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Somani S, Takhar S, Miller D, Camarillo H, Zhu M, Tran K. Compass Rose™ Implementation in a Large Academic Medical Center. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 15:100462. [PMID: 38983636 PMCID: PMC11231745 DOI: 10.1016/j.rcsop.2024.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/01/2024] [Accepted: 06/06/2024] [Indexed: 07/11/2024] Open
Abstract
Background Compass Rose™, a case management tool developed by Epic®, was designed to track various patient coordination tasks, outreaches, and outcomes. This report describes the implementation of Compass Rose™ within an internal health-system specialty pharmacy (HSSP) and changes in care coordination metrics before and after implementation. To the best of our knowledge, this is the first study of its kind to discuss the implementation of Compass Rose™. Objectives The goals of this study were to describe the implementation process of Compass Rose™ at an internal HSSP and compare staff satisfaction before and after Compass Rose™ as the primary outcome. Methods This was an Institutional Review Board exempt, retrospective cohort study conducted between June 2022 to December 2022 that assessed staff satisfaction, refill documentation time, prescription turnaround time, and patient satisfaction pre- and post- Compass Rose™ implementation through survey administration, observed time studies, and internal data reports. The process of Compass Rose™ implementation was also described and discussed. Results 24 specialty pharmacy staff members participated in the Compass Rose™ implementation survey. No statistically significant differences were observed in either staff satisfaction (3.96 ± 0.95 versus 3.70 ± 0.69, p = 0.29) or predicted versus actual challenge of implementation (3.67 ± 1.17 versus 3.09 ± 0.96, p = 0.064). There was no significant difference in refill documentation time pre- versus post- Compass Rose™ implementation (4.22 ± 3.15 minutes versus 4.10 ± 2.36 minutes, p = 0.82); however, there was a statistically significant increase in prescription turnaround time post implementation (2.59 ± 2.85 days versus 2.69 ± 2.35 days, p = 0.002). Conclusion Compass Rose™ implementation had no significant impact on staff satisfaction, patient satisfaction, or overall refill documentation time. Prescription turnaround time increased, which could be due to significant workflow changes with Compass Rose™ or several other contributing factors such as increased prescription volume and training new staff during this period.Benefits of Compass Rose™ included standardization of workflow, ability to quantify staff performance and clinical impact, and increased transparency regarding care provided by the specialty pharmacy team.
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Affiliation(s)
- Selina Somani
- University of California, Davis Health Department of Pharmacy, Sacramento, CA, United States of America
| | - Shannan Takhar
- University of California, Davis Health Department of Pharmacy, Sacramento, CA, United States of America
| | - Derek Miller
- University of California, Davis Health Department of Pharmacy, Sacramento, CA, United States of America
| | - Hana Camarillo
- University of California, Davis Health Department of Pharmacy, Sacramento, CA, United States of America
| | - Mency Zhu
- University of California, Davis Health Department of Pharmacy, Sacramento, CA, United States of America
| | - Kathie Tran
- University of California, Davis Health Department of Pharmacy, Sacramento, CA, United States of America
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Mamarabadi M, Fafoutis E, Geronimo A, Walsh S, Simmons Z. Sodium phenylbutyrate-taurursodiol access, adherence and adverse event in patients with amyotrophic lateral sclerosis: Experience at one center in the United States. Muscle Nerve 2024; 70:204-209. [PMID: 38828849 DOI: 10.1002/mus.28175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION/AIMS Sodium phenylbutyrate-taurursodiol (PB-TURSO) was recently approved for treating amyotrophic lateral sclerosis (ALS). Third-party payors' coverage policies are evolving, and adverse events are just being fully assessed. The goals of this study were to evaluate patients' experiences in obtaining and continuing PB-TURSO and assess adverse events and medication adherence. METHODS Medical records of 109 ALS patients who were considered PB-TURSO candidates by the treating physician at a tertiary ALS clinic from October 2022 to May 2023 were reviewed. Data was recorded for demographics, clinical, and insurance information. A survey was e-mailed to patients asking about out-of-pocket expenses for PB-TURSO, financial assistance, medication start and (if applicable) stop dates, and reasons for discontinuation. RESULTS Insurance information was available for 91 patients [57 males (62%); mean age 64.8 years (range 25.7-88)]. Of 79 who applied for insurance approval, 71 (90%) were approved; however, 19 required 1-3 appeals. Among 73 patients with available data about medication status, 54 started PB-TURSO and 19 did not, most commonly due to personal choice or out-of-pocket expenses. About 44% of patients (24/54) stopped taking PB-TURSO, primarily due to adverse events. Monthly out-of-pocket expenses varied from $0 to $3500 and 36 patients qualified for financial assistance. Administrative and nursing staff devoted 7.2 hours/week to the insurance authorization process. DISCUSSION Most patients received insurance approval for PB-TURSO, but one-fourth required appeals. Some out-of-pocket costs were very high. Investment of staff time was substantial. These findings have implications for insurance coverage of, and adherence to, future ALS treatments.
