2023 Poster Abstracts

1. Utilization of Video-Based Interactive Tools as a Lecture

Replacement and Supplementation in an Integrated Pharmacotherapy Course

Authors: Jennifer Wood, PharmD, BCPS; Rebecca Grand; Devin Olden; Scott Perkins, PharmD; Riley Bowers, PharmD, BCPS, BCCP

Institution: Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC

Objectives: The primary objective of this study was to evaluate results from the implementation of interactive video-based tools as a replacement and supplement to in-class lectures in an integrated cardiovascular pharmacotherapy course.

Methods: Faculty members created an abbreviated interactive lecture accompanied by two interactive video-based supplemental tools, which were uploaded into the learning management system. This was offered as an alternative to the standard two-hour lecture and provided students with the opportunity to review pharmaco- therapy for arrhythmias. The first supplemental tool focused on atrial arrhythmias and was comprised of five case-based vignettes. The second supplemental tool focused on ventricular arrhythmias and was comprised of four case-based vignettes, along with an abbreviated asynchronous lecture with added instructor commentary. It was not mandatory for students to complete the supplemental tools, with students being able to select how many modules within the tools to complete. After exposure to course material and the interactive video-based materials, all learners completed an assessment with material from the lecture replacement and material covered in traditional lectures. These assessment scores were compared between serious users of the new tool versus non-users.

Results: At least one module within the optional supplemental tool was utilized by 39 (56.2%) students in the class. Serious attempts at completing the tool were made by 22 (32.8%) learners. Mean assessment score for questions related to the optional interactive video tools for serious users was 81.5% versus 72.1% for non-users (P=0.0026). Scores related to non-interactive topics showed no difference when comparing serious users of the tool versus non-users (81.2% vs. 77.8%; P=0.1401). Overall, utilization of optional video-based learning tools was correlated with improved performance on targeted disease states compared to non-supplemented material.

Conclusion: Results indicate that implementation of interactive video-based supplemental material is an effective approach to enhance learning outcomes in an integrated pharmacotherapy course.

2. Implementation of a HFpEF/ HFmrEF medication order set to improve evidence-based therapies at hospital discharge

Authors: Jacklyn Rispin, PharmD, Carrie Baker, PharmD, MBA, BCPS, Riley Bowers, PharmD, BCCP, BCPS

Institution: Cape Fear Valley Medical Center, Fayetteville NC

Objective: The objective of this study was to compare the percentage of patients optimized on guideline-directed medical therapy (GDMT) based on the 2022 ACC/AHA/HFSA Heart Failure guideline updates at discharge before and after the implementation of an order set.

Methods: This retrospective cohort study examined adult patients hospitalized with a heart failure diagnosis, ejection fraction (EF) ≥ 41%, and NYHA class II-IV, receiving medical treatment pre and post-order set implementation. The primary objective was to compare the percentage of patients fully optimized on GDMT before and after order set implementation. Full optimization was defined as patients receiving all clinically appropriate agents for heart failure with mildly reduced ejection fraction (HFmrEF)/heart failure with preserved ejection fraction (HFpEF) prior to discharge.

Preliminary Results: There were 372 patients included in the pre-order set group. A total of 41 patients had a diagnosis of HFmrEF, and 330 had HFpEF. At admission, 43.3% were receiving an ACEi/ARB/ARNI, 63.4% a beta-blocker (BB), 9.9% a mineralocorticoid receptor antagonist (MRA), and 7.5% were on a sodium-glucose co-transporter-2 inhibitor (SGLT2i). Overall, 5 patients (1.3%) received appropriate therapy at discharge, with 20 patients in the HFmrEF group and 248 patients in the HFpEF group qualifying for additional therapy. There were 115 patients included in the post-order set group. A total of 15 patients had a diagnosis of HFmrEF, and 100 had HFpEF. At admission, 43.5% were receiving an ACEi/ARB/ARNI, 60.9% a BB, 7% an MRA, and 6.1% were on an SGLT2i. There were 5 patients (4.3%) receiving appropriate therapy at discharge with the opportunity for further optimization in 11 patients with HFmrEF, and 68 patients with HFpEF. The order set was utilized by providers on 9 patients (7.8%).

Conclusion: Appropriate GDMT at discharge increased by 3% after the implementation of an order set; however, opportunities for further optimization of therapy remain.

3. Direct Oral Anticoagulants: A Retrospective Evaluation of Prescribing Practices

Authors: Lyric Chaplin, PharmD; Hau Le, PharmD; Kristen Mcknight, PharmD, BCPS, CDCES, CPP; Justin Arnall, PharmD BCOP; Paige Carson, PharmD, CDCES, BCPS, CPP; Andrew Clark, PharmD, BCPS, CDCES, CPP; Laura Skaff, PharmD, BCACP, CPP

Institution: Atrium Health Cabarrus, Concord NC

Objective: The purpose of this study is to review current drug utilization and identify prescription trends that may indicate needed interventions.

