2026 Eastern States Conference

Authors:
Ali Al Ali, BA, PharmD; Debra Wilner, BA, PharmD, BCIP; Amanda S. Rampersaud, PharmD, BCPS

Learning Objective:
Describe the appropriateness of cabotegravir-rilpivirine use and its impact on treatment outcomes in patients with human immunodeficiency virus

Background/Objective:
Evaluate the appropriateness of cabotegravir and rilpivirine use based on approved indications and assess treatment outcomes in patients with human immunodeficiency virus.

Methods:
This retrospective, single-center study evaluated adults aged 18 years and older who received at least one dose of cabotegravir and rilpivirine between September 1, 2023 and September 1, 2025 at an urban healthcare system. Appropriateness was defined based on approved indications including virologic suppression, no history of treatment failure, and no known or suspected resistance. Primary outcomes included appropriateness of use and rates of treatment failure.

Results:
Pending

Conclusions:
Pending

Authors: Brielle Liberty, PharmD; Leonard Partanna, PharmD, BCPP; Allison Pezick, PharmD, BCPP; Madeleine Morin, PharmD, BC

Learning objective: At the conclusion of my presentation, the participant will be able to compare treatment retention outcomes between methadone and buprenorphine/naloxone in patients with opioid use disorder and apply study findings to optimize medication selection and management strategies for patients with opioid use disorder.

Self Assessment Question: Why is treatment retention considered an important outcome in opioid use disorder management? A. It predicts improved blood pressure control B. It is associated with reduced relapse and overdose risk C. It eliminated the need for psychosocial support D. It guarantees abstinence from all substances

Background: 
Veterans are twice as likely to die from overdose and often medications used for opioid use disorder (OUD) are stopped soon after starting. This study aims to compare retention rates between methadone and buprenorphine/naloxone in Veterans with OUD.

Methods: This is a retrospective chart review study of veterans receiving care within a Veterans Affairs Healthcare system. Eligible patients will include Veterans 18 years and older diagnosed with opioid use disorder who initiated methadone or buprenorphine/naloxone between January 2019 and December 2024. Patients with reported prior use of medications for OUD, lacking a diagnosis of OUD, transferring care from an outside facility, or those with incomplete treatment records will be excluded. The primary outcome is to compare treatment retention rates at 1, 3, 6, and 12 months in patients initiated on methadone versus buprenorphine/naloxone. Secondary outcomes will evaluate long-term retention and reasons for discontinuing medication. Data collection will include patient demographics, comorbidities, type of medication for opioid use disorder and dose, duration of treatment, and reported reasons for discontinuation. Data will be obtained from electronic health and outpatient clinical records. Descriptive statistics will be used throughout the project.

Results: Data is in the process of being analyzed. As of now, initial data collection yielded a population of 355 veterans and more than 200 veterans were excluded based on the inclusion and exclusion criteria. Patient characteristics are significant for about 94% male population, mean age is about 60 years old, and about half the population is of black or African American race. Most commonly abused drugs are cocaine, heroin, and opioids. Full results of this study are pending.

Conclusion: This study will evaluate differences in treatment retention between methadone and buprenorphine/naloxone in a veteran population. Findings are expected to provide insight into real-world medications for OUD effectiveness and identify factors influencing treatment engagement. Results may inform targeted interventions, optimize medication selection and dosing strategies, and support improved retention among veterans with opioid use disorder.

Authors
Michael Duong, PharmD; Victoria Ireland, PharmD; Swana Thomas, PharmD, MPH; Erin McMahan; PharmD, BCPS
Objective
To compare recurrent venous thromboembolism (VTE) in patients with obesity receiving reduced-dose apixaban (2.5 mg twice daily) versus standard-dose apixaban (5 mg twice daily) during extended anticoagulation.
Methods
This retrospective cohort study includes obese adults (body mass index ≥ 30 kg/m2) with prior VTE receiving apixaban 2.5 mg or 5 mg twice daily for extended anticoagulation after completing at least 6 months of initial therapy. Data was obtained from the Geisinger Health System electronic health record from January 1, 2022 to December 31, 2024
The primary outcome is recurrent VTE during extended therapy. Secondary outcomes include time to recurrent VTE and major bleeding defined by International Society on Thrombosis and Hemostasis criteria.
Due to limitations in capturing outpatient dose transitions, the start of extended therapy was standardized as 6 months after the index VTE
Results
Results are pending at the time of submission.
Conclusion
This study will provide real-world data comparing reduced-dose and standard-dose apixaban for extended anticoagulation in patients with obesity with VTE and may help inform dosing decisions in this population.
Self-Assessment Question
In patients with obesity receiving extended anticoagulation for VTE, how do recurrent VTE and major bleeding outcomes differ between reduced-dose and standard-dose apixaban?

