scholarly journals Impact of Pharmacy Services on Time to Elexacaftor-Tezacaftor-Ivacaftor Initiation

2021 ◽  
Author(s):  
Lauren Roder ◽  
Michelle Simonsen ◽  
Lindsey Fitzpatrick ◽  
Jennifer Loucks ◽  
Jianghua He
Keyword(s):  
Cystic Fibrosis ◽  
Health System ◽  
Retrospective Chart Review ◽  
Pharmacy Services ◽  
Related Complication ◽  
Receptor Modulator ◽  
Medication Access ◽  
Fda Approval ◽  
Specialty Pharmacy ◽  
The Impact

The approval of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) expanded highly effective cystic fibrosis transmembrane receptor modulator therapy to approximately 90% of persons age 12 and older with cystic fibrosis. Clinical pharmacists and pharmacy technicians played a key role in planning for ELX/TEZ/IVA initiation prior to FDA approval as well as initiating therapy after approval. This study evaluates the impact of pharmacy services on time to ELX/TEZ/IVA initiation. A retrospective chart review evaluated patients qualifying for ELX/TEZ/IVA at a single health system between October 21, 2019 and April 1, 2020. Patients filling ELX/TEZ/IVA at an integrated health system specialty pharmacy (HSSP) versus an outside specialty pharmacy (SP) started on therapy an average of 10.8 days faster (10.8 days ± 14.0 vs 21.6 days ± 18.8 respectively; p=0.006). More patients filling at a HSSP received ELX/TEZ/IVA within 14 days of the prescription being written compared to outside SPs (82.0% vs 41.4% respectively; p=0.001). Pre-ELX/TEZ/IVA initiation, patients were hospitalized for a CF related complication for an average of 6.26 days (range 0-183) compared to 1.16 days (range 0-91) post-ELX/TEZ/IVA initiation. Lastly, an estimated $134,810 was saved in the 105 patients that were able to fill ELX/TEZ/IVA at a HSSP by initiating drug an average of 10.8 days quicker than outside SPs. The results of this study demonstrate the value of an integrated HSSP model. Further advocacy for inclusion of integrated HSSPs by pharmacy benefit managers is needed to optimize medication access, control costs, and improve patient outcomes for patients receiving care within a health system.

scholarly journals 241: The impact of implementing specialty pharmacy services within a cystic fibrosis clinic

2021 ◽  
Vol 20 ◽  
pp. S117
Author(s):  
J. Scheper ◽  
S. Bruner ◽  
P. Flume ◽  
L. McCoy ◽  
S. Gray ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pharmacy Services ◽  
Specialty Pharmacy ◽  
The Impact

scholarly journals Impact of health-system specialty pharmacy services on medication adherence in pediatric patients with cystic fibrosis

2019 ◽  
Vol 8 (sup1) ◽  
pp. 40-40
Author(s):  
Vincent Tao ◽  
Talia Papiro ◽  
Martha Stutsky ◽  
Mitchell DelVecchio ◽  
Sarah A. Kelly
Keyword(s):  
Cystic Fibrosis ◽  
Medication Adherence ◽  
Health System ◽  
Pediatric Patients ◽  
Pharmacy Services ◽  
Specialty Pharmacy

scholarly journals 2435. The Impact of Treatment Strategy and Toxin Status on Outcomes of Patients with Clostridioides difficile Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S842-S842
Author(s):  
Daniel Friedman ◽  
Karen Zurek ◽  
Leyla Asadi ◽  
Mao-Cheng Lee ◽  
Holly Hoang
Keyword(s):  
Treatment Guidelines ◽  
Retrospective Chart Review ◽  
Toxin Production ◽  
Toxin Gene ◽  
Composite Outcome ◽  
Related Complication ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Treatment Escalation ◽  
The Impact

Abstract Background Clostridioides difficile infection (CDI) is an important cause of morbidity and mortality and management continues to evolve. For laboratories that diagnose by detection of toxin gene, it is unclear whether reporting toxin production is additive to patient care. Furthermore, is there still a role for metronidazole (MNZ) given treatment guidelines now recommend vancomycin (VAN) as first-line therapy for non-severe cases? We analyzed cases of CDI in our hospital to assess outcomes of patients on MNZ vs. VAN and with or without toxin production. Methods A retrospective chart review of inpatients with CDI (based on detection of C. difficile toxin gene by PCR) was conducted between November 2017 and August 2018. Comparison of demographics and outcomes was performed in a) cases that were toxin-positive by enzyme immunoassay vs. negative and b) non-severe cases initially managed with MNZ vs. VAN. Results 76 patients were included (46 toxin-positive, 30 toxin-negative). Toxin-positive patients were older (mean age 77 vs. 62, p = 0.002) but had similar disease severity and initial treatment. A CDI recurrence occurred in 22% vs 0% in the toxin-positive cases (p = 0.006). Any CDI-related complication occurred in 23% of toxin-negative and 35% of toxin-positive cases (ns). After adjusting for toxin-status, age, and severity, the odds ratio of the composite outcome of any complication with toxin-positive CDI was not significant (OR 1.45 95% CI 0.45 -4.6, p = 0.52). There were 37 (49%) patients with non-severe CDI (27 MNZ, 10 VAN). Patients treated with VAN had higher stooling/day (6.3 vs 4.4, p = 0.04) and heart rate (p = 0.02). Initial MNZ use was associated with treatment escalation in 48% of cases compared with 10% in those treated with VAN alone (p = 0.03). CDI-associated mortality was higher in the VAN group (2/10 vs 0/27, p = 0.017). The rate of other complications was not significantly different. Conclusion Although no difference in the composite outcome of any CDI-related complication was detected between toxin positive vs negative patients, toxin-positivity may predict patients at risk for subsequent recurrence. Patients with non-severe CDI did not have increased risk of complications when managed with MNZ; however, they were more likely to require treatment escalation. Disclosures All authors: No reported disclosures.