Methods: This medication use evaluation was a retrospective, multicenter chart review with a data collection period from January 1st, 2021, to June 30th, 2021. Data was collected from identified inpatient hospitals and outpatient clinics in the Charlotte,

NC Metro region from patients who were started on therapeutic apixaban, rivaroxaban, or dabigatran. Patients were included in the study if they were aged 18 or older and who were initiated on a DOAC by a prescriber within the Atrium Health system. Primary outcomes included the number of major bleeding events, major adverse cardiovascular events (MACE), venous thromboembolism (VTE) events, stroke, emergency department/hospital admissions, and adverse reactions to a DOAC. Secondary outcomes included the type of drug therapy problem which prevented the appropriate use of DOACS, the number of patients with pharmacy intervention/consults regarding their DOAC dose, and which disease state or DOAC had the most frequent inappropriate dosing.

Results: A total of 200 patients were included in the medical use evaluation. The mean age was 62.3, apixaban was prescribed in 79% of the patients, while the other 21% were prescribed rivaroxaban. Patients were being treated for atrial fibrillation (35%), pulmonary embolism (33%), or deep vein thrombosis (29%). 14.5% of patients experienced a primary outcome related to a DOAC within 6 months after starting. 32% of patients experienced a drug therapy problem within 6 months of starting a DOAC.

Conclusion: Patients who are started on DOAC therapy need routine monitoring to ensure they are maintained on the correct dose. Pharmacists can evaluate DOAC therapy to assess proper dosing and adjust as necessary through routine outpatient mon-

4. Impact of a Clinical Decision Support System on Antibiotic Prescribing Durations

Authors: Marcus Mize, PharmD; Nicolo Vargas, PharmD, BCPS; Vickie Malloy, PharmD; Jennifer Wood, PharmD, BCPS; Serina Tart, PharmD

Institution: Cape Fear Valley Medical Center, Fayetteville NC

Objective: The primary objective of this study was to compare the number of patients who received evidence-based antimicrobial duration for urinary tract infection (UTI) and community-acquired pneumonia (CAP) before and after implementation of clinical decision support systems with indication-specific, guideline-directed durations of therapy. Secondary objectives included the number of patients who received evidence-based antimicrobial durations for UTI or CAP and the mean overall durations of therapy before and after the implementation of clinical decision support systems.

Methods: The medical records of 994 patients receiving antibiotics for CAP and/or UTI from October 1, 2022, to November 30, 2022, and January 1, 2023, to February 28, 2023, were reviewed. Patients who had COVID-19 infections, concomitant bacterial infections requiring prolonged antibiotics, were discharged to another facility, left against medical advice, or expired during admission were excluded. Data collected included patient demographics, antibiotic allergies, indication for antibiotics, as well as name and duration

of prescribed antibiotic(s).

Preliminary Results: 125 patients with CAP and 111 patients with UTI were included in the pre-implementation group, and 76 patients with CAP and 98 patients with UTI were included in the post-implementation group. The duration-appropriate durations were 115/213 in the pre-implementation group and 104/164 in the post-implementation group. The mean total durations for CAP were 7.9 days prior to implementation and 7.8 days after implementation. The mean total duration for UTI was 7.0 days prior to implementation and 6.9 days after implementation.

Conclusion: Although the implementation of a clinical decision support tool increased the percentage of patients receiving guideline-directed durations of therapy for UTI and CAP, the overall duration was not significantly different before and after implementation. Further interventions may be necessary to reduce the duration of antibiotics prescribed to hospitalized patients to improve adherence with guideline-recommended durations.

millions of Americans. The primary purpose of this study is to determine whether a presentation on signs and symptoms of opioid overdose and naloxone use increases attendee knowledge and confidence pre-and post-intervention.

Methods: A presentation on opioid overdose and its treatment was delivered to undergraduate and graduate students, faculty, staff, and guests of a private university. Participants 18 years of age and older were included. Pre- and post-presentation surveys assessed attendee baseline knowledge of opioid overdose signs and symptoms and gauged understanding regarding using naloxone in overdose situations. Survey questions included multiple-choice and open-ended questions. Additionally, students were asked to rate their confidence in recognizing signs and symptoms of an opioid overdose (scale of 1 to 10, 10 = very confident). Participants who completed both surveys were included in the study.

