Background Pharmacists can optimize outcomes related to diabetes mellitus (T2DM) by taking advantage of telehealth opportunities despite the COVID-19 Public Health Emergency (COVID-19 PHE). Objective Identify and compare changes in T2DM outcomes prior to (August 2019 through February 2020) and during (March 2020 through October 2020) the COVID-19 PHE. Secondary objectives were to identify and compare pay-for-performance metrics and additional fee-for-service submitted in these patients. Methods This study examined changes in T2DM outcomes at one primary care office within a community health system. Pharmacists started regularly using Remote Patient Monitoring (RPM) services during the COVID-19 PHE to reduce in-person visits. Patients with an initial A1C greater than or equal to 8% were included. Data collected included comorbidities, change in A1C, and diabetes and statin medication therapy adherence. Percentage of Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) measures met, and billing code frequencies were also assessed. Results In the pre COVID-19 PHE group (N=30), the average three and six month A1C reductions were 1.3% and 1.2%, respectively, while the reductions were 2.0% and 2.2% in the during COVID-19 PHE group (N=61). The percentage of patients appropriately initiated or maintained on statins was 96.2% in the pre COVID-19 PHE group versus 82.6% in the during COVID-19 PHE group. Related to HEDIS, statin adherence was 95.2% in the pre COVID-19 PHE group and 84.2% in the during COVID-19 PHE group while A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% pre COVID-19 PHE versus 73.8% during the COVID-19 PHE. Diabetes medication adherence related to HEDIS and medication reconciliation related to MIPS was 100% for both groups. Conclusion Data demonstrates the opportunity for pharmacists to maintain and improve clinical outcomes related to T2DM despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.

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Purpose Patients with non-valvular atrial fibrillation or venous thromboembolism have historically been treated with vitamin-k antagonist therapy; however, due to well-documented limitations, direct oral anticoagulant (DOAC) use has been increasing.(1)(2) The convenience and clinical utility of DOACs is not applicable to all patients, and some must be transitioned to warfarin therapy. Despite practice recommendations, suggestions from package inserts, and clinical trial evidence, there remains a lack of literature describing real-word examples of patient transition from DOACs to warfarin.(3–11) Summary All patients who were transitioned from a DOAC to warfarin from January to December 2016 and were managed by the clinic were included. Patients were excluded if the transition to warfarin did not include ≥ 2 days of DOAC overlap or if DOAC therapy was used as a bridge to surgery or procedure. St. Joseph's/Candler Health System IRB granted expedited approval and waived informed consent. Four elderly, Caucasian patients met the inclusion criteria. Four patients were successfully transitioned from a DOAC to warfarin for their atrial fibrillation, 3 were transitioned from apixaban and 1 was transitioned from rivaroxaban. Conclusion Overall the purpose of this retrospective, observational study was to highlight real-world management of the transition of DOACs to warfarin in an outpatient, pharmacist-led clinic.

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