Background: The impact of pharmacist-led transition of care services with collaborative drug therapy management has shown to improve patients’ outcomes and decrease health costs. Compelling statistics show higher readmission rates for under-insured patients compared with insured patients at primary health care clinics. Methods: This is a single center, prospective, cohort study designed to examine team-based collaborative drug therapy management and its effect on therapeutic outcomes of under-insured patients with target chronic diseases managed in a primary health center. Targeted chronic diseases included dyslipidemia, diabetes, hypertension, anticoagulation disorders, chronic obstructive pulmonary disease, and heart failure. The primary outcome measures included percentage of time in therapeutic international normalized ratio (INR) and percentage of patients at targeted goals of blood pressure, lipids, and hemoglobin A1c (HbA1c). Secondary outcomes included reduced emergency department visits, number of patient encounters, hospital readmissions within 30 days of discharge, and disease exacerbation rates. Results: Patients were at INR goal 58% of the time compared with 52% at baseline ( P = .66). There was a 9% improvement in mean HbA1c in the intervention group when compared with baseline (9.6% vs 10.9%, P = .03). With pharmacist intervention, 73.8% of the patients had their blood pressure at goal compared with 50% at baseline ( P = .14). A limited number of patients were readmitted for different reasons, including uncontrolled disease states. Conclusions: The pharmacist-physician collaborative drug therapy management led to improved blood pressure control, average HbA1c, and time in therapeutic INR range. A decrease in health care utilization was also identified.

INTRODUCTION: Current stroke guidelines recommend that treatment with tissue plasminogen activator (tPA) should be initiated as quickly as possible in eligible patients to provide maximum therapeutic benefit. Pharmacists possess multiple skills including knowledge of dosing, reconstitution, and improved access to medication that may positively impact door-to-needle (DTN) times for patients with acute ischemic stroke. OBJECTIVE: The objective was to evaluate the impact of a clinical pharmacist on time to tPA administration in patients with acute ischemic stroke. METHODS: This was a retrospective, single-center cohort study at a community teaching hospital and certified primary stroke center from January 1, 2014 to December 31, 2018. The primary outcome of this study was to compare the average DTN time with a pharmacist present at a stroke team activation vs no pharmacist present. Secondary outcomes included the proportion of patients in each group meeting a DTN time of less than 60 minutes and the proportion of patients in each group meeting a DTN time of less than 45 minutes. Statistical analysis utilized included Wilson's t-test to compare average DTN time and the odds ratio to determine a DTN time <60 or 45 minutes between the pharmacist and non-pharmacist groups.RESULTS: Pharmacist involvement was associated with a reduction in the average DTN time: 66 minutes vs 78 minutes (P = .038). The DTN time of less than 60 minutes was met in 60% of cases with a pharmacist present compared with 35% without a pharmacist (P = .005). The DTN time of less than 45 minutes was met in 18% of cases with a pharmacist present vs 20% without a pharmacist (P = .71).CONCLUSION: Pharmacist participation in stroke teams in the emergency department may reduce DTN times and increase the likelihood of a patient receiving tPA in less than 60 minutes.

Purpose: The objective of this study is to determine the impact of a 48-hour time-out on the utilization of targeted empiric intravenous (IV) antibiotics through a systematic approach. Methods: This is a single-center, prospective, interventional study approved by the Institutional Review Board. Study groups were stratified into a control and intervention arm. Inclusion criteria consisted of patients 18 years of age or greater, on targeted broad-spectrum IV antibiotics for more than 24 hours: daptomycin, ertapenem, meropenem, piperacillin-tazobactam, vancomycin. Exclusion criteria included febrile neutropenic, pregnant, critically ill, and surgical prophylactic patients. Targeted interventions made by pharmacists included: IV to oral conversions, dose optimizations/adjustments, and de-escalations. Primary endpoints were days of therapy per 1000 patient days (DOT/1000), days of therapy at risk per 1000 patient days (DOT/1000 DAR), and de-escalation rates. Results: Table 1 depicts a total 88.69% mean reduction of DOT/1000 of the intervention arm for vancomycin, piperacillin/tazobactam, and meropenem ( P-value <.0001) when compared to the control arm. Table 2 depicts a total 88.86% mean reduction of DOT/1000 DAR of the intervention arm for vancomycin, piperacillin/tazobactam, and meropenem ( P-value <.0001) when compared to control. Table 3 shows a 77.11% increase in total de-escalation rates ( P-value = .0107) in the intervention group when compared to control group (63.52%). Conclusion: This study displays the essential role that pharmacists play in antibiotic stewardship. This study further reveals that the stewarding tool utilized contributed to significant reductions in the usage of targeted empiric intravenous antibiotics.