Abstract
Introduction
Inflammatory bowel disease (IBD) is a chronic disease state with growing focus, due to its significant medical and economic health burden. Although targeted therapy against tumor necrosis factor (anti-TNF), interleukin receptors, and integrin receptors have established roles in ulcerative colitis and Crohn’s disease management, medication accessibility and literacy contribute to medication non-adherence. Non-adherence to IBD therapy is associated with 62% higher costs for hospitalizations, along with increased disease mortality, relapse, loss of response, and antibody formation. IBD centers recognize the collaborative importance of a pharmacist’s role in medication optimization, patient adherence, and transitions of care.
Methodology
From November 2017 - April 2018, patients discharged from the inpatient IBD Service received a post discharge follow-up (PDFU) call from a pharmacist within 72 hours. Concurrently, the pharmacist provided pharmacotherapy optimization and education during the 4 hour weekly clinic visits, followed by a call within 72 hours.
For all sites of care, the pharmacist performed a comprehensive evaluation for healthcare maintenance (including notable lab values, drug levels, and/or antibody levels), adherence to IBD medications, and drug interactions.
The primary outcome was 30-day readmissions. The secondary outcomes included the number and severity of drug-related problems (DRPs) identified, validated by two gastroenterologists.
Results
132 patients were included in the study (63 inpatient; 69 clinic). The inpatient 30-day readmission rate for the study period was 14.3% versus 22.1% in 2016 (P=0.15). In comparison, the 30-day hospitalization rate for clinic patients remained relatively unchanged.
123 DRPs were identified from 132 patients, averaging 0.93 DRPs per patient. There were 87 DRPs from the inpatient setting and 36 DRPs identified in clinic. Of the DRPs, 60% of DRPs were prescriber-related and 40% were patient-related. 2% (2 cases) were considered life-threatening, and 40% of cases were significant DRPs; the remaining DRPs were low risk. Potential admissions were avoided in 6 patients (11%) by early detection of a drug-related error.
Conclusion
Results demonstrate the opportunities for a pharmacist to be involved in managing biologics and health maintenance therapy in the IBD patient population. There was an overall positive trend of a pharmacist role on IBD admission rates and decrease in medication related errors.
Correction to: Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials