2026 Eastern States Conference

Title: 
Changes in thyroid stimulating hormone levels and levothyroxine dosage for patients prescribed with injectable weight loss medications

Authors: 
Sammie Zou, Pharm D; Gabriela Smicherko, Pharm D; Holland Hood, Pharm D
Wilkes-Barre Veterans Affairs Medical Center, Wilkes-Barre, PA

Learning Objective:
By the end of this presentation, participants will be able to evaluate the importance of monitoring thyroid stimulating hormone (TSH) levels and address potential need for levothyroxine dose adjustment for patients prescribed with injectable weight loss medications.

Objective: 
The objective of this study is to monitor change in weight and TSH levels to assess the need for dose adjustment of levothyroxine in patients taking injectable weight loss medications.

Self Assessment Question:
True or False: TSH monitoring may be beneficial in patients taking both levothyroxine and injectable weight loss medication.

Methods:
In this retrospective chart-review, quality-improvement project data was obtained from the Computerized Patient Record System (CPRS) for patients with obesity and receiving injectable weight loss medication (semaglutide or tirzepatide) along with receiving levothyroxine for hypothyroidism from September 2022 to September 2025. Patients excluded were those with a history of thyroid cancer, receiving amiodarone, unable to tolerate injectable weight loss medications, utilizing injectable weight loss medication with only minimal weight loss effect (less than five percent reduction in body weight), or had no baseline TSH levels within at least six months while receiving levothyroxine. The primary outcome was the change in dose of levothyroxine since the initiation of an injectable weight loss medication, and the secondary outcomes were changes in weight and changes in TSH levels at baseline, three months, six months, and years one through three.
 
Results: 
A total of 170 charts were reviewed, and 57 patients met inclusion criteria and were included in the analysis. The primary outcome showed that 71.9% of patients had no changes made in their levothyroxine dose, 24.6% of patients had a decrease in levothyroxine dose, and 3.5% of patients had an increase in levothyroxine dose. Patients with a higher degree of weight loss did experience a reduction in their levothyroxine dose, and the average TSH levels have decreased with initiation of a weight loss injectable before stabilizing after dose adjustments of levothyroxine were made.

Conclusion: 
Most patients did not have levothyroxine dose adjustments following initiation of weight loss injectable. However, patients with greater weight loss had a greater likelihood of needing a dose reduction with their levothyroxine. Data was also limited due to lack of a recent TSH level for some patients which emphasized the need for routine monitoring of TSH levels particularly every 6 months and every 3 months for patients experiencing at least 15% weight loss until weight loss stabilizes.

Title:
Evaluation of type II diabetes mellitus control with continuous glucose monitoring versus blood glucose monitoring in a veteran population

Authors:
Christopher Lombardo, PharmD; Angela Bang, PharmD, BCPS; Patricia White-Thorpe, PharmD, BCGP; Allison Wostbrock, PharmD

Learning Objective:
Audience members will be able to identify  and quantify the reasons for and differences in the degree of hemoglobin A1C (HbA1c) reduction in patients with type II diabetes mellitus (T2DM) given either a blood glucose monitor (BGM) or continuous glucose monitor (CGM) for self monitoring of blood glucose (SMBG).

Background/Objective:
This project aims to evaluate glycemic control for patients utilizing CGMs versus patients utilizing BGMs at the VA New Jersey Health Care System, to determine the potential benefit of CGM use to the veteran patient population

Methods:
This was a single centered, retrospective, pre-post observational quality improvement project which was conducted using an electronic health record reporting system at the VA New Jersey Health Care System. Patients were included if they were aged 18 years or older with a diagnosis of T2DM, received either the Accu-Chek Guide Me Blood Glucose Meter or the Freestyle Libre 3 CGM System between January 1st, 2024 and September 30th, 2024, and were actively enrolled with a VA provider. Patients were excluded if they did not have a baseline HbA1c measurement collected within 3 months prior to or one month after meter initiation, if their baseline HbA1c measurement was > 7.0%, if they had received a CGM prior to Freestyle Libre 3, if their T2DM was managed by an outside provider, and if they did not have a HbA1c measurement collected within 9-15 months after meter initiation. The primary outcome was the change from baseline HbA1c at approximately 12 months after meter initiation. Descriptive statistics were used to assess study outcomes.

