Objectives: The primary objective of this study is to determine the effect of proactive pharmacist identification of high-risk patients eligible for diagnostic spirometry testing on the percentage of appropriate spirometry referrals ordered and the percentage of spirometry tests completed in those that qualify. Methods: This prospective study compares spirometry referrals ordered and tests completed between an intervention site and control site within a federally qualified health center (FQHC) where pharmacists provide spirometry services. At both sites, all patients who had a primary care provider (PCP) appointment and qualified for spirometry screening on the designated intervention dates during a 12-week period were included in this study. At the intervention site, the pharmacist recommended a spirometry screening to the PCP prior to identified high-risk patients’ appointments. At both sites, a chart review was completed to determine if referrals were ordered and tests were completed for patients who qualified. Results: The number of patients eligible for diagnostic spirometry testing at the intervention and control sites was 190 (n = 125 vs n = 65, respectively). Among eligible patients, the percentage of referrals ordered was significantly higher at the intervention site (47.2% vs 7.7%, P < .001). Among patients who qualified, completion of spirometry testing was significantly higher in the intervention site (23.2% vs 3.1%, P < .001). Conclusion: Results of this study suggest that pharmacists proactively identifying high-risk patients for spirometry screenings within an FQHC increases appropriate referrals ordered by PCPs and tests completed by high-risk patients. Pharmacists in the primary care setting can aid the PCP in the management of chronic obstructive pulmonary disease through significantly increased spirometry referrals and therapeutic clinical assessments and recommendations. They also can provide face-to-face motivational counseling for smoking cessation, inhaler education, and vaccine recommendations. This population health approach to spirometry testing represents an emerging role for pharmacists and could be adopted in other primary care settings.

Background: In October 2012, a pharmacy-driven Inpatient Diabetes Patient Education (IDPE) program was implemented at the University of Toledo Medical Center (UTMC). Objective: To determine the difference in 30-day hospital readmission rates for patients who receive IDPE compared to those who do not. Methods: This retrospective cohort was completed at UTMC. Patients admitted between October 1, 2012, and September 30, 2013, were included if they were ≥18 years and had one of the following: (1) diagnosis of diabetes mellitus, (2) blood glucose >200 mg/dL (>11.11 mmol/L) on admission, or (3) hemoglobin A1C of >6.5% (>48 mmol/mol). Patients who received IDPE from a pharmacist or student pharmacist (intervention group) were compared to patients who did not receive IDPE (control group). Results: The 30-day readmission rate was 13.2% for the intervention group (n = 364) and 21.5% for the control group (n = 149) ( P = .023). Average time to 30-day readmission was 13.1 (±8.3) days for the IDPE group and 11.9 (±7.9) days for the control group. There was no significant difference in diabetes-related readmission between the intervention and control groups (25.5% vs 21.9%). Conclusions: An IDPE program delivered primarily by pharmacists and student pharmacists significantly reduced 30-day readmission rates among patients with diabetes.

Background and Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used pain medications among US adults with about 70 million people regularly taking NSAIDs annually. Despite clear recommendations from current clinical practice guidelines and recent supporting literature, NSAIDs are continually prescribed inappropriately in patients with chronic kidney disease (CKD), hypertension (HTN), and heart failure (HF). The purpose of this project was to determine the impact of direct pharmacist-led education to providers on rates of inappropriate prescribing of NSAIDs in high-risk populations in a family medicine setting. Methods: This study included all adult (aged 18 years or older) patient charts with NSAIDs prescribed, refilled, or recorded within the specified time periods. We defined inappropriate orders as oral and of chronic duration (at least 90 days) with at least one high-risk International Classification of Diseases-10 chart diagnosis (HTN, HF, CKD). This was a single-center, retrospective chart review of prescribing rates during a 3-month period before and after provider education delivered by a pharmacist. Results: We identified a total of 325 charts from preintervention and 489 charts postintervention that met inclusion criteria. Of those, the charts with orders categorized as inappropriate were 90 versus 44, respectively. The rate of inappropriate prescribing of NSAIDs significantly decreased from 27.7% to 9.0% (P&lt;.0001) postintervention. Among chronic NSAID users, both serum creatinine and systolic blood pressure significantly increased following NSAID initiation. Conclusions: A single pharmacist-led education intervention to primary care providers on inappropriate NSAID use in high-risk patient populations had a significant impact on minimizing inappropriate NSAID prescribing patterns within a family medicine outpatient office.

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Type: Letter