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Purpose: To assess the impact of a pharmacist-led warfarin to DOAC conversion initiative during the COVID-19 pandemic. Methods: Patients who were prescribed warfarin and followed with the anticoagulation clinic for INR monitoring were assessed by outpatient clinical pharmacists as potential candidates for transition to DOACs from March-August 2020. Results: 530 patients were assessed for transition to DOACs, of which 373 (70.4%) were deemed by clinical pharmacists to be candidates for DOACs.  Of the patients who were candidates for DOACs, 66 (17.7%) were transitioned from warfarin to a DOAC.  Of the patients who transitioned to a DOAC, 59 (89.4%) remained on a DOAC after one year. Conclusion: Outpatient clinical pharmacists are an effective resource to help identify patients who are candidates for DOACs and assist with transition from warfarin. Further, high persistence rates with DOAC therapy after one year demonstrate the positive impact of the clinical pharmacist on medication adherence.

Objective:To describe the initial results of implementing pharmacogenomics testing in a community-based psychiatry practice and potential impacts on medication management.Method:Retrospective chart review of prospectively maintained medical records of all adult patients with pharmacogenomics results from 9/01/2017 to 6/30/2019 under the care of psychiatrist and clinical pharmacist.Results:A total of 51 patients met inclusion criteria. A total of 7 pharmacokinetic genes and, due to changes in the test report over time, a range of 6-10 pharmacodynamic genes relevant to psychotropic medications were evaluated per patient. Every patient had genetic variations, with an average of 6.1 per patient (range 3-9; SD= 1.5). Patients were taking an average of 3.6 (range 1-8; SD=1.7) psychiatric medications at the time of the genetic test, to treat an average of 5 psychiatric conditions (range 1-9; SD=2.2). An average of 1.2 (range 0-4; SD=1.0) gene-drug interactions were uncovered per patient. Following review by psychiatrist and pharmacist, medication adjustments resulted in patients remaining on an average of 3.6 psychiatric medications, but decreasing the average number of gene-drug interactions per patient to 0.8 (range 0-3, SD=0.8).Discussion:The large number of genetic variations observed per patient is consistent with previous findings 1-2. The decrease in number of gene-drug interactions following testing demonstrates the practical utility of pharmacogenomics information to guide medication therapy. This study did not examine outcomes such as improvement in psychiatric condition or reduction in medication adverse effects; however, these endpoints have been evaluated in other trials 3-4.Conclusions:Pharmacogenomics testing presents an opportunity for a personalized medicine approach in a community-based psychiatry practice.

Purpose. To describe the employment of an automated text messaging text-bot during the 2019 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting Residency Showcase and its impact on the number of applications received for the postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) pharmacy residency programs at a medium-sized community hospital. Methods. Visitors at the residency showcase booth were asked to text a code word to a program number. The text-bot collected the visitor’s contact information and program of interest (PGY1 or PGY2). A series of automated messages were sent to all visitors following the showcase and up until the residency application deadline. Results. 71% (20/28) of visitors to the program’s showcase booth registered with the text-bot and of these, 65% (13/20) submitted applications to the residency program in phase I of the match. Both the PGY1 and PGY2 programs saw an increase in the amount of applications received compared to previous year. Conclusion. A text messaging text-bot may be a useful residency recruitment tool.