5. Assessing self-perceived recognition of opioid overdose signs and symptoms and use of naloxone through the use of an open-ended survey pre- and post-educational encounter

Authors: Rama Shamieh, PharmD Candidate; Susan M. Smith, BS, PharmD, BCPS

Objective: Misuse of opioids affects the health and well-being of

Results: Fifty-three attendees (n=11 [21%] graduate students, n=42 [79%] undergraduate students) completed both surveys. The mean pre- and post-presentation confidence of attendees in recognizing overdose signs and symptoms was 4.5 and 7.9, respectively (p<0.001). Prior to the presentation, 9% (n=5) of participants correctly identified signs and symptoms of an overdose which improved to 34% (n=18) post-presentation. When asked if a prescription was needed for naloxone, most participants stated they were unsure (n=22, 42%). After the presentation, 92%

(n=49) of participants stated that a prescription was not needed. In response to the open-ended question, “What is naloxone used for?” 57% (n=30) correctly stated “opioid overdose reversal;” this improved to 85% (n=45) post-presentation.

Conclusion: A presentation on opioid overdose and naloxone use can significantly improve attendee knowledge as well as improve self-perceived confidence in recognizing overdose situations. Educational efforts geared specifically toward undergraduate students can be very impactful.

6. System Integration of P&T and Policies and Procedures across Managed Entities

Authors: Ryan Mills, PharmD, MBA, MHA, BCPS, CSP, Toni Currin, PharmD, MBA, MSCR

Institution: UNC Health – UNC Health Johnston and UNC Health REX

Objective: This review aims to describe the regionalization of P&T and Policies and Procedures across UNC Health Johnston and UNC Health REX.

Methods: The first step in aligning our local P&T and Policies and Procedures across four hospitals in the region was designing a structure, cadence, and bylaws agreed upon across the region. Multiple stakeholders were involved in the design, creating ownership and buy-in. Simultaneously while designing our regional P&T, Policies, and Procedures were reviewed locally for regional alignment.

Policies and Procedures were cataloged and ranked based on key protocols, clinical documentation paths, and medication selection processes that are common to all four hospitals. We chose one or two to tackle each week using the catalog summary comparing UNC Health Johnston and UNC Health Rex policies. The policies that are coming up for review at local P&T were prioritized. Policies were meshed together based on likeness, removing what was no longer relevant. Then we prepared a draft for stakeholder feedback. The goal was to begin aligning the Policies and Procedures to facilitate the transition to a regional P&T, which helped address barriers such as different sites practicing differently. The regional P&T serves as the approval committee of regional policies and procedures.

Conclusion: Standardizing Policies and Procedures while building the framework for regionalizing P&T is a beneficial model addressing barriers and challenges of aligning managed hospitals across a health system.

7. Antipsychotic utilization, healthcare resource use, costs, and quality of care among all fee-for-service Medicare beneficiaries with schizophrenia in North Carolina

Authors: Jalpa A. Doshi1, Sanghyuk Seo2, Charmi Patel2, Zhi Geng1, Carmela Benson2, Brianne Brown2, Pengxiang Li1 Institution: 1University of Pennsylvania, Philadelphia, PA, USA; 2Janssen Scientific Affairs, LLC, Titusville, NJ, USA

Objective: To describe antipsychotic use, healthcare resource use (HRU), costs, and quality of care among all fee-for-service (FFS) Medicare beneficiaries with schizophrenia in North Carolina and examine county-level variations in these measures.

Methods: The sample included all adult Medicare beneficiaries in North Carolina with continuous FFS Medicare Parts A, B, and D coverage and 1 inpatient and/ or ≥2 outpatient claims with a diagnosis for schizophrenia in the 2019 100% Medicare data files. Summary statistics on antipsychotic use, HRU and cost, and quality measures were reported.

Results: In our final sample of 11,457 beneficiaries, 92% received Part D low-income subsidies, and 87% were dually eligible for Medicare and Medicaid. About 91% used any antipsychotic, 23% used any long-acting injectable (LAI), and 16% used atypical LAIs. About 27% of patients had ≥1 hospitalization, and 50% had ≥1 emergency room (ER) visits, with the majority of both related to mental health. Mean total annual all-cause, mental health, and schizophrenia-related costs were $23,015, $14,431, and $12,109, respectively. Among patients with hospitalizations, 15% and 24% had readmission within 7 and 30 days, and 56% and 70% had a physician visit and an antipsychotic fill 30 days post-discharge, respectively. Large county-level variations were found in LAI use (14% [Stanly and Iredell] to 36% [Franklin]), all-cause hospitalizations (19% [Randolph and Rutherford] to 48% [Granville]), all- cause ER visits (32% [Watauga] to 69% [Pender]), all-cause total costs ($11,871 [Currituck] to $ 35,316 [Jones]), and 30-day hospital readmissions (17% [Gaston] to 38% [Cumberland]).

Conclusions: In this study examining all 2019 FFS Medicare beneficiaries with schizophrenia in North Carolina, we found high levels of hospital admissions, readmissions, and ER visits, suggesting a high burden of schizophrenia. Large county-level variations found in LAI use, HRU, cost, and quality measures across North Carolina call for additional targeted quality improvement initiatives by state and local policymakers.