Results:
A total of 80 patients were included in this study. 40 patients conducted SMBG using BGMs and 40 patients conducted SMBG using CGMs during the study period. The mean baseline HbA1c measurements in the BGM and CGM groups were 9.81% and 9.33% respectively. CGM use was associated with a mean HbA1c reduction of 1.43% at 12 months, whereas BGM use was associated with a mean HbA1c reduction of 1.27% at 12 months.

Conclusions:
This study found that veterans who conducted SMBG utilizing CGMs saw a slightly larger average reduction in HbA1c at 12 months than those utilizing BGMs. Patients utilizing CGMs had higher baseline HbA1C levels and a higher incidence of insulin use than those utilizing BGMs. For these reasons, the use of CGMs over in patients on noninsulin therapy warrants further investigation.

Self Assessment Question:
Which of the following patients would be most likely to benefit from initiation of a CGM?
 A. 85-year-old male with A1C of 8.4%, FBG between 60 - 150
 B. 45-year-old female with A1C of 9.7%, FBG between 144 – 171
 C. 71-year-old male with A1C of 10.9%, FBG between 55 – 207
 D. 60-year-old male with A1C of 7.7%, FBG between 100 - 180

Title: Pumping Up a Patient's Time in Range 

Authors: Nikki Polivka, PharmD, Marissa Chiumento, PharmD, Christina Brady, PharmD, BC-ADM, Rachel Wesolowski, PharmD, BCACP 
Learning Objective: Identify the difference in time in range (TIR) for patients who transition from a closed loop or open loop tubed insulin pump system to the closed loop Omnipod 5 tubeless system. 

Learning Objective: Identify the difference in Time in Range (TIR) seen when patients with type 1 diabetes transition from a closed loop or open loop tubed insulin pump system to the closed loop Omnipod 5 tubeless pump system

Background/Objective: Insulin pump systems (both tubed and tubeless) that communicate with continuous glucose monitors (CGMs) are considered “closed-loop” as they can automatically adjust insulin based on blood glucose readings whereas pump systems that do not communicate with CGMs are considered “open-loop.” Closed-loop systems have previously shown improvements in TIR as well as A1c measurements in comparison to open-loop systems, and in practice patients tend to prefer a tubeless system in order to avoid the bulkiness of a tubed system. This research will provide further insight on the difference in TIR seen when patients with type 1 diabetes transition from a closed loop or open loop tubed insulin pump system to the closed loop Omnipod 5 tubeless pump system. 

Methods: This is a retrospective cohort study using electronic health records of adult patients with type 1 diabetes who transitioned from a closed or open loop tubed insulin pump to the closed loop tubeless Omnipod 5 insulin pump system managed by Geisinger providers from 2/1/2022-8/1/2025. Patients were excluded from the study if they had used an Omnipod 5 system for less than three months, used a tubed pump system for less than three months, had a pregnancy throughout any duration of the study period, and if they were less than 18 years of age. Data review involved the use of CGM/pump websites (Dexcom Clarity, Libreview, Glooko, Medtronic Carelink, Tandem Source) in order to find exact TIR reports. A paired t-test was used to compare changes in TIR and hemoglobin A1c readings between time spent on the tubed pump vs the tubeless system. An unpaired t-test was used to compare the amount of hospital admissions due to hypoglycemia and diabetic ketoacidosis for those on tubed pump therapy versus those on the Omnipod 5. 

