(1222) Evaluation of a Vitamin D Supplementation Consultation Service in a Supermarket Community Pharmacy

Objectives: Objectives
The objectives of this study are to: 1) Describe the implementation of a community pharmacy vitamin D screening and consultation service, 2) Describe pharmacist recommendations to patients and prescribers, and 3) Describe patient uptake and provider responses. Especially at latitudes farther from the equator and during the winter months, most people are likely not to receive enough vitamin D in their diet to sustain healthy levels. Additionally, guidelines regarding vitamin D supplementation have shifted towards using vitamin D3 over vitamin D2, yet many patients are still being prescribed vitamin D2. The rationale for the study is that pharmacists are positioned to make interventions on behalf of patients and make recommendations to prescribers regarding appropriate vitamin D3 dosing regimens. There is an opportunity to improve vitamin D supplementation's efficacy and health outcomes.

Methods: Methods

This is a prospective single-group intervention study of a pharmacist-provided vitamin D consultation service at a supermarket pharmacy in the Midwest U.S. Inclusion criteria include patients age 18 or older who are currently not taking vitamin D supplementation or patients with active vitamin D2 prescriptions who use the study pharmacy. Exclusion criteria include individuals with kidney or liver disease, parathyroid disease, hypersensitivity to lanolin or vitamin D, hypervitaminosis D, or anyone who does not understand English or Spanish.
The pharmacist will work with dieticians to recruit patients for the service for both initial vitamin D screening and for those who are currently taking vitamin D2, modifying an existing service for vitamin D screening typically done by dieticians. Pamphlets and flyers promoting the vitamin D3 serum level screening and consultation service will be attached to prescription bags and displayed on the pharmacy counter and in the vitamin aisle. It is expected that for the duration of the study, all patients will be at risk of vitamin D depletion during the winter months. Likewise, all patients will be considered for the service unless they meet exclusion criteria. Patients included in the study who are not currently taking vitamin D will be offered a vitamin D point-of-care test at their expense. Results will be sent to the study pharmacist, who will contact the patient and make appropriate recommendations for vitamin D3 supplementation. For those already taking vitamin D2, the study pharmacist will fax recommendations to the patient’s prescriber if a change to vitamin D3 is warranted, as well as request updated vitamin D labs after 2-3 months on the vitamin D3 regimen. The pharmacist will follow up with each patient in 2-3 months with a survey about the perceived benefits of vitamin D3 and satisfaction with the screening and consultation service. Primary data collected will include patient serum vitamin D levels, number and type of interventions, number of recommendations accepted, cost of vitamin D therapy, and patient satisfaction with the service. Descriptive statistics will be used to describe the results.

Results: Results
This is research in progress. Initial screening of patient profiles for active vitamin D2 prescriptions reported at least 71 active prescriptions for D2 within the past 6 months.

Conclusions: Implications/conclusions
The goal of this project is to identify patients taking D2 who may benefit from a switch to vitamin D3—likewise, screening patients not currently on vitamin D supplements and making appropriate recommendations on vitamin D3 dosing may address a current gap in care. By offering vitamin D screenings and consultations, we hope to bring awareness of vitamin D deficiency and potential health consequences. The goal for the future is to implement and expand this service at other locations within the chain.