Literature Collection

Background: Obesity is a prevalent condition associated with numerous comorbidities. Weight loss medications reduce comorbidity burden, but barriers hinder access and titration. Clinical pharmacists play a key role in chronic disease management, but limited research exists on pharmacists managing weight loss. Objective: Evaluate the impact of a clinical pharmacist on weight loss medication management for adults without diabetes in an outpatient Internal Medicine primary care resident clinic. Methods: This matched case-control study included adults without diabetes with at least 1 weight management visit with a clinical pharmacist between July 2023 and May 2024. Controls were matched on insurance and baseline body mass index, and included patients prescribed weight loss medications by clinicians and those without pharmacotherapy. Data were collected over 6 months. The primary outcome was percent weight loss. Rate of weight loss was explored as a secondary outcome. Results: 94 patients were included: 35 pharmacist-managed, 24 clinician-managed, and 35 without pharmacotherapy. At 6 months, mean weight change was -11.8%, -8.3%, and +1.3% in the pharmacist, clinician, and nonmedication groups, respectively. Absolute weight loss was greater in the pharmacist group, but not statistically significant compared with the clinician-managed group (P = 0.12). The weekly rate of weight loss was significantly higher in the pharmacist group (-0.29 kg/week; P = 0.04 and P < 0.001 vs controls). Conclusion: Patients prescribed obesity medications experienced significant weight loss, regardless of whether the patients were managed by pharmacists or primary care clinicians. These findings support a collaborative care model in obesity management.

OBJECTIVE: This study examines the impact of an insurance-mandated change in formulation of buprenorphine/naloxone (BNX) for patients with opioid use disorder treated in a primary care clinic. METHODS: A retrospective cohort study was conducted to determine the proportion of patients who were switched back to the previous BNX formulation and rates of aberrant urine drug tests for the 3 months before and 3 months after a mandated change in BNX from the sublingual film to the rapidly dissolving tablet (BNX-RDT). Aberrant urine drug tests were defined as the presence of cocaine, nonprescribed opioids/benzodiazepines, or the absence of buprenorphine. RESULTS: In all, 186 patients were included in the analysis. At 3 months after the change, 36.0% of patients remained on BNX-RDT at equivalent dose, 9.1% were prescribed a higher dose of BNX-RDT, 52.7% were switched back to their previous formulation after a trial of BNX-RDT, and 2.2% dropped out of care. There was no significant change in the rates of aberrant urine drug tests pre and postchange (36.6% vs 33.7%; P = 0.27) or in any individual component of urine drug testing. Age, sex, and starting dose were not associated with remaining on BNX-RDT at equivalent dose, compared with increasing dose or changing formulation. CONCLUSIONS: Most patients were dissatisfied with the change in formulation and requested a return to the previous formulation. This change did not appear to impact drug use; however, the flexibility that permitted patients to switch back to their previous BNX formulation likely attenuated the policy's impact.