Assessment of integrated specialty pharmacy services as a medication optimization strategy for rifaximin in hepatic encephalopathy patients

Elezabeth Mac, A. Battershell, Haitam Buaisha, K. Nolan
{"title":"Assessment of integrated specialty pharmacy services as a medication optimization strategy for rifaximin in hepatic encephalopathy patients","authors":"Elezabeth Mac, A. Battershell, Haitam Buaisha, K. Nolan","doi":"10.1080/21556660.2019.1658320","DOIUrl":null,"url":null,"abstract":"Abstract Background: Lactulose non-adherence has been identified as a factor for recurrent episodes of hepatic encephalopathy (HE). Treatment guidelines recommend adding rifaximin (Xifaxan1) to lactulose for ongoing management after an overt HE recurrence on lactulose alone to reduce the risk of further episodes and HE-related hospitalizations. Clinical observations suggested that rifaximin therapy is not initiated in patients upon HE-related hospital discharge where indicated. Aims: Integrate the CHI Health Specialty Pharmacy medication access coordinator (MAC) into the cascade of care of patients during an HE-related hospitalization to optimize access to and initiation of rifaximin upon discharge. Methods: Retrospective assessment of integrated MAC assistance in the CHI Health gastroenterology clinic from 26 September 2018 to 31 March 2019. Hospitalized patients were identified using TheraDoc2 reporting. Inclusion criteria: rifaximin ordered during an HE-related hospital admission at CHI Health. Exclusion criteria: discharge care assignment to an alternative physician group or facility. Primary outcome: the percentage of patients initiated on rifaximin upon hospital discharge via the integrated MAC. Secondary outcomes: cases requiring benefits verification and financial assistance, and number of rifaximin prescriptions acquired by the CHI Health Specialty Pharmacy. Results: A total of 40 patients met the inclusion criteria during the assessed timeframe. Thirty-one patients were excluded, 27 to other groups and 4 to facilities. Integrated MAC assistance was utilized for the remaining 9 patients and 100% were initiated on rifaximin upon discharge. Of those, 4 required benefits prior authorizations, 2 qualified for manufacturer patient assistance and 3 received sample medication. CHI Health Specialty Pharmacy acquired 2 rifaximin prescriptions. Conclusions: Integrated MAC assistance in a health-system gastroenterology clinic optimizes rifaximin access and initiation in patients following an HE-related hospitalization. It is anticipated that more patients going forward will qualify for MAC assistance due to a reduction in the community physician groups providing care at CHI Health. Further evaluation is warranted to determine whether medication optimization results in improved adherence and reduced readmissions in this population.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658320","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Drug Assessment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/21556660.2019.1658320","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Abstract Background: Lactulose non-adherence has been identified as a factor for recurrent episodes of hepatic encephalopathy (HE). Treatment guidelines recommend adding rifaximin (Xifaxan1) to lactulose for ongoing management after an overt HE recurrence on lactulose alone to reduce the risk of further episodes and HE-related hospitalizations. Clinical observations suggested that rifaximin therapy is not initiated in patients upon HE-related hospital discharge where indicated. Aims: Integrate the CHI Health Specialty Pharmacy medication access coordinator (MAC) into the cascade of care of patients during an HE-related hospitalization to optimize access to and initiation of rifaximin upon discharge. Methods: Retrospective assessment of integrated MAC assistance in the CHI Health gastroenterology clinic from 26 September 2018 to 31 March 2019. Hospitalized patients were identified using TheraDoc2 reporting. Inclusion criteria: rifaximin ordered during an HE-related hospital admission at CHI Health. Exclusion criteria: discharge care assignment to an alternative physician group or facility. Primary outcome: the percentage of patients initiated on rifaximin upon hospital discharge via the integrated MAC. Secondary outcomes: cases requiring benefits verification and financial assistance, and number of rifaximin prescriptions acquired by the CHI Health Specialty Pharmacy. Results: A total of 40 patients met the inclusion criteria during the assessed timeframe. Thirty-one patients were excluded, 27 to other groups and 4 to facilities. Integrated MAC assistance was utilized for the remaining 9 patients and 100% were initiated on rifaximin upon discharge. Of those, 4 required benefits prior authorizations, 2 qualified for manufacturer patient assistance and 3 received sample medication. CHI Health Specialty Pharmacy acquired 2 rifaximin prescriptions. Conclusions: Integrated MAC assistance in a health-system gastroenterology clinic optimizes rifaximin access and initiation in patients following an HE-related hospitalization. It is anticipated that more patients going forward will qualify for MAC assistance due to a reduction in the community physician groups providing care at CHI Health. Further evaluation is warranted to determine whether medication optimization results in improved adherence and reduced readmissions in this population.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
综合专科药房服务作为利福昔明治疗肝性脑病患者药物优化策略的评估
摘要背景:乳果糖不依从性已被确定为肝性脑病(HE)复发的一个因素。治疗指南建议在单独使用乳果糖后出现明显的HE复发后,在乳果糖中加入利福昔明(西法仙1)进行持续治疗,以降低进一步发作和HE相关住院的风险。临床观察表明,利福昔明治疗不适用于HE相关出院的患者。目的:将CHI Health Specialty Pharmacy药物获取协调员(MAC)整合到HE相关住院期间的患者级联护理中,以优化出院时利福昔明的获取和启动。方法:回顾性评估2018年9月26日至2019年3月31日CHI Health胃肠病诊所的综合MAC援助。使用TheraDoc2报告确定住院患者。纳入标准:在CHI Health的HE相关住院期间订购利福昔明。排除标准:将出院护理分配给替代医师组或机构。主要结果:通过综合MAC在出院时开始服用利福昔明的患者百分比。次要结果:需要福利验证和经济援助的病例,以及CHI健康专业药房获得的利福昔明处方数量。结果:在评估时间段内,共有40名患者符合纳入标准。31名患者被排除在外,27名患者进入其他组,4名患者进入设施。其余9名患者采用综合MAC辅助治疗,出院后100%开始服用利福昔明。其中,4人需要福利事先授权,2人有资格获得制造商的患者援助,3人接受了样本药物。CHI Health Specialty Pharmacy获得了2张利福昔明处方。结论:卫生系统胃肠病诊所的综合MAC辅助优化了HE相关住院患者利福昔明的获取和启动。由于在CHI Health提供护理的社区医生团体减少,预计未来将有更多的患者有资格获得MAC援助。需要进一步评估,以确定药物优化是否能改善该人群的依从性和减少再次入院。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
自引率
0.00%
发文量
0
审稿时长
8 weeks
期刊最新文献
Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews. Investigation of potential substandard dry powder inhalers on EU and North African markets - evaluation of the delivered and fine particle doses. Real world evidence study on treatment patterns and health resource utilization in patients with HR+/HER2- locally advanced or metastatic breast cancer in Korea. A review of the risks of long-term consequences associated with components of the CHOP chemotherapy regimen. Real-world experience of ocrelizumab in multiple sclerosis in an Arab population.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1