scholarly journals Specialty Pharmacy Services: Preparing for a New Era in Health-System Pharmacy

2015 ◽  
Vol 50 (9) ◽  
pp. 834-839 ◽  
Author(s):  
Blake Shay ◽  
Les Louden ◽  
Bonnie Kirschenbaum
Keyword(s):  
Health System ◽  
Pharmacy Services ◽  
New Era ◽  
Specialty Pharmacy

Development of health-system inpatient pharmacy clinical metrics

2019 ◽  
Vol 76 (23) ◽  
pp. 1958-1964
Author(s):  
Stacy Cassat ◽  
Lindsay Massey ◽  
Stephanie Buckingham ◽  
Tamara Kemplay ◽  
Jeff Little
Keyword(s):  
Clinical Outcome ◽  
Health System ◽  
Outcome Measures ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Time Frame ◽  
Pharmacy Services ◽  
Systematic Process ◽  
Institutional Review Board Review ◽  
The Impact

Abstract Purpose To describe a process to identify metrics that represent the impact of inpatient pharmacy services on patient outcomes across a health system. Summary The authors describe a systematic process of identifying inpatient clinical outcome measures that could represent pharmacists’ impact on patient outcomes and eventually be displayed in a dashboard within the electronic medical record (EMR). A list was generated through literature review, assessment of practices at other sites, evaluation of current pharmacy services, and collaboration with the quality department and System Pharmacy Clinical User Group. The project team narrowed the list through assessment against standardized criteria. An assessment tool was designed and distributed to stakeholders to prioritize clinical outcome measures for inclusion on the dashboard. The clinical outcome measures were transformed into metrics by determining measurement criteria, inclusion and exclusion parameters, and review time frame. After validation, the metrics are planned to be displayed on an inpatient pharmacy EMR dashboard. Exemption from institutional review board review was granted for this project. Conclusion A systematic process was developed and used to identify inpatient clinical outcome metrics.

scholarly journals Advancing Patient Care Through Specialty Pharmacy Services in an Academic Health System

2017 ◽  
Vol 23 (8) ◽  
pp. 815-820 ◽  
Author(s):  
Autumn Bagwell ◽  
Tara Kelley ◽  
Alicia Carver ◽  
Jennifer B. Lee ◽  
Brandon Newman
Keyword(s):  
Health System ◽  
Patient Care ◽  
Pharmacy Services ◽  
Academic Health ◽  
Specialty Pharmacy

Evaluation of a specialty hepatitis C virus telephone pharmacy service

2021 ◽  
Author(s):  
Ashley A Sabourin ◽  
Kaleigh K Fisher-Grant ◽  
Adam R Saulles ◽  
Rima A Mohammad
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Pharmacy Service ◽  
Hcv Infection ◽  
Pharmacy Services ◽  
Specialty Pharmacy ◽  
Clinically Significant ◽  
Direct Acting ◽  
The Impact

Abstract Purpose Direct-acting antivirals (DAAs) used to treat hepatitis C virus (HCV) infection are associated with significant drug-drug interactions (DDIs). Pharmacists are well positioned to identify and mitigate these DDIs. Data to guide assessment of the impact of HCV specialty pharmacy services on identifying and addressing DDIs with DAAs are lacking. The overall purpose of the study described here was to determine the incidence and severity of DDIs identified by specialty pharmacists among patients treated with DAAs prior to and 1 month into therapy. Methods An observational, retrospective study was conducted to evaluate the impact of specialty pharmacy services in mitigating DDIs associated with use of DAAs. Adult patients with HCV infection (n = 200) who received DAAs and were enrolled with a specialty pharmacy service over a 1-year period were included. Endpoints included number, severity, and type of DDIs and DDIs per patient at baseline and 1 month into therapy, pharmacists’ interventions, and safety and clinical outcomes. Results Fifty-nine percent of patients had at least 1 DDI. A total of 170 DDIs were identified (137 at baseline and 33 at 1-month follow-up), and the mean number of DDIs per patient significantly decreased from baseline to 1-month follow-up (from 1.38 to 0.16, P < 0.0001). The rate of “potentially clinically significant” or “critical” interactions was significantly lower at 1-month follow-up vs baseline assessment (69.6% vs 81.7%, P < 0.0001). The most commonly identified DDIs involved acid suppressive medications (49.6% and 66.6% of DDIs at baseline and follow-up assessment, respectively) and cardiovascular medications (26.2% and 21.2%, respectively). Total number of DDI interventions was 131, with an acceptance rate of 85%. Most common intervention was patient education and monitoring. Conclusion Approximately 60% of patients had DDIs with DAAs. Implementing HCV specialty pharmacy services significantly decreased DDIs while maintaining SVR12.

scholarly journals Predicting time to medication access for hematologic malignancies: the impact of an integrated specialty pharmacy and limited distribution drug networks

2019 ◽  
Vol 8 (sup1) ◽  
pp. 45-45
Author(s):  
Autumn D. Zuckerman ◽  
Megan E. Peter ◽  
Samuel Starks ◽  
Matthew Maulis ◽  
Josh Declerq ◽  
...  
Keyword(s):  
Hematologic Malignancies ◽  
Limited Distribution ◽  
Medication Access ◽  
Specialty Pharmacy ◽  
The Impact ◽  
Drug Networks
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