Authors: 
Abigail Valente, PharmD; Joseph Cencetti, PharmD, BCACP, CLS; Emily Hoffmann, PharmD
Learning Objective:
By the end of this project, participants will be able to assess the clinical importance of lipoprotein(a) and its relationship with both atherosclerotic cardiovascular disease and associated comorbid conditions.
Objective:
The objective of this study was to illustrate the importance of measuring lipoprotein(a) and to assess its overall relationship with atherosclerotic cardiovascular disease.
Self-Assessment Question:
What Lp(a) level is typically considered elevated?

• < 75 nmol/L
• 75-125 nmol/L
• > 125 nmol/L

Methods:
The primary objective of the study was to assess the role of lipoprotein(a) levels in atherosclerotic cardiovascular disease development. The secondary objective was to analyze the relationship between lipoprotein(a) levels and chronic kidney disease. The study was conducted as a single-center, retrospective, chart-review, quality-improvement study with data obtained from the Computerized Patient Record System (CPRS) for relevant patients by a Patient Aligned Care Team (PACT) pharmacist from the Wilkes-Barre VA Medical Center between January 1, 2023 – October 1, 2025.
Results:
This study aimed to assess the importance of obtaining lipoprotein(a) levels and evaluate the relationship between lipoprotein(a) and atherosclerotic cardiovascular disease, as well as chronic kidney disease, a significant comorbid condition. Approximately 21% of patients had an Lp(a) > 125 nmol/L. Out of the 132 patients with atherosclerotic cardiovascular disease, only 25% had an Lp(a) > 125 nmol/L which was not expected. Prevalence of elevated Lp(a) in those with chronic kidney disease, specifically GFR < 60 mL/min, was not as high as anticipated. On the other hand, many patients with an LDL < 70 mg/dL still had an Lp(a) > 125 nmol/L.
Conclusion:
In this study, the percentage of patients found to have an elevated Lp(a) level was an accurate reflection of current literature. However, the prevalence of elevated Lp(a) in atherosclerotic cardiovascular disease and chronic kidney disease was not as high as expected. Interestingly, many with a well-controlled LDL  had an elevated Lp(a) level, confirming that elevated Lp(a) carries further residual cardiovascular risk. These findings supplement the notion that Lp(a) testing is crucial in clinical practice. Its utilization may help clarify risk and improve treatment strategies in primary and secondary atherosclerotic cardiovascular disease prevention.

Title: Specialty Pharmacy Adherence Optimization: Evaluating Adherence Using Medication Possession Ratio

Authors: Lily M. Frappier, PharmD; Katheryn A. Fierros, CPhT, MBA; Emmaline R. Libby, PharmD, CSP; Gabrielle N. Plaia, PharmD, CSP; Wen Jie J. Song, PharmD, BCPS

Learning Objective: At the conclusion of this presentation, the audience will be able to evaluate the impact of medication possession ratio (MPR) reports on optimizing medication adherence in patients with Cystic Fibrosis (CF), Human Immunodeficiency Virus (HIV), and Multiple Sclerosis (MS)

Self-Assessment Question: What is a calculation commonly used in specialty pharmacy to measure patient adherence?

• Medication Possession Ratio
• Medication Therapy Management
• Total number of prescriptions written
• Defined Daily Dose

Background/Objective: Adherence to specialty medications is essential for optimal management of chronic conditions such as CF, HIV, and MS. Low adherence is associated with higher rates of exacerbations, hospitalizations, healthcare costs, and reduced quality of life. The primary objective of this quality improvement initiative was to develop a best practice model to identify patients with suboptimal adherence using MPR analysis and subsequently implement targeted interventions to improve adherence. Secondary objectives included evaluating changes in MPR from baseline to post-intervention and identifying demographic trends that may correlate with higher non-adherence risk.

Methods: This prospective quality improvement project included patients enrolled in CF, HIV, or MS programs through Compass Rose™ who received medications through Dartmouth-Hitchcock (DH) Specialty Pharmacy and had an MPR < 80%. Patients were excluded if their MPR ≥ 80% or if, they did not fill their specialty prescriptions through DH Specialty Pharmacy. From August 2025 to January 2026, bi-weekly pharmacy dispensing reports identified patients with an MPR < 80%. Comprehensive chart reviews were conducted to confirm true non-adherence by excluding cases of artificially low MPR due to factors such as insurance barriers, hospitalization, early refills, change in care, and specialty opt-out status. Pharmacist-led outreach interventions were initiated for patients confirmed to be non-adherent, and medication therapy problems (MTPs) were documented after successful outreach to the patient. During outreach efforts, pharmacists assessed medication-taking behaviors, evaluated ongoing adherence risk, and documented related MTPs. A Plan-Do-Study-Act (PDSA) framework was utilized throughout the project to continually refine the intervention process. Baseline and post-intervention MPR scores were compared to assess adherence improvement. Additional analyses evaluated demographic and disease-specific trends associated with non-adherence.