8. Evaluation of appropriate antithrombotic prescribing in patients with primary ASCVD in a community hospital

Authors: Sarah McGrath, PharmD, MSCR, Carrie Baker, PharmD, MBA, BCPS, Riley Bowers, PharmD, BCCP, BCPS

Institution: Cape Fear Valley Health Systems, Fayetteville, NC, Campbell University College of Pharmacy, Buies Creek, NC

Objective: The primary objective was to compare the percentage of appropriately prescribed antithrombotic medications based on guideline-recommended medications and durations of therapy in patients with ASCVD based on the initial event.

Methods: This single-center retrospective cohort study identified patients through a computer-generated report based on a diagnosis of primary ASCVD defined as stable ischemic heart disease (SIHD), minor stroke/transient ischemic attack (TIA), or acute coronary syndrome (ACS) receiving antithrombotic medications during hospitalization between June 1, 2020 – June 1, 2021. Discharge summaries and outpatient fill histories at 1 month, 3 months, 6 months, or 12 months were used to assess antithrombotic prescribing appropriateness based on the indication.

Results: A total of seventy-six patients were included in the study. The majority of patients had a past medical history significant for hypertension (87%), hyperlipidemia (71%), and diabetes (59%). There was no difference in the primary endpoint of the percentage of appropriate antithrombotic medication prescribing in patients with ASCVD based on the initial event, defined as SIHD, minor stroke/TIA, or ACS (p = 0.155). The percentage of appropriate antithrombotic prescribing in patients by indication was SIDH: 13/25 (50%), minor stroke/TIA: 6/12 (50%), and ACS: 21/38 (55%). No difference in appropriate antithrombotic prescribing was seen based on the patient’s self-identified race (p=0.793) or insurance status (p=0.111).

Conclusion: Despite the lack of statistically significant results, DAPT duration remained incorrect in approximately 50% of the patient population. This highlights the necessity for additional prescriber education for the most effective patient outcomes.

Based Dosing in Patients with Extremes of Body Weight

Authors: Taylor Felton, PharmD; Emily Johnson, PharmD, BCPS; Riley Bowers, PharmD, BCCP, BCPS; Brock Dorsett, PharmD, BCPS

Institution: Cape Fear Valley Medical Center- Fayetteville, NC

Objective: The purpose of this study was to assess the attainment of initial therapeutic concentration in patients with extremes of body weight receiving AUC/MIC-based dosing versus trough-based vancomycin dosing.

Methods: Adult patients hospitalized at Cape Fear Valley Medical Center, who were considered obese or underweight, that received vancomycin therapy with at least one documented vancomycin concentration, were retrospectively reviewed in this single-center cohort study. Obese was defined as weighing at least 100 kilograms or with a BMI of at least 30 kg/m2, and underweight was described as weighing 50 kilograms or less or with a BMI of 18.5 kg/m2 or less. The primary endpoint was the percentage of obese and underweight patients achieving initial therapeutic concentration for AUC/MIC-based vancomycin versus trough-based vancomycin dosing.

Results: 220 patients met the inclusion criteria, with 114 patients in the trough-based dosing group and 106 patients in the AUC/MICbased dosing group. AUC/MICbased dosing yielded a higher rate of initial therapeutic concentrations than trough-based dosing, 50.0% vs. 17.5%, respectively (p<0.0001). This difference was primarily driven by the underweight population, with 62.5% of the AUC/MIC-based dosing group achieving initial therapeutic concentrations versus only 9.3% in the trough-based dosing.

Conclusion: AUC/MIC vancomycin dosing is superior to troughbased vancomycin dosing in patients with extremes of body weight.

10. Standard Versus Minimal Monitoring for Hepatitis C Direct Acting Antiviral (DAA) Therapy at an Academic Medical Center

Authors: Anita Yang, PharmD1; Neel Swamy, MPH, PharmD Candidate2, Jane Giang, PharmD, BCPS, BCGP, CPP1

Institutions: 1University of North Carolina Health Care, Chapel Hill, North Carolina, USA

2University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA

Objective: The purpose of this study was to assess minimal monitoring approaches in Hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy to overcome the burden for clinic and patient while maintaining undetectable HCV RNA 12 weeks after the end of treatment (SVR12).

Methods: A 12-month, single-center retrospective chart review was conducted in treatment-naïve HCV-infected adults who received DAA therapy between 5/1/2020 to 4/30/2021. Patients in Cohort 1, the standard monitoring group, had > 1 in-person clinic visit during DAA treatment. Cohort 2, the minimal monitoring group, had entirely virtual visits during treatment. Both groups received telephonic touchpoints from a Clinical Pharmacist Practitioner (CPP) and Nurse Care Coordinator (NCC) throughout DAA treatment. The primary outcome was the SVR12 rate. Student t-tests were conducted for continuous variables and chi-square tests for categorical variables.

