2026 Eastern States Conference

Title:
Assessing the impact of a pharmacist-led proton pump inhibitor deprescribing initiative on the pattern of proton pump inhibitor use.

Authors:
Min Jung Jo, PharmD; Kelsey Ryan, PharmD

Objective: 
Audience members will be able to describe the impact of a pharmacist-led proton pump inhibitor (PPI) deprescribing initiative on the pattern of PPI use.

Self-Assessment Question: 
How can pharmacists promote appropriate use of PPIs in hospital settings?

Background: 
While proton pump inhibitors (PPIs) can effectively treat acid-related gastrointestinal disorders, overuse during hospital admissions is an ongoing concern. Pharmacist-led interventions can reinforce appropriate use of PPIs.

Methods: 
This pre- and post-implementation study evaluated the pattern of proton pump inhibitor (PPI) use in two publicly funded hospitals and assessed the impact of a pharmacist-led PPI deprescribing initiative after a proposed intervention. Pre-intervention data came from patients with an active PPI order between September 2024 and August 2025. Patients who were hospitalized for less than 3 months or already discharged were excluded. Data collected included treatment duration, indication, deprescribing attempts, and reported adverse effects associated with long-term use. The intervention included an in-service presentation focused on PPI deprescribing and an evidence-based deprescribing algorithm for providers to reference. Post-intervention data included PPI orders discontinued, dose or frequency adjustments, or change to a different antisecretory agent.

Results: 
Prior to intervention, 98 patients were identified for data analysis. Thirty-seven (37.8%) had an appropriate indication for long-term PPI use. There were 91 (92.9%) patients who were prescribed a PPI for more than 3 months. PPI use beyond 1 year was seen in 43 (43.9%) patients, half of which experienced hypomagnesemia, hypocalcemia, or C. difficile related diarrhea. Deprescribing attempts were documented in 32 (23.5%) patients. Post-implementation preliminary data includes 86 patients. PPI deprescribing attempts were made in 21 (24.4%) patients. Data collection is ongoing; results may be updated.

Conclusion: 
Findings from this study suggest that pharmacist-led interventions may reinforce more safe and effective use of PPIs.

Title: Incorporating penicillin allergy assessment in preoperative evaluation: landmine antimicrobial stewardship effort in support of surgical services within a military treatment facility

Authors: Kailey B. Moss, PharmD; Memar D. Ayalew, PharmD, BCIDP, AAHIVP

Learning Objective: Describe the impact pharmacist-led penicillin de-labeling services can have on optimizing surgical prophylaxis.

Background/Objective: Identify patients with penicillin and/or other β-lactam allergies ahead of elective surgical procedures, provide a link to appropriate de-labeling services in the perioperative arena, and facilitate access to first-line prophylactic antibiotics.

Methods: Utilizing generated reports, pharmacist-led Penicillin Allergy Management (PAM) clinic personnel screened and identified the target population: patients > 18 years of age, non-pregnant, labeled penicillin (PCN) and/or other β-lactam allergy, and anticipated procedure between Oct. 1st to Dec. 31st, 2025.
An Antimicrobial Stewardship Pharmacist then risk-stratified patients with labeled PCN allergies using previously validated risk assessment tools (PEN-FAST and PAT-C score), with low-risk patients contacted to schedule a direct oral amoxicillin challenge (DOAC) appointment prior to respective surgery.
Patients identified as having moderate to high risk PCN and/or cephalosporin allergies were referred to the Allergy and Immunology (A/I) clinic for further evaluation by an allergist.
Upon successful intervention either by PAM or the A/I clinic, the allergy was removed from the health record, and the patient was longitudinally followed for utilization of first-line prophylactic antibiotics.

Results: A total of 962 patients were screened over the course of the 3-month period with 99 (10%) patients flagged as having a PCN and/or other β-lactam allergy, 93-99% of whom were stratified as having low-risk PCN allergy. Twenty patients in this cohort were de-labeled successfully either by DOAC or chart review: 14 were de-labeled prior and 6 were de-labeled after their respective procedure. Of the 14 patients de-labeled prior to surgery, 10/14 required administration of systemic antibiotics with 8/10 (80%) receiving first-line surgical prophylaxis. This compares to only 15/38 (39%) patients who received first-line surgical prophylaxis in individuals unable to receive intervention prior to procedure (p-value < 0.05).