Results: This initiative enabled the development of a best-practice model to identify non-adherent patients with CF, HIV, and MS. Of the 72 patients meeting inclusion criteria, 20 were identified as truly non-adherent following chart review. Interventions were implemented for all identified patients, however, 2 of the 20 patients were unreachable despite multiple outreach attempts. One patient who had previously opted out of DH Specialty refill services re-enrolled following pharmacist outreach. Secondary outcomes demonstrated that 3 of 20 patients showed improvement in MPR from baseline to the most recent assessment. There was no significant improvement in MPR across the study population. Additionally, no association was found between patient demographics and risk of non-adherence. The most frequently represented medications in the study included bictegravir-emtricitabine-tenofovir alafenamide fumarate, elexacaftor-tezacaftor-ivacaftor, emtricitabine-tenofovir disoproxil fumarate, and ofatumumab.

Conclusions: The integration of MPR report analysis can serve as a useful tool for identifying potential medication non-adherence and facilitating pharmacist-led interventions. This pilot successfully established a scalable best-practice model that could be applied across various specialty disease states. However, the intervention was not associated with a significant overall improvement in MPR. The short pilot duration (5 months) compounded by the larger number of days in the MPR measurement period (13 months) may have limited the ability to detect meaningful changes in adherence. Non-adherent patients typically require continuous follow up as well, rather than a single adherence reminder. While improvements in MPR were observed in a small subset of patients, a longer follow-up period and the addition of continuous adherence check-in interventions might be necessary to better evaluate the impact of pharmacist-led interventions on medication adherence and related clinical outcomes.

Title: Pharmacist impact on Medicare healthcare effectiveness data and information set (HEDIS) measures in primary care offices
Authors: Hima Dileep, PharmD, PGY-1 Pharmacy Resident, M. Kathryn Goodell, PharmD, BCPS, Shelby Zavala, PharmD
Learning Objective: Identify barriers to implementing a pharmacist led statin care gap program for Medicare
Background Objective: Evaluate the impact of a pharmacist-led service on addressing statin-related care gaps in patients with diabetes and cardiovascular disease to improve adherence to quality measures.
Methods: This multi-center retrospective chart review included patients with diabetes and atherosclerotic cardiovascular disease from primary care offices during the 2025 measurement year. Patients with statin-related care gaps were identified through payor reports, followed by pharmacist-led chart review to confirm eligibility. Pharmacists provided recommendations for statin initiation or optimization and documented interventions, provider responses, and outcomes in the electronic health record. Primary outcome was provider response to recommendations. Secondary outcomes included number of interventions, acceptance rate, patients reached for education, documented exclusions, and cases with no action. Descriptive statistics were used.
Results: A total of 114 patients were identified in the statin use in diabetes measure and 33 in the cardiovascular disease measure. Statin therapy was recommended for 44 (38%) and 5 (15%) patients, respectively, with initiation occurring in 4 and 1 patients. Pharmacists also identified patients requiring exclusion documentation and provided medication education. Exclusions included cirrhosis, dialysis, end stage renal disease, pre-diabetes, pregnancy, lactation, myopathy, rhabdomyolysis. Key barriers included lack of provider follow-up and incomplete documentation. Efforts are focused on improving follow-up processes, reminders, and prescriber education.
Conclusions: Pharmacist-led interventions improved identification of statin care gaps, however, low initiation rates highlight barriers such as inconsistent chart access, limited provider follow-up, and lack of prescribing privileges. These findings support the need for standardized processes, improved communication, and targeted education, as well as use of collaborative practice agreements. Expanding pharmacist integration may improve quality measures, increase statin use, and reduce cardiovascular risk.
Self-assessment question:
Which of the following was identified as a key barrier to statin initiation in this study? (Select all that apply)
A. Inconsistent chart access
B. High medication cost
C. Limited provider collaboration
D. Lack of available statins

Authors: Kayleigh Conaway, PharmD; Kristen Zak, PharmD, BCPS, CDCES 

Learning Objective: Audience members will be able to describe observed impacts on insulin doses made by transitioning from a glucagon-like peptide-1 receptor agonist to tirzepatide in patients with type 2 diabetes. 

Primary Objective: The primary objective of this study was to describe changes in insulin doses before and at least three months after transitioning from dulaglutide or semaglutide to tirzepatide. 

