Pharmacy Leaders Highlight Innovations in Acute and Ambulatory Care Medication-Use

At the 2025 ASHP Midyear Clinical Meeting & Exhibition, Tyler Vest, PharmD, MS, MSSCM, BCPS, BCSCP, FNCAP, and Nick Gazda, PharmD, MS, BCPS, CSP, discussed a pharmacy literature series showcasing innovations in the medication-use process across acute and ambulatory care. In an interview with Pharmacy Times, Vest highlighted acute care trends, including regulatory impacts, clinical decision support, and interdisciplinary collaboration, while Gazda focused on ambulatory care, emphasizing technology, access, and financial stewardship. Key developments include computerized provider order entry (CPOE) optimization, expanded pharmacy technician roles, artificial intelligence (AI) applications, and the intersection of acute and ambulatory care practices. Both stressed the importance of publishing innovations to guide health-system pharmacy leaders and advance the field.

Pharmacy Times: Can you introduce yourself?

Tyler Vest, PharmD, MS, MSSCM, BCPS, BCSCP, FNCAP: My name is Tyler Vest. It's great to be here with you today. I'm an associate professor of clinical education at the UNC Eshelman School of Pharmacy and lead author on one of the articles in the series we’re discussing.

Nick Gazda, PharmD, MS, BCPS, CSP: Hi, my name is Nick Gazda. Thanks for having me. I'm the director of pharmacy for oncology and infusion services at Cone Health in Greensboro, North Carolina, and the lead author on the ambulatory care medication-use process publication.

Pharmacy Times: To begin, could you provide a brief overview of this year’s series and how it highlights key trends and innovations in the medication-use process?

Vest: I’m happy to provide an overview of how this series came to be. In early 2018, our research team noticed there wasn’t a way for pharmacy leaders to find a summary of practice-enhancing publications or interventions for improving health-system pharmacy practice. We found several in various clinical areas, including critical care and infectious diseases. To address this, we started the series to help pharmacy leaders understand what interventions exist. Since then, we’ve published the article annually in HHP. The research lags a year behind because we wait for the calendar year to end before conducting the publication. Since 2020, we’ve actively presented this research at Midyear Clinical Meetings. Around 2020–2021, we noticed more articles in the ambulatory care setting, so we expanded the series to include both acute care and ambulatory care. I lead acute care, and Nick leads ambulatory care. Now, the midyear presentation includes authors we identify from HHP publications, who are invited to share their research.

Gazda: Having done this for several years, we’ve continued to see the series evolve with different trends. Splitting the topics made sense, and it has become a well-attended annual program. It’s a great opportunity for authors to share best practices published in the past year. We’re excited to help coordinate and facilitate that.

Pharmacy Times: What recent research has been most impactful in shaping our understanding of the medication-use process and ambulatory care challenges?

Vest: At a high level, the medication-use process, as defined by USP, includes eight steps: procurement, prescribing, transcribing, order entry, preparation, dispensing, administration, and monitoring. For our acute care series, we’ve distilled this to prescribing, transcribing, dispensing, administration, and monitoring. Trends in prescribing and transcribing focus on optimization and clinical decision support. Dispensing reflects regulatory impacts, such as the DSCSA and controlled substance management. Administration involves high-risk areas and interdisciplinary collaboration. This step historically has the fewest articles, but recent publications focus on infusion pump work. Monitoring has historically had the most articles, with trends in medication reconciliation, antimicrobial stewardship, and transitions of care. These trends highlighted overlap between acute and ambulatory care, prompting development of the ambulatory care series.

Gazda: In ambulatory care, the medication-use process has historically been acute care-focused. Our articles aim to define key steps and priorities for ambulatory care, emphasizing medication access, financial stewardship, and reimbursement considerations. Technology and remote care are major trends. Less focus has been on operations and medication-use processes in ambulatory infusion, which is an opportunity for future research.

Pharmacy Times: From the key interventions seen in 2024, which do you believe will most influence the future of ambulatory care and the medication-use process?

Vest: We’ve discussed several trends, but it’s also important to consider disruptors. Processes will continue evolving, whether through modifications or new interventions. CPOE will continue to impact transcribing. Other areas include analytics in acute care, automation, expanded roles for pharmacy technicians, formulary and supply chain considerations, and financial implications of high-cost drugs. Another emerging area is artificial intelligence. I’ll turn it over to Nick to discuss ambulatory care trends.

Gazda: Technology remains a common theme in ambulatory care, including AI for prior authorizations, patient-facing adherence tools, and safe dispensing. Literature also emphasizes entrepreneurial approaches to improve care. Collaborative practices under state pharmacy laws allow pharmacists to work alongside physicians or as extenders. Breaking down silos and cost-justifying services, particularly specialty or oncology pharmacy, is another focus. Our series highlights intersections between acute and ambulatory care to show enterprise-wide alignment and business sustainability.

Pharmacy Times: Is there anything you would like to add?

Vest: Pharmacy’s involvement will continue to grow. Health-system pharmacists have responsibility and leadership to optimize the medication-use process as it becomes more complex. We hope this literature series helps leaders incorporate findings effectively. I also want to recognize our authors and research team for their contributions in both acute and ambulatory care.

Gazda: I echo that. One trend in ambulatory care is a decrease in articles published over the last few years. It’s crucial to encourage pharmacy teams nationwide to publish innovations in acute and ambulatory care to capture industry advancements in the literature.