Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022;27(4):306-311.
doi: 10.5863/1551-6776-27.4.306. Epub 2022 May 9.

Development and Evaluation of a Pharmacist-Driven Vitamin D Protocol for a Cystic Fibrosis Clinic

Elizabeth S Yett  1 , Ha Phan  2 , Alex R Mills  2 , Joshua W Fleming  2 , Joseph M Majure  3 , Scott S Malinowski  2 , Kim G Adcock  2
Affiliations

Development and Evaluation of a Pharmacist-Driven Vitamin D Protocol for a Cystic Fibrosis Clinic

Elizabeth S Yett et al. J Pediatr Pharmacol Ther. 2022.

Abstract

Objective: Vitamin D deficiency is commonly found in patients with cystic fibrosis (CF) and can have a negative effect on patients who are not at target goal according to Cystic Fibrosis Foundation's Vitamin D Deficiency Clinical Care Guidelines. The objective of this study is to determine the effectiveness of a pharmacist-driven vitamin D protocol (PDVDP) in improving, achieving, and maintaining 25-hydroxyvitamin D levels of patients in a pediatric CF clinic.

Methods: A retrospective chart review was conducted for pediatric patients with CF from August 2018 to March 2020 to determine the percent of patients with improvement in 25-hydroxyvitamin D levels to target goal (≥ 30 ng/mL). Patients' 25-hydroxyvitamin D levels at 6, 12, and 18 months after automatic enrollment into the PDVDP were compared to determine if improvement occurred, and to calculate relative percent increase of 25-hydroxyvitamin D levels for these patients.

Results: The mean 25-hydroxyvitamin D levels of the patients at baseline before the protocol and 6, 12, and 18 months after enrollment in the protocol were 23.2, 33.3, 32.7, and 34.6 ng/mL, respectively. These results demonstrate mean 25-hydroxyvitamin D levels at all follow-up time points were significantly greater than baseline (p < 0.001). At 6 months, 50% (n = 20) of pediatric patients reached the target 25-hydroxyvitamin D levels.

Conclusions: The PDVDP was effective in increasing the number of patients able to reach target 25-hydroxyvitamin D levels. Our PDVDP process may also be used at other CF clinics to improve vitamin D outcomes collaboratively with the interprofessional CF team.

Keywords: cystic fibrosis; pharmacists; protocol; vitamin D; vitamin D deficiency.

PubMed Disclaimer

Conflict of interest statement

Disclosures. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure 1.
Figure 1.
PDVDP used in clinic, adapted from The Cystic Fibrosis Foundation Vitamin D Deficiency Clinical Care Guidelines.
Figure 2.
Figure 2.
25-hydroxyvitamin D levels of CF patients (N = 95) in 2017 prior to initiation of pharmacist-driven vitamin D protocol.
Figure 3.
Figure 3.
25-hydroxyvitamin D levels (ng/mL) of patients at specified times after enrollment in PDVDP.
See this image and copyright information in PMC

References

    1. Rovner AJ, Stallings VA, Schall JI et al. Vitamin D insufficiency in children, adolescents, and young adults with cystic fibrosis despite routine oral supplementation. Am J Clin Nutr . 2008;86(6):1694–1699.
    1. Tangpricha V, Kelly A, Stephenson A et al. An update on the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis: evidence-based recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab . 2012;97(4):1082–1093. - PubMed
    1. Aris RM, Merkel PA, Bachrach LK et al. Guide to bone health and disease in cystic fibrosis. J Clin Endocrinol Metab . 2005;90(3):1888–1896. - PubMed
    1. Pincikova T, Nilsson K, Moen IE et al. Vitamin D deficiency as a risk factor for cystic fibrosis-related diabetes in the Scandinavian Cystic Fibrosis Nutritional Study. Diabetologia . 2011;54:3007–3015. - PubMed
    1. Vanstone MB, Egan ME, Zhang JH et al. Association between serum 25-hydroxyvitamin D level and pulmonary exacerbations in cystic fibrosis. Pediatr Pulmonol . 2015;50(5):441–446. - PubMed

LinkOut - more resources