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Affiliation(s)
- Mansoureh Mamarabadi
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Eleni Fafoutis
- Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Andrew Geronimo
- Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Susan Walsh
- ALS United Mid-Atlantic, Ambler, Pennsylvania, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Manoliu-Hamwi EM, Dascălu CG, Zegan G, Cărăușu EM, Ghiciuc CM, Ivănescu MC, Stan CD. Patient's satisfaction level with community pharmacies services in Romania: a questionnaire-based study. J Pharm Policy Pract 2024; 17:2381104. [PMID: 39081709 PMCID: PMC11288202 DOI: 10.1080/20523211.2024.2381104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction The patient satisfaction questionnaires in literature are according to the community pharmacies services in the authors' countries and not all have psychometric reports to support the results. We designed a questionnaire specific to the services of community pharmacies in Romania to evaluate the level of patient satisfaction. Methods We carried out a cross-sectional study on voluntary patients. The questionnaire consisted of 22 items, grouped into three domains corresponding to patient satisfaction with pharmacies, pharmaceutical staff and medication availability, and four subdomains related to pharmaceutical staff skills. The 5-point Likert scale was used. Statistical analysis was done in SPSS 27.0. Results The Cronbach's Alpha was 0.861. The Inter-rater Agreement was 72.0%, the Item Content Validity was 97.6% and the completeness index was 100%. The factor analysis indicated 6 factors (Eigen values >1.0). The 809 patients had a median of overall satisfaction score of 3.77; the median was 4.0 regarding satisfaction score with pharmaceutical staff skills. Respondents characteristics varied the patient's satisfaction level (p ≤ 0.05). Conclusions The reliability and validity of the questionnaire have been demonstrated. Overall patient satisfaction with community pharmacy services had a moderate level, but the attitude and confidence in the pharmacist had a high level of satisfaction.
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Affiliation(s)
- Etidal-Mihaela Manoliu-Hamwi
- Department of Pharmaceutical Sciences II, Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Cristina Gena Dascălu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Georgeta Zegan
- Department of Surgical, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Elena-Mihaela Cărăușu
- Department of Implantology, Removable Prosthesis, Denture Technology Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Morpho-Functional Sciences II, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- St. Mary’s Emergency Children Hospital, Iasi, Romania
| | - Mircea Cătălin Ivănescu
- Department of Implantology, Removable Prosthesis, Denture Technology Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Cătălina Daniela Stan
- Department of Pharmaceutical Sciences II, Faculty of Pharmacy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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Patrawala S, Mustafa SS, Ramsey A. Role of an embedded health system specialty pharmacy on prescription of biologics in allergy/immunology. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00432-0. [PMID: 39009218 DOI: 10.1016/j.anai.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Sara Patrawala
- Rochester Regional Health, Rochester, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - S Shahzad Mustafa
- Rochester Regional Health, Rochester, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Ramsey
- Rochester Regional Health, Rochester, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York
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Bryan ED, Renfro CP, Anguiano RH, Kumor L, DeClercq J, Choi L, Zuckerman AD. Evaluating patient-reported adherence and outcomes in specialty disease states: A dual-site initiative. J Manag Care Spec Pharm 2024; 30:710-718. [PMID: 38950163 PMCID: PMC11217860 DOI: 10.18553/jmcp.2024.30.7.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are often used by clinicians to evaluate patient response to specialty medications used to treat multiple sclerosis (MS) and rheumatologic conditions. Identifying associations among PROs and patient characteristics could inform patient-centered treatment monitoring. OBJECTIVE To examine the association among patient characteristics and PROs, including patient-reported adherence (defined as no missed doses), medication tolerance, patient perceived effectiveness, and health care resource utilization (HCRU; defined as emergency department visits or hospitalizations), for patients prescribed specialty medications in 2 health system specialty pharmacies. METHODS A dual-center, retrospective review of monthly medication assessments completed by Vanderbilt Specialty Pharmacy and University of Illinois Hospital and Health Sciences System specialty pharmacy was conducted. Patients were included if they received at least 3 fills of a specialty medication from rheumatology or MS clinics from October 2019 to March 2022, excluding patients with more than a 30-day supply. Primary outcomes were the PROs of patient-reported adherence, medication tolerability, perceived effectiveness, and HCRU. For each of the 2 primary outcomes (adherence and tolerability), a mixed-effects logistic regression model was used to test for associations with age, sex, race, clinic, site, and the other PROs. RESULTS A total of 61,926 assessments were completed from 3,677 patients (Site 1 = 3,346; 91.0% and Site 2 = 331; 9.0%). Patients were predominantly White (75.6%) and female (71.7%) with a median age of 50 years (IQR = 37-61). Assessments most frequently originated from rheumatology (76.0%). Nonadherence was reported 4.0% of the time, with the most common explanations being forgetfulness (33.1%) and medication being held because of a procedure or illness (29.5%). Most responses indicated perceived effectiveness as good/excellent (93.9%), with 98.5% of responses indicating no issues with tolerability. Patients who reported tolerability issues were 2.5 times more likely to report a missed dose (95% CI = 1.87-3.23, P < 0.001). An effectiveness rating of fair was associated with a 61% increase in the odds of a missed dose compared with a rating of good/excellent (95% CI = 1.33-1.94). CONCLUSIONS Patients filling rheumatology or MS specialty medications within health system specialty pharmacies reported high rates of medication effectiveness and adherence and low rates of issues with tolerability and HCRU. Patients who report tolerability issues or lower perceived effectiveness may benefit from additional monitoring to prevent nonadherence.
