There were 466 (311 high-risk) pharmacist-physician and 549 (237 high-risk) physician-managed DXAs included. For high-risk DXAs, collaborative management resulted in increased rates of receiving antifracture therapy prescriptions over physician-only management (66% vs 34%, P < 0.001), advisement for antifracture therapy (87% vs 32%, P < 0.001), and calcium and vitamin D (97% vs 45%, P < 0.001). Collaborative management also improved calcium and vitamin D advisement among all DXAs (96% vs 46%, P < 0.01). There was no difference in adverse events documented in the pharmacist-physician compared with physician-only management (7.2% vs 3.7%, P = 0.32). Conclusion and Relevance: Pharmacist-physician collaboration is associated with higher treatment rates of osteoporosis. This study supports the pharmacist-physician partnership as one method of improving osteoporosis management.

Nationally, the prescription of opioids for acute and chronic pain is increasing. As opioid use continues to expand and become of increased concern for health-care practitioners, so do the adverse effects and long-term management of those effects. Opioid-induced constipation (OIC) presents a unique challenge because tolerance does not develop to this particular adverse effect, making chronic pain management a delicate balance between relieving pain and preventing long-term adverse effects such as constipation and dependence. Several agents have been developed for the treatment of OIC in patients with chronic noncancer pain on the basis of short-term studies of 12 weeks or less. However, chronic pain management often extends beyond this 12-week boundary, resulting in health-care professionals questioning the safety and efficacy of continued treatment with OIC agents. This review evaluates available literature on long-term treatment of OIC in patients with chronic noncancer pain with lubiprostone, naloxegol, and methylnaltrexone as well as preliminary results of the recently completed naldemedine long-term trial, COMPOSE-3.

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Background National vaccination rates remain below goals. Given the geographic availability of community pharmacies, pharmacists are uniquely positioned to provide immunizations. However, many pharmacists may not be proactively recommending vaccinations to patients. Objective The objective of this project was to assess recommendation acceptance rates among patients who attended a pharmacy student–driven statewide free health screening. Methods A brief algorithm addressing 4 routine adult vaccinations was created for use by student pharmacists to initiate conversations regarding potentially indicated vaccines with patients. This algorithm was employed at statewide screenings in 2014 and 2015 with expert users available for further discussion. Follow-up to determine recommendation acceptance and identify barriers to immunization occurred 3 to 12 months after screening. The primary end point of change in immunization recommendation acceptance rates between 2014 and 2015 was analyzed using a chi-square test; secondary objectives included changes in consent rates and thematic analysis of reported barriers. Results A total of 1016 patients were screened. Of these, 403 (39.7%) patients gave consent for student pharmacists to follow-up on vaccine recommendations. The overall recommendation acceptance rate was 27%, with approximately 46% of patients accepting at least 1 recommendation. Acceptance rates significantly decreased in the second year (36.5% vs 23.5%, P < .001), while consent for follow-up significantly increased (20% vs 64%, P < .001). Commonly reported barriers to immunization included resistance to vaccines, forgetfulness, and cost. Conclusion This algorithm provided a method for novice users to initiate conversations with patients about immunizations and may allow novices to act as pharmacist extenders to improve immunization rates.

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