Conclusion: Consistent with reported literature, we found local prevalence of patients with PCN and/or other β-lactam allergy in this study cohort to be 10%. Following successful pharmacist-driven de-labeling, 80% of patients received first-line prophylactic antibiotics. This demonstrates that appropriate de-labeling in the perioperative arena is essential to optimizing surgical prophylaxis, and by extension, critical to improving overall patient outcomes.

Self-Assessment Question: Which tool(s) can be utilized to determine risk of an IgE-mediated reaction to a direct oral amoxicillin challenge in patients with a penicillin allergy?
A. PEN-FAST Score
B. PAT-C Score
C. q-SOFA Score
D. MELD Score
E. Both A and B

Authors: Lexi Barbush, PharmD; Sheshadri Hoque, PharmD; Evan Hurley, PharmD, BCIDP 
Learning Objective: Identify common medication errors at discharge in patients initially admitted with sepsis to implement effective pharmacist-led review processes 
Self-Assessment Question:  
True/False Pharmacist intervention led to a decrease in medication errors attributable to readmissions after being hospitalized for sepsis
Background/Objective: Sepsis hospitalizations often require reassessment of chronic medications due to changes in clinical baseline, yet optimization at discharge may be overlooked as focus remains on the acute infection. 
Methods: This was a pre- and post-implementation study that was conducted September 2025 through March 2026. This study included patients ≥18 years old who were hospitalized with sepsis. Patients were excluded if they were discharged to hospice, or left against medical advice. A pharmacist assessed antihypertensives, antimicrobials, antidiabetics, and anticoagulants. Types of interventions involved dose adjustments, discontinuation of duplicate or unindicated therapies, identification of discharge list discrepancies, and initiation of indicated therapies. The primary outcome was 30-day readmissions in patients with reviewed discharge lists versus unreviewed discharge lists. Secondary outcomes included types of interventions and the number of accepted vs rejected interventions. 
Results: Preliminary results for January through February 2026 show that the readmission rate in unreviewed patients is 21% vs 13% in the reviewed patient group (p=0.2). The most common intervention type was adding a medication at discharge and most interventions were concerning antihypertensives. The most frequently rejected intervention was removing an antimicrobial from the discharge list, as providers preferred to extend therapy past IDSA guidelines recommended durations. Most notably, of the reviewed patients who were readmitted (n=11), zero were due to reasons relating to the pre-defined drug classes and the disease states they manage versus 9 of the 50 readmitted patients in the pre-implementation group.
Conclusion: Preliminary data demonstrates that in patients initially admitted with sepsis, the pharmacist-reviewed group had a lower readmission rate compared to non-reviewed patients (13% vs 21%, p=0.2). The pharmacist-review process led to a decrease in readmissions attributable to errors in the pre-defined drug classes or the disease states they target compared to Phase I readmitted patients (0% vs 18%).

Title: Systemic corticosteroids with or without stress ulcer prophylaxis: a retrospective comparative analysis of gastrointestinal bleeding risk and adverse outcomes

Authors: Sara Girgis, PharmD; Shivankar Vajinepalli, PharmD; Megan Trombi, PharmD; Yong-Bum Song, PharmD

Objective: The audience will be able to compare the risk of stress-related gastrointestinal bleeding (GIB) in hospitalized patients receiving systemic corticosteroids (SCS) with and without stress ulcer prophylaxis (SUP).

Self-Assessment Question: True/false: The 2024 Society of Critical Care Medicine (SCCM) Guideline for the Prevention of Stress-Related GIB in Critically Ill Adults considers SCS a risk factor for stress-related GIB that necessitates SUP. 

Background: Evidence correlating SCS and GIB is limited, and current guidelines do not recommend SUP for patients receiving SCS. This study aimed to evaluate whether coadministration of SUP is associated with a lower incidence of GIB in patients receiving SCS.

