Objective: To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention in an underserved, rural asthma patient population. Subjects and Methods: Patients with asthma were randomized to receive either standard care or telephone consultations from pharmacists regarding asthma self-management over a 3-month period. Qualitative interviews were conducted to identify participants' attitudes/ opinions regarding the intervention. Baseline and follow-up surveys assessed asthma control, patient activation, and medication utilization. Results: Ninety-eight adults were recruited (78% accrual); 83 completed the study (15% dropout). Participants reported positive opinions and believed the intervention improved their asthma self-management. The intervention group had significantly higher patient activation compared with the control (p < 0.05). There were no significant between-group differences regarding asthma control. However, within-group analyses of the intervention group showed an improvement in asthma control (p < 0.01) and medication adherence (p < 0.01). No within-group differences were found for the control group. Conclusions: This telepharmacy intervention is feasible and showed indicators of effectiveness, suggesting the design is well suited for a robust study to evaluate its impact in uncontrolled asthma patients. Pharmacists helping patients manage asthma through telecommunications may resolve access barriers and improve care.

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Although the application of a consistent process of care serves as a foundational principle for most health care professions, this is not true for the discipline of clinical pharmacy. Without an explicit, reproducible process of care, it is not possible to demonstrate to patients, caregivers, or health professionals the ways in which the clinical pharmacist can reliably contribute to improved medication-related outcomes. A consistent patient care process should describe the key steps that all clinical pharmacists will follow when they encounter a patient, regardless of the type of practice, the clinical setting, or the medical conditions or medications involved. Four essential elements serve as the cornerstones of the clinical pharmacist's patient care process: assess the patient and his or her medication therapy, develop a plan of care, implement the plan, and evaluate the outcomes of the plan. Despite the fact that several processes of care have been advocated for clinical pharmacists, none has been adopted by the clinical pharmacy discipline. In addition, numerous publications evaluate outcomes related to clinical pharmacy services, but it is difficult to determine what process of patient care was used in most of these studies. In our view, a consistent process of direct patient care that includes the four essential elements should be adopted by the clinical pharmacy discipline. This process should be clear, straightforward and intuitive, readily documentable, and applicable to all practice settings. Once adopted, the process should be implemented across practice settings, taught in professional degree programs, integrated into students' clinical rotations, refined during residency training, and used as a foundation for future large-scale studies to rigorously study the effects of the clinical pharmacist on patients' medication-related outcomes.

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A significant proportion of DOAC prescriptions did not adhere to protocol expectations. While enrollment in DOAC management through the Marshfield Clinic Anticoagulation Service was not associated with increased adherence to protocols, opportunities exist to optimize DOAC prescribing. Defining ideal DOAC management requires additional research.

Introduction: Improper inhaler technique is a common problem affecting asthma control and healthcare costs. Telephonic asthma management can increase access to care while reducing costs and hospitalizations. However, no reliable method has been established for telephonically evaluating and correcting inhaler technique. Objective: The purpose of this study was to pilot test a method for assessing and correcting patient inhaler technique via telephone. Methods: Participants (n = 30) were adults with asthma using metered-dose inhalers (MDIs) and diskus inhalers. A pharmacist was located in one room and communicated via telephone with a participant in another room. The pharmacist telephonically assessed and taught inhaler technique. Participants were videorecorded, and videos were later examined by a second pharmacist to visually evaluate inhaler technique. Participants were assigned pre-and posteducation inhaler technique scores for the telephonic and video assessments. Scores were based on summated scales for MDI (0-9) and diskus (0-11) inhalers. Paired samples t-tests were used to compare telephone and video assessments. Results: Findings indicated a significant difference between the telephone and video assessments of MDI technique (p < 0.05); however, no difference was found for the diskus inhaler. Comparing pre-and posteducation inhaler technique for MDI and diskus, mean scores significantly improved from 5.7 to 7.8 (p < 0.05) and from 8.5 to 10.4 (p < 0.05), respectively. Conclusions: The telephonic method was able to improve and detect some deficiencies in patients' inhaler technique. However, modifications and further investigation will more clearly determine the role and value of such a telephonic intervention.

BACKGROUND: The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events.

Purpose As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing within a large rural healthcare system, patients who received pre-emptive pharmacogenetic testing and warfarin dosing were monitored until June 2017. Summary Over a 20-month period, 749 patients were genotyped for VKORC1 and CYP2C9 as part of the electronic Medical Records and Genomics Pharmacogenetics (eMERGE PGx) study. Of these, 27 were prescribed warfarin and received an alert for pharmacogenetic testing pertinent to warfarin; 20 patients achieved their target international normalized ratio (INR) of 2.0–3.0, and 65% of these patients achieved target dosing within the recommended pharmacogenetic alert dose (± 0.5 mg/day). Of these, 10 patients had never been on warfarin prior to the alert and were further evaluated with regard to time to first stable target INR, bleeds and thromboembolic events, hospitalizations, and mortality. There was a general trend of faster time to first stable target INR when the patient was initiated at a warfarin dose within the alert recommendation versus a dose outside of the alert recommendation with a mean (± SD) of 34 (± 28) days versus 129 (± 117) days, respectively. No trends regarding bleeds, thromboembolic events, hospitalization, or mortality were identified with respect to the pharmacogenetic alert. The pharmacogenetic alert provided pharmacogenetic dosing information to prescribing clinicians and appeared to deploy appropriately with the correct recommendation based upon patient genotype. Conclusion Implementing pharmacogenetic testing as a standard of care service in anticoagulation monitoring programs may improve dosage regimens for patients on anticoagulation therapy.