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Affiliation(s)
- E. Danielle Bryan
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | - Chelsea P. Renfro
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN
| | | | - Lisa Kumor
- Specialty Pharmacy Services at University of Illinois Hospital and Health Sciences System, Chicago
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Autumn D. Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN
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Bhat S, Lyu R, Agarwal M, Becker M, Bloomfeld R, Bruining DH, Cohen BL, Ivanov M, Leighton JA, Stewart AP, Trocke L, Tse SS, Ungaro RC, Vaughn BP, Regueiro M, Sokn E, Rieder F. Defining the Roles of Inflammatory Bowel Disease Clinical Pharmacists in the United States: A Systematic Review and National RAND/UCLA Consensus. Inflamm Bowel Dis 2024; 30:950-959. [PMID: 37650888 PMCID: PMC11145011 DOI: 10.1093/ibd/izad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Given the complexity of inflammatory bowel disease (IBD) care, utilization of multidisciplinary teams is recommended to optimize outcomes. There is a growing recognition that clinical pharmacists should be an integral part of this care model. We sought to define the roles of IBD clinical pharmacists in the United States. METHODS A national multidisciplinary expert panel of 12 gastroenterologists and clinical pharmacists practicing in IBD clinics was assembled. We used the RAND/University of California, Los Angeles appropriateness method, with a total of 281 statements generated based on a systematic literature review and expert opinion. Each statement was anonymously rated as appropriate, uncertain, or inappropriate in 2 rounds of voting. RESULTS The number of publications evaluating the clinical pharmacists' roles in IBD is limited, primarily focusing on thiopurine initiation and monitoring, medication adherence, and switching to biosimilars. Medication education; medication initiation and monitoring; therapeutic drug monitoring; biosimilar management; health maintenance review; and transitions of care were deemed by the panel to be appropriate roles for IBD clinical pharmacists. In considering real-world settings, IBD clinical pharmacists should practice clinically under a predefined scope and primarily focus on complex treatments (eg, immunomodulators, biologics, and small molecules). Clinical pharmacists should also be included in practice settings with IBD specialized physicians. Additionally, clinical pharmacists caring for patients with IBD should be residency trained and board certified. CONCLUSIONS This consensus defines IBD clinical pharmacists' roles and provides a framework for embedded clinical pharmacists in IBD care.
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Affiliation(s)
- Shubha Bhat
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | - Ruishen Lyu
- Department of Quantitative Health Science, Cleveland Clinic Foundation, OH, USA
| | - Mitali Agarwal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | | | - Richard Bloomfeld
- Section of Gastroenterology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | - Marina Ivanov
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jonathan A Leighton
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Alyssa P Stewart
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Lindsay Trocke
- Department of Gastroenterology, M Health Fairview, Minneapolis, MN, USA
| | - Stacy S Tse
- Susan and Leonard Feinstein IBD Clinical Center, Mount Sinai Hospital, New York, NY, USA
| | - Ryan C Ungaro
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Byron P Vaughn
- Department of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
| | - Erick Sokn
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Foundation, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, OH, USA
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El-Khouri AC, Giavatto C, Hickman A, Fitzpatrick C, Mourani J, Tiger K, Rees M, Lopez-Medina AI. Health-system specialty pharmacist intervention types, acceptance, and associated actions for patients with multiple sclerosis. Am J Health Syst Pharm 2024; 81:S29-S39. [PMID: 38298009 DOI: 10.1093/ajhp/zxae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Indexed: 02/02/2024] Open
Abstract
PURPOSE Health-system specialty pharmacy (HSSP) pharmacists play an integral role in the care of patients with multiple sclerosis (PwMS) by facilitating medication access, providing counseling, improving adherence, and decreasing provider workload. However, current literature detailing pharmacist interventions and their acceptance rates in this population is limited. The purpose of this study was to identify the types and acceptance rate of clinical interventions completed by pharmacists for PwMS. METHODS To evaluate the acceptance rate of HSSP pharmacist interventions, we conducted a retrospective, multicenter, observational, descriptive study for the period from October 2019 to August 2022. Intervention types were categorized into reasons for intervention, recommendations from the pharmacists, and their acceptance rates. RESULTS For 225 patients enrolled in HSSP services, 449 interventions were completed, with an average of 2.0 interventions per patient. Most interventions identified were associated with medication adherence (28.7%), medication regimen (27.6%), adverse drug reaction (ADR) (20.7%), and laboratory values (15.1%). The average adherence, defined by the proportion of days covered, was 94%. The most common recommendations were to continue therapy (14.9%), schedule laboratory tests (12.7%), and follow up with providers (11.8%). Recommendations had an acceptance rate of 85.3%, with 3.8% of recommendations declined and 10.9% requiring follow-up with providers. CONCLUSION Pharmacists impact patient outcomes through the completion of clinical interventions that improve adherence, identify medication regimen problems, manage ADRs, and coordinate proper laboratory testing. Pharmacist recommendations were most often accepted for interventions related to medication regimen and ADRs. Proper identification and management of medication regimen concerns, as well as tolerability of medications, can positively impact adherence and improve overall patient outcomes.
