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Pharmacy and Pharmaceutical Sciences
Submission Category Specialty Pharmacy
Purpose Specialty medications for inflammatory conditions have demonstrated decreased effectiveness, safety, and quality of life, largely attributable to inadequate medication adherence. Furthermore, with poorer health outcomes, patients face greater healthcare costs associated with exacerbations, flares, and hospitalizations. Monitoring for non-adherence, side effects, and health status changes is essential for patients diagnosed with inflammatory conditions. The benefit of a standardized pharmacist clinical follow-up assessment is currently lacking in specialty pharmacy literature. This study will implement a standardized pharmacist follow-up frequency guide and determine its clinical value and utility for patient safety and therapeutic goals in newly established patients diagnosed with inflammatory conditions.
Methods A standardized follow-up frequency adjustment guide based on patient-specific factors, such as patient adherence, side effects experienced, and therapy efficacy was provided to all pharmacists where clinical consultations should be conducted at month 0, 1, and 4. After the implementation of the pharmacist guide, the electronic health system record was reviewed for all patients who received an inflammatory condition new patient consultation between August 5th, 2019 and October 4th, 2019. Pharmacist consultations are conducted by utilizing pre-designed assessment forms, the “New Patient Inflammatory Assessment” for initial consults and the “Specialty Medication Management Services (SMMS) Inflammatory Assessment” for follow-up assessments. How often pharmacists consistently stay within the standardized follow-up intervals versus how many times they deviate from the guide for patient care or safety reasons will be evaluated as the primary outcome. Secondary outcomes include categorizing and assessing the reasons for pharmacist deviation, assessing quantity and types of pharmacist (RPh) interventions made during deviations from the guide by medication and condition, evaluate patient reported medication adherence, quality-of-life (QoL) metrics, and pharmacist time spent per assessment. Patient-reported QoL was reported on a scale of 0 to 10, with 0 representing the best QoL and 10 representing poor QoL.
Results There were a total of 154 patients enrolled into the study. Out of the 185 completed follow-up assessments, 36 were deviations. The reasons for pharmacist deviation from the guide included inability to reach the patient during standardized follow-up frequency (41.7%), RPh clinical decision that sooner follow up was necessary (27.8%), patient initiated consult (25%), and RPh failed to attempt follow-up consultation at month 1 and/or 2 (5.6%). Pharmacist interventions occurred predominantly at month 0 (71.7%), month 1 (15.5%), & month 4 (6.6%). The most frequent pharmacist interventions during consult deviations comprised of medication reconciliation (37%), and side effect management (33%), the remaining interventions were equal to or less than 7%. Following the initial assessment, the medication adalimumab and inflammatory condition psoriatic arthritis required the most pharmacist intervention at 32.2% and 21.5% of all follow-up interventions, respectively. However, it was tofacitinib and ankylosing spondylitis, which required the most pharmacist consultation time. Tofacitinib averaged 13.2 minutes and ankylosing spondylitis averaged 15.2 minutes per consultation. Patients taking adalimumab reported missed or late doses most frequently (33.3% of the 24 reported). Although QoL metrics were not consistently reported, there is a notable improvement from baseline to month 4. At month 0, the average patient-reported QoL was 5.6, while after 4 months of treatment, QoL scores improved to 3.6.
Conclusion The standardized pharmacist follow-up frequency guide has provided a clinically meaningful strategy to monitor and follow-up with patients prescribed high-cost, high-risk inflammatory disease-modifying therapies. By establishing that the majority of clinically significant interventions occurred during the standardized frequency intervals, this guide accomplished maintaining patient safety, in addition to aiding patients with their clinical goals and overall quality of life. In addition, this data supports continuing a standard follow-up frequency at month 1 and 4 by demonstrating that no critical interventions were missed and most deviations occurred due to pharmacist’s inability to reach patients during the pre-defined intervals. Although most pharmacist interventions occurred at the recommended intervals, it is important to consider patient-specific factors when determining follow-up frequency. Thus, it is reasonable for specialty pharmacists to utilize a standardized follow-up frequency guide that allows modifications based on clinical judgment to manage patients diagnosed with an inflammatory condition.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2020
Providence Portland Medical Center, PGY-1 Health-System Pharmacy Administration Residency Program
Castrillo, Rochelle; Huynh, Linda; Berkson, Tara; and Saulles, Adam, "Standardizing Specialty Pharmacist Follow-Up Frequency in Patients Prescribed Inflammatory Disease-Modifying Therapies" (2020). Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020. 16.