'Do they care?': a qualitative examination of patient perspectives on primary care clinician communication related to opioids in the USA.

Objectives: This substudy's objectives were to (1) examine the transferability of a four archetype framework (simplified pattern of prototypical features) for patients at high risk for opioid use disorder (OUD) developed from a previous study with a similar population; (2) explore how patient preferences for terminology can inform clinician communication strategies for patients with OUD across archetypes and (3) explore how patient perceptions of opioid risks can inform clinician communication strategies across patient archetypes.

Design: This qualitative study collected data via semistructured phone interviews with patients about views on opioid-related discussions with primary care clinicians. Qualitative data were coded using the Rigorous and Accelerated Data Reduction technique and analysed via iterative inductive/deductive thematic analysis.

Medical Marijuana Documentation Practices in Patient Electronic Health Records: Retrospective Observational Study Using Smart Data Elements and a Review of Medical Records.

Background: Medical marijuana (MMJ) is available in Pennsylvania, and participation in the state-regulated program requires patient registration and receiving certification by an approved physician. Currently, no integration of MMJ certification data with health records exists in Pennsylvania that would allow clinicians to rapidly identify patients using MMJ, as exists with other scheduled drugs. This absence of a formal data sharing structure necessitates tools aiding in consistent documentation practices to enable comprehensive patient care.

Discussions of Cannabis Over Patient Portal Secure Messaging: Content Analysis.

Background: Patient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform.

Objective: This study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania.

Methods: We examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022.

Initial Experience of Implementing a Pre-treatment Dry Run for HyperArc Stereotactic Radiosurgery Treatments With Optical Surface Imaging for Intra-fraction Motion Monitoring.

Linac-based stereotactic radiosurgery (SRS) with planning target volume (PTV) margins <1 mm has become increasingly common in recent years. Optical surface imaging for surface-guided radiation therapy (SGRT) is often used for intra-fraction motion monitoring during these treatments to facilitate the use of a smaller PTV margin by providing real-time quantitative patient positioning information. However, rotating the couch introduces errors to SGRT-reported translations and rotations that can be problematic for SRS treatments with non-coplanar arcs and very small PTV margins.

Qualitative evaluation to understand barriers and facilitators to prescribing angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose cotransporter inhibitors (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF).

Background: Despite sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor/neprilysin inhibitors (ARNi) being cost-effective evidenced-based therapies for the management of Heart Failure with Reduced Ejection Fraction (HFrEF), research shows that less than 30% of patients with HFrEF are prescribed these agents.

Objective: This study aimed to understand clinician-perceived barriers and facilitators to prescribing ARNi and SGLT2i in patients with HFrEF.

Methods: We conducted virtual and in-person semi-structured interviews in a large integrated healthcare delivery system in the United States.

Impact of an Electronic Health Record-Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial.

Background: Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%-30% of referrals from primary care to neurology. In primary care, electronic health record-based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care.

Objective: This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients' overall headache management.

Using a Preceptor Development Series in Writing and Publication to Improve Residency Research Manuscripts.

: Rates of pharmacy residency research projects making it to peer review and publication are low (between two and seven percent). Little is known about the influence of preceptor development on moving projects to peer-review and publication. : The primary objective was to describe the effect of a preceptor development series on writing and overall manuscript quality leading to submission to a peer-reviewed publisher.

Impact of cost on prescribing diabetes medications for older adults with type 2 diabetes in the outpatient setting.

Background: Newer diabetes medications have cardiorenal benefits beyond blood sugar lowering that make them a preferred treatment option in many patients. Despite this, studies have shown that prescribing of these medications remains suboptimal with medication costs being hypothesized as a reason for underutilization.

Objective: To understand clinicians' decision-making processes for prescribing diabetes medications in older adults, focusing on higher cost medications.

Automated Test for Monthly Quality Assurance of Optical Surface Imaging Dynamic Localization Accuracy.

The American Association of Physicists in Medicine (AAPM) recently published the report of Task Group (TG) 302, which provides recommendations on acceptance, commissioning, and ongoing routine quality assurance (QA) for surface-guided radiation therapy (SGRT) systems. One of the recommended monthly QA tests is a dynamic localization accuracy test. This work aimed to develop an automated procedure for monthly SGRT dynamic localization QA.

Dispensaries and Medical Marijuana Certifications and Indications: Unveiling the Geographic Connections in Pennsylvania, USA.

Introduction: Pennsylvania opened its first medical marijuana (MMJ) dispensary in 2018. Qualifying conditions include six conditions determined to have no or insufficient evidence to support or refute MMJ effectiveness. We conducted a study to describe MMJ dispensary access in Pennsylvania and to determine whether dispensary proximity was associated with MMJ certifications and community demographics.

Evaluation of pharmacist-led transition of care program in patients with acute coronary syndrome.