Methods: This single-center, retrospective chart review included patients aged 18 years or older who received SCS for at least 24 hours, with or without coadministration of SUP such as pantoprazole or famotidine. Patients with active GIB upon admission or with risk factors for GIB who required SUP, were excluded. The primary outcome compared the incidence of clinically important GIB between the cohorts. The secondary outcomes assessed the occurrence of adverse effects associated with SUP, including newly confirmed pneumonia, Clostridium difficile, and change in platelet count. 

Results: The analysis included 412 patients, of whom 176 received SCS along with SUP and 236 received SCS alone. Among those patients, clinically significant GIB was observed in one patient (0.4%) from the SCS-alone group (p > 0.99). Newly confirmed pneumonia developed in 14 patients overall, consisting of 4 patients (3.4%) in the SCS + SUP group and 10 patients (4.2%) in the SCS-alone group (p = 0.28). There were no reported cases of Clostridium difficile in either cohort. The median change in platelet count for the SCS + SUP group was -15, whereas the SCS-alone group was -13 (p = 0.31).


Conclusions: The use of SUP was not associated with a lower incidence of clinically significant GIB among patients receiving SCS. The incidence of newly confirmed pneumonia, Clostridium difficile infection, and change in platelet count were not significantly different between the cohorts. Future research involving larger sample sizes is essential to further assess whether SUP is associated with a lower incidence of clinically significant GIB in this patient population.

Title: Cost-effectiveness of paliperidone long-acting injectable antipsychotic vs oral second-generation antipsychotics in patients hospitalized for psychosis

Authors: Baylee Beaver, PharmD, MBA; Michaela E. Huddleston, PharmD, BCPS, BCGP, BCPP; Lora Good, PharmD; Patrick Kerr, PhD; Jonathan Robles-Diaz, PharmD; Brian Burton, MS

Background: This study evaluates the true cost-effectiveness of paliperidone long-acting injectable (LAI) in patients with schizophrenia and schizoaffective disorder to guide clinical practice and administrative decisions regarding antipsychotic selection.  

Methods: Medical records of 200 patients admitted to the inpatient psychiatric unit at CAMC General Hospital for schizophrenia or schizoaffective disorder from September 1st, 2016, to September 1st, 2024, were reviewed. Data collected included patient demographics, prescribed second-generation antipsychotic information, hospital length of stay (LOS) and cost, number of emergency department (ED) visits and hospital inpatient admissions in the 12-months before and after the index admission, and social determinants of health.

Results: The mean admission cost of patients discharged paliperidone LAIs was lower compared to patients discharged on oral second-generation antipsychotic agents ($76,964.40 vs $43,049.80, p<0.0001). Patients started on paliperidone LAI had longer LOS on the index admission compared to patients on oral second-generation antipsychotics (10.98 days vs 8.69 days, P=0.0001). No difference was identified in the number of readmissions or ED visits between groups. Among patients who were readmitted, there was no difference in LOS between the two groups. 

Conclusions: Paliperidone LAIs were associated with lower admission costs despite the association with a longer length of stay. However, there was no improvement in the rate of readmissions and emergency department visits.

Title: Real-world assessment of rapid blood culture identification technology on emergency department blood culture callback process 
Authors: Eleanor Carr, PharmD, Casey Boyer, PharmD, BCEMP, Sangeeta Sastry, MD, Jihye Kim, PharmD, BCPS, BCIDP 
Learning Objective: Describe the clinical impact of BioFire® FilmArray® Blood Culture Identification 2 (BCID2) implementation on readmission rate for patients with coagulase-negative Staphylococcus (CoNS) -positive blood cultures after discharge from the emergency department (ED).  
 
Self-Assessment Question: 
What outcome significantly changed after implementation of BCID2 for patients who returned to the ED with coagulase‑negative Staphylococcus–positive blood cultures? 

1. Readmission rate 
2. Hospital length of stay  
3. Prolonged antibiotic administration
4.  None

Background:  
The objective of the study is to compare the callback readmission rates in patients discharged from the ED with CoNS blood cultures prior to and after BCID2 implementation at our institution on March 13,2023. 
 
