Study Supports Feasibility of Integrating Specialty Pharmacists in Health Systems

Integrating specialty pharmacists into health systems may help promote safe and effective use of biologic treatment, say newly published findings from a Veterans Health Administration (VHA) hospital.

The data from the first year of the centralized specialty medication management (CSMM) service implemented various interventions for appropriate use of treatment, as well as quick identification and intervention for serious adverse effects.

Their program, explained the researchers, is the first of its kind within the VHA and shows the feasibility of the service, with a high retention rate among the 54 patients. Patients were enrolled from rheumatology, allergy, cardiology, dermatology, and gastroenterology clinics. The researchers noted that there was lower enrollment than expected, largely due to the COVID-19 pandemic.

“As the CSMM clinic has grown, there has been more uptake, and [clinical pharmacist practitioners] are now generally seeing 4-7 patients per half day. To date, 165 patients have been seen, and 42 patients have successfully completed the planned CSMM service monitoring and have been discharged,” detailed the researchers. “There are approximately 100-120 patients managed by the CSMM service at any given time. The service continues to manage a high proportion of patient on adalimumab, though alirocumab, benralizumab, and dupilumab have increased in use.”

The researchers largely attributed the feasibility of the program to scheduling support, access to the electric medical records, a patient identification process, and communication for improving specialist provider awareness.

Among the cohort included in the analysis, there were 160 clinical outcomes documented throughout the year. The researchers noted that while injection technique corrections and medication changes or discontinuations made by the pharmacists were not the most common interventions, they were more consequential. The researchers underscored that there was no control group included in their study, causing uncertainty around which outcomes would have occurred without the service.

“Other more clerical interventions, such as ensuring appropriate injection supplies, refill assistance, and safe needle disposal, should not be overlooked as they also ensure safe medication use and have been shown to be an important component of the specialty pharmacist role,” explained the researchers. “However, the most consequential interventions were likely the early identification and intervention after the emergence of serious adverse effects. While this occurred less frequently, the introduction of early close CPP monitoring may have prevented longer lasting ramifications for these individuals.”

Administrative assistance (34%), such as having alcohol swaps at their disposal, and medication assistance (9%), such as filling refills on time, were common throughout the year.

Reference

Albright T, Simonet R, Bollom E, et al. Feasibility of a centralized specialty biologic medication management clinic at a VA hospital. J Am Pharm Assoc. 2022;62(5):1694-1699