Background: Guideline-directed medical therapies (GDMTs), initiated in-hospital and continued during the transition to outpatient care, are paramount to successful outcomes for patients with acute coronary syndrome (ACS). Incomplete discharge medication prescribing and delayed follow-up lead to worse cardiovascular outcomes.

Objectives: We investigated a system of care using inpatient and outpatient clinical pharmacists to close GDMT gaps, ensure seamless transition to outpatient care, improve patient education, and optimize therapies.

Pre-emptive pharmacogenomics implementation among polypharmacy patients 65 years old and older: a clinical pilot.

Pre-emptive testing of pharmacogenomic (PGx) variations has potential to improve medication safety and effectiveness; however, testing is not routine. Given the newfound payor coverage of multigene testing and the potential value of testing within aging patients, it is imperative to test local PGx testing capabilities, report results to patients and providers, and determine the value of testing. We designed a randomized clinical pilot of a pre-emptive PGx testing process using the electronic health record compared with usual care among an aging primary care population.

Factors Affecting Prescribing of Type 2 Diabetes Medications in Older Adults within an Integrated Healthcare System.

Background: Despite type 2 diabetes guidelines recommending against the use of sulfonylureas in older adults and for the use of sodium-glucose cotransporter-2 inhibitors (SGLT2) and glucagon-like peptide-1 agonists (GLP1s) in patients with atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and heart failure (HF), real-world guideline-concordant prescribing remains low. While some factors such as cost have been suggested, an in-depth analysis of the factors associated with guideline-concordant prescribing is warranted.

Objective: To quantify the extent of guideline-concordant prescribing in an integrated health care delivery system and examine provider and patient level factors that influence guideline-concordant prescribing.

Assessing Ability Recovery of the Sequential IRT Model With Unstructured Multiple-Attempt Data.

The unstructured multiple-attempt (MA) item response data in virtual learning environments (VLEs) are often from student-selected assessment data sets, which include missing data, single-attempt responses, multiple-attempt responses, and unknown growth ability across attempts, leading to a complex and complicated scenario for using this kind of data set as a whole in the practice of educational measurement. It is critical that methods be available for measuring ability from VLE data to improve VLE systems, monitor student progress in instructional settings, and conduct educational research. The purpose of this study is to explore the ability recovery of the multidimensional sequential 2-PL IRT model in unstructured MA data from VLEs.

Associations of Healthcare Utilization and Costs with Increasing Pain and Treatment Intensity Levels in Osteoarthritis Patients: An 18-Year Retrospective Study.

Introduction: Osteoarthritis (OA) is a complex disease, and prior studies have documented the health and economic burdens of patients with OA compared to those without OA. Our goal was to use two strategies to further stratify OA patients based on both pain and treatment intensity to examine healthcare utilization and costs using electronic records from 2001 to 2018 at a large integrated health system.

Methods: Adult patients with ≥1 pain numerical rating scale (NRS) and diagnosis of OA were included.

A mixed methods evaluation of medication reconciliation in the primary care setting.

Objectives: To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation.

Design: Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys.

Setting: Primary care practices within an integrated healthcare delivery system in the United States.

Informing collaborative relationships between community pharmacists and health care professionals in primary care practices.

Background: Collaborative relationships between community pharmacists and health care professionals in primary care practices can assist with the provision of medication and disease management services in community pharmacy settings.

Objectives: The objective was to describe the attitudes of providers working in primary care practices with on-site pharmacist collaborators to understand how to facilitate similar collaborations with pharmacists in community pharmacy settings.

Methods: This qualitative study was conducted among physicians, nurse practitioners, and nurses of 3 primary care practice sites in the Commonwealth of Pennsylvania.

A mixed methods evaluation of the implementation of pharmacy services within a team-based at-home care program.

Background: Sub-optimal medication use results in significant avoidable morbidity, mortality, and costs. Programs, such as comprehensive medication management (CMM), can help to optimize medication use, improve outcomes, and reduce costs. However, implementing programs like CMM can be challenging and differences in how CMM has been implemented may be responsible for observed heterogeneity in the outcomes associated with CMM.

Associations of Opioid Prescriptions with Death and Hospitalization across the Spectrum of Estimated GFR.

Background And Objectives: Most opioids undergo kidney excretion. The goal of this study was to evaluate opioid-associated risks of death and hospitalization across the range of eGFR.

Design, Setting, Participants, & Measurements: The study population included adult primary care patients in Geisinger Health (Danville, PA) between 2008 and 2017.

The impact of community pharmacist involvement on transitions of care: A systematic review and meta-analysis.

Objectives: To evaluate the impact of community pharmacist involvement on transitions of care, specifically on 30-day hospital readmissions.

Data Sources: We searched the following databases from inception to August 2018: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts, ProQuest Health and Medical Collection, ProQuest Nursing and Allied Health Database, and Web of Science. We also searched clinical trials registries and personal files to identify additional studies.