Results: There was a total of 44 patients included in this study. Prior to pump system switch, there were a total of 22 patients who had their pump in automated mode while 22 patients had their pump in manual mode. Upon analysis, there was a statistically non-significant increase in TIR for patients who transitioned from tubed pump therapy to the Omnipod 5 (mean change +4.21%; p = 0.064). There was a statistically significant decrease in A1c for patients who transitioned from tubed pump therapy to the Omnipod 5 (mean change (mean change -0.41; p = 0.005). Finally, there was a statistically non-significant difference in the number of admissions for hypoglycemia (1 for tubed pump system, 1 for Omnipod 5; p = 1), and a statistically non-significant difference in the number of admissions for diabetic ketoacidosis (0 for tubed pump system, 0 for Omnipod 5; p = 1). 

Conclusion: There is a statistically non-significant increase in TIR for patients who transition from an open or closed loop tubed pump system to the tubeless closed loop Omnipod 5. 

Self-Assessment Question: T/F: It can be concluded that there is a true increase in time in range for patients who transition from a tubed pump system to the tubeless Omnipod 5. 

Authors: Samarah Wallace, PharmD; Ronald Carico Jr, PharmD, MPH; Rachele Subik, PharmD

Background/Objective: The purpose of this study is to compare the incidence of all-cause hospitalizations in patients aged 65 and older who are newly initiated on oxybutynin versus mirabegron for the treatment of overactive bladder over their first 3-months of treatment. 

Methods: This is a retrospective study comparing the incidence of all-cause hospitalizations in patients aged 65 and older who are newly initiated on oxybutynin versus mirabegron for the treatment of overactive bladder or a related condition over their first 3-months of treatment. Secondary outcomes include emergency department visits within the first year not leading to hospitalizations and initiation of a medication with potential to have been started due to an adverse event caused by oxybutynin or mirabegron. Patients were pulled from Marshall Health Internal Medicine’s electronic health record, and demographics and outcomes were assessed using the t-test or Fisher’s exact.

Results: The study assessed 338 patients over 65-years-old. 73% of the participants were female with 82% in the mirabegron arm and 66% being in the oxybutynin arm. 97% of participants were white with even distribution between both arms. The primary outcome was observed in 1% of patients in the mirabegron group and 7% in the oxybutynin group. Patients with oxybutynin had a 6-fold increased risk of hospitalization within the first 3 months. The secondary outcome for all-cause emergency department visits not resulting in a hospitalization within the first year of treatment was found to be non-significant. However, statistical significance was seen when assessing initiation of treatment for suspected adverse drug reactions to mirabegron or oxybutynin.

Conclusion: When evaluating patients 65-years-old and older who are receiving treatment with oxybutynin or mirabegron for overactive bladder, mirabegron demonstrates superior outcomes. Mirabegron, compared head-to head with oxybutynin, demonstrated a reduced incidence of adverse outcomes resulting in visits to the emergency department, hospital admissions, and the initiation of a medication that may have been started due to an adverse event.

Title
Alcohol use disorder identification test consumption score changes in patients on glucagon-like peptide-1 and glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide agonists

Authors
Sarah Alleva, PharmD; Jocelyn Mumbulo, PharmD, BCCP; Sara Skoritowski, PharmD

Learning objective
At the conclusion of my presentation, the participant will be able to describe the potential effect of GLP-1 and GLP-1/GIP agonist therapy on alcohol consumption as measured by changes in AUDIT-C scores.

Background
Preclinical studies and observational data show that GLP-1 and GLP-1/GIP dual agonists may help in the reduction of alcohol consumption.

Assessment Question:
Based on the findings of this study, which patient population may derive the greatest dual benefit from GLP-1 or GLP-1/GIP agonist therapy?
-Patients with alcohol use disorder alone
-Patients with diabetes or obesity and concurrent alcohol use
-Patients with depression without metabolic disease
-Patients without alcohol use

Methods
This single‑center, retrospective chart‑review quality‑improvement project used data from the Computerized Patient Record System (CPRS) at the Wilkes‑Barre Veterans Affairs Medical Center to identify patients with diabetes or obesity, a positive Alcohol Use Disorders Identification Test–Consumption (AUDIT‑C) score, and who were prescribed an injectable glucagon‑like peptide‑1 receptor agonist (GLP-1) or a dual GLP‑1/GIP agonist between October 2022 and December 2024. Patients were excluded if they had a negative baseline AUDIT‑C score, received therapy for less than one month, or were under 18 years old. The primary outcome was the change in alcohol use from baseline to follow‑up, measured by the AUDIT‑C score. Secondary outcomes included evaluating whether age influenced alcohol‑use reduction and comparing BMI changes between diabetes‑focused and weight‑loss–focused patients.

