Implementing a Quality Intervention to Improve Confidence in Outpatient Venous Thromboembolism Management.

Introduction: Guidelines recommend that patients with acute venous thromboembolism (VTE) represented by low-risk deep vein thrombosis (DVT) and pulmonary embolism (PE) receive initial treatment at home versus at the hospital, but a large percentage of these patients are not managed at home. This study assessed the effectiveness of a quality intervention on provider knowledge and confidence in evaluating outpatient treatment for patients with VTE in the emergency department (ED).

Methods: A pilot program to overcome obstacles to outpatient VTE treatment in appropriate patients was initiated at Baylor Scott & White Health Temple ED.

An interrupted time series study of electronic health record clinical decision support for providers caring for patients with atrial fibrillation at increased stroke risk.

Purpose: To measure the effect of clinical decision support (CDS) on anticoagulation rates in patients with atrial fibrillation (AFib) or atrial flutter (AFlut) at high stroke risk and receiving care in outpatient settings, and to assess provider response to CDS.

Methods: This observational, quasi-experimental, interrupted time series study utilized electronic health record data at a large integrated delivery network in Texas from April to November 2020. CDS consisted of an electronic Best Practice Advisory (BPA)/alert (Epic Systems Corporation, Verona, WI) with links to 2 AFib order sets displayed to providers in outpatient settings caring for non-anticoagulated patients with AFib and elevated CHA2DS2VASc scores.

Cardiovascular Outcomes Among Patients with Type 2 Diabetes Newly Initiated on Sodium-Glucose Cotransporter-2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Other Antidiabetic Medications.

Background: Cardiovascular disease (CVD) remains the most prevalent cause of morbidity and mortality in patients with type 2 diabetes (T2D) and is a primary driver for health care costs associated with diabetes management. Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant reductions in cardiovascular endpoints in clinical trials compared with placebo. However, it is uncertain whether these findings can be applied to the broader T2D population because these trials specifically included high-risk patients with established CVD.

Guidelines impact cholesterol management.

Background: Previous research demonstrates increased utilization of high-intensity statins, but unchanged low-density lipoprotein cholesterol (LDL-C) levels, immediately after the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline release.

Objective: The objective of this study was to determine achievement of statin therapy goals in patients with atherosclerotic cardiovascular disease (ASCVD) before and up to 4 years after the 2013 ACC/AHA guideline release compared with LDL-C goals of <70 mg/dL and <100 mg/dL previously recommended by other professional societies.

Methods: The single-system cohort study used medical records, laboratory results, and claims data (November 2012-October 2017) of adults with ≥1 claim for a statin, ≥1 ASCVD diagnosis in propensity score-matched analyses.

Predictors of Appropriate Pharmacotherapy Management of COPD Exacerbations and Impact on 6-Month Readmission.

Background: Suboptimal treatment of exacerbations is a major concern in management of chronic obstructive pulmonary disease (COPD). The Pharmacotherapy Management of COPD Exacerbation (PCE) Healthcare Effectiveness Data and Information Set (HEDIS) measure is a quality measure included by the National Committee for Quality Assurance that focuses on appropriate use of steroids and bronchodilators during an acute COPD exacerbation. There is limited evidence evaluating predictors of this quality measure, as well as its association with hospital readmission and cost outcomes.

Analysis of Glycemic Control of a Pharmacist-Led Medication Management Program in Patients with Type 2 Diabetes.

Background: An integrated health care system with its own regional health plan located in Texas implemented a pharmacist-led diabetes medication management program (MMP) to treat type 2 diabetic patients (baseline A1c > 7.5%). The MMP formed collaborative practice agreements with the system's physicians to allow ambulatory care pharmacists to modify and adjust diabetic drug regimens when appropriate.

Development and implementation of a telephone medication therapy management program for Medicare beneficiaries.

Purpose: A pharmacist-provided telephone medication therapy management (MTM) program for Medicare beneficiaries is discussed.

Summary: The Medicare Modernization Act of 2003 requires the provision of MTM to eligible beneficiaries. Using an MTM framework as a guide, Scott & White Health Plan (SWHP), a regional Medicare Part D plan, developed and implemented a pharmacist-provided telephone MTM service for Medicare beneficiaries.

The need for improved medical management of patients with concomitant hypertension and type 2 diabetes mellitus.

Objectives: To determine level of blood pressure (BP) control and to evaluate hypertension management strategies in patients with hypertension and type 2 diabetes mellitus.

Study Design: Retrospective review of 2 consecutive years of pharmacy and medical insurance claims data and medical charts from patients participating in 10 health plans in 9 states.

Patients And Methods: Patients 18 years and older with a medical or pharmacy claim related to hypertension were identified and assessed for inclusion in the database.