ASHP 2021: News and Updates

For the second year, the American Society of Health-System Pharmacists (ASHP) took to the web, hosting its Midyear Clinical Meeting and Exhibition virtually from December 5 through 9, 2021. The team at Drug Topics® joined one of the largest gatherings of pharmacy professionals to provide the latest clinical news.

Evaluating Analgesic Use During COVID-19

During the COVID-19 pandemic, costs associated with the use of opioid analgesics were significantly reduced, according to a poster presented at ASHP Midyear 2021.1 In the single-center, retrospective study, investigators sought to evaluate the use of both opioid and nonopioid analgesics during the COVID-19 pandemic. They compared data from before and after the COVID-19 pandemic, which they measured using days of therapy per 1000 patient-days and drug cost per 1000 patient-days.

Nonopioid drug classes included anxiolytics, induction agents, nonsteroidal anti-inflammatory drugs, regional or local anesthetics, sedatives, sedatives or hypnotics, skeletal muscle relaxants, and other analgesics. Following the start of the pandemic, the study center experienced a “significant reduction” in mean opioid and nonopioid days of therapy per 1000 patient days (1024.1 ± 79.6 vs 898.8 ± 121.4 and 1415.6 ± 40 vs 1357.3 ± 84.6). A significant reduction in mean drug cost per 1000 patient days for opioids was also noted ($2.98± $0.57 vs $2.15 ± $0.31); the same reduction was not seen with nonopioid medications.

“Many variables may have contributed to the significant decrease in opioid use during the COVID-19 pandemic,” the authors noted, adding that these variables include ongoing provider education and a decrease in elective surgeries.¹

Addition of Pharmacists to Diabetes Management Teams Enhances Care

Including a pharmacist on diabetes management teams can improve patient care while increasing therapy optimization and enhancing medication access, according to a poster presented at the 2021 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition.2 The study was conducted over a 3-month period, with patients chosen through reports taken from the electronic health record. Participants were included in the study if they were patients at 1 of 2 main primary care clinics, had a baseline hemoglobin A1c (HbA1c) level of 9% or greater, and their diabetes was being managed by a primary care provider.

A total of 52 patients met the criteria and underwent a comprehensive medication review. The average patient age was 57.5 years (. 65 years, 28.8%) and 55.8% were men. Patients had an HbA1c level of 10.5% ± 1.6%, blood pressure of 136 ± 20/80 ± 11 mmHg, a body mass index of 34.4, and an estimated glomerular filtration rate of 92.5 mL/minute/1.73 m2. A total of 80 interventions occurred, involving provider recommendations, therapy optimization, patient education, and counseling. Among the 44 interventions recommended to providers, 4 patients began a new antidiabetic agent, 4 patients were ordered fasting blood work, and 3 patients had their antidiabetic agents increased.

In addition, 75% of the 44 interventions were linked to chronic conditions other than diabetes. Findings showed that clinical inertia was overcome by reviewing patients who have not returned to care after an elevated HbA1c level. Team members reached out to patients to look further into medication adherence and to schedule follow-up appointments.

“The pharmacist was able to identify opportunities for therapy optimization, lower patient co-pays, and increase medication access,” the investigators concluded, “and, ultimately, enhance overall patient care.”²

Magnesium Supplements Affect Patient Blood Pressure Control

Use of magnesium supplementation may lead to a “significant difference” in blood pressure control, according to the results of a retrospective chart review presented at the 2021 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition.⁴

Investigators evaluated whether there is a correlation between magnesium supplementation and blood pressure control in patients with a cardiovascular diagnosis. In particular, the aim of the study was to examine whether magnesium supplements would increase, decrease, or show no difference in blood pressure control.

The investigators also evaluated the baseline characteristics linked with blood pressure control. The study cohort included adults presenting to a family medicine clinic in 2018 and 2019. Patients were categorized based on the treatment they received. Group A included those prescribed daily magnesium supplements who were adherent to daily magnesium supplementation. Group B included patients who were not prescribed daily magnesium supplementation.

A total of 569 charts were evaluated of long-term patients who had a cardiovascular diagnosis such as hypertension. Patients were excluded if they were pregnant, outside the age range, or taking a dosage of daily elemental magnesium above 1000 mg. Patients who were not prescribed magnesium were more likely to have high blood pressure (14%) compared with patients who were prescribed magnesium (8.4%). The odds of having high blood pressure were 1.78 times greater for those not taking magnesium compared with patients who were taking magnesium (95% CI, 1.04-3.05).

”This review demonstrated a significant difference in blood pressure control and the use of the vitamin magnesium,” the investigators concluded, adding that the increase in use of vitamins and other alternative therapies will “demand more education on the selection of these therapies and how they can make an impact on a patient’s life.”⁴