Results: From 5/1/2020 to 4/30/2021, 133 HCV patients met inclusion criteria and were treated with DAA (Cohort 1: n=56; Cohort 2: n=77). There were no differences in baseline demographics, and most patients received Epclusa or Mavyret for 8-12 weeks. Total encounters remained significantly higher in Cohort 1 compared to Cohort 2 (Cohort 1: 3.1 ± 1.0 vs. Cohort 2: 2.8 ± 1.2; p=0.047), whereas Cohort 2 had higher telephonic CPP and NCC touchpoints (Cohort 1: 2.1 ± 1.2 vs Cohort 2: 2.5 ± 1.9; p=0.045). Although Cohort 2 had a higher loss to follow-up rates (Cohort 1: 7.1% vs. Cohort 2: 18.2%; p=0.06), ultimately, there were no differences in SVR rate between cohorts (Cohort 1: 91.1% vs. Cohort 2: 77.9%; p=0.13),

Conclusion: This single-center study demonstrates that minimal monitoring during HCV treatment through post-treatment week 12 is more effective in achieving SVR cure rates than standard monitoring. Eliminating required in-person clinic visits during DAA therapy alongside a collaborative approach may play a major role in overcoming barriers to HCV care in select patients.

11. Community Health Outreach: Sugary Beverage Consumption and Obesity & Type 2

Diabetes Mellitus

Authors: Audrey Shulz, Kennedy Bradsher, Eric Melton, Chad Staunton, Semya Thompson, and Amie J. Dirks-Naylor

Institution: Wingate University School of Pharmacy, Wingate, North Carolina

Objective: The Healthy People 2030 established that over-consumption of sugary beverages has caused an increase in the prevalence of obesity & type 2 diabetes mellitus (T2DM) in the U.S. Thus, the overarching goal of this project was to reduce the prevalence by educating college students on sugary beverage consumption (SBC) and risks of developing obesity and T2DM. The specific objective was to determine if a pharmacy student-led educational session, delivered via Zoom or a tri-fold display booth, could improve knowledge regarding SBC and T2DM/obesity and increase the likelihood of reducing SBC among college students.

Methods: An educational session was delivered using two different formats; one developed using PowerPoint and delivered via Zoom in a group setting, and the other utilizing a tri-fold display with content delivered via oneon-one walk-up discussions. Both types of sessions were held on a college campus and presented to mainly undergraduate students by five second-year student pharmacists. Both formats included the same educational content. Links to online pre- and post-surveys were provided to partici- pants. Responses were recorded using Qualtrics.

Results: Sixty-two and 64 participants completed the pre-survey and post-survey, respectively. Approximately 79% attended the Zoom session vs. the alternative. Participants were mostly female (61%) and split evenly between exercisers and non-exercisers. Approximately 70% consume 1-2 sugary drinks daily, while 20% consume three or more daily. Nearly 97% stated that the educational session changed their perspective on SBC, with 86% likely to change their SBC. The intervention improved knowledge of the topic, including recommended daily maximum sugar intake, how to read a nutrition label to determine sugar consumption, conversion of grams to teaspoons of sugar, and characteristics of T2DM/ obesity.

Conclusion: The pharmacy student-led educational sessions increased awareness and knowledge of SBC and T2DM/obesity and increased the self-reported likelihood of a change in SBC.

12. Care Coordination for High Need Children: Structure and Process from EPIC Billed Medical Notes

Authors: Cassie Twisdale, PharmD Candidate1, Catherine Allen, PharmD Candidate1, Neal DeJong M.D. 2, Izabela Annis, MS,1

Kathleen C Thomas, Ph.D. 1

Institution: 1UNC Eshelman

School of Pharmacy, 2UNC School of Medicine the structures and processes of billed care coordination notes for youth with intellectual and developmental disabilities, psychiatric conditions, and complex medical conditions. This study seeks to describe elements of billed care coordination to facilitate broader billing for care coordination in practices and research using real-world administrative data.

Methods: Billed medical notes involving care coordination for children with intellectual and developmental disabilities, psychiatric conditions, and three or more complex chronic conditions seen annually from 2015-2019 were extracted (N=36). A literature review was conducted to identify common features of care coordination services. Medical notes were coded for potential structure and process aspects of a care coordination visit. Illustrative quotes were collected, and medical notes were analyzed for key themes. Two team members developed a coding manual, coded each record, and met periodically to discuss and reconcile differences. Co-authors provided input to describe the sample, clinical practice, and research implications of the data.

Some themes were linked to billing requirements, while others involved addressing medical and non-medical needs.

Conclusion: Findings provide insight into the structures and processes of real practice care coordination that have not been well described before. Billed care coordination medical notes involve themes that support high-quality care coordination. The inclusion of key themes related to structure and process of care coordination to support billing of these services has the potential to help provide high-need children with holistic care.