Methods: A retrospective chart review was performed to evaluate the effect on insulin doses of transitioning from dulaglutide or semaglutide to tirzepatide after at least one encounter at a Luminis Health Primary Care or Endocrinology location. Data was extracted from the electronic medical record of adult patients with type 2 diabetes who were prescribed incretin mimetics and insulin between July 1, 2024, and December 31, 2025.  Manual chart reviews were performed to collect pertinent data elements. Secondary endpoints included timing of insulin reduction, changes in hemoglobin A1C and patient weight, trends in dosing when transitioning from glucagon-like peptide-1 receptor agonists to tirzepatide, and identification of clinically significant hypoglycemia. The primary objective will be evaluated using the Wilcoxon signed-rank test to compare insulin doses for individual patients at each time point. Secondary objectives will be analyzed via descriptive statistics.  

Results: Sixty-two patients met criteria and were considered for review. Median time to first, second, and third follow up was 3, 6, and 9 months respectively. For the primary outcome, median insulin dose was reduced from 46 to 40 units within six months (-13%, p<0.001). For secondary outcomes, median A1C decreased from 8% to 7.4% over 6 months (-0.6%). Mean weight decreased by 1.2% at 6 months and 2.2% at 9 months. Over 60% of patients were started at the lowest doses of tirzepatide (2.5 or 5 mg). Median time to insulin dose adjustment and tirzepatide dose adjustment was 3 months. Hypoglycemia was reported in 15 of 62 patients (24.2%), with no reported emergency department visits or admission related to hypoglycemia.  

Conclusion(s): Insulin percent reduction observed in this study after transitioning from dulaglutide or semaglutide to tirzepatide is comparable to that of similar studies. A statistically significant reduction in insulin doses and clinically significant decreases in A1C were observed over the course of the study period. The slow, cautious tirzepatide and insulin titration schedules and low initial tirzepatide doses in this population may have impacted the results.  

Self-Assessment Question: Based on the results of this study, what is the expected magnitude of insulin dose reduction for patients with type 2 diabetes on insulin who transition from treatment with semaglutide or dulaglutide to tirzepatide? 

Title: Time to first dose antibiotics administered IV push versus IV piggyback in sepsis in the emergency department 
 
Authors: Maya Smith, PharmD; Randi Jenkins, PharmD, BCPS 
 
Learning Objective: At the conclusion of this presentation, audience members will be able to explain the effect of antibiotic administration method on time to first dose of antibiotics in sepsis and cost considerations. 
 
Background/Objective: A shorter time to initial antibiotic administration is associated with reduced mortality in sepsis. The purpose of this investigation is to determine the difference in time to first dose antibiotics when administered IV push versus IV piggyback for sepsis in the emergency department. 
 
Methods: This retrospective review was conducted at a 397-bed community medical center before and after the administration of ceftriaxone, cefepime, cefazolin, and piperacillin-tazobactam was switched from IV piggyback to IV push in 2023. This study included patients aged 18 years and above who presented to the emergency department, had documentation of sepsis via ICD-10 code in their electronic health record, and received ceftriaxone, cefepime, cefazolin, and/or piperacillin-tazobactam. The IV piggyback cohort included patients treated between 1/1/2023-6/1/2023 and the IV push cohort included those treated between 1/1/2024-6/1/2024. Patients who were transferred from an outside hospital or had an antibiotic ordered but not administered were excluded. The primary outcome was the time to first dose of antibiotic. Secondary outcomes included time to first dose of second antibiotic when applicable and cost of administration.  
 
Results: A total of 719 patients were assessed for eligibility; 714 met the prespecified inclusion criteria. Of those included, 339 patients received IV piggyback antibiotics and 375 patients received IV push antibiotics. The median time to first dose of antibiotic was 115 minutes in the IV piggyback group and 119 minutes in the IV push group. The median time to first dose of second antibiotic from administration of first antibiotic was 58 minutes in the IV piggyback group and 32 minutes in the IV push group. A student’s t-test will be used to determine statistically significant differences between groups relative to each outcome. An approximation of the cost associated with each method of administration will be made using standard market prices. 
 
Conclusion(s): The preliminary results of this study suggest that there is not a notable difference in time to first dose of antibiotic between IV piggyback and IV push administration. However, IV push antibiotic administration appears to be associated with a reduced time to first dose of second antibiotic. Assessing the difference in cost of administration will provide useful information to further determine which of these methods may be preferred in an emergency department setting.  
 
Self-Assessment Question:
Based on the results of this study, which of the following statements is true?

