Browsing by Author "Walroth, Todd A."

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Implementation and preliminary clinical outcomes of a pharmacist-managed venous thromboembolism clinic for patients treated with rivaroxaban post emergency department discharge
    (Wiley, 2017) DiRenzo, Baely M.; Beam, Daren M.; Kline, Jeffrey A.; Deodhar, Karishma S.; Davis, Christina M.; Weber, Zachary A.; Walroth, Todd A.; Emergency Medicine, School of Medicine
    Objective To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider. Interventions Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Pharmacists in the VTE clinic work independently under a collaborative practice agreement. An evaluation of thirty-four patients, seventeen in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a primary care provider. Results The primary endpoint was a six month composite of anticoagulation treatment-related complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p=1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in 8 patients in the pharmacist group versus 0 patients in the control group. No differences were seen amongst other secondary endpoints. Conclusions The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting. The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a collaborative practice agreement may be as safe as care by a primary care provider.
  • Thumbnail Image
    Item
    A prospective analysis describing the innovative use of liposomal bupivacaine in burn patients
    (Elsevier, 2020-03) Boyd, Allison N.; Blair, Mary E.; Degenkolb, Kerri E.; Foster, David R.; Hartman, Brett C.; Sood, Rajiv; Walroth, Todd A.; Medicine, School of Medicine
    Burn patients frequently require autograft harvesting to facilitate wound healing, often resulting in significant pain. Liposomal bupivacaine is indicated for administration into a surgical site to produce postsurgical analgesia. The objective of this study was to evaluate efficacy, safety, and duration of postoperative analgesia with liposomal bupivacaine for donor site pain in burn patients. This was an observational, case–control study including adult patients with <20% total body surface area (TBSA) burned who received liposomal bupivacaine for postoperative pain management after autograft harvesting from lower extremity donor site(s). Patients from the case group were matched to historical control patients treated with traditional pain management. The primary outcome was the cumulative pain scores on postoperative day one measured by the area under the curve (AUC0–24). Secondary outcomes included AUC0–72, total milligram morphine equivalents (MME), length of stay, and adverse events. Data were collected in 36 patients who received liposomal bupivacaine, with 21 patients eligible for matching to historical controls. Patients included in the intervention and control groups were well-matched at baseline. Patients in the intervention group had a significantly lower median (IQR) AUC0–24 [578 (408,740) vs. 680 (544,803); p = 0.05] and shorter length of stay [4 days (1,9.5) vs. 6 days (318); p = 0.01]. No differences in adverse events related to the administration of liposomal bupivacaine or opioid-related adverse events were observed. Results indicate liposomal bupivacaine is safe and effective in burn patients. The results of this study add to the limited body of literature examining efficacy in this population.
  • Thumbnail Image
    Item
    Review and evaluation of the role of a psychiatric pharmacist on medication management in a gender health program
    (ACCP, 2022-12) Wartman, Carolanne; Walroth, Todd A.; Butterfield, David; Anderson, Lindsey; Peters, Michael; Schmelz, Andrew; Ott, Carol; Psychiatry, School of Medicine
    Introduction People who identify as transgender experience a significant amount of mental health concerns compared to the general population. Gender health programs offer the opportunity to provide comprehensive care for this highly stigmatized population, with the potential for psychiatric pharmacists to assist other providers and serve this need. This study aimed to evaluate the number and type of interventions made by a psychiatric pharmacist within a gender health program. Methods A retrospective review of the electronic medical record was conducted analyzing mental health visits completed by psychiatric pharmacists within the Gender Health Program between May 1, 2020 and December 31, 2021. The primary outcome was number and type of interventions, defined as medication adjustments, laboratory monitoring, and completion of prior authorizations. Secondary outcomes included a description of medication regimens, number and type of patient education provided, and referrals to other healthcare professionals. Key subgroup analyses consisted of number of interventions based on gender identity, race identity, and insurance status. Results There were a total of 152 appointments among 93 patients. Sixty-one patients (66%) received at least one intervention [median (interquartile range, IQR) of 2 (2, 4)], which occurred across 81 pharmacist appointments (53%). Psychotropic medications were adjusted at 79 appointments (97%), with primarily medication initiations. Patient education was completed and documented at 102 appointments with a median (IQR) of 2 (1, 2) topics discussed per appointment. There was a statistically significant difference found between transmen and transwomen on number of interventions [31 (67%) vs 15 (45%), P = 0.048]. Conclusion The pharmacist in this study had the opportunity to bridge gaps in access to care to healthcare providers by initiating and managing medications, providing thorough education, and referring patients to further resources. This study affirms the accessibility and role of a psychiatric pharmacist on the interdisciplinary team caring for lesbian, gay, bisexual, transgender, queer or questioning, and more (LGBTQ+) patients.
  • Thumbnail Image
    Item
    Transition From Intravenous to Subcutaneous Insulin in Critically Ill Adults
    (SAGE, 2016-06-28) Doolin, Meagan K.; Walroth, Todd A.; Harris, Serena A.; Whitten, Jessica A.; Fritschle-Hilliard, Andrew C.; Pharmacy, Eskanazi Health
    BACKGROUND: Glycemic control decreases morbidity and mortality in critically ill patients. However, limited guidance exists regarding the transition from intravenous (IV) to subcutaneous insulin therapy. A validated protocol for transition is necessary since glycemic variability, hyperglycemia, and hypoglycemia adversely impact patient outcomes. METHOD: The objective was to determine the safest and most effective method to transition critically ill adults from IV to subcutaneous insulin. This single-center, retrospective, observational study included adults admitted to the burn, medical, or surgical/trauma intensive care units from January 1, 2011, to September 30, 2014. A computer-based program provided a reflection of the patient's total daily IV insulin requirements. This information was then utilized to stratify patients into groups according to their initial dose of subcutaneous insulin as a percentage of the prior 24-hour IV requirements (group stratification: 0-49%, 50-59%, 60-69%, 70-79%, ≥80%). The primary endpoint was the percentage of blood glucose (BG) concentrations within target range (70-150 mg/dL) 48 hours following transition. RESULTS: One hundred patients with 1394 BG concentrations were included. The 50-59% group achieved the highest rate of BG concentrations in goal range (68%) (P < .001). The 0-49% group, which was the transition method utilized most often, resulted in the lowest rate of goal achievement (46%). CONCLUSIONS: This retrospective study suggests critically ill adults may be safely transitioned to 50-59% of their 24-hour IV insulin requirements. A dosing protocol will be implemented to transition to 50-70% subcutaneous insulin. Follow-up data will be reviewed to assess the protocol's safety and efficacy.