Methods: 
This is a single‑center, retrospective, pre-post quasi-experimental study of adult patients (≥18 years) with at least one positive blood culture for CoNS and discharged from the ED between January 1, 2022, and August 31, 2025. Patients with polymicrobial blood cultures were excluded. Outcomes included hospital readmission rates, empiric CoNS antibiotic initiation upon readmission, and antibiotic duration greater than 72 hours, with statistical analyses performed using JMP® software. 
  
Results:  
A total of 55 patients (pre-BCID2, n=31; post-BCID2, n=24) met inclusion criteria. Readmission rate after BCID2 implementation was not statistically different between the two groups (pre-BCID2: n=18/32 (58.1%) vs post-BCID2: n=12/24 (50%), p = 0.5945). Implementation of BCID2 was associated with a significant decrease in antibiotic initiation upon readmission (pre-BCID2: n=14/18, (77.8%) vs post-BCID2: n=4/12 (33.3%), p = 0.0243). Additionally, prolonged use of empiric antimicrobials was significantly higher in pre-BCID2 group compared to post-BCID2 group during further evaluation upon readmission (pre-BCID2: n=5/18 (27.8%) vs post-BCID2: n=0/12 (0%), p = 0.0455).  
  
Conclusion: 
The implementation of BCID2 did not significantly reduce readmission rates among patients with CoNS‑positive blood cultures at our institution. However, BCID2 was associated with a statistically significant reduction in rates of antibiotic initiation and prolonged duration of therapy. These findings highlight an opportunity to further characterize re-admitted patients and develop an institution‑specific protocol to optimize and standardize ED blood culture callback processes and resource utilization. 
 

Title: Comparing the effectiveness of glucagon-like peptide 1 receptor agonists and sodium glucose co-transporter 2 inhibitors in a nationwide observational cohort study on the rates of cardiovascular outcomes.
Authors: Madison Jones, PharmD; Tanvi Patil, PharmD, BCPS, DPLA; John Minchak, PharmD, MBA, BCPS, BCGP; Alamdeep Kaur, PharmD, BCPS
Learning Objective: At the conclusion of my presentation, the participant will be able to explain the comparative effectiveness of glucagon-like peptide 1 receptor agonists (GLP1-RA) versus sodium glucose co-transporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in a nationwide observational cohort study.
Background/Objective: The purpose of this study is to compare cardiovascular composite outcomes in patients newly initiation on GLP1-RA or SGLT2i.
Methods: This retrospective active comparator new-user cohort study included veteran patients who newly initiated on either GLP1-RA or SGLT2i. We collected electronic health record data from nationwide Veterans Health Administration (VHA) database from 1/1/2018 through 1/1/2024.   Data was collected and combined from individual electronic medical records to the VA Corporate Data Warehouse (CDW) where it was modeled and prepared for use by The VA Informatics and Computing Infrastructure (VINCI) and extracted for study using sequel query language. We included patients who were newly started on either an SGLT2i or GLP1-RA. Patients taking a combination of a GLP1-RA and an SGLT2i any time before, during, or after the study period were excluded.  Patients with type I diabetes, renal or liver transplants prior to or during the duration of the study were excluded. Patients were excluded if they did not have any encounters with VA healthcare system within the past 2 years of study index date or have history of prior use of any combination of GLP1RA or SGLT2i in the previous 1-year lookback period. Confounding was accounted via nearest-neighbor pairwise propensity score (PS) matching informed by expert-identified variables meeting the disjunctive cause criterion.
The primary outcome was a composite rate of 4-point major adverse cardiovascular events (MACE): ischemic stroke (IS), myocardial infarction (MI), coronary revascularization (CV) and hospitalization for heart failure (HHF). Secondary outcomes included comparing the rates of individual components of the primary outcomes, peripheral arterial disease (PAD) as well as chronic pulmonary disease (CPD) hospitalizations and emergency room visits and atrial fibrillation between the two groups.
Results: Matched cohorts included 51,919 patients in each of the GLP1RA and SGLT2i exposure groups. Greater than 86.8% were males with mean age of 62.5 years. The rate of four-point MACE was increased in the matched cohort when compared to the GLP1 cohort (incidence rate per 100 person-years (IR)= 22.5 vs 20.4; adjusted Hazard Ratio (aHR)= 0.88 [0.85-0.92]; p= <0.001[MJ1] ). The rate of 3-pt MACE was lower in the GLP1RA group compared to the SGLT2i. (IR= 19.6 vs 17.9; aHR= 0.91 [0.87-0.95]; p= <0.001).
The secondary outcomes rates were lower in the GLP1RA group compared to SGLT2i for :  MI (IR= 12.7 vs 11.5; aHR= 0.81[0.76-0.86]; p= <0.001), IS (IR= 16.2 vs 13.8; aHR= 0.84[0.8-0.89]; p=<0.0010), Any stroke (IR=27.4 vs 24.9; aHR=0.88[0.82-0.94]; p=<0.001), and coronary vascularization (IR= 2.06 vs 1.77; aHR=0.8[0.68-0.95]; p=0.01). The rates of HHF were not significantly different between the cohorts (IR= 6.5 vs 4.44; aHR=0.82[0.64-1.04]; p=<0.097). No statistically significant difference was noted in the rates of  PAD(IR=25.9 vs 22; aHR= 0.99[0.93-1.07]; p=0.953) and atrial fibrillation (IR=41.2 vs 37.8; aHR=1.03[0.98-1.08; p=0.259), however atrial fibrillation did occur less frequently in the GLP1-RA group when limiting timeline to 90 days after therapy initiation (IR=27.5 vs 23.9; aHR=0.9[0.86-0.94]; p=<0.001) while the rates were similar at 180 days. The rates of CPD hospitalization (IR: 1.76 vs 1.42 SGLT2i ; aHR= 0.68[0.56-0.81]; p= <0.001) and emergency room visits (IR: 7.74 vs 6.21 SGLT2i; aHR= 0.85[0.78-0.92]; p=<0.001) were significantly lower in the GLP1RA group compared to SGLT2i.
Conclusions(s): Overall, the rate of 4-point MACE and 3-point MACE was significantly lower in GLP1RA group compared to SGLT2i, however, the rates of HHF were similar with numerically higher incidence rates in GLP1RA as compared to SGLT2i. No difference in the rates of Atrial fibrillation was found however the risk was lower at 90 days in the GLP1RA group however no significant difference in rates were noted between the cohorts at 180 days, indicating time varying confounders and warrants further research. Our study also showed that the rates of ER and Hospitalization for CPD were significantly lower in the GLP1RA group compared to SGLT2i in agreement. Future prospective studies should focus on ascertaining the difference between COPD and ASTHMA rates individually, differences in the rates of Atrial fibrillation with long term GLP1RA utilization as well as differences based on previous history of diabetes.
Self Assessment Question: MACE (MI, ischemic stroke, HF, CV) occurred more frequently in patients receiving an SGLT2i than patients using GLP1-RAs. (True/False)