1. IVP antibiotic administration is associated with improved outcomes comparedto IVPB administration 
2. There is no significant cost difference between IVP and IVPB antibioticadministration 
3. IVP antibiotic administration is associated with a significantly shorter time to1st dose of 2nd antibiotic 
4. IVPB antibiotic administration is associated with a significantly shorter time to1st dose of antibiotic 

​​​​Title:
Impact of clinical pharmacy involvement in patients naïve to direct oral anticoagulants (DOACs)

Authors:
Darla Khouri (PharmD), Kristen Fink (PharmD, BCPS, BCACP, CDES), Brandon Biggs (PharmD), Seema Ledan (PharmD)

Objective:
Identify the preferred anticoagulant options for patients requiring long-term anticoagulation therapy

Self Assessment Question:
True or False: Direct oral anticoagulants (DOACs) are the preferred first‑line anticoagulants for most patients with non‑valvular atrial fibrillation

Background:
This study evaluates the impact of pharmacist intervention during direct oral anticoagulant (DOAC) initiation at Kaiser Permanente Mid-Atlantic States and its impact on medication adherence and adverse events.

Methods:
A report of patients who initiated DOAC therapy between January 1, 2024 to March 31, 2025 was compiled and patients were divided into two groups: those with a pharmacy consult referral within 30 days of DOAC initiation and those without. A randomized sample of 200 patients from each group was reviewed. The primary objective was to assess adherence to DOAC therapy, measured by proportion of days covered (PDC) of ≥80% within the first 6 months of initiation. Secondary outcomes included percentage of patients who experienced a serious bleeding event, thromboembolic (TE) events, and incidence of adverse effects outside of bleeding and TE events. A retrospective chart review was done within Kaiser Permanente Health Connect to assess the endpoints using medical record numbers. The chi-square test of independence was performed for statistical analysis.

Results:
Most patients in the study received DOAC therapy for atrial fibrillation, pulmonary embolism (PE), or deep vein thrombosis (DVT). Dabigatran was the most prescribed DOAC. A significantly greater number of patients in the pharmacist intervention group achieved a PDC ≥80% (χ²= 7.3; P = .007). The pharmacist intervention group had a mean PDC of 91.3% within the first 6 months of DOAC initiation, compared with a PDC of 84.4% in the no intervention group. Secondary outcomes, including serious bleeding events, serious thromboembolic events, and other adverse events did not differ significantly between groups (P=0.12, P=0.59, respectively).

Conclusion:
Patients receiving clinical pharmacist intervention at the start of DOAC therapy demonstrated a statistically significant improvement in PDC compared to those who did not receive counseling. This study indicates that pharmacist intervention at DOAC initiation improved patient adherence as measured by PDC. Although safety outcomes did not differ significantly between groups, pharmacists should continue to emphasize safety considerations when counseling patients on DOAC therapy.

Authors:

• Jilu Jacob, PharmD, BSPK
• Dante M. Grassi, PharmD, BCPS
• Sara Gaines, PharmD, BCPS
• Jennifer Heikkinen, PharmD, BCACP

Learning Objective:
Identify opportunities to improve workflow and provider understanding when addressing hepatitis B vaccine care gap notifications.
Self-assessment Questions:
True or False: Provider interpretation of hepatitis B vaccine care gap alerts influences whether patients receive appropriate vaccination.
Background:
A medication use evaluation was conducted between August 1, 2023 to September 30, 2025 to evaluate the accuracy of hepatitis B vaccine care gaps. This study determined that most inappropriate hepatitis B vaccine care gaps were due to positive serology and of this population, patients received unnecessary vaccinations. As a result, the purpose of this study is to assess barriers to appropriate interpretation of hepatitis B vaccine care gap notifications and identify opportunities for workflow improvement.
Methods:
This was a qualitative study conducted through survey and optional interview to current Geisinger primary care providers, nurses and pharmacists involved in the management of hepatitis B vaccine care gap notifications. The survey was dispersed via email and was open from February 23, 2026 to March 26, 2026. A variable question format was used to assess provider interpretation of hepatitis B vaccine care gap notifications, initial response behaviors and possible barriers to appropriate alert management. At the end of the survey, participants were offered the option of a brief follow-up interview to provide additional details on the workflow processes, barriers encountered and suggested strategies for improvement. Data was collected using Microsoft Forms and Microsoft Teams and analyzed qualitatively to identify recurring themes.
Results: 
The survey was sent to 126 participants, and 27 (21.4%) responses were received. Among providers, 15 (83%) reported first reviewing immunization history when encountering a hepatitis B vaccine care gap notification, while 6 (67%) nurses reported first asking patients about vaccination history. The most common factor determining vaccination appropriateness was documentation of completed vaccination series (59%).
A total of 8 (29.6%) interviews were conducted as a follow-up to the survey. Interview findings showed serologic factors were not commonly incorporated into decision-making with participants primarily focusing on immunization history, outside vaccination records, and patient-reported vaccination history.
Conclusions: 
Across survey and interviews, immunization history review was the primary factor used when assessing hepatitis B vaccine care gaps. Care gap notification may help guide clinical decision making, but patient specific factors should also be considered. Suppressing alerts in patients with documented immunity along with improving education on vaccine guidelines and serology interpretation may help limit unnecessary vaccinations.