13. Impact of a pharmacist-led “Every Try Counts” smoking cessation appointments on quit attempts in a primary care clinic

Authors: Danielle McGlynn, PharmD, Erika McClain, PharmD, BCPS, BCACP, CPP, and Elizabeth Hudson, PharmD, MBA, BCACP, CPP

Institution: Cape Fear Valley Health System, Fayetteville, NC

Objective: The primary objective of this study was to examine

Results: Structures of care coordination notes involved timing, billing codes, and standard phrasing. Key themes of processes identified include medical specialists, identification of family structure, addressing the challenges of moving, assessment for state and federal benefits, school communication, parent communication, assessment of basic needs, mental health, vaccines, and direct patient follow-up.

Objective: The primary purpose of this study was to describe the impact of “Every Try Counts” in a primary care clinic on patients’ ability to have at least one successful quit attempt, defined as abstaining from smoking for at least 24 hours in a 30-day period. Secondary objectives were to describe the mean number of successful quit attempts per patient in a 30-day period, the impact of implementing “Every Try Counts” on patients’ ability to abstain from smoking for 3 and 5 days, patient perceptions of “Every Try Counts” evaluated during 1-month follow-up survey, and the rate of pharmacologic therapies utilized in combination with “Every Try Counts” to assist with smoking cessation. macists prescribing hormonal contraceptives in North Caroli- of pharmacists surveyed. All endpoints were analyzed using descriptive statistics.

Methods: From November 1, 2022, to March 30, 2023, 18 patients saw a Clinical Pharmacist Practitioner at a primary care clinic for a smoking cessation appointment where strategies from the FDA campaign “Every Try Counts” were utilized. A 1-month follow-up phone call and survey were completed to quantify quit attempts and patient satisfaction.

Results: Of the 18 patients attending the initial smoking cessation appointment, 6 scheduled follow-up visits, 2 attended follow-up visits, and 6 completed the 1-month follow-up survey. At least one successful quit attempt in a 30-day period was had by 4 of 6 patients (66.7%). The mean number of quit attempts per patient over a 30-day period was 2. Although only 50% of patients were able to abstain from smoking for 3 days and 33.3% of patients were able to abstain from smoking for 5 days, all 6 patients felt “Every Try Counts” was helpful, rating it at least a 3, on a scale from 1 to 5. Half of the patients utilized pharmacologic therapy.

Conclusion: Patient perceptions of the “Every Try Counts” smoking cessation method were positive; however, barriers exist to implementing smoking cessation services.

Authors: Joseph Martinez, PharmD1,2; Katie Trotta, PharmD, BCACP2; James Honeycutt, PharmD, MBA1; Charles Herring, PharmD, BCPS, CPP2.

Institution: 1Walgreen Co, Deerfield, IL; 2Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC.

Objective: North Carolina House Bill 96 allows an immunizing pharmacist to provide hormonal contraceptives (HCs). The purpose of this study was to gather and collate information regarding successes/challenges from pharmacists who have provided HCs in an outpatient practice to assist others in the implementation of this service. The primary objective was to assess the proportion of NC pharmacists who developed this service and provided HCs in an outpatient setting. The secondary objectives were to address the outcomes/barriers during the required training/ implementation of this service.

Results: The survey was sent to a total of 1633 pharmacists. 96 completed surveys were included in the analysis (5.88% completion rate). 19 pharmacists (19.8%) developed a HC service, with 15 of these pharmacists having provided HCs (15/96, 15.63%). All 15 respondents reported positive patient feedback, while 7 reported improved job satisfaction. The barriers reported include a lack of appropriate reimbursement, cost prohibitions for patients, and time constraints. 11 (11.5%) respondents had yet to complete the NCAP training, while 66 respondents had completed the training without implementing the service (66/96, 68.75%).

Conclusions: A small proportion of advanced-trained NC outpatient pharmacists are providing HCs to their patients, mostly in rural independent pharmacies. Addressing the numerous barriers would expand the scope of this service and innovate the outpatient pharmacy setting.

14. Implementation and perception of outpatient phar-

Methods: A cross-sectional, webbased survey was sent in December 2022 to NC pharmacists enrolled in the required North Carolina Association of Pharmacists (NCAP) HC training, with all responses between December 2022 and January 2023 considered. Inclusion criteria included pharmacists licensed in NC and performed at least 50% of their clinical practice in an outpatient setting. The primary endpoint was the percentage of pharmacists who had prescribed HCs out

15. Impact of Therapeutic Carbohydrate Reduction on Weight, Cardiometabolic Laboratory Markers, and Medication Requirements in Patients with Type 2 Diabetes

Authors: Kendrick Murphy, PharmD, BCACP; Amy Thompto, MS, RD/N; Kaitlyn Quinn, PharmD

Institution: Charles George VA Medical Center, Asheville NC

Objective: The primary objective of this project is to evaluate the impact of adopting a low or very low-carbohydrate diet on weight loss, cardiometabolic laboratory markers, and medication requirements in patients with type 2 diabetes.

