Data was analyzed to determine any gaps of care or implicating trends at the participating primary care clinics.
 
Results:
Three hundred forty-eight patients were screened for eligibility with total n of 300. Pharmacy was consulted on 82 of the 300 patients with 30/82 on a SGLT2 inhibitor (36.6%). Of the 30 patients on a SGLT 2 inhibitor in the pharmacist/physician cohort, 28 of them had correct heart failure dosing (93.3%). The remaining 2 patients in the pharmacy cohort had diabetes and were receiving the recommended dose for diabetes. The physician-only cohort (218 patients) was found to have 73 patients on a SGLT2 inhibitor (33.4%). Fifty-one of these patients were found to be on correct heart failure dosing (69.8%) with 10 of the remaining 22 patients with incorrect dosing being due to diabetes (45.4%). Hospital admissions due to heart failure were less prevalent in the pharmacy cohort (31.77% vs 44.0%). The pharmacy/physician cohort had 13 patients with HFrEF, 7 of which were on an SGLT2 inhibitor (53.8%) compared to 26/56 patients in the physician-only cohort. Likewise, 23/69 patients with HFpEF were on an SGLT2 inhibitor in the pharmacy group (33.3%) with 47/162 (29.0%) in the physician-only group.
 
Conclusions: 
Rates of SGLT2 inhibitor use in heart failure patients NYHA class II-IV were overall higher in the pharmacist/physician group, although comparable between the groups. The biggest impact was seen in the heart failure dosing. Pharmacy involvement resulted in appropriate dosing for all patients on a SGLT2 inhibitor. All-cause hospitalizations were similar; however, hospitalizations due to heart failure saw the largest difference favoring pharmacy involvement.  Collaborative care was more likely to prescribe a SGLT2 inhibitor for both heart failure with reduced and preserved ejection fraction. 

TitleAuthorsPractice SiteBackgroundEvaluate the impact of a pharmacist-led weight loss medication management service in a Veteran population.MethodsThis was a retrospective, prospective quality improvement initiative. Eligible Veterans with verifiable participation in the comprehensive lifestyle intervention (CLI) provided by our facility, MOVE!, were prescribed one of the following five medications approved by the Food and Drug Administration for weight loss: naltrexone/bupropion, orlistat, phentermine/topiramate, semaglutide, or tirzepatide. Veterans were excluded if they were not established with a Department of Veterans Affairs (VA) primary care provider. Data was collected via the Computerized Patient Records System (CPRS).  Post-medication initiation, Veterans were assessed by a Clinical Pharmacist Practitioner (CPP) at 4-week intervals to assess tolerability and weight loss.  Results47 Veterans were included. 28 (59.57%) achieved ≥ 5% TWBL. 

By medication:

• semaglutide (n=32): 59.38% achieved ≥5% TBWL, 90.63% ≥3% TBWL
• tirzepatide (n=6): 83.33% achieved ≥5% TBWL
• phentermine/topiramate (n=6): 50% achieved ≥5% TBWL
• orlistat (n=2): 50% achieved ≥5% TBWL
• naltrexone/bupropion (n=1): 0% achieved ≥3% TBWL

ConculsionsPharmacist-led medication management of anti-obesity medications appeared effective in achieving the primary endpoint of 5% TBWL or greater at 12 weeks after medication initiation. As anticipated, semaglutide and tirzepatide displayed the highest success rates. One limitation of this quality improvement initiative was the small sample sizes for some medications, namely the oral medication options.  The findings align with clinical trial data and highlight the role of pharmacists in optimizing weight loss therapy. Future initiatives may focus on assessing success rates beyond 3 months to identify the long-term benefit of a pharmacist-led weight management medication service. 

Title: Diabetes Outcomes of Patients Followed by Embedded Pharmacists in Primary Care Clinics


Authors: Cassie Twisdale, Amy Robinson, Danielle Land, Alex Ewing 


Objective: Identify diabetes outcomes and early impacts of having embedded pharmacists in primary care clinics


Self Assessment Question: Which of the following were early impacts within 3-6 months of having pharmacists manage diabetes in primary care clinics?
A) Significant lowering of A1c
B) Close follow up with phone visits
C) Increased prescribing of GLP-1 agonists
D) All of the Above


Background: The American Diabetes Association supports the use of a collaborative, multidisciplinary team approach to improve patient care when managing diabetes. Pharmacists ensure patients are on optimal guideline directed medical therapy, provide patient education, and monitor with close follow-up to allow for quicker dose escalations. Prisma Health recently embedded clinical pharmacists into two additional primary care clinics. This study will assess the pharmacists’ impact on quality of care by comparing diabetes outcomes of patients managed by newly embedded clinical pharmacists to diabetes outcomes of patients managed exclusively by providers.  


Methods: A multicenter, observational, retrospective cohort study was conducted examining adults 18 years of age or older with a diagnosis of diabetes and a hemoglobin A1c (A1c) above 8%. Patients in the pharmacist intervention group were referred to the PharmD between December 2023 to March 2024 and were required to have at least two interactions with the pharmacists during the study period. Comparator clinics were two primary care clinics within the health system that did not have an embedded pharmacist but were of similar size and patient demographics to the investigated clinics. Patients meeting inclusion criteria from the comparator clinics were randomly selected for analysis using a random number generator. The primary outcome was the reduction in A1c from baseline to next A1c three to six months later. Secondary outcomes include percent of patients on a continuous glucose monitor (CGM), number of CGM touchpoints or interpretations, number of visits during study period, use of evidence-based therapies, emergency room or hospital admissions related to diabetes care, weight loss, and number of patients assisted with medication access issues.  


Results: A total of 98 patients were included in the IRB-approved study with 49 patients in the pharmacist intervention group and 49 patients in the comparator primary care provider group. Baseline characteristics were similar between groups. The pharmacist group had a change in A1c from 9.97% to 7.83% at 3-6 months while the provider group had change in A1c of 9.51% to 9.36% at 3-6 months. A significant difference was found with the pharmacist group lowering A1c by 2.14% compared to the provider group lowering by 0.15% (p<0.001). Secondary outcomes of phone encounters, medication adjustment, continuous glucose monitor use, and assistance with medication access were statistically significant (p<0.001 for all). Pharmacists also initiated more GLP-1 RAs compared to provider (20 additional patients vs 1 additional patient, p<0.001). In patients with cardiovascular disease, pharmacists also had significantly more patients on a GLP-1 RA compared to the provider group (68.42% vs 11.76%, p=0.002) No significant differences were found between groups with SGLT-2 inhibitor use, emergency room or hospital admissions related to diabetes care or weight loss.


Conclusion: Pharmacist management of type 2 diabetes significantly lower A1c.  Pharmacists were able to provide closer follow up and assist with more medication access and continuous glucose monitor assessment than primary care providers. The early impacts of pharmacist management of diabetes can help to provide additional justification of more pharmacists in the primary care setting. Additionally, the impacts of pharmacists on diabetes outcomes help to support an automatic referral to pharmacists for patients with uncontrolled diabetes.