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Affiliation(s)
| | | | | | | | | | - Kipp Tiger
- CPS Solutions, LLC, Dublin, OH
- Summa Health System, Akron, OH, USA
| | - Megan Rees
- CPS Solutions, LLC, Dublin, OH
- Summa Health System, Akron, OH, USA
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Alfian SD, Sania JA, Aini DQ, Khoiry QA, Griselda M, Ausi Y, Zakiyah N, Puspitasari IM, Suwantika AA, Mahfud M, Aji S, Abdulah R, Kassianos AP. Evaluation of usability and user feedback to guide telepharmacy application development in Indonesia: a mixed-methods study. BMC Med Inform Decis Mak 2024; 24:130. [PMID: 38773562 PMCID: PMC11106925 DOI: 10.1186/s12911-024-02494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND In Indonesia, the adoption of telepharmacy was propelled by the COVID-19 pandemic, prompting the need for a user-friendly application to support both the general population and pharmacists in accessing healthcare services. Therefore, this study aimed to evaluate usability and user feedback of a pioneering telepharmacy application known as Tanya Obat (translating to "Ask about Medications") in Indonesia, from the perspectives of the general population and pharmacists. METHODS A mixed-methods sequential study was conducted with the early-stage Tanya Obat application in Bandung City. Participants, including the general population and pharmacists, were instructed to use the application for a week. Questionnaires for the general population and pharmacists were distributed from March to May and February to June 2023, respectively. The System Usability Scale questionnaire was adopted to describe usability of the developed application. Further exploration of the quantitative results required collecting open-ended feedback to assess the impressions of the participants, difficulties encountered, and desired features for enhanced user-friendliness. The collected statements were summarized and clustered using thematic analysis. Subsequently, the association between the characteristics of participants and perceived usability was determined with the Chi-square test. RESULT A total of 176 participants, comprising 100 individuals from the general population and 76 pharmacists, engaged in this study. In terms of usability, the questionnaire showed that Tanya Obat application was on the borderline of acceptability, with mean scores of 63.4 and 64.1 from the general population and pharmacists, respectively. Additionally, open-ended feedback targeted at achieving a more compelling user experience was categorized into two themes, including concerns regarding the functionality of certain features and recommendations for improved visual aesthetics and bug fixes. No significant associations were observed between the characteristics of participants and perceived usability (p-value > 0.05). CONCLUSION The results showed that the perceived usability of Tanya Obat developed for telepharmacy was below average. Therefore, feature optimizations should be performed to facilitate usability of this application in Indonesia.
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Affiliation(s)
- Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia.
- Center for Health Technology Assessment, Universitas Padjadjaran, Jatinangor, Indonesia.
| | - Jihan A Sania
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Dzulfah Q Aini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Qisty A Khoiry
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Meliana Griselda
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Yudisia Ausi
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Jatinangor, Indonesia
| | | | - Saktian Aji
- Dienggo Kreasi Nusantara Company, Jakarta, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Angelos P Kassianos
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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O'Reilly E, Foushee S, Nolan L, Maier C, McPheeters C. Evaluation of the impact of a health-system specialty pharmacy patient management program on achieving predefined clinical outcome measures. Am J Health Syst Pharm 2024; 81:e226-e233. [PMID: 38169475 DOI: 10.1093/ajhp/zxad341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Specialty medications often have high costs, pose difficulties with payor approval, and require additional monitoring. Earlier articles have defined various examples of clinical outcome measures (COMs); however, goals and benchmarks have not been well defined, and a gap in the literature exists. This study evaluated the effectiveness of our health-system specialty pharmacy (HSSP) patient management program (PMP) in achieving predefined COM goals. METHODS Disease state protocols were developed within the HSSP, and clinical and adherence goals were created for each COM based on primary literature. This retrospective, single-center review examined outcomes and adherence data on patients enrolled in the PMP during 2022. The primary outcome was the number of predefined disease state COM goals met. Secondary outcomes included the number of predefined adherence goals met and annual financial impact. RESULTS Of 1,431 patients whose records were reviewed, 1,053 met criteria for inclusion. The primary outcome analysis showed that 85% (33 of 39) of the predefined disease state goals were met. Predefined adherence goals were met, with an average proportion of days covered (PDC) for all specialty medications of >90%. The PMP yielded $5,167,043 in direct patient cost savings and $167,260 in cost avoidance. CONCLUSION The PMP yielded positive results in meeting goals set for the COMs in the disease states managed within the HSSP. COMs will remain a focus for HSSPs to help patients achieve desired clinical outcomes and HSSPs adhere to accreditation standards. More research in this field and standardization of COM goals may benefit the larger HSSP community.