Methods: Twenty-seven participants initially enrolled in the sixteen-week Therapeutic Carbohydrate Reduction (TCR) Aspire program. All participants were asked to obtain pre-program labs within one month of the class start date or up to two weeks after the class start date. Ordered labs include HbA1c, fasting blood glucose, lipid panel, serum creatinine/eGFR panel, liver function panel, and C-peptide. Participants are asked to regularly check their blood glucose and blood pressure and report their weight on a weekly basis. A registered dietitian will lead a weekly virtual group class helping participants successfully reduce carbohydrate consumption. A Clinical Pharmacist Practitioner and PGY1 pharmacy resident will make medication interventions as indicated to manage hypoglycemia, hypotension, and other side effects of carbohydrate reduction. Participants will complete repeat labs during the final two weeks of the program. Any labs obtained two weeks after the last session will be included for review.

Results: The TCR Aspire program will conclude in late April 2023. As of week 12, several patients have had antihyperglycemic & antihypertensive medications reduced or discontinued. Eighteen participants obtained baseline labs. Average baseline laboratory results include the following:

HgbA1c = 7.7%; fasting blood glucose = 177; total cholesterol = 150 mg/dL; LDL = 89 mg/dL; HDL = 37 mg/dL; triglycerides = 215 mg/dL; AST = 23 U/L; ALT = 40 IU/L; ALP = 86 U/L; albumin = 3.8 g/dL. Average BMI = 38.7. In all patients, eGFR > 45 mL/min/1.73 m2 and serum creatinine < 2.0 mg/dL. C-peptide was within normal limits for all patients. Conclusion: To be determined.

16. Impact of Clinical Pharmacist Practitioner Service Implementation on Hormone Therapy Adherence in Hormone-Positive Breast Cancer Patients

Authors: Lainey Vargo, PharmD, Dustin Bryan, PharmD, BCPS, Paige Perez, PharmD, BCPS, CPP Institution: Cape Fear Valley Medical Center, Fayetteville, NC

Objective: The primary purpose of this study was to evaluate the impact of a Clinical Pharmacist Practitioner (CPP) on the adherence rates in hormone-positive breast cancer patients referred for suboptimal adherence at Cape Fear Valley Cancer Treatment and Cyberknife Center. This research will also identify and describe adherence barriers commonly seen among this patient population.

Methods: The medical records of 92 patients with hormone-positive breast cancer who have filled an oral hormone therapy within the Cape Fear Valley Health System between May 2022 and October 2022 were reviewed. Patients who filled more than a 30-day supply at a time and whose adherence at baseline was identified to be > 90% utilizing proportion of days covered (PDC) were excluded. Data collection included patient demographics, hormone medication, duration of therapy, baseline and follow-up PDC, and patient-described adherence barriers.

Results: Nine patients with a mean age of 59 years, and a mean baseline PDC of 0.68 were included. Majority of patients were on letrozole (33%), followed by anastrozole (22%), tamoxifen (22%), abemaciclib (11%), and palbociclib (11%). Three-month analysis after the intervention with a CPP showed that PDC increased by an average of 0.09. Post-intervention mean PDC was 0.76. Survey results for patient-described adherence barriers revealed that the most common adherence barrier in this patient population was due to adverse effects. Other common adherence barriers included poor health literacy, and medication non-compliance.

Conclusions: In hormone positive breast cancer patients identified to have sub-optimal adherence an appointment with a CPP increased patients PDC on average by 0.09.

17. Outcomes of Student Pharmacist-Led Educational Interventions on Medication Reconciliation Process

Authors: Lauren Fasth, PharmD Candidate1, Chelsea Atkins, MS, MPH2, Nancy Kubiak, MD, FACP2, Casey Wells, PharmD, CPP1,2

Institution: 1UNC Eshelman School of Pharmacy, Asheville NC; 2Mountain Area Health Education Center (MAHEC), Asheville NC cists can effectively provide educational interventions to CMAs to improve the thoroughness of medication reconciliations completed in outpatient clinical settings. However, due to the decline in performance seen between months 1 and 3, regular training is needed for sustained improvement. Future research should consider the impact of an embedded medication reconciliation checklist in the EHR to further improve CMA performance.

Objective: To determine if student pharmacist-led educational interventions improved the thoroughness of medication reconciliations completed by certified medical assistants (CMAs) over extended time periods.

Methods: Over a 4-month period, seven CMAs within an Internal Medicine Clinic were observed conducting 100 medication reconciliations. First, an initial observation of 25 medication reconciliations was completed by two investigators (LF, CW). Then, CMAs attended three 30-minute lectures over the course of a fourmonth period: T1 = teaching one on medication reconciliation best practices, T2 = teaching two on the top 50 medications prescribed by providers in internal medicine, T3 = teaching three on over-thecounter products. Each was conducted by the student-pharmacist and developed based on best practices for medication reconciliations outlined in the 2018 ASHP Medication Reconciliation Guidance Document for Pharmacists. Post-education observations were conducted after 1-month, 3-month, and 4-month intervals.

