Abstract
Disclaimer
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Purpose
To describe a pharmacist-managed virtual consult service practice model to improve medication safety in a population of rheumatology patients and evaluate its initial impact on guideline compliance.
Summary
Optimal pharmacologic care of patients with rheumatologic conditions often revolves around the use of specialty medications such as self-injectable biologics and infused therapies, including biologic response modifiers (BRMs), nearly all of which carry risks of serious adverse events due to their immune-suppressive properties. Possible adverse events include serious infections such as reactivation of tuberculosis (TB) and viral hepatitis B (HBV). This articles describes a pharmacist-managed virtual consult service introduced by a large university-affiliated health system in 2018 to integrate clinical, specialty pharmacy, and therapeutic infusion services for proactive medication and safety management for patients with rheumatologic conditions requiring specialty or infused medications. During a 4-month evaluation period, 157 referrals were sent to the consult service; of 137 consults included in the analysis, 42% were for self-injectable biologic medications, 28% were for intra-articular injections, 26% were for infusions, and 4% were for oral specialty medications. Forty-one percent of the pharmacy benefit consult orders required an intervention prior to submission of prior authorization requests. Most interventions (61%) were clinical in nature and involved the pharmacists ensuring that necessary laboratory work, clinical disease activity scoring, or radiographic imaging were completed prior to submission of the consult results for insurer approval.
Conclusion
National rates of HBV screening and TB screening for patients prescribed BRMs continue to be suboptimal. The pharmacist-managed virtual consult service is a novel practice model to increase the screening rate to 100% to ensure the safety and appropriate monitoring of patients who are starting or continued on these complex medications.
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