Results
A total of 111 charts were reviewed, and 46 patients met inclusion criteria. 65 patients were excluded due to one of the following: negative or missing baseline AUDIT‑C scores, therapy started outside the Wilkes‑Barre VA, outside the study timeframe, or therapy under one month. The primary outcome was a change in AUDIT-C score, which decreased by 43% at initial follow‑up and 57% at second follow-up. Secondary outcomes demonstrated a decrease in AUDIT‑C scores for both age groups, with reductions of 43% and 57% at the first and second follow‑up, among those aged 18–64, and 40% and 60% among those aged 65–99. BMI decreased by 8% in weight‑loss patients and 4% in diabetes patients.

Conclusion
Based on the results of this QA‑QI project, there was a decrease in AUDIT-C scores in patients receiving GLP‑1 or GLP‑1/GIP therapy, suggesting a possible association between these agents and decreased alcohol consumption.  

Authors:

Lacey Blauser, PharmD
Benjamin Heikkinen, PharmD, BCIDP
Devaney Taylor, PharmD
Keturah DelGrosso, PharmD, BCPS
Jennifer Heikkinen, PharmD, BCACP
Catherine Haupt, PharmD, BCACP

Learning Objective:


Identify potential barriers to iron deficiency screening for patients newly diagnosed with heart failure by cardiology providers.



Self-Assessment Question:


True or False: A patient newly diagnosed with heart failure with preserved ejection fraction should be screened for iron deficiency.


Background:


The purpose of this study is to identify current practices and barriers to iron deficiency screening completion for newly diagnosed heart failure patients by cardiology providers and Medication Therapy Disease Management (MTDM) pharmacists.


Methods:


This cross-sectional study was conducted via anonymous Microsoft Forms survey and dispersed via email to cardiology providers and MTDM anemia and cardiology pharmacists between February 24, 2026, and March 20, 2026. The survey consisted of various question types (select all that apply, multiple choice, etc.) aimed to assess current understanding of guideline recommendations, current practices by the individual, perceived barriers impacting screening rates, and potential benefit of various interventions targeted at increasing iron deficiency screening rates for heart failure patients systemwide. Data collected from the survey was utilized in an aggregate manner to minimize the risk of answers being identifiable and then analyzed using Excel functions.


Results:


The survey was sent to a total of 133 individuals with completion by 17 unique participants (13.5%). Among survey respondents, there were discrepancies with baseline knowledge of guideline recommendations. Potential misconceptions identified include additional criteria needed for screening, such as baseline anemia or left ventricular ejection fraction less than 40%. In practice, the most prevalent reason for not screening at initial visit was the completion of recent lab work; however, the definition of recent varied between providers. The largest perceived barrier to screening was unfamiliarity with guideline recommendations. Respondents identified provider education and creation of a lab order bundle as most impactful interventions.


Conclusions:

Survey results suggest unfamiliarity with guideline recommendations may be significantly impacting iron deficiency screening completion rates. Next steps include targeted interventions including provider education and lab order bundles for implementation within the health system.

Title: Impact of clozapine risk evaluation and mitigation strategy (REMS) removal on absolute neutrophil count (ANC) monitoring

Authors: Rhonda Moton (PharmD), Seema Ledan (PharmD), Jessica Ho (PharmD, BCPS, BCPP), Kristen Fink (PharmD, BCPS, BCACP, CDCES)

Learning objective: Audience members will be able to analyze the impact of the removal of the clozapine REMS program on monitoring practices of pharmacists and psychiatrists at a managed care institution

Self-Assessment Question:
True/False: Currently, clozapine therapy requires regular monitoring of a patient’s absolute neutrophil count (ANC) to ensure safe continuation of treatment.

