ObjectiveEmbedding clinical pharmacists into ambulatory care settings needs to be assessed in the context of established medical home models.MethodsA retrospective, observational study examined the effectiveness of the Intermountain Healthcare Collaborative Pharmacist Support Services (CPSS) program from 2012–2015 among adult patients diagnosed with diabetes mellitus (DM) and/or high blood pressure (HBP). Patients who attended this program were considered the intervention (CPSS) cohort. These patients were matched using propensity scores with a reference group (no-CPSS cohort) to determine the effect of achieving disease management goals and time to achievement.ResultsA total of 17,684 patients had an in-person office visit with their provider and 359 received CPSS (the matched no-CPSS cohort included 999 patients). CPSS patients were 93% more likely to achieve a blood pressure goal < 140/90 mmHg, 57% more likely to achieve HbA1c values < 8%, and 87% more likely to achieve both disease management goals compared with the reference group. Time to goal achievement demonstrated increasing separation between the study cohorts across the entire study period (P < .001), and specifically, at 180 days post-intervention (HBP: 48% vs 27% P < .001 and DM: 39% vs 30%, P < .05).ConclusionsCPSS participation is associated with significant improvement in achievement of disease management goals, time to achievement, and increased ambulatory encounters compared with the matched no-CPSS cohort.

Amiodarone adverse event monitoring was lower than dofetilide in this cohort. Improving the monitoring of these agents may decrease morbidity risk in this population.

Complex regional pain syndrome (CRPS) was described in 1864 by Mitchell et al as a condition characterized by many unique symptoms. Although symptoms may differ from patient to patient, the most common complaints are painful swelling in upper or lower extremities or changes in the skin. CRPS has been given many different names since it was first mentioned in the literature in 1851. The most common alternative names include causalgia, aglodystrophy, and sympathetic dystrophy syndrome. This condition is generally diagnosed in older adults because of trauma, nerve damage, and coronary artery disease; however, there are cases of CRPS affecting the pediatric and young adult population. The fourth edition of the diagnostic and treatment guidelines of CRPS published by Harden et al in 2013 suggest many different pharmacologic treatment options for these patients. Intravenous lidocaine is used to block the sodium channels in neuronal membranes, thus stopping initiation and conduction of impulses associated with neuropathic and inflammatory pain. The use of regional intravenous lidocaine (by applying a tourniquet on the affected extremity) has been well-documented in the literature with a successful decrease in pain symptoms. A unique case of the use of systemic intravenous lidocaine will be presented.