Results: The overall number of questions CMAs asked during their medication reconciliations increased by 12.6% over the 4-month period after attending three teaching sessions. In addition, the overall number of questions CMAs omitted decreased by 40.5%. However, an increase was observed in the number of questions omitted between months 1 and 3, in which no educational intervention occurred.

18. The Effect of Semaglutide on Insulin Requirements and Overall Diabetes Control in Patients with Type 2 Diabetes at the Charles George VA Medical Center

Authors: Diana Loffgren, PharmD, MHPA, BCACP, CDCES, and Lindsey Baugham, PharmD

Institution: Charles George Veterans Affairs Medical Center, Asheville NC

Objective: The purpose of this project was to assess changes in insulin regimens and overall diabetes control in patients on semaglutide and insulin at the Charles George VA Medical Center. The primary outcome was any change in insulin doses 6 and 12 months after the initiation of semaglutide. The secondary outcomes were any changes in A1c or weight at the same time points.

Patients were excluded if they had Type 1 Diabetes, had prior semaglutide use, used semaglutide for less than 6 months, or were on hospice or pregnant at the time of semaglutide initiation.

Results: 161 patients were included in the final analysis. The most common reason for exclusion was less than 6 months of semaglutide use (95%), with the next most common reason being prior semaglutide use (5%). On average, patients were taking 77 units of basal insulin at baseline and had a subsequent dose reduction of 4 and 6 units at 6 and 12 months, respectively (p<0.01 for both time points). This correlates roughly to a 5-8% dose reduction. Patients were taking an average of 80 units of bolus insulin at baseline and had a subsequent dose reduction of 6 and 8 units at 6 and 12 months, respectively (p<0.01 for both time points). This correlates roughly to an 8-10% dose reduction. Patients lost an average of 8 pounds and had an average 1% reduction in A1c over 12 months.

Conclusion: The use of semaglutide was associated with statistically significant reductions in insulin doses. The clinical significance of these results will vary depending on a patient’s initial insulin dose.

Conclusions: Student pharma-

Methods: 201 patients with Type 2 Diabetes were identified for chart review. Patients were included if they received a new prescription for semaglutide between October 2020 and October 2021 and were already on insulin prior to semaglutide initiation.

19. Medication Use Evaluation of Dipeptidyl-Peptidase 4 Inhibitors (DPP4-I) in Primary Care Patients at Atrium Health

Authors: Luis Trejo, PharmD; Paige Carson, PharmD, CDCES, BCPS, CPP, DPLA; Jessica Cole, PharmD, BCACP, CPP; Maeghan

Troyer, PharmD, BCACP, CDCES, CPP

Institution: Atrium Health Cabarrus, Concord NC

Objective: The purpose of this study was to evaluate the use of dipeptidyl-peptidase 4 inhibitors (DPP4-I), assess safety and efficacy, and identify opportunities to optimize diabetes regimens.

Methods: This was a retrospective medication use evaluation. Patients were identified via reports from electronic medical records and included adults with an Atrium Health primary care provider who was prescribed a DPP4-I between October 1, 2021, and March 31, 2022. Data collected included demographics, DPP4-I and prescriber information, adverse effects, dosing errors, drug interactions, baseline and follow-up A1c values, and pharmacist involvement in diabetes management. Data were analyzed using descriptive statistics.

Results: One hundred patients with a mean age of 64 years were included. There were 52% female, 61% White, 27% Black, 5% Hispanic/Latino, 23% had atherosclerotic cardiovascular disease, 15% had chronic kidney disease, and 13% had heart failure. The most prescribed DPP4-I was sitagliptin, with 68% receiving sitagliptin and 19% sitagliptin-metformin. Four adverse effects were attributed to DPP4-I, hypoglycemia, vomiting, hypotension, and leg pain and swelling. There were three dosing errors with patients prescribed sitagliptin 100 mg once daily with an eGFR <45 mL/ min/1.73m2. Ten patients were on concomitant glucagon-like peptide 1 (GLP-1) agonists, with subcutaneous semaglutide and dulaglutide being the most common (three each). There was an average A1c lowering of 0.91%. There were 11 patients who had a pharmacist involved in their diabetes management; There were no dosing errors and no concomitant GLP-1 agonist use in these patients. The mean follow-up A1c of the patients who had a pharmacist involved was lower at 7.80% compared to 7.95% of the overall study group. www.workingadvantage.com

Conclusion: DPP4-Is are relatively safe and have minimal drug interactions; however, there is room for medication optimization, given that 10% of the patients were concomitantly on a GLP-1 agonist. Pharmacist involvement appears to be beneficial in diabetes management.

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