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Affiliation(s)
- Emily O'Reilly
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
| | - Sarah Foushee
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
| | - Lindsey Nolan
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
| | - Chelsea Maier
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
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Meadors C, McPheeters C, Maier C, O'Reilly E. Health-system specialty pharmacy: Overview of a hybrid clinical model. Am J Health Syst Pharm 2024; 81:e256-e260. [PMID: 38146967 DOI: 10.1093/ajhp/zxad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE The prevalence of specialty pharmacies has grown, especially within the hospital setting. These pharmacies have shown benefits in the areas of patient education and adherence, financial support, and patient and provider satisfaction. Currently, there are gaps in literature describing use of a hybrid clinical model in health-system specialty pharmacies. SUMMARY The UofL Health - UofL Hospital Specialty Pharmacy (UofL Health SP) is attached to a retail pharmacy in a larger health system. Pharmacists in the UofL Health SP utilize a hybrid clinical model in which they split their time between working in a specialty clinic and staffing in the specialty pharmacy. The specialty pharmacy and its oncology satellite pharmacy each have a primary staffing pharmacist, and 5 other pharmacists participate in this hybrid clinical model. In addition to the specialty pharmacists, pharmacy technicians and patient care advocates support the operations of the specialty pharmacy and ensure financial access to medications for patients. CONCLUSION With the hybrid clinical model at UofL Health SP, there is increased workflow efficiency and better communication between specialty clinics and the specialty pharmacy, which results in a streamlined patient experience. Additionally, there has been an increase in specialty pharmacy prescriptions dispensed in the specialty pharmacy since the implementation of this hybrid clinical model.
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Affiliation(s)
- Crystal Meadors
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
| | | | - Chelsea Maier
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
| | - Emily O'Reilly
- UofL Health - UofL Hospital Specialty Pharmacy, Louisville, KY, USA
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11
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Jude D. Comprehensive specialty pharmacist support for HIV postexposure prophylaxis in a health system-based emergency department setting. Am J Health Syst Pharm 2024; 81:265-269. [PMID: 38141253 DOI: 10.1093/ajhp/zxad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 12/25/2023] Open
Affiliation(s)
- Daniel Jude
- Trellis Rx at North Memorial Health, Robbinsdale, MN
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
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Giavatto C, Mourani J, Fitzpatrick C, Hardin B, Skrtic A, Evans A, Sredzinski E, Trieu S, Setter AI, Kobiska L, Lopez-Medina AI. Biosimilar perceptions among autoimmune prescribers and pharmacists in health system specialty pharmacy. J Manag Care Spec Pharm 2024; 30:175-182. [PMID: 38308629 PMCID: PMC10839464 DOI: 10.18553/jmcp.2024.30.2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
BACKGROUND By the end of 2023, 10 self-administered biosimilars indicated for autoimmune conditions are expected to launch in the United States, resulting in alternative treatment options for patients and a potential for cost savings. However, studies about perception and knowledge of self-administered biosimilars among health system prescribers and health system specialty pharmacists are limited. OBJECTIVE To assesses knowledge and perceptions of biosimilars among autoimmune prescribers and health system specialty pharmacists across the United States. METHODS An anonymous, cross-sectional self-administered online questionnaire was conducted among prescribers and health system specialty pharmacists practicing in the specialties of rheumatology, dermatology, and gastroenterology across the United States. The survey was available from January 2023 to February 2023. RESULTS 31 prescribers and 44 pharmacists completed the questionnaire. Only 16.0% of prescribers and 13.4% of pharmacists reported being "very prepared" to have conversations with patients about biosimilar options. 43% of prescribers indicated they would prescribe a biosimilar to biologic naive patients. However, 13.3% of prescribers would be willing to prescribe a biosimilar to patients successfully established on biologic therapy. Among pharmacists, 68.1% were comfortable recommending a biosimilar substitution to a biologic naive patient, but only 18.1% would recommend a biosimilar substitution to an existing patient successfully established on a biologic therapy. Less than half of prescribers (48.0%) and pharmacists (42.0%) understood regulations of interchangeability and substitution. CONCLUSIONS Our study highlights several knowledge gaps and hesitancies that exist among health system specialty prescribers and pharmacists regarding biosimilar products. Education efforts are needed to overcome the lack of biosimilar adoption, which will increase affordability of therapy for patients and health care savings.