Title 
Assessing the acceptance of pharmacist recommendations and impact on polypharmacy management in ambulatory care 
 
Authors 
Primary Author: Peaches Brown, PharmD, Bayhealth Medical Center, Delaware 
Co-Author: Amanda Kobylinski, PharmD, BCGP 
 
Learning Objective 
At the conclusion of this activity, participants will be able to describe acceptance of pharmacist recommendations and their impact on polypharmacy management in ambulatory care. 
 
Self-Assessment Question 
What impact do pharmacist-led medication recommendations have on reducing polypharmacy in ambulatory care settings?  
 
Background 
Polypharmacy, defined as the use of five or more medications, increases the risk of drug-related problems and adverse outcomes, particularly in older adults. This study evaluated acceptance of pharmacist recommendations and their impact on polypharmacy management in ambulatory care. 
 
Methods 
This retrospective, multicenter chart review included adults at least 18 years of age who were prescribed at least 5 medications and were referred for pharmacist-led polypharmacy review from January 1, 2024, to June 30, 2025, within a community health system in Delaware. Data collected included demographics, the total number of medications, the number of recommendations provided by the clinical pharmacist, and the number of recommendations which were accepted by the consulting provider.  Secondary outcomes included number and type of potentially inappropriate medications based on Beers Criteria and clinical judgment. Descriptive statistics and Wilcoxon rank-sum testing were used. 
 
Results 
Patients with accepted pharmacist recommendations had substantially more deprescribed medications than patients whose recommendations were not accepted. This difference was statistically significant (Wilcoxon rank-sum p < 0.001) and represented the strongest observed association in the study. 
 
Conclusion 
The acceptance of pharmacist recommendations by clinicians was associated with meaningful reductions in polypharmacy in our patient population. These findings support the role of pharmacists in optimizing medication use and highlight opportunities to improve provider–pharmacist collaboration in ambulatory care. 

Title: Evaluating Factors Affecting Pharmacist Career Paths in Oncology
Authors: Morgan McIntyre, PharmD; Tristain Maiers, PharmD, BCOP; Elena Patestos, PharmD
Learning Objective: Describe how exposure to oncology-related learning experiences, or lack thereof, may impact pharmacists’ trajectory into the field of oncology.
Background/Objective: This study aims to evaluate the influence of oncology-related exposure on the career paths of pharmacists. Additionally, this study will identify the possible factors that may contribute to increased or reduced interest in oncology-related careers.
Methods: This study utilized an electronic survey to gather insights from practicing clinical oncology pharmacists regarding their perceptions of the impact of oncology-related experiences. Participants were recruited through a convenience sample of current Geisinger oncology pharmacists and email listservs obtained from the Hematology/Oncology Pharmacy Association. An email was distributed, which outlined the purpose of the study and provided a link to a Microsoft Forms questionnaire. The survey included an informed consent document, Likert-scale questions, and optional open-ended prompts to provide context for participant answers. Likert-scale data were analyzed using descriptive statistics, while open-ended responses were reviewed by the study investigators to identify common themes.
Results: Out of 106 participants, 50% felt their pharmacy education provided sufficient oncology exposure. Most had the opportunity to complete an oncology APPE rotation (77.4%), though many lacked access to an oncology-focused elective course (56.6%). Many reported oncology-related education (48.1%) and mentorship (50%) influenced their pursuit of oncology. 95.3% felt the complexity of oncology pharmacotherapy improves engagement in this field, while 52.5% felt emotional demands may limit long-term career satisfaction. Most would recommend a career in oncology (95.3%) and would choose oncology again if restarting their career (93.4%). Open-ended responses will be reviewed, and major themes will be identified and presented.
Conclusion: This study highlights the significance of oncology-related education and mentorship in shaping pharmacists’ career paths. Although didactic courses remain limited, clinical rotations provide practical, hands-on experience that enhances interest in oncology. Major themes from open-ended responses are anticipated to provide further context to Likert-scale responses.
Self-Assessment Question: True or False - Adequate exposure to oncology-related experiences does not play a major role in pharmacists' decision to pursue a career in oncology.