Background: Clozapine treats resistant schizophrenia but is underused due to risks like agranulocytosis. After REMS ended in 2025, this study evaluates how its removal affected ANC monitoring over a 6-month period before and after REMS discontinuation.

Methods: Patients treated with clozapine from August 25, 2023 to August 25, 2025 were identified for evaluation. ANC data will be reviewed and compared across the six months before and after REMS discontinuation to determine any meaningful shifts in monitoring practices. The primary outcome is the frequency of ANC monitoring completed per patient over a 12-month period. Secondary outcomes include number of clozapine prescriptions not dispensed due to missing ANC values, the incidence and severity of neutropenia events, and rates of hospital, emergency department (ED), or urgent care visits related to psychosis. Additional measures include the number of new clozapine starts before and after REMS removal, as well as demographics, comorbidities, and encounter types gathered for context. Statistical analysis will use chi-square testing for the primary objective and descriptive methods for secondary outcomes. The project was reviewed and approved by Kaiser Permanente’s Institutional Review Board.

Results: Sixty-three clozapine patients were evaluated-59 pre-REMS and 58 post-REMS. All patients completed required ANC monitoring in both six-month periods, resulting in no variability and preventing chi-square analysis; thus, indicating no p-value. No prescriptions were denied for missing labs. Hematologic events were rare: one patient had mild neutropenia and another showed persistent neutrophilia. Fifty-nine patients started clozapine before REMS removal and four after. Pre-REMS, three patients required acute psychiatric care, while one post-REMS patient had increased psychiatric-related healthcare use, including multiple service encounters, follow-up visits, and additional outpatient visits to address ongoing symptoms.

Conclusion: Clozapine REMS discontinuation did not reduce adherence to ANC monitoring, which remained 100% in both pre- and post-REMS groups. No prescriptions were denied for missing labs, and hematologic events were rare. Few new clozapine starts occurred after REMS removal, suggesting institutional practices continued to support consistent monitoring. Larger studies with extended follow-up are needed to better evaluate potential long-term effects of REMS discontinuation more clearly.

Authors: Gi Eun (Jemma) Han, PharmD; Anthony M. Ishak, PharmD

Objective: Audience members will be able to assess the clinical relationship between losartan vs thiazide or thiazide-like diuretic use and gout/hyperuricemia incidence in patients who have hypertension.

Self-Assessment Question: How would the results of this study affect your decision with antihypertensive agent selection in patients with or at-risk for gout?

Background: Current gout guidelines preferentially recommend losartan for hypertension in individuals with gout for its suggested uricosuric effects. There are no real-world studies that directly compare losartan to thiazides and/or thiazide-like diuretics regarding their correlation to gout or hyperuricemia.

Methods: A total of 5,388 patients prescribed losartan or thiazide/thiazide-like diuretics (chlorthalidone, hydrochlorothiazide, indapamide, and metolazone) between July 1, 2023 and June 30, 2024 were identified from 11 primary care clinics in the Massachusetts General Hospital (MGH) system. The index event was defined as outpatient visits (including urgent care and emergency department) or hospitalization with a gout/hyperuricemia ICD-10 code as the primary or first diagnosis during the 1-year period. New outpatient prescriptions of colchicine, indomethacin, corticosteroids (i.e. prednisone, prednisolone, methylprednisolone, and triamcinolone acetonide injection), and uricosuric agents (i.e. allopurinol, febuxostat, probenecid) were also identified during the study period. Serum uric acid levels within 1 year prior to the index event were collected.

Results: Of the 2,591 patients taking losartan, 72 (2.8%) had visits related to gout/hyperuricemia. Of the 2,797 patients taking thiazides or thiazide-like diuretics, 77 (2.8%) had visits. There was no statistically significant difference between the two groups regarding the index event (p=0.954). Patients in the thiazide or thiazide-like diuretics group had a higher number of new prescriptions per patient than those in the losartan group for each type of medication. The mean serum uric acid level was lower in the losartan group compared to the thiazides and thiazide-related diuretics group (6.1 mg/dL [± 2.3 mg/dL] vs. 6.9 mg/dL [± 1.8 mg/dL]).

Conclusion: There was no statistically significant difference in gout/hyperuricemia occurrence for patients with hypertension taking losartan compared to those taking thiazides or thiazide-like diuretics during a 1-year study period.

Impact of pharmacist-managed weight management service on weight loss and associated clinical outcomes

Authors: Rita Chen, PharmD; Kelly Goldberg, PharmD, BCACP; Emmanuel Kim, PharmD; Jessie Morgan, PharmD, MSHA, BCPS; Kristen Fink, PharmD, BCPS, BCACP, CDCES 

Background/Objective: The purpose of this study is to evaluate the impact of a pharmacist-managed weight management service (WMS) on weight loss and related clinical outcomes in patients newly initiated on GLP-1 receptor agonist (RA) or GIP/GLP-1 RA therapy. 

Methods:
This retrospective cohort study evaluated adults enrolled in a pharmacy WMS within Kaiser Permanente Mid-Atlantic States between June 1, 2024 to May 31, 2025. Eligible patients were ≥18 years of age and newly initiated on a GLP-1 RA or GIP/GLP-1 RA through WMS. Patients <18 years of age, pregnant or breastfeeding, using compounded GLP-1 RA or GIP/GLP-1 RA, previously initiated on GLP-1 RA or GIP/GLP-1 RA therapy prior to enrollment, or paying cash for therapy were excluded. Of 6,968 enrolled patients, 127 WMS patients and 127 usual care patients were randomly selected.  Primary outcomes were percent change in body weight from baseline to program completion and percent change in body mass index (BMI). Secondary outcomes included changes in blood pressure, HbA1c, and lipids; pharmacist intervention; medication adherence (proportion of days covered); enrollment duration; and adverse events. Baseline characteristics were summarized descriptively, and independent t-tests compared outcomes (α=0.05). 

Results:  
Mean weight change was 8.07% with pharmacist-managed care versus 4.23% in usual care (p<0.001), with BMI reduction of 2.80 vs 0.27 kg/m² (p=0.045). A higher proportion of control group patients achieved ≥5% weight loss (36.2% vs 33.9%), likely due to tirzepatide use versus semaglutide in WMS. WMS patients experienced greater cardiometabolic improvements, with 88% showing blood pressure reductions compared with 71.2% in controls, and 75% of diabetic patients demonstrating HbA1c improvement versus 53.8%. Pharmacist interventions included dose titration, adverse effect management, and lifestyle counseling. Adverse events were primarily gastrointestinal. PDC not calculated due to monthly GLP-1 RA or GIP/GLP-1 RA titration and insufficient refill history. 

Conclusion:
Pharmacist-managed weight management services were associated with greater weight reduction and favorable cardiometabolic outcomes among adults initiating GLP-1 RA or GIP/GLP-1 RA therapy compared with usual care. These findings highlight the value of pharmacist-led weight management programs in supporting medication optimization, adherence, and multidisciplinary obesity care. 

Learning Objective:
Describe the impact of a pharmacist-managed weight management service on weight loss and associated clinical outcomes in adults newly initiated on GLP-1 RA or GIP/GLP-1 RA therapy. 

Self-Assessment Question:  
True or False: Pharmacists can support patients taking GLP-1 RA or GIP/GLP-1 RA medications by managing dosing, monitoring for adverse effects, and providing lifestyle counseling. 

Title: Evaluation of subcutaneous furosemide prescribing patterns and perceptions among cardiology providers in patients with heart failure

Authors: Ashley Mayes, PharmD, MPH, Keturah DelGrosso, PharmD, BCPS, Danielle Karaffa, PharmD, BCPS, Michael DiMaggio, PharmD Sarah Krahe Dombrowski, PharmD, BCACP

Learning Objective: Identify potential barriers and knowledge gaps influencing the use of subcutaneous (SQ) furosemide in the ambulatory cardiology setting for patients with heart failure (HF).