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13
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Gutenschwager DW, Patel A, Soyad AT, Patel S, Szandzik EG, Kelly B, Smith ZR. Provision of ambrisentan from a health-system specialty pharmacy affiliated with a pulmonary hypertension Center of Comprehensive Care. Am J Health Syst Pharm 2024; 81:66-73. [PMID: 37611180 DOI: 10.1093/ajhp/zxad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE This descriptive report describes the process used to obtain access to providing ambrisentan from a health-system specialty pharmacy (HSSP) affiliated with a pulmonary hypertension Center of Comprehensive Care, develop a pulmonary arterial hypertension (PAH) care team at the HSSP, and characterize medication adherence and access metrics. SUMMARY PAH is a rare disease treated with several specialty medications requiring intensive monitoring. Historically, specialty medications used to treat PAH have been provided by only select specialty pharmacies due to restricted drug distribution channels. It is recommended that patients with PAH receive their care at centers with expertise in the diagnosis and management of this disorder, but the HSSPs at these expert centers are unable to provide specialty PAH medications. The current care model for PAH leads to patients receiving their medical and pharmaceutical care from separate entities. This descriptive report describes a multidisciplinary team's approach to gaining access to providing ambrisentan and developing a disease state care team within an established HSSP. After implementing this service, specialty pharmacy metrics were assessed, including proportion of days covered (PDC), time to first fill, patient contact rate, Risk Evaluation and Mitigation Strategy (REMS) program compliance, time to prior authorization (PA) approval, rate of optimal adherence (PDC of >80%), and PA renewal rate, to demonstrate a proof-of-concept HSSP model for PAH. In this model, the HSSP was able to demonstrate high-quality specialty pharmacy metrics with regard to medication adherence, medication access, and REMS program compliance. CONCLUSION The development of a PAH care team to provide ambrisentan at an existing HSSP was associated with high adherence rates, efficient and reliable medication access, and REMS program compliance.
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Affiliation(s)
| | - Anand Patel
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Amanda T Soyad
- Clinical Pharmacy Services, Pharmacy Advantage, Rochester Hills, MI, USA
| | - Sweta Patel
- Clinical Pharmacy Services, Pharmacy Advantage, Rochester Hills, MI, USA
| | | | - Bryan Kelly
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Zachary R Smith
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
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Kelley TN, Canfield S, Diamantides E, Ryther AMK, Pedersen CA, Pierce G. ASHP Survey of Health-System Specialty Pharmacy Practice: Practice Models, Operations, and Workforce - 2022. Am J Health Syst Pharm 2023; 80:1796-1821. [PMID: 37742303 DOI: 10.1093/ajhp/zxad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE The results of the 2022 American Society of Health-System Pharmacists (ASHP) Survey of Health-System Specialty Pharmacy (HSSP) Practice: Practice Models, Operations, and Workforce are presented. METHODS A total of 273 leaders in HSSPs were contacted by email to complete a survey hosted using Qualtrics. The survey sample was compiled from ASHP member lists, the presence of a specialty pharmacy indicated in previous ASHP surveys, and outreach to ASHP member organizational leaders. RESULTS The survey response rate was 35.9%. Most HSSPs dispense 30,000 or fewer specialty prescriptions annually. Most respondents have an annual revenue of $100 million or less, are part of a 340B-covered entity, operate one location, have 1 to 2 specialty pharmacy accreditations, dispense both nonspecialty and specialty medications, and employ an average of 15.5 pharmacists and 17.6 technicians. The majority (66.7%) dispense 50% or less of prescriptions written by internal providers due to payor and manufacturer network restrictions. Over one-third employ nonpharmacist and nontechnician professionals. Specialty pharmacists are involved in treatment decisions and therapy selection before prescription generation (69.8%), and 47.7% of respondents report pharmacists operating under collaborative practice agreements. Most (82.6%) offer experiential or formal education in specialty pharmacy. The top point of pride remains patient satisfaction and level of service. Top challenges include access to payor networks, the ability to hire and retain qualified staff, and shrinking reimbursement from payors. CONCLUSION The HSSP is a continually maturing integrated advanced practice model focused on providing patient-centric care to all patients and employees of the health system regardless of network status. HSSPs are raising the standards for quality in specialty pharmacy care.
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Affiliation(s)
- Tara N Kelley
- Vanderbilt Specialty Pharmacy Services, Nashville, TN, USA
| | - Scott Canfield
- Clinical Program Development, Johns Hopkins Home Care Group, Baltimore, MD, USA
| | | | | | - Craig A Pedersen
- Virginia Mason Franciscan Health, Seattle, WA, and University of Washington, Seattle, WA, USA
| | - Gabrielle Pierce
- Member Relations, Section of Specialty Pharmacy Practitioners, American Society of Health-System Pharmacists, Bethesda, MD, USA
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15
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Zuckerman AD, Banks AM, Wawrzyniak J, Rightmier E, Simonson D, Zagel AL, Turco E, Blevins A, DeClercq J, Choi L. Patient-reported outcomes and pharmacist actions in patients with multiple sclerosis managed by health-system specialty pharmacies. Am J Health Syst Pharm 2023; 80:1650-1661. [PMID: 37556317 DOI: 10.1093/ajhp/zxad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE This study evaluated patient-reported outcomes (PROs) and pharmacist actions for patients on disease-modifying therapies (DMTs) for multiple sclerosis (MS) through health-system specialty pharmacies (HSSPs). METHODS A multisite, prospective cohort study of patients utilizing an HSSP for DMT fulfillment was performed. Primary outcomes were affirmative answers to PRO questions regarding impacted productivity, hospitalization, and relapse and pharmacist actions. Rates of pharmacist actions were reported as the number of person-years of treatment per action. Univariate and multivariate logistic regression were used to evaluate the association between each PRO and covariates, including the number of pharmacist actions performed, age, sex, insurance, site, and route of administration. RESULTS The 968 patients included had 10,562 fills and 6,946 PRO assessments. The most common affirmative PRO was impacted productivity (14.6%). Pharmacists performed 3,683 actions, most commonly general medication education (42.6%) and safety (33.3%). Rates of general medication education and nonfinancial coordination of care actions were similar across medication classes; other pharmacist actions varied by medication class. Insurance type was significantly associated with reporting impacted productivity; patients with Medicare and Medicaid were 2.2 and 3.1 times more likely to have reported impacted productivity, respectively (P < 0.001) than commercially insured patients. Patients who reported impacted productivity had more pharmacist actions (P < 0.001). CONCLUSION Patients on DMTs through an HSSP reported low rates of impacted productivity, relapse, and hospitalization due to MS, although patients with noncommercial insurance were more likely to have impacted productivity. Patients reporting impacted productivity and those taking certain DMTs may require more frequent pharmacist actions.
