Introduction The Veterans Affairs (VA) has been at the forefront of harnessing the skills of clinical pharmacy specialists (CPS) in patient‐aligned care teams (PACT) to improve patient care outcomes and create access for veterans. With the unfortunate arrival of Coronavirus disease 2019 (COVID19), PACT CPS were duty‐bound to expand telehealth services at an accelerated rate. The purpose of this quality improvement analysis is to compare CPS efficiency as well as some objective patient metrics to assess for a change in the quality of care. This is the first study to compare the efficiency and quality of care by CPS in the VA pre‐COVID19 and during the COVID19 pandemic. Methods This is a retrospective review of PACT CPS comprehensive medication management from 3/10/19 to 11/30/19 and 3/10/20 to 11/30/20. Data points focused on clinic encounters, patient accountability to appointments, disease state expansion, and markers of disease‐state management. Given diabetes and hypertension are the main disease states managed by most PACT CPS', the study evaluated changes in hemoglobin A1c (HbA1c) and blood pressure (BP) between the two cohorts as well. Data were analyzed using GraphPad Software or Microsoft Excel. A student T‐test was used for continuous data and Chi‐squared or Fishers Exact for nominal data. Results The total number of PACT CPS encounters increased 32% in 2020, and the number of unique patients increased by 12%. There were a statistically significant increase in telephone and direct‐to‐consumer (DCT) video visits. The rates of no shows and cancellations significantly decreased between 2019 and 2020. There was no difference in the average change in HbA1c or average blood pressure between the two study groups. Conclusions When PACT CPS services transitioned from primarily face‐to‐face visits to all virtual care, the consistency of care improved, and the quality of care was not compromised.

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In 1992–1993, the U.S. Food and Drug Administration (FDA) conducted a statistically based study of pesticide residues in domestic and imported pears and tomatoes. For pears, 710 domestic and 949 imported samples were collected and analyzed; 79% of the domestic and 72% of the imported samples had detectable residues. Thiabendazole, a fungicide with postharvest uses, was found with greatest frequency in both groups of pears. Four domestic and 12 imported samples contained violative residues, mainly of pesticides for which there are no U.S. tolerances on pears. The statistically weighted (by shipment size) violation rates for domestic and imported pears were 1.0 and 0.9%, respectively. For tomatoes, 1219 domestic and 144 imported samples were collected and analyzed; 84% of the domestic and 91% of the imported samples had detectable residues. Methamidophos, an insecticide, had the greatest frequency of occurrence in both groups of tomatoes. Thirtythree domestic and 5 imported samples were violative, nearly all the result of acephate use, for which there is no U.S. tolerance on tomatoes. The statistically weighted violation rates for domestic and imported tomatoes were 1.9 and 7.0%, respectively. The statistically weighted violation rates calculated for domestic and imported pears and domestic tomatoes in this study were lower than those observed under FDA’s regulatory monitoring in recent years. The violation rate for imported tomatoes was somewhat higher under statistical monitoring than under regulatory monitoring. The results of the statistically based study show that, as in regulatory monitoring, the levels of pesticide residues found are generally well below U.S. tolerances.

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