Comparing commercial pharmacogenetic testing results and recommendations for antidepressants with established CPIC guidelines.

Introduction: Increasingly, pharmacogenetic testing helps providers with medication selection based upon patient-specific DNA results. While several government-funded organizations work towards consensus and standardization for testing and interpretation, compliance to these best practices remains inconsistent. Pharmacogenetic testing companies often develop proprietary practices for interpreting and reporting, which can lead to incongruency of reported results among companies and potential discrepancies in interpretation.

Interdisciplinary Deprescribing of Aspirin Through Prescriber Education and Provision of Patient-Specific Recommendations.

Background: Inappropriate aspirin use can lead to increased frequency of bleeding events and poor patient outcomes.

Objectives: Compare current aspirin prescribing to guideline recommendations and analyze the impact of pharmacist education for clinicians with provision of patient-specific recommendations.

Methods: Internal medicine residents received 1 educational session on appropriate aspirin use.

Preliminary outcomes of preemptive warfarin pharmacogenetic testing at a large rural healthcare center.

Purpose: As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing within a large rural healthcare system, patients who received pre-emptive pharmacogenetic testing and warfarin dosing were monitored until June 2017.

Summary: Over a 20-month period, 749 patients were genotyped for VKORC1 and CYP2C9 as part of the electronic Medical Records and Genomics Pharmacogenetics (eMERGE PGx) study. Of these, 27 were prescribed warfarin and received an alert for pharmacogenetic testing pertinent to warfarin; 20 patients achieved their target international normalized ratio (INR) of 2.

Comparison of Prescribing Practices with Direct Acting Oral Anticoagulant Protocols.

Background: The goal of anticoagulation management programs is to prevent thrombosis while minimizing the risks of hemorrhage. Direct acting oral anticoagulants (DOACs) selectively inhibit coagulation proteins to inhibit thrombosis. Previous studies suggest patient monitoring and education provided through anticoagulation services enhance adherence and decrease adverse outcomes in patients receiving DOAC therapy.

Best practices: an electronic drug alert program to improve safety in an accountable care environment.

Background: The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events.

Clinical pharmacy should adopt a consistent process of direct patient care.

Although the application of a consistent process of care serves as a foundational principle for most health care professions, this is not true for the discipline of clinical pharmacy. Without an explicit, reproducible process of care, it is not possible to demonstrate to patients, caregivers, or health professionals the ways in which the clinical pharmacist can reliably contribute to improved medication-related outcomes. A consistent patient care process should describe the key steps that all clinical pharmacists will follow when they encounter a patient, regardless of the type of practice, the clinical setting, or the medical conditions or medications involved.

Assessment of dabigatran utilization and prescribing patterns for atrial fibrillation in a physician group practice setting.

For years, warfarin and aspirin have been standard therapies for prophylaxis of stroke in atrial fibrillation. In late 2010, dabigatran, an oral direct thrombin inhibitor, became available for use in nonvalvular atrial fibrillation. We sought to evaluate utilization and prescribing patterns of dabigatran in a physician group practice setting.

Designing a pharmacy residency program: focus on a common accreditation challenge.

Purpose: One organization's stepwise approach to achieving full compliance in an area often cited for improvement in pharmacy residency accreditation surveys is described.

Summary: Principle 4 of the American Society of Health-System Pharmacists (ASHP) accreditation standard for postgraduate year 1 (PGY1) residencies lists requisite components of program design, conduct, and evaluation; many organizations seeking accreditation are evaluated as being in partial compliance with one or more elements of Principle 4. Several years ago, the Marshfield Clinic, a physician group practice in Wisconsin, launched an initiative to expand its postgraduate medical training program to include a PGY1 pharmacy residency.

Patient and phaRmacist telephonic encounters (PARTE) in an underserved rural patient population with asthma: results of a pilot study.

Objective: To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention in an underserved, rural asthma patient population.

Subjects And Methods: Patients with asthma were randomized to receive either standard care or telephone consultations from pharmacists regarding asthma self-management over a 3-month period. Qualitative interviews were conducted to identify participants' attitudes/opinions regarding the intervention.

Telephonic monitoring and optimization of inhaler technique.

Introduction: Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique.

Patient And phaRmacist Telephonic Encounters (PARTE) in an underserved rural population with asthma: methods and rationale.

Purpose: Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described.

Summary: In a randomized controlled trial (RCT), the Patient And phaRmacist Telephonic Encounters (PARTE) project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center.