Background:The role of clinical pharmacists in the care of hospitalized patients has evolved over time, with increased emphasis on collaborative care and patient interaction. The purpose of this review was to evaluate the published literature on the effects of interventions by clinical pharmacists on processes and outcomes of care in hospitalized adults.

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Background Access to human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is often poor in small urban and rural areas because of stigma and long distances to providers. The Iowa Department of Public Health and The University of Iowa created a regional telehealth program to address these barriers (“Iowa TelePrEP”). We describe initial TelePrEP results and share lessons learned. Methods Iowa Department of Public Health personnel in sexually transmitted infection (STI) clinics, disease intervention specialist and partner services, and HIV testing programs referred clients to pharmacists at University of Iowa. Clients could also self-refer via a website. Pharmacists completed video visits with clients in the community on smartphones and other devices, arranged local laboratory studies, and mailed medications. We performed a retrospective record review to quantify rates of PrEP referral, initiation, retention, guideline-concordant laboratory monitoring, and STI identification and treatment. Results Between February 2017 and October 2018, TelePrEP received 186 referrals (37% from public health) and completed 127 (68%) initial video visits with clients. Median client age was 32; 91% were men who have sex with men. Most clients with video visits (91%) started PrEP. Retention in TelePrEP at 6 months was 61%, and 96% of indicated laboratory monitoring tests were completed. Screening identified 37 STIs (8 syphilis, 10 gonorrhea, 19 chlamydia). Disease intervention specialist and partner services linked all clients with STIs to local treatment within 14 days (80% in 3 days). Conclusions Using widely available technology and infrastructure, public health departments and health care systems can collaborate to develop regional telehealth programs to deliver PrEP in small urban and rural settings.

Home specimen self-collection kits with central laboratory testing may improve persistence with PrEP and enhance telehealth programs. We offered Iowa TelePrEP clients the choice of using a home kit or visiting a laboratory site for routine monitoring. Mixed-methods evaluation determined the proportion of clients who chose a kit, factors influencing choice, associations between kit use and completion of indicated laboratory monitoring, and user experience. About 46% (35/77) chose to use a kit. Compared to laboratory site use, kit use was associated with higher completion of extra-genital swabs (OR 6.33, 95% CI 1.20–33.51, for anorectal swabs), but lower completion of blood tests (OR 0.21, 95% CI 0.06–0.73 for creatinine). Factors influencing choice included self-efficacy to use kits, time/convenience, and privacy/confidentiality. Clients reported kit use was straight-forward but described challenges with finger prick blood collection. Telehealth PrEP programs should offer clients home kits and support clients with blood collection and kit completion.

REFERENCES1. Zanetti M, Ballabio C, Abbate C et al. Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: A 3-year followup study. J Am Geriatr Soc 2006;54:580-586. 2. Solfrizzi V, Panza F, Colacicco AM et al. for the Italian Longitudinal Study on Aging Working Group. Vascular risk factors, incidence of MCI, and rates of progression to dementia. Neurology 2004;63:1882-1891. 3. Panza F, D'Introno A, Colacicco AM et al. Cognitive frailty: Predementia syndrome and vascular risk factors. Neurobiol Aging 2006;27:933-940. 4. Panza F, D'Introno A, Colacicco AM et al. Current epidemiology of mild cognitive impairment and other predementia syndromes. Am J Geriatr Psychiatry 2005;13:633-644. 5. Lopez OL, Jagust WJ, DeKosky ST et al. Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study. Part 1. Arch Neurol 2003;60:1385-1389. 6. Hanninen T, Hallikainen M, Tuomainen S et al. Prevalence of mild cognitive impairment: A population-based study in elderly subjects. Acta Neurol Scand 2002;106:148-154. 7. Frisoni GB, Fratiglioni L, Fastbom J et al. Mild cognitive impairment in the population and physical health: Data on 1,435 individuals aged 75-95. J Gerontol A Biol Sci Med Sci 2000;55A:M322-M328. 8. Busse A, Bischkopf J, Riedel-Heller SG et al. Subclassifications for mild cognitive impairment: Prevalence and predictive validity. To the Editor: Hearing impairment (HI) is a prevalent and underrecognized disorder in elderly veterans. Previous studies indicate that up to 80% of primary providers do not routinely screen for HI, and even if diagnosed, patients do not receive treatment. 1 Furthermore individuals suffering from HI are only accurate about 60% of the time in identifying their own hearing deficits. Proper diagnosis can be difficult, because older people with HI are often thought to be suffering from cognitive disorders and perceive others as lacking in understanding. 2 HI has been shown to have a number of direct psychological consequences on the aging individual. Studies have shown on a variety of mental health scales that HI affects psychological well-being. 3-5 In a study by de Graff et al., the odds of developing depression with HI was 1.51 compared with age-matched controls with no sensory loss. 6Our study hypotheses were that aging veterans suffering from HI have significantly higher rates of depression and that the presence of HI in the aging veteran predisposes them to a higher risk of poorer health-related quality of life (HRQOL).Patients in our study were drawn from the Enhanced Pharmacy Outpatient Clinic Study, a randomized prospective trial evaluating the effect of a structured pharmacist intervention that has been described previously. 7 The institutional review board at the University of Iowa Carver College of Medicine and Department of Veterans Affairs Iowa City Healthcare System approved this study.Identification of depression and HI were accomplished using physician-generated problem lists and outpatient Interna...