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Affiliation(s)
- Autumn D Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aimee M Banks
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julie Wawrzyniak
- University of Rochester Specialty Pharmacy, UR Medicine, Rochester, NY, USA
| | | | - Dana Simonson
- Fairview Specialty Pharmacy, Fairview Pharmacy Services, Minneapolis, MN, USA
| | | | - Evan Turco
- WVU Medicine Specialty Pharmacy Services, Allied Health Solutions, Morgantown, WV, USA
| | - Abbi Blevins
- WVU Medicine Specialty Pharmacy Services, Allied Health Solutions, Morgantown, WV, USA
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
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Kibbons AM, Moore R, Choi L, Zuckerman AD. Patient-Tailored Interventions to Improve Specialty Medication Adherence: Results from a Prospective Randomized Controlled Trial. Am J Med 2023; 136:694-701.e1. [PMID: 37028694 PMCID: PMC10794990 DOI: 10.1016/j.amjmed.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Specialty medication nonadherence results in poor clinical outcomes and increased costs. This study evaluated the impact of patient-tailored interventions on specialty medication adherence. METHODS A pragmatic, randomized controlled trial was conducted at a single-center health-system specialty pharmacy from May 2019 to August 2021. Participants included recently nonadherent patients prescribed self-administered specialty medications from multiple specialty clinics. Eligible patients were stratified by historical clinic rates of nonadherence and randomized 1:1 to usual care or intervention arms. Intervention patients received patient-tailored interventions and 8 months of follow-up. A Wilcoxon test was used to analyze the difference in 6-, 8-, and 12-month post-enrollment adherence, calculated using proportion of days covered, between the intervention and usual care arms. RESULTS Four hundred and thirty eight patients were randomized. Baseline characteristics were similar between groups: mostly women (68%), white (82%), with a median age of 54 years (interquartile range, 40, 64). The most common reasons for nonadherence in the intervention arm were memory (37%) and unreachability (28%). There was a significant difference in median proportion of days covered between patients in the usual care and intervention arms at 8-months (0.88 vs 0.94, P < .001), 6-months (0.90 vs 0.95, P = .003), and 12-months post-enrollment (0.87 vs 0.93, P < .001). CONCLUSIONS Patient-tailored interventions resulted in significant specialty medication adherence improvement compared with standard of care. Specialty pharmacies should consider targeting nonadherent patients for adherence interventions.
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Affiliation(s)
| | - Ryan Moore
- Vanderbilt University Medical Center, Nashville, United States
| | - Leena Choi
- Vanderbilt University Medical Center, Nashville, United States
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Zuckerman AD, Mourani J, Smith A, Ortega M, Donovan JL, Gazda NP, Tong K, Simonson D, Kelley T, DeClercq J, Choi L, Pierce G. 2022 ASHP Survey of Health-System Specialty Pharmacy Practice: Clinical Services. Am J Health Syst Pharm 2023; 80:827-841. [PMID: 36999452 DOI: 10.1093/ajhp/zxad064] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Results of the first ASHP national survey of clinical services provided by health-system specialty pharmacies (HSSPs) are presented. METHODS A survey questionnaire was developed by 26 HSSP contacts after reviewing available literature on the role and services of HSSPs. After pilot and cognitive testing resulting in a final questionnaire of 119 questions, a convenience sample of 441 leaders in HSSPs was contacted using email and invited to participate in the survey. RESULTS The survey response rate was 29%. Almost half of respondents (48%) had offered pharmacy services for 7 years or more, and most (60%) dispensed more than 15,000 prescriptions annually. Respondents most commonly (42%) reported a specialist model wherein staff are dedicated to specific specialty disease states. Over half of respondents reported providing several medication access, pretreatment assessment, and initial counseling services to patients referred to them, regardless of whether the HSSP was used for medication fulfillment. All HSSP activities were noted to be documented in the electronic health record and visible to providers frequently or always. Almost all respondents noted that HSSP pharmacists have a role in specialty medication selection. Disease-specific outcomes were tracked in 95% of responding HSSPs, with 67% reporting that outcomes were used to drive patient monitoring. HSSPs were often involved in continuity of care services such as transitions of care (reported by 89% of respondents), referral to other health-system services (53%), and addressing social determinants of health (60%). Most respondents (80%) reported providing clinical education to specialty clinic staff, including medicine learners (62%). Though only 12% of respondents had dedicated outcomes research staff, many reported annually publishing (47%) or presenting (61%) outcomes research. CONCLUSION HSSPs are a clinical and educational resource for specialty clinics and have developed robust patient care services that encompass the patient journey from before specialty medication selection through treatment monitoring and optimization.
