Nicotine addiction and dependence is a chronic relapsing disease driven by addiction to nicotine. Proactive treatment for all tobacco users, regardless of their readiness to quit, is recommended. First-line tobacco cessation medications include nicotine replacement therapy, bupropion, and varenicline. Comprehensive treatment with behavioral interventions and pharmacologic therapy increases success rates of smoking cessation. Although there are many popular alternative treatments, they should not replace or delay the use of known effective therapies. KEY POINTSAn individualized treatment for tobacco cessation is necessary and should be based on severity of nicotine dependence, probability of developing withdrawal symptoms, comorbidities, local resources, and patient preferences.Comprehensive smoking cessation treatment provides counseling, assesses the patient's readiness to quit, offers treatment options, and arranges follow-up.Evidence is lacking to support the use of smart phone "apps" for smoking cessation as monotherapy. E-cigarettes are not used in tobacco cessation treatment as they can also cause nicotine addiction and other concerns.

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe the role of the pharmacist in and initial outcomes of a remote monitoring and telemanagement program implemented to proactively provide outreach to high-risk patients during the coronavirus disease 2019 (COVID-19) pandemic. Summary A remote monitoring and telemanagement program was developed at a large, nonprofit, multicenter, academic health system as an innovative way to manage patients at risk for decompensation of their chronic diseases in the midst of the COVID-19 pandemic. The program mobilized an interprofessional workforce including nurses, medical assistants, social workers, virtualists, patient schedulers, and ambulatory care pharmacists. Patient outreach included a combination of telephone calls and digital outreach. The goal was to monitor patients’ health status remotely and assess for early signs of decompensation. Pharmacists conducted telephone outreach to answer patients’ medication questions and address signs and symptoms of worsening chronic conditions. Pharmacists were able to utilize an existing collaborative practice agreement (CPA) to adjust medication therapy and order laboratory tests as needed for safety and efficacy monitoring. Since the program’s inception in April 2020 through January 2021, pharmacists have addressed over 1,600 medication questions or instances of worsening clinical signs and symptoms. Conclusion A comprehensive remote monitoring and telemanagement program utilized a multidisciplinary team to monitor high-risk patients during the COVID-19 pandemic. Pharmacists contributed to chronic disease management via the use of a comprehensive CPA, allowing medications to be started, stopped, or adjusted on the basis of patients’ needs, to improve population health management and reduce workload for primary care providers who were addressing new and emerging issues during the pandemic.

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The purpose of this study was to explore access to breathing medications in an uninsured and underinsured patient population and identify needs for additional medication access resources. Quantitative data were collected from a dispensing report, financial database, and medical records review of patients who filled prescription medications at a charitable pharmacy in Ohio between December 11, 2014 and March 11, 2015, and qualitative data were collected from five semi-structured interviews with patients regarding breathing medication access. A total of 181 patients filled a breathing medication during the study period, which is nearly a quarter of the pharmacy’s patient population. The majority of patients were African American or Caucasian, and almost half were uninsured. Ultimately, the pharmacy had to purchase nearly half of breathing medications provided despite utilizing several medication access routes. Thus, access remains a significant challenge. Efforts are needed to ensure that vulnerable populations can consistently access breathing medications.   Type: Clinical Experience

Pharmacists are providing clinical services in nontraditional practice settings including the patient-centered medical home (PCMH). PCMHs strive to improve patient outcomes in a number of ways, including through innovative use of health information technology (HIT) and by encouraging patients to take an active role in their health care. This paper describes a pharmacist-directed smoking cessation program at a PCMH that utilizes HIT to engage patients in the smoking cessation process and lessons learned from implementation of the program to guide other pharmacists considering implementing a similar program. Secure messaging through the patient portal of the electronic medical record (EMR) can be an effective way to deliver a smoking cessation program for appropriately selected patients and aligns with PCMH standards as the program uses HIT to engage patients in self-management.   Type: Original Research