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COVID-19 has necessitated alterations to the delivery of healthcare services. Modifications include those made to improve patient and healthcare worker safety such as the use of personal protective equipment. Pharmacy services, specifically pharmacy transitions of care services have not been immune to change which have brought along their own set of unique challenges to consider. This paper discusses how COVID-19 has impacted the delivery of pharmacy transitions of care services with real world examples from Sharp Grossmont Hospital and Hoag Memorial Hospital Presbyterian. Procedures implemented to minimize the spread and contraction of COVID-19 such as minimized patient contact and altered visitor policies have made it more challenging to obtain a best possible medication list the patient was taking prior to arrival to the hospital which has lead to an increased reliance on secondary sources to complete medication histories. Regarding discharge prescriptions, preference has shifted to the use of electronic vs. hard copy prescriptions, mail order, and utilization of med to bed programs and other hospital medication delivery services to limit patient contact in outpatient pharmacies. An improved effort to resolve medication acquisition issues prior to discharge utilizing patient assistance programs and other hospital programs to cover the cost of medications for COVID positive patients under certain circumstances has been seen. This paper highlights the important role pharmacists can play in providing effective communication, supporting continuity of care, and advocating for patient engagement and empowerment during transitions of care in the COVID-19 pandemic.

BACKGROUND/OBJECTIVES: Glyburide was added to the 2012 American Geriatrics Society (AGS) Beers Criteria ® due to the risk of hypoglycemic events in older adults. The objective of this study was to evaluate trends of glyburide use in persons aged 65 and older with diabetes mellitus, type II, before, during, and after the 2012 AGS Beers Criteria ® Update. DESIGN: Multicenter retrospective cohort study comparing pharmacy claims data from four Sharp Rees-Stealy clinic regions over 5 years (2010-2015). SETTING: Pharmacy claims database. PARTICIPANTS: A total of 3,005 patients with diabetes mellitus, type II, aged 65 and older. MEASUREMENTS: Prescription fill history of the sulfonylureas glyburide, glipizide, and glimepiride were collected along with comorbidity (Elixhauser) and demographic information. Odds of glyburide prescribing were stratified by year, clinic region, and by prescriber type. RESULTS: Glyburide use decreased across each study year (35.8%, 27.7%, and 4.2% in 2011, 2013, and 2015, respectively; P < .01). Adjusted odds of glyburide use indicated that regions A and D were 24% (P = .045) and 11% (P < .01) less likely to prescribe glyburide in 2011, regions A and D were 37% (P < .01) and 8% (P = .03) less likely to prescribe glyburide in 2013, respective to the overall average, whereas region B was 41% (P = .04) more likely. No significant regional site variations remained in 2015. Internists were 47% more likely to prescribe glyburide than family medicine providers in 2013; P < .01), but not in any other study years. CONCLUSION: Rates of glyburide use decreased after release of the 2012 AGS Beers Criteria ® demonstrating successful adoption of evidence-based medicine at a large multiregional site. However, regional differences may affect timing of implementation. Education, system-level initiatives, and strong professional support may help enhance more uniform adoption.