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Affiliation(s)
- Autumn D Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy Smith
- University Specialty Pharmacy, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Melissa Ortega
- Tufts Medicine Specialty Pharmacy, Tufts Medical Center, Boston, MA, USA
| | | | | | - Kimhouy Tong
- Outpatient Pharmacy Services, Yale New Haven Health, Hamden, CT, USA
| | | | - Tara Kelley
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gabrielle Pierce
- American Society of Health-System Pharmacists, Bethesda, MD, USA
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18
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Cobaugh DJ. Health-system specialty pharmacy services: Setting the standard. Am J Health Syst Pharm 2023; 80:787-788. [PMID: 37140160 DOI: 10.1093/ajhp/zxad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Indexed: 05/05/2023] Open
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Zuckerman AD, DeClercq J, Simonson D, Zagel AL, Turco E, Banks A, Wawrzyniak J, Rightmier E, Blevins A, Choi L. Adherence and persistence to self-administered disease-modifying therapies in patients with multiple sclerosis: A multisite analysis. Mult Scler Relat Disord 2023; 75:104738. [PMID: 37182475 DOI: 10.1016/j.msard.2023.104738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Though there are several disease-modifying therapy (DMT) options for patients with multiple sclerosis (MS), treatment outcomes rely on patient adherence and persistence. Previous studies have demonstrated suboptimal adherence rates and high rates of early treatment discontinuation. Health-system specialty pharmacies (HSPPs) are a growing practice model that have demonstrated adherence and persistence benefits through single site evaluations. Research is needed across multiple HSSPs to understand and validate the outcomes of this practice model. METHODS A multisite prospective cohort study was performed including patients with at least three fills of a DMT between January 2020 and June 2021 at an HSSP. Patients were excluded due to pregnancy or death. Enrollment occurred for 6 months followed by 12 months of follow-up. Adherence was measured using pharmacy claims to calculate proportion of days covered (PDC) during the follow-up period. Time to non-persistence was calculated as the time from an index DMT fill to the first date of a gap of >60 days between medication exhaust and fulfillment dates. Adherence and persistence calculations were assessed at the therapeutic class level (any self-administered DMT dispensed by the HSSPs). The Kaplan-Meier method was used to present the probability of being persistent, and Cox proportional hazards regression analysis was used to estimate hazard ratios of factors associated with non-persistence, which included age, sex, study site, insurance type, and whether the patient switched medication as potential factors. RESULTS The most common self-administered DMTs filled among 968 patients were glatiramer acetate (32%), fingolimod (18%), and dimethyl fumarate (18%). Most patients (96%) did not switch DMT during the study period. The median PDC was 0.97 (interquartile range 0.90-0.99), which was similar across all sites. Patients who had at least one DMT switch were 76% less likely to have a higher PDC than those who did not have any switch after adjusting for other covariates (Odds ratio: 0.24, 95% confidence interval [CI]: 0.14-0.40, p<0.001). Most patients (86%) were persistent to DMT over the 12-month study period. Among those non-persistent, median time to non-persistence was 231 (IQR 177-301) days. Patients who switched medications were 2.4 times more likely to be non-persistent (95% CI: 1.3 - 4.5, p = 0.005). The most common reasons for non-persistence were discontinuation/medication held for an extended period (30%), often due to patient or prescriber decision (75%). CONCLUSION High rates of DMT adherence and persistence were seen among patients serviced by HSSPs, indicating potential benefits of this model for patients with MS. Switching DMTs was associated with lower adherence and persistence and may be an opportunity for added care coordination or resources to optimize therapy transitions.
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Affiliation(s)
- Autumn D Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, 726 Melrose Ave, Nashville, TN 37211, United States.
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, United States
| | - Dana Simonson
- Fairview Specialty Pharmacy, 711 Kasota Ave SE, Minneapolis, MN 55414, United States
| | - Alicia L Zagel
- Fairview Pharmacy Services, 711 Kasota Ave SE, Minneapolis, MN 55414, United States
| | - Evan Turco
- WVU Medicine Specialty Pharmacy Services, Allied Health Solutions, 3040 University Ave Suite 1400, Morgantown, WV 26505, United States
| | - Aimee Banks
- Specialty Pharmacy Services, Vanderbilt University Medical Center, 726 Melrose Ave, Nashville, TN 37211, United States
| | - Julie Wawrzyniak
- University of Rochester Specialty Pharmacy, UR Medicine, 601 Elmwood Ave, Rochester NY 14642, United States
| | - Elizabeth Rightmier
- University of Rochester Specialty Pharmacy, UR Medicine, 601 Elmwood Ave, Rochester NY 14642, United States
| | - Abbi Blevins
- WVU Medicine Specialty Pharmacy Services, Allied Health Solutions, 3040 University Ave Suite 1400, Morgantown, WV 26505, United States
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, United States
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