Self-Assessment Question: Potential barriers of SQ furosemide use in the ambulatory setting include insurance or prior authorization issues, out-of-pocket expense to patients, and concerns surrounding patient self-administration (True/False)

Background: Subcutaneous (SQ) furosemide is an alternative to IV furosemide for HF exacerbation due to equal bioavailability and ambulatory administration. This study examined cardiology provider perceptions of SQ furosemide in ambulatory HF patients.

Methods: This retrospective mixed-methods analysis was conducted via Epic SlicerDicer and surveys distributed to Geisinger cardiology providers and cardiology pharmacists.  Epic SlicerDicer was utilized to identify patients with active SQ furosemide prescriptions as well as those who may have been potential candidates for SQ furosemide based on a proposed high-risk criteria. Survey participants received an email with an overview of the project, education regarding SQ furosemide, and the survey link as well as a reminder email at 7 and 14 days. The survey was open from 3/3/2026 to 3/20/2026. Multiple choice, select all that apply, ranking, Likert-type and open-ended questions were utilized to identify clinical perceptions and potential barriers of SQ furosemide prescribing in the outpatient cardiology setting as well as gather provider insight on appropriate patient selection criteria for SQ furosemide use.  Data was anonymously collected via Microsoft Forms and analyzed via Microsoft Excel.

Results: Preliminary analysis of quantitative data revealed that that of 94,833 adult patients with HF at Geisinger, 23 had an active prescription for SQ furosemide between 10/10/22-10/1/25. Of those with HF, 3,079 were on a maintenance oral loop diuretic regimen of ≥ 40 mg furosemide daily or equivalent AND had at least 1 hospitalization or emergency department (ED) visit for HF within the past 6 months OR were administered an IV loop diuretic for HF within the past 6 months - indicating that they could potentially benefit from SQ furosemide. The survey was sent to 128 participants and received 13 (10.2%) responses. Qualitative survey results are currently being analyzed and results will be reported at the conference.  

Conclusion: Survey results showed most providers have positive clinical perceptions of SQ furosemide and find it at least somewhat beneficial for outpatient management of HF exacerbation.  A major perceived barrier to SQ furosemide prescribing identified was cost concern.  Given the positive response from clinicians, a subsequent cost analysis of SQ furosemide versus alternatives was presented to pharmacy leadership for potential implementation.

Implementation of allergy reconciliation for beta-lactam allergies

Authors: Mark Angel, PharmD; Lori Belle Slone, PharmD, BCPS; Jessica Sobnosky, PharmD, BCPS, BCIDPObjective: •Audience members will be able to apply the PEN-FAST tool during medication reconciliation to risk-stratify beta-lactam allergies.

UDIEBackground: Inaccurate beta-lactam (BL) allergy documentation limits first-line antibiotic use and promotes broad-spectrum alternatives. This study evaluates whether pharmacy led allergy reconciliation improves documentation accuracy and antimicrobial selection.Methods: This study reviewed electronic health records of patients ≥18 years with a documented beta-lactam (BL) allergy who underwent pharmacist-led allergy reconciliation between November 1, 2025, and March 1, 2026. Allergy documentation was evaluated for accuracy and clinical relevance following reconciliation. The primary outcome was the proportion of patients with updated BL allergy documentation. Secondary outcomes included the proportion of patients with antimicrobial therapy modification and BL utilization following clarification. Data were collected via retrospective chart review at study completion, de-identified, and securely stored. Descriptive statistics were used, with categorical variables such as PEN-FAST risk levels and documentation rates reported as frequencies and percentages to identify gaps between clinical reconciliation and formal documentation practices.

Results: A total of 189 patients were eligible for inclusion with 50 being randomized for analysis. Risk stratification using the PEN-FAST tool identified 14 patients (28%) as very low risk, 19 (38%) as low risk, 15 (30%) as moderate risk, and 2 (4%) as high risk. The primary outcome of updated allergy documentation was achieved in one patient (2%). Regarding secondary outcomes, no modifications to antimicrobial therapy were observed during the initial admission following reconciliation. Prior to PEN-FAST assessment, 66% of low-risk patients were already receiving BL therapy. Zero adverse drug reactions related to BLs occurred during the study period.