Title: Impact of a Clinical Pharmacy Diabetes Service on Glycemic Outcomes in Patients Newly Initiated on GLP-1 Receptor Agonists
Authors: Abosede Onibon-oje, PharmD; Kelly Goldberg, PharmD, BCACP; Kristen Fink, PharmD, BCPS, BCACP, CDCES; Emmanuel Kim, PharmD
Objective: At the conclusion of my presentation, the participant will be able to describe the impact of pharmacist-led diabetes services on A1c reduction and medication-related outcomes in adults newly initiated on GLP-1 receptor agonists
Self Assessment Question: What impact did pharmacist-led diabetes services have on glycemic outcomes among adults newly initiated on GLP-1 receptor agonists?
Background: Clinical pharmacy involvement at GLP-1 initiation may improve glycemic outcomes. This study evaluated the impact of a pharmacist-led diabetes service on changes in A1c and medication outcomes in adults with Type 2 diabetes.
Methods: This is an observational retrospective cohort study in Kaiser Permanente Mid-Atlantic States (KPMAS) patients with Type 2 diabetes newly initiated on a GLP-1 receptor agonist and managed by a clinical pharmacy diabetes service compared with a usual care cohort without pharmacist involvement between September 2024 and August 2025. All data was collected from KPMAS electronic medical records. Patients under 18 years of age or using GLP-1 receptor agonists for non-T2DM indications were excluded. The primary outcome was change in A1c from baseline to program discharge at six months in the intervention group and from initiation to six months in the control group. Secondary outcomes included GLP-1 adherence, adverse events, and patient retention. Descriptive statistics summarized baseline characteristics, and independent t-tests were used to compare mean A1c change between groups, with statistical significance set at alpha 0.05. Patient retention and follow-up rates were summarized descriptively based on the availability of discharge or 6-month A1c data.
Results: A total of 178 patients were included (pharmacist intervention = 89; usual care n=89). Mean A1c reduction was significantly greater in the pharmacist intervention group compared with usual care (−1.8 ± 1.4% vs −0.5 ± 1.8%, p < 0.001). A greater proportion of patients in the pharmacist group achieved an A1c reduction of at least 1%. Medication adherence to GLP-1 receptor agonists at discharge was high in the pharmacist intervention group, and adverse events were infrequent and primarily gastrointestinal. Retention was 100% in both groups, as all patients had available discharge or 6-month A1c values.
Conclusion: Clinical pharmacy involvement at GLP-1 receptor agonist initiation was associated with improved glycemic outcomes compared with usual care. These findings support the role of pharmacist-led diabetes services in optimizing early GLP-1 therapy and highlight the value of pharmacists in chronic disease management and interdisciplinary care models.

Title: Evaluation of warfarin versus direct oral anticoagulant prescribing among primary care patients for venous thromboembolism

Authors: Grace O’Toole, PharmD; Sarah Krahe Dombrowski, PharmD, BCACP; Kayla Kline, PharmD, BCACP; Bernard Eck, BS Pharm, CACP, CDCES; Keturah DelGrosso, PharmD, BCPS

Learning Objective: Describe key drivers of anticoagulant selection for venous thromboembolism (VTE) and how pharmacists can facilitate appropriate transitions from warfarin to direct oral anticoagulants (DOACs) despite cost and clinical barriers.

Self-Assessment Question: In the current study evaluating anticoagulant selection for VTE, which patient factors were significantly associated with differences in anticoagulant prescribing?

• Age > 65
• BMI > 40
• CKD diagnosis
• Cirrhosis diagnosis

Background/Objective: This study evaluated Geisinger anticoagulation prescribing patterns for VTE and compared safety and efficacy outcomes of warfarin and DOACs. The goal was to inform evidence-based, patient-centered anticoagulant prescribing policies.

Methods: A retrospective cohort study was conducted using an electronic health record reporting system and Geisinger’s clinical anticoagulation dashboard. Adults (> 18 years) with an outpatient order for warfarin, dabigatran, apixaban, rivaroxaban, or edoxaban for VTE between 1/1/2015-6/30/2025 were included if they had a Geisinger primary care visit during the study period. Patients with a mechanical prosthetic valve, mitral stenosis, antiphospholipid syndrome, active cancer at VTE diagnosis, allergy to studied anticoagulant(s), or deceased status were excluded. Anticoagulant distribution and patient characteristics were collected; analysis of bleeding and thrombotic outcomes is in progress. Manual chart review was performed for those who switched anticoagulant classes to identify the rationale. Study findings will be integrated with current guidelines and product labeling to develop a clinical decision tree and cost assistance to support appropriate transitions from warfarin to DOAC therapy.

