UC Davis Pharmacy Residents Conduct Impactful Research on Medication Management, Patient Care: Jeremiah J. Duby, PharmD, BCPS, BCCCP

In the final clip, Jeremiah J. Duby, PharmD, BCPS, BCCCP, research advisor for pharmacy residents at the University of California (UC), Davis, highlights recent and ongoing projects that have significantly influenced patient care and pharmacy practice.

He notes that pharmacy researchers excel at studying the "how," meaning how medications are started, titrated, and managed, which brings significant value to patient care and advancing understanding of pharmacotherapy.

Watch parts 1 and 2 to learn more about his responsibilities in this role.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What are some recent or ongoing resident research projects that you feel have had a meaningful impact on patient care or pharmacy practice at UC Davis?

We have about 46 resident research projects per year. I say about 46 because there's some collaboration on projects between residents, and we also have staff who initiate their own projects or carry forward projects that weren't finished from the previous year. Adding that all up, I think there are probably somewhere around 100 projects swirling, either at some point of early development or completion, either through an abstract and poster at a conference or through publication.

That's a lot of plates or balls, whatever you imagine, juggling, and a lot of teams to try to keep up with, and there's a lot of overlap between groups, as well. I probably at any one point am working on 4 or 5 different manuscripts at a time, so it's really hard to say, "Here's one project that I think is going to be really impactful." I would also refer anyone and everyone to the work on our website. Our resident research projects are all listed there.

I just finished a project, looking at their bibliometrics, so our scholarship and publications for the last 20 years, so I can tell you where that production is. It's hard to predict which projects are going to be most impactful. I think I learned really early on that, as an investigator, if what you're doing is really novel and innovative, people aren't going to recognize the impact until 2, 3, 4 years after your publication. You'll probably struggle getting it printed; that's the hardest thing. If you're way in the lead, it's harder to get people to catch up and adopt or embrace what you're doing. They're more likely to hold on to their current practice or what they currently know. Thinking you have the answer is the biggest barrier to learning something new or embracing some new idea.

But there are some projects that come to mind. Some of the exciting projects we're working on right now have to do with readmission from the ambulatory care setting back into the inpatient setting, as it relates to potentially inappropriate or high-risk medications for elderly patients. We're also doing a lot of work with what's called a modified Delphi method, where we assemble teams or panels of experts from all over the country to answer questions that sort of fall through the cracks with guidelines. Your clinical practice guideline can cover maybe 5 or 6 PICO questions at a time. The answers are based on meta-analyses that have really strict inclusion/exclusion criteria in terms of the papers that are considered, and they tend to focus on who and what.

I think the biggest opportunity for pharmacists in research is the "how." How do you start the medication? How do you titrate the medication? How do you select the agent? How do you mitigate the [adverse] effects? Those are areas of research where I think pharmacy researchers and investigators have consistently done really well and added a lot of value to patient care and our understanding of common problems and pharmacotherapy.

I think our physician colleagues, again, tend to focus on what agent and what patient, and that's about as far as it goes. Maybe, what target are we aiming for? I think pharmacists are filling in the gaps with that pharmacotherapy but also describing how they did it, and maybe it's a pre-post study looking at the intervention, which might be a new algorithm or new protocol, or it might just be the pharmacist themselves serving as the intervention. Those are projects that kind of get me excited.

It's honestly hard to pick an individual one, because, like I said, there are probably 3 or 4 that I'm working on at any given time. Another one that comes to mind, though, is a project by Mackenzie Pierce, PharmD, BCPS, BCPP, looking at long-acting injectable antipsychotics and the pharmacist's role in managing those agents to try to mitigate hospitalization. That's another setting where there is a very high-risk patient population, and readmission is a high-impact negative outcome.

We were able to demonstrate very clearly that just having a pharmacist on the team, dose-adjusting those medications, and reaching out to those patients to ensure that they had the resources they needed to continue receiving those medications, made a huge difference in their risk for hospitalization, which is good for everyone. That's good for the patient, that's good for the payer, and it's also good for the institution. Those are the projects, I think, that merit the most attention and most energy, and so that's where we're trying to focus our time and energy.