Conclusion: Although pharmacy-led reconciliation did not result in immediate antimicrobial therapy changes, it identified a gap between allergy risk assessment and clinical decision-making. Most patients were low or very low risk by PEN-FAST and were already receiving beta-lactams. However, improved allergy documentation provides lasting value by supporting optimized antibiotic selection in future encounters and highlights the need for better use of validated assessment tools.

References:
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Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183–198.

Centers for Disease Control and Prevention. Antibiotic use in the United States: penicillin allergy. Atlanta, GA: US Department of Health and Human Services; 2021.

Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol. 2014;133(3):790–796.

Torres MJ, Adkinson NF Jr, Caubet JC, Khan DA, Kidon MI, Mendelson L, Gomes ER, Rerkpattanapipat T, Zhang S, Macy E; AAAAI/WAO 2018 Symposium Penicillin and Cephalosporin Allergy Testing Working Group. Controversies in drug allergy: beta-lactam hypersensitivity testing. J Allergy Clin Immunol Pract. 2019;7(1):40–45.

Trubiano JA, Vogrin S, Kruse O, Phillips EJ. Development and validation of a penicillin allergy clinical decision rule. JAMA Intern Med. 2020;180(5):745–752

Title: Evaluating pharmacist impact on clinical outcomes in chronic care management  
Author: Justin Chan, PharmD; Kimberly Dowdell, MD, FACP; Morgan Lockhart, PharmD, BCACP 
Learning Objective: At the conclusion of my presentation, the participant will be able to describe how the involvement of a pharmacist in chronic care management can influence diabetes-related clinical and financial outcomes.  
Self-Assessment Question: Pharmacist and nurse involvement in the chronic care management (CCM) program increase revenue compared to those not enrolled in the CCM program. (True/False)
Background: No studies have directly compared clinical outcomes among patients seen by nurse care coordinators, patients seen by nurse care coordinators and pharmacists, and those not enrolled in chronic care management (CCM). 
Methods: This is a single-center, retrospective, cohort study. Patients included were adults 65 years and older, enrolled in Medicare, with a diagnosis of type 2 diabetes mellitus who received care at the University Physicians of Charlottesville from January 1, 2024- June 30, 2025. Patients had at least two recorded hemoglobin A1c values (baseline and follow-up) and followed for a minimum of 6 months. Primary endpoint is the proportion of patients achieving a target A1c goal of <8% among those managed by a pharmacist and nurse care coordinators, compared with patients managed by nurse care coordinators alone, and those not enrolled in the CCM program. Secondary endpoints include meeting individualized A1c goals, mean A1c change, completion of eye exams, foot exams, urine albumin-to-creatinine ratio screening (UACR), ratio of reimbursed to billed revenue, and mean net revenue generated per month. Fisher’s exact test, Kruskal-Wallis tests, and descriptive statistics were used where appropriate. 
Results: There were 24 patients in the non-CCM group, 5 patients in the nurse-care coordinators group, and 4 patients seen by nurse-care coordinators and a pharmacist. A1c <8% was achieved in 75% (3/4) of patients in the nurses and pharmacist group compared to 42% (10/24) and 40% (2/5) in the non-CCM group and nurses' only group respectively; target A1c was achieved in 50% (2/4) vs 25% (6/24) and 20% (1/5), respectively. Patients in the pharmacist and nurses’ group had the greatest mean A1c reduction (2.15%) and the highest rates of annual diabetic preventable screenings completed except for UACR. Mean net revenue generated was $155.48 per month in patients seen by nurses only compared to $191.48 per month in those seen by nurses and a pharmacist.  
Conclusion: These results suggest pharmacist involvement may improve clinical outcomes and increase revenue. Lack of statistical significance from the results is likely due to small sample size and limited power. Larger prospective studies are needed to confirm these findings. Future studies should assess patients transitioning from pharmacist to nurse-only care and could include additional endpoints such as BMI changes and statin use.