Results: Among eligible patients diagnosed with VTE between 2015-2025, warfarin prescribing declined from 88% in 2015 to 24% in 2025, while DOAC prescribing increased from 12% to 76%. Differences in anticoagulant selection were significantly associated with body mass index (BMI), insurance, and chronic kidney disease (CKD) diagnosis (p < 0.001). Among 660 patients who switched anticoagulant classes, 306 patients switched to a DOAC, whereas 354 switched to warfarin. Cost was the leading factor for switching from a DOAC to warfarin (p < 0.001). Moving forward, the incidence of recurrent VTE or a bleeding event between warfarin and DOAC (gastrointestinal, neurologic, genitourinary, ear/nose/throat, pulmonary, or other/unknown) will be explored.

Conclusion: Continued prescribing of warfarin despite the favorable safety and efficacy profile of DOACs highlights the need for comprehensive DOAC initiation and management protocols. A clinical decision tree tool is in development to guide transitions from warfarin to DOACs when appropriate. Next steps also involve collaboration with Medication Therapy Disease Management (MTDM) leadership and Geisinger’s internal cost assistance team to mitigate DOAC cost barriers and support access.

Title: Assessing atopic eczema severity through patient-reported outcomes: the role of the specialty pharmacist in bridging treatment gaps at a rural health system

Authors: Alexander J. Vose, Gabrielle N. Plaia; Dartmouth-Hitchcock Medical Center, Lebanon, NH

Learning Objective: Recognize the capacity of the pharmacist to coordinate care through the use of a patient reported outcomes questionnaire (POEM).

Background/Objectives: Rural health centers face gaps in atopic dermatitis care. By using the POEM tool, pharmacists can remotely monitor symptoms, triage issues, and optimize therapy. This improves outcomes, reduces urgent visits, and highlights pharmacist value.

Background: Specialty pharmacy medications aim to improve quality of life in chronic conditions such as atopic dermatitis. At our rural health center, a gap exists between when a patient with atopic dermatitis is given treatment and when efficacy is assessed. It is especially necessary to engage these patients in between visits given barriers to in-person care. Specialty pharmacists are able to provide a solution by utilizing patient-reported outcome measures through the Patient Oriented Eczema Assessment (POEM) which monitors the patient experience with eczema in a timely fashion. Leveraging the pharmacist to administer the POEM can help to bridge this gap by improving patient care and outcomes.

Objectives: Given the costs associated with patient’s over and/or underutilization of provider services, the POEM score will better provide clarity on which patients require care from a provider in clinic and those who do not. With implementation of the POEM tool, patients can self-report symptoms and initiate pharmacist intervention if necessary. Pharmacists can triage issues to alert clinics as needed, allowing providers to see patients sooner if their therapy is ineffective. This generates more timely interventions to better optimize therapy and prevents patients from having severe symptom flare ups. Integrating the POEM tool into workflow leverages pharmacists’ skills, improves patient reported outcomes, and lowers the need for urgent or acute visits while justifying the value of pharmacist-provided services.

Methods: The Patient Oriented Eczema Measure (POEM) questionnaire was offered to eligible patients with an atopic dermatitis diagnosis at baseline, defined as two weeks before or two weeks after starting specialty treatment. Patients conducted this assessment either during clinic visit, via telephone, or by filling out a questionnaire sent directly to them in the electronic medical record (EMR). The pharmacist then followed up 3-4 months after starting therapy to re-assess symptoms via the questionnaire. Patients must be ≥ 6 months of age and treated through collaborative services between a DH Dermatology Clinic and DH Specialty Pharmacy for atopic dermatitis. Additionally, patients must be able to read and comprehend the questions included on the POEM either themselves or by proxy.

Results: 30 patients were enrolled and 12 completed both the initial and follow-up questionnaire. 13 patients were lost to follow up due to insurance mandates, three patients did not start therapy, and two patient discontinued therapy. Implementation of the POEM tool led to a reduction in scores for almost all (91.7%) of patients at follow-up. The average POEM score at baseline was 18.5 (range 7-28) and the average POEM score at follow-up was 5.5 (range 0-24). This indicates a decrease in symptom frequency and severity. One patient was referred back to their dermatologist for a therapy change due to pharmacist-identified increase in POEM score.

Conclusion: The POEM tool and associated pharmacist-led monitoring can aid in therapy optimization and bridge gaps in assessing efficacy of atopic dermatitis treatment. The role of the pharmacist in this model enhances outcomes and ensures appropriate utilization of provider services. Integration of this workflow can be translated to other chronic conditions to improve therapy management and can potentially reduce burden on acute care serves.

Self-Assessment Question: Which monitoring questionnaire could pharmacists utilize to assess therapy efficacy in atopic dermatitis?
a. MIDAS
b. RAPID-3
c. POEM
d. SIBDQ

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:
Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Platt R, Polk RE, Sandora TJ, Tamma PD, Trivedi KK. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(10):e51–e77.

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.