Title: Enoxaparin for trauma-related venous thromboembolism prophylaxis: Bleeding risk with vs. without monitoring in a rural academic medical center 
Authors: Lauren Wagner, PharmD, MBA; Alena Thannikal, PharmD, BCPS, BCCCP; Michelle Budzyn, PharmD, BCPS 
Learning Objective: Evaluate trauma-related bleeding complications with or without a pharmacist-driven monitoring protocol 
Self-assessment question: True or False: In trauma patients receiving anti-Xa monitoring, the rate of clinically significant bleeding is decreased
Background/objective: Pharmacist‑driven monitoring and dose adjustment may optimize enoxaparin prophylaxis, but rates of bleeding in rural trauma patients receiving enoxaparin for VTE prophylaxis remains understudied.  This study evaluates bleeding outcomes with or without pharmacist‑driven monitoring. 
Methods: This single‑center retrospective cohort study examined adult trauma patients who received enoxaparin for trauma‑related VTE prophylaxis from 9/1/24–1/1/25, compared those with pharmacist‑driven monitoring to those without it. Included criteria were trauma patients ≥18 years who received enoxaparin during hospitalization at a Geisinger Medical Center facility. Patients were excluded if they were on hemodialysis, pregnant, had known enoxaparin hypersensitivity, or anticoagulated immediately before prophylaxis. The primary outcome was the rate of clinically significant bleeding in monitored versus non‑monitored patients and assess factors influencing complications, including traumatic brain injury (TBI), spinal cord injury, pelvic fractures, advanced age, and low body weight. Secondary outcomes include incidence of any thrombotic event. The primary outcome was analyzed using a chi-square test with associated factors evaluated through a multivariable logistic regression model in a forest plot. The secondary outcome was analyzed using Fisher’s exact test. Statistical significance was defined as α = 0.05 for all analyses. 
Results: Out of 673 patients, 324 were included in the analysis, 203 in the monitored group, and 121 in the non-monitored group. Incidence of significant bleeding occurred in 17.7% in the monitored group and 11.6% in the non-monitored group (RR 1.53, p = 0.137). Two variables, advanced age (OR 6.56, p = 0.114) and monitored/non-monitored (OR 7.93, p = 0.083), were identified to have an increased odd of bleeding. Incidence of new thrombotic events occurred in 0.5% in the monitored group and 2.5% in the non-monitored group (RR 0.20, p = 0.149).
Conclusion: The results of this study showed no statistical significance in bleeding events nor new thrombotic events between the two groups. Therefore, Anti-Xa level monitoring may be beneficial in high-risk patient populations such as advanced age, traumatic brain injury (TBI), or pelvic fractures. However, larger, more refined studies will be required to confirm these findings.

Authors: Michael Remmel, PharmD; Memar Ayalew, PharmD, BCIDP, AAHIVP

Objectives: Evaluate the impact of provider education and an ED-specific outpatient order set on guideline-concordant antibiotic prescribing for CAP, characterize drivers of non-adherence, and assess associated clinical outcomes and adverse drug reactions.

Background: 
Community-acquired pneumonia (CAP) is a common cause of emergency department (ED) visits, and antibiotic prescribing often deviates from guideline selection, dose, and duration of therapy. This study evaluated whether an order set intervention improved adherence to local CAP guidelines.

Methods:
This retrospective, , pre-post intervention quasi-experimental quality improvement study evaluated CAP management at Walter Reed National Military Medical Center ED. Patients were included if >/= 18 years of age, diagnosed with CAP in the ED and received oral antibiotics upon discharge between July 1, 2025 and January 31, 2026 October 16, 2025, used as the pre- and post-intervention cutoff. Prescribing trends were compared before and after intervention which included provider education, implementation of an emergency department-specific updated outpatient protocol and creating a corresponding order set in the electronic medical record (EMR)Patients with recent oral or intravenous antibiotic exposure, recent hospitalization or ED visits, concurrent infections, no discharge antibiotic, or poor demographic data were excluded. The primary outcome was rate of  local guideline-concordant antibiotic therapy selection ; secondary outcomes included regimen selection, dose, frequency, duration, and treatment outcomes. Descriptive statistics were used to summarize prescribing patterns and outcomes.

Results:
Of 111 screened patients, 82 patients met inclusion criteria, including 28 pre-intervention and 54 post-intervention. Guideline-concordant antibiotic selection increased from 10.7% in the pre-intervention period to 22.2% post-intervention period. Prescriptions for 3- to 5-day treatment durations increased from 35.7% to 53.7%, while durations of at least 6 days decreased from 64.3% to 46.3%. Use of non-preferred antibiotic regimens categorized as “other” decreased from 50.0% to 25.9%. Common drivers of nonadherence were medication selection (36.0% vs 40.5%), duration (24.0% vs 21.4%), and multiple discordant components (36.0% vs 35.7%).

Conclusion:
Education and outpatient CAP order set implementation were associated with improved guideline-concordant prescribing in the ED, particularly for antibiotic selection and shortening durations of therapy. These findings support continuing antimicrobial stewardship efforts in the ED and further order set refinement to improve discharge prescribing quality.

Title: Evaluation of a Pharmacy-Managed Weight Loss Program in the VA Healthcare System One Year Post-Implementation
Authors: 
Melissa Contreras PharmD; Tanvi Patil, MPH, PharmD, BCPS, DPLA; Brandi Sugonis, PharmD, BCACP; John Minchak, BS, PharmD, MBA, BCPS, BCGP; Alamdeep Kaur, PharmD, BCPS; Jena Willis, PharmD, Kayla Williams

Presentation Objective: At the conclusion of my presentation, the participant will be able to evaluate the effectiveness of a pharmacy-managed weight loss program within the VA Healthcare System one year after its implementation.
 
Self-Assessment Question: True or false: There is greater follow-up in patients managed by a CPP compared to a non-CPP.

Background: Obesity is a chronic disease associated with significant morbidity, mortality, and healthcare costs, yet it remains undertreated despite the availability of effective pharmacologic therapies. Weight loss medications have demonstrated meaningful reductions in body weight, along with improvements in cardiovascular outcomes however, clinical inertia has limited their use. Contributing factors include limited provider time and lack of healthcare resources. Clinical Pharmacy Practitioners (CPPs) can fill this gap by supporting medication optimization, education, and monitoring to improve weight management care.  This study aims to evaluate the impact of pharmacist managed weight loss program (PMWP) at a single center rural VA healthcare system one year post implementation.

Methods: This single-center quality improvement study evaluated a PMWP implemented in collaboration with VA MOVE! program dietician (weight management program for veterans). Weight loss medications were managed by either a CPP or other providers.  Patients with less than 6 months of follow-up after medication initiation, therapy discontinuation, or those transferred to another facility within a 6-month period were excluded. The primary outcome was to compare the proportion of patients achieving ≥5% weight loss within 6 months in the CPP versus non-CPP groups. Secondary outcomes included the proportion of patients achieving ≥5% weight loss by the end of the study and the mean difference in the average weight loss % achieved between the two groups at 6 months and end of study period. Patients who were followed for >6 months an additional weight was recorded at last follow-up to calculate weight loss at the end of the study period. The primary outcome was evaluated using chi-square test or Fisher’s exact. Continuous variables were compared using Student t-test or Mann-Whitney U test.
 
Results
The preliminary analysis of our study is included currently as the data collection is still in progress. A total of 161 patients were reviewed. After applying exclusion criteria, where non-completion of at least 6 months of weight loss medication therapy was the most common reason for exclusion, the study had a sample of 54 patients to be included. The study included 47 patients in CPP group and 7 patients in non-CPP managed group. The mean age was 58.1 years, height was 69.9-inches, and weight was 324.5 lbs. Majority of patients were non-Hispanic, white male with type 2 diabetes. The most common comorbidities included type 2 diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. The most prescribed weight loss medication was tirzepatide followed by semaglutide.
At 6 months proportion of patients who achieved at least 5% of weight loss in CPP vs. non-CPP group were 25 (71.43%) vs. 3 (42.86%) with p-value 0.197 while at the end of the study period the proportion of patients were CPP 27 (81.82%) vs. non-CPP 3 (42.86%) and p-value of 0.052 respectively. At the end of 6 months and end of study period mean weight loss in CPP vs. non-CPP group was 31.86 vs. 13.19 lbs. P-value of 0.03 and 35.69 vs. 13.71 lbs. with p-value of 0.03 respectively. The mean percent weight loss achieved in CPP vs. non-CPP group was 9.74% vs. 3.8% at 6 months and 11.54% vs.4.32% at the end of study period.
 
Conclusion
Overall, our study shows at the preliminary analyses that patients enrolled in the CPP group had higher proportion of patients achieving at least 5% of weight loss and the mean weight loss achieved was significantly higher in the CPP group as compared to the non-CPP group.

Title: Implementation gap in mineralocorticoid receptor antagonist use in patients with heart failure with reduced ejection fraction
Authors: Oyinlola Shofolawe-Bakare, PharmD; Scott Baker, PharmD, BCPS.
Learning objective: Audience members will be able to identify reasons for non-initiation of mineralocorticoid receptor antagonist in eligible heart failure patients with reduced ejection fraction and assess whether reasons are appropriate or if interventions could have been made to prevent non-initiation.
Self-assessment question: Which of the following non-initiation reasons can an intervention be potentially made to allow for initiation of MRA on discharge without the need for continuous monitoring?
 A.) Acute kidney injury
 B.) Acute hyperkalemia
 C.) Low blood pressure
 D.) None of these
Background: The objective of the study was to review hospitalized patients with heart failure with reduced ejection fraction (HFrEF) to identify reasons for non-initiation of mineralocorticoid receptor antagonists (MRAs) at hospital discharge and evaluate readmission rates within this group. The American college of cardiology/ American heart association guidelines recommend MRAs for optimized guideline directed medical therapy (GDMT) in patients with chronic HFrEF who remain symptomatic despite optimal dosing of (renin-angiotensin-aldosterone) RAAS inhibitors, beta blockers and other standard therapies. However, their use remains suboptimal in this demographic.
Methods: A single-center retrospective cohort study in adults with a HFrEF diagnosis and LVEF < 40% who at the time of discharge were eligible to receive an MRA but either received or did not receive an MRA on discharge. The primary outcome was 30-day heart failure readmission rates between patients who were not discharged on an MRA based on the reasons for non-initiation. Secondary outcomes included 30-day and 90-day hospital readmission rates among patients discharged with vs. without an MRA and 1-year mortality.
Results: Of 278 patients screened, 218 met the eligibility criteria for the study. 121 patients received and continued MRA on discharge. 97 patients did not receive MRA on discharge. Non-initiation on discharge was determined by the physician. The reasons for non-initiation were largely undocumented for most patients. Other reasons included blood pressure, renal function, hyperkalemia or the patients were deferred to outpatient cardiology for follow-up. Hospital readmission rates in these groups were 13.0%, 11.8%, 33.3%, 0.0% and 14.3% respectively. There was no statistically significant difference in 30-day re-admission rates among the groups. For secondary outcomes, there was a statistically significant difference in 30-day (2.4% vs 19%) and 90-day (5.7% vs. 21%) hospital readmission rates among patients discharged with vs. without an MRA (p-value < 0.001). However, there was no difference in 1-year mortality in both groups (p-value = 0.50).
Conclusion: In this small, retrospective cohort study, majority of patients who were eligible for an MRA received one on discharge. In the group of patients who did not receive an MRA, reasons fell into a few categories. Although there was no difference in 30-day readmission rates within the non-MRA initiation group, this study highlights the importance of evaluating the appropriateness of non-initiation of therapy.

Title: Correlating application screening rubric categories with interview invitations at a postgraduate year 1 (PGY1) residency program
Authors: Paige Spencer, PharmD, Gail M. Sanchez, PharmD, BCPS, DPLA and Xia Thai, PharmD, BCPS; Cambridge Health Alliance (CHA), Cambridge, MA.
Objective: At the conclusion of the presentation, audience members will be able to state the process used to evaluate an application screening rubric for a PGY1 residency program.
Self Assessment Question: What is the importance of evaluating an application screening rubric for PGY1 residency programs discussed today?
Background: Identify which screening rubric categories are significant predictors of PGY1 interview offers.
Methods: This retrospective quality improvement project evaluates the scoring of PGY1 residency applications utilizing our institution’s ten category weighted rubric. Completed applications received through the online centralized application service by the cycle deadline of the Phase 1 Match from 2017-2024 are included and de-identified using a random number generator. The candidates invited for an interview serve as the test group and those not invited serve as the control group. A logistic regression analysis will be performed. The primary outcome will be the correlation of each individual rubric category score and whether or not the candidate was offered an interview. Secondary outcomes will include the correlation between interview invitation and the practice area of the reviewer and the pharmacy school location. We hypothesize the correlation analysis will determine how to best modify the screening rubric to improve efficiency while still offering interviews to highly qualified candidates.
Results: Our program received 441 completed applications from 2017 to 2024. We excluded 12 applications due to incorrect documentation of screening scores leaving 429 applications included in the final analysis. Of the 429 applicants, 209 (49%) received an interview offer. In the final multivariate logistic regression, the overall impression variable was excluded to address multicollinearity, while publications and other skills were removed due to a lack of statistical significance. The resulting model demonstrated a robust fit (McFadden’s R2= 0.32, p<0.001), identifying seven rubric categories as significant predictors of interview offers: grades, leadership, letter of intent, letter of recommendation, presentations, rotations, and work experience.
Conclusion: Based on our results and the relative importance of each category to our institution, the authors plan to modify the screening rubric for future PGY1 recruitment cycles. These changes aim to improve